|
REVISE/REPL VAGUS N ELTRD
|
Facility
|
IP
|
$1,651.00
|
|
|
Service Code
|
CPT 64569
|
| Hospital Charge Code |
6164569
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$450.72 |
| Max. Negotiated Rate |
$1,568.45 |
| Rate for Payer: Cash Price |
$990.60
|
| Rate for Payer: Cigna Commercial |
$1,403.35
|
| Rate for Payer: First Health Commercial |
$1,485.90
|
| Rate for Payer: First Health Workers Compensation |
$637.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,485.90
|
| Rate for Payer: GEHA Commercial |
$1,155.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,485.90
|
| Rate for Payer: Multiplan All |
$1,502.41
|
| Rate for Payer: OMNI Networks Commercial |
$1,155.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,485.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,568.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,238.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,535.43
|
| Rate for Payer: Zelis Auto |
$660.40
|
| Rate for Payer: Zelis Worker's Compensation |
$450.72
|
|
|
REVISE/RMV PN/GASTR STIMUL
|
Facility
|
IP
|
$386.00
|
|
|
Service Code
|
CPT 64595
|
| Hospital Charge Code |
6164595
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$105.38 |
| Max. Negotiated Rate |
$366.70 |
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cigna Commercial |
$328.10
|
| Rate for Payer: First Health Commercial |
$347.40
|
| Rate for Payer: First Health Workers Compensation |
$149.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$347.40
|
| Rate for Payer: GEHA Commercial |
$270.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$347.40
|
| Rate for Payer: Multiplan All |
$351.26
|
| Rate for Payer: OMNI Networks Commercial |
$270.20
|
| Rate for Payer: One Health Plan PPO/POS |
$347.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$366.70
|
| Rate for Payer: Three Rivers Provider Network All |
$289.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$358.98
|
| Rate for Payer: Zelis Auto |
$154.40
|
| Rate for Payer: Zelis Worker's Compensation |
$105.38
|
|
|
REVISE/RMV PN/GASTR STIMUL
|
Facility
|
OP
|
$386.00
|
|
|
Service Code
|
CPT 64595
|
| Hospital Charge Code |
6164595
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$105.38 |
| Max. Negotiated Rate |
$6,530.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,191.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$231.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,191.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,528.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,265.48
|
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cigna Commercial |
$328.10
|
| Rate for Payer: First Health Commercial |
$347.40
|
| Rate for Payer: First Health Workers Compensation |
$149.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$347.40
|
| Rate for Payer: GEHA Commercial |
$308.80
|
| Rate for Payer: GEHA Medicare |
$3,265.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$347.40
|
| Rate for Payer: Humana ChoiceCare |
$3,592.03
|
| Rate for Payer: Humana Medicare Advantage |
$3,265.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,486.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,580.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,265.48
|
| Rate for Payer: Multiplan All |
$351.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,551.32
|
| Rate for Payer: OMNI Networks Commercial |
$270.20
|
| Rate for Payer: One Health Plan PPO/POS |
$347.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,979.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,580.18
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,265.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$366.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,530.96
|
| Rate for Payer: Three Rivers Provider Network All |
$289.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,200.17
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,580.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,265.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$358.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,265.48
|
| Rate for Payer: Zelis Auto |
$154.40
|
| Rate for Payer: Zelis Medicare |
$2,775.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,918.58
|
| Rate for Payer: Zelis Worker's Compensation |
$105.38
|
|
|
REVISE SPERMATIC CORD VEINS
|
Facility
|
IP
|
$901.00
|
|
|
Service Code
|
CPT 55530
|
| Hospital Charge Code |
6155530
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$245.97 |
| Max. Negotiated Rate |
$855.95 |
| Rate for Payer: Cash Price |
$540.60
|
| Rate for Payer: Cigna Commercial |
$765.85
|
| Rate for Payer: First Health Commercial |
$810.90
|
| Rate for Payer: First Health Workers Compensation |
$347.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$810.90
|
| Rate for Payer: GEHA Commercial |
$630.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$810.90
|
| Rate for Payer: Multiplan All |
$819.91
|
| Rate for Payer: OMNI Networks Commercial |
$630.70
|
| Rate for Payer: One Health Plan PPO/POS |
$810.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$855.95
|
| Rate for Payer: Three Rivers Provider Network All |
$675.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$837.93
|
| Rate for Payer: Zelis Auto |
$360.40
|
| Rate for Payer: Zelis Worker's Compensation |
$245.97
|
|
|
REVISE SPERMATIC CORD VEINS
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
CPT 55535
|
| Hospital Charge Code |
6155535
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$240.79 |
| Max. Negotiated Rate |
$837.90 |
| Rate for Payer: Cash Price |
$529.20
|
| Rate for Payer: Cigna Commercial |
$749.70
|
| Rate for Payer: First Health Commercial |
$793.80
|
| Rate for Payer: First Health Workers Compensation |
$340.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$793.80
|
| Rate for Payer: GEHA Commercial |
$617.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$793.80
|
| Rate for Payer: Multiplan All |
$802.62
|
| Rate for Payer: OMNI Networks Commercial |
$617.40
|
| Rate for Payer: One Health Plan PPO/POS |
$793.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$837.90
|
| Rate for Payer: Three Rivers Provider Network All |
$661.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$820.26
|
| Rate for Payer: Zelis Auto |
$352.80
|
| Rate for Payer: Zelis Worker's Compensation |
$240.79
|
|
|
REVISE SPERMATIC CORD VEINS
|
Facility
|
OP
|
$901.00
|
|
|
Service Code
|
CPT 55530
|
| Hospital Charge Code |
6155530
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$245.97 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$540.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$540.60
|
| Rate for Payer: Cash Price |
$540.60
|
| Rate for Payer: Cigna Commercial |
$765.85
|
| Rate for Payer: First Health Commercial |
$810.90
|
| Rate for Payer: First Health Workers Compensation |
$347.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$810.90
|
| Rate for Payer: GEHA Commercial |
$720.80
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$810.90
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$819.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$630.70
|
| Rate for Payer: One Health Plan PPO/POS |
$810.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$855.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$675.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$837.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$360.40
|
| 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 |
$245.97
|
|
|
REVISE SPERMATIC CORD VEINS
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
CPT 55535
|
| Hospital Charge Code |
6155535
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$240.79 |
| 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 |
$529.20
|
| 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 |
$5,924.89
|
| Rate for Payer: Cash Price |
$529.20
|
| Rate for Payer: Cash Price |
$529.20
|
| Rate for Payer: Cigna Commercial |
$749.70
|
| Rate for Payer: First Health Commercial |
$793.80
|
| Rate for Payer: First Health Workers Compensation |
$340.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$793.80
|
| Rate for Payer: GEHA Commercial |
$705.60
|
| Rate for Payer: GEHA Medicare |
$5,924.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$793.80
|
| 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 |
$802.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,072.31
|
| Rate for Payer: OMNI Networks Commercial |
$617.40
|
| Rate for Payer: One Health Plan PPO/POS |
$793.80
|
| 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 |
$5,924.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$837.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,849.78
|
| Rate for Payer: Three Rivers Provider Network All |
$661.50
|
| 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 |
$820.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,924.89
|
| Rate for Payer: Zelis Auto |
$352.80
|
| 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 |
$240.79
|
|
|
REVISE STOMACH-BOWEL FUSION
|
Facility
|
OP
|
$3,450.00
|
|
|
Service Code
|
CPT 43860
|
| Hospital Charge Code |
6143860
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$862.50 |
| Max. Negotiated Rate |
$3,277.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,070.00
|
| Rate for Payer: Cash Price |
$2,070.00
|
| Rate for Payer: Cigna Commercial |
$2,932.50
|
| Rate for Payer: First Health Commercial |
$3,105.00
|
| Rate for Payer: First Health Workers Compensation |
$1,332.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,105.00
|
| Rate for Payer: GEHA Commercial |
$2,760.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,105.00
|
| Rate for Payer: Humana ChoiceCare |
$897.00
|
| Rate for Payer: Multiplan All |
$3,139.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,070.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,415.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,105.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,277.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,587.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,036.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$862.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,208.50
|
| Rate for Payer: Zelis Auto |
$1,380.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,725.00
|
| Rate for Payer: Zelis Worker's Compensation |
$941.85
|
|
|
REVISE STOMACH-BOWEL FUSION
|
Facility
|
IP
|
$3,593.00
|
|
|
Service Code
|
CPT 43865
|
| Hospital Charge Code |
6143865
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$980.89 |
| Max. Negotiated Rate |
$3,413.35 |
| Rate for Payer: Cash Price |
$2,155.80
|
| Rate for Payer: Cigna Commercial |
$3,054.05
|
| Rate for Payer: First Health Commercial |
$3,233.70
|
| Rate for Payer: First Health Workers Compensation |
$1,387.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,233.70
|
| Rate for Payer: GEHA Commercial |
$2,515.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,233.70
|
| Rate for Payer: Multiplan All |
$3,269.63
|
| Rate for Payer: OMNI Networks Commercial |
$2,515.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,233.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,413.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,694.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,341.49
|
| Rate for Payer: Zelis Auto |
$1,437.20
|
| Rate for Payer: Zelis Worker's Compensation |
$980.89
|
|
|
REVISE STOMACH-BOWEL FUSION
|
Facility
|
IP
|
$3,450.00
|
|
|
Service Code
|
CPT 43860
|
| Hospital Charge Code |
6143860
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$941.85 |
| Max. Negotiated Rate |
$3,277.50 |
| Rate for Payer: Cash Price |
$2,070.00
|
| Rate for Payer: Cigna Commercial |
$2,932.50
|
| Rate for Payer: First Health Commercial |
$3,105.00
|
| Rate for Payer: First Health Workers Compensation |
$1,332.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,105.00
|
| Rate for Payer: GEHA Commercial |
$2,415.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,105.00
|
| Rate for Payer: Multiplan All |
$3,139.50
|
| Rate for Payer: OMNI Networks Commercial |
$2,415.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,105.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,277.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,587.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,208.50
|
| Rate for Payer: Zelis Auto |
$1,380.00
|
| Rate for Payer: Zelis Worker's Compensation |
$941.85
|
|
|
REVISE STOMACH-BOWEL FUSION
|
Facility
|
OP
|
$3,593.00
|
|
|
Service Code
|
CPT 43865
|
| Hospital Charge Code |
6143865
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$898.25 |
| Max. Negotiated Rate |
$3,413.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,155.80
|
| Rate for Payer: Cash Price |
$2,155.80
|
| Rate for Payer: Cigna Commercial |
$3,054.05
|
| Rate for Payer: First Health Commercial |
$3,233.70
|
| Rate for Payer: First Health Workers Compensation |
$1,387.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,233.70
|
| Rate for Payer: GEHA Commercial |
$2,874.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,233.70
|
| Rate for Payer: Humana ChoiceCare |
$934.18
|
| Rate for Payer: Multiplan All |
$3,269.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,155.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,515.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,233.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,413.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,694.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,161.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$898.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,341.49
|
| Rate for Payer: Zelis Auto |
$1,437.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,796.50
|
| Rate for Payer: Zelis Worker's Compensation |
$980.89
|
|
|
REVISE THIGH MUSCLES/TENDONS
|
Facility
|
IP
|
$1,422.00
|
|
|
Service Code
|
CPT 27400
|
| Hospital Charge Code |
6127400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$388.21 |
| Max. Negotiated Rate |
$1,350.90 |
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cigna Commercial |
$1,208.70
|
| Rate for Payer: First Health Commercial |
$1,279.80
|
| Rate for Payer: First Health Workers Compensation |
$549.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,279.80
|
| Rate for Payer: GEHA Commercial |
$995.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,279.80
|
| Rate for Payer: Multiplan All |
$1,294.02
|
| Rate for Payer: OMNI Networks Commercial |
$995.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,279.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,350.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,066.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,322.46
|
| Rate for Payer: Zelis Auto |
$568.80
|
| Rate for Payer: Zelis Worker's Compensation |
$388.21
|
|
|
REVISE THIGH MUSCLES/TENDONS
|
Facility
|
OP
|
$1,422.00
|
|
|
Service Code
|
CPT 27400
|
| Hospital Charge Code |
6127400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$388.21 |
| 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 |
$853.20
|
| 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 |
$853.20
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cigna Commercial |
$1,208.70
|
| Rate for Payer: First Health Commercial |
$1,279.80
|
| Rate for Payer: First Health Workers Compensation |
$549.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,279.80
|
| Rate for Payer: GEHA Commercial |
$1,137.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,279.80
|
| 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 |
$1,294.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$995.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,279.80
|
| 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 |
$1,350.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,066.50
|
| 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 |
$1,322.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$568.80
|
| 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 |
$388.21
|
|
|
REVISE THUMB TENDON
|
Facility
|
OP
|
$1,558.00
|
|
|
Service Code
|
CPT 26490
|
| Hospital Charge Code |
6126490
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$425.33 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$934.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$934.80
|
| Rate for Payer: Cash Price |
$934.80
|
| Rate for Payer: Cigna Commercial |
$1,324.30
|
| Rate for Payer: First Health Commercial |
$1,402.20
|
| Rate for Payer: First Health Workers Compensation |
$601.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,402.20
|
| Rate for Payer: GEHA Commercial |
$1,246.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,402.20
|
| 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 |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,417.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,090.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,402.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,480.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,168.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,448.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$623.20
|
| 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 |
$425.33
|
|
|
REVISE THUMB TENDON
|
Facility
|
IP
|
$1,704.00
|
|
|
Service Code
|
CPT 26496
|
| Hospital Charge Code |
6126496
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$465.19 |
| Max. Negotiated Rate |
$1,618.80 |
| Rate for Payer: Cash Price |
$1,022.40
|
| Rate for Payer: Cigna Commercial |
$1,448.40
|
| Rate for Payer: First Health Commercial |
$1,533.60
|
| Rate for Payer: First Health Workers Compensation |
$657.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,533.60
|
| Rate for Payer: GEHA Commercial |
$1,192.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,533.60
|
| Rate for Payer: Multiplan All |
$1,550.64
|
| Rate for Payer: OMNI Networks Commercial |
$1,192.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,533.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,618.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,278.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,584.72
|
| Rate for Payer: Zelis Auto |
$681.60
|
| Rate for Payer: Zelis Worker's Compensation |
$465.19
|
|
|
REVISE THUMB TENDON
|
Facility
|
IP
|
$1,558.00
|
|
|
Service Code
|
CPT 26490
|
| Hospital Charge Code |
6126490
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$425.33 |
| Max. Negotiated Rate |
$1,480.10 |
| Rate for Payer: Cash Price |
$934.80
|
| Rate for Payer: Cigna Commercial |
$1,324.30
|
| Rate for Payer: First Health Commercial |
$1,402.20
|
| Rate for Payer: First Health Workers Compensation |
$601.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,402.20
|
| Rate for Payer: GEHA Commercial |
$1,090.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,402.20
|
| Rate for Payer: Multiplan All |
$1,417.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,090.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,402.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,480.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,168.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,448.94
|
| Rate for Payer: Zelis Auto |
$623.20
|
| Rate for Payer: Zelis Worker's Compensation |
$425.33
|
|
|
REVISE THUMB TENDON
|
Facility
|
OP
|
$1,704.00
|
|
|
Service Code
|
CPT 26496
|
| Hospital Charge Code |
6126496
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$465.19 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,022.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,022.40
|
| Rate for Payer: Cash Price |
$1,022.40
|
| Rate for Payer: Cigna Commercial |
$1,448.40
|
| Rate for Payer: First Health Commercial |
$1,533.60
|
| Rate for Payer: First Health Workers Compensation |
$657.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,533.60
|
| Rate for Payer: GEHA Commercial |
$1,363.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,533.60
|
| 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 |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,550.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,192.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,533.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,618.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,278.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,584.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$681.60
|
| 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 |
$465.19
|
|
|
REVISE ULNAR NERVE AT ELBOW
|
Facility
|
IP
|
$1,203.00
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
6164718
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$328.42 |
| Max. Negotiated Rate |
$1,142.85 |
| Rate for Payer: Cash Price |
$721.80
|
| Rate for Payer: Cigna Commercial |
$1,022.55
|
| Rate for Payer: First Health Commercial |
$1,082.70
|
| Rate for Payer: First Health Workers Compensation |
$464.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,082.70
|
| Rate for Payer: GEHA Commercial |
$842.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,082.70
|
| Rate for Payer: Multiplan All |
$1,094.73
|
| Rate for Payer: OMNI Networks Commercial |
$842.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,082.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,142.85
|
| Rate for Payer: Three Rivers Provider Network All |
$902.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,118.79
|
| Rate for Payer: Zelis Auto |
$481.20
|
| Rate for Payer: Zelis Worker's Compensation |
$328.42
|
|
|
REVISE ULNAR NERVE AT ELBOW
|
Facility
|
OP
|
$1,203.00
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
6164718
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$328.42 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$721.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$721.80
|
| Rate for Payer: Cash Price |
$721.80
|
| Rate for Payer: Cigna Commercial |
$1,022.55
|
| Rate for Payer: First Health Commercial |
$1,082.70
|
| Rate for Payer: First Health Workers Compensation |
$464.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,082.70
|
| Rate for Payer: GEHA Commercial |
$962.40
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,082.70
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$1,094.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$842.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,082.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,142.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$902.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,118.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$481.20
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$328.42
|
|
|
REVISE ULNAR NERVE AT WRIST
|
Facility
|
OP
|
$1,017.00
|
|
|
Service Code
|
CPT 64719
|
| Hospital Charge Code |
6164719
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$277.64 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$610.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Cigna Commercial |
$864.45
|
| Rate for Payer: First Health Commercial |
$915.30
|
| Rate for Payer: First Health Workers Compensation |
$392.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$915.30
|
| Rate for Payer: GEHA Commercial |
$813.60
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$915.30
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$925.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$711.90
|
| Rate for Payer: One Health Plan PPO/POS |
$915.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$966.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$762.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$945.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$406.80
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$277.64
|
|
|
REVISE ULNAR NERVE AT WRIST
|
Facility
|
IP
|
$1,017.00
|
|
|
Service Code
|
CPT 64719
|
| Hospital Charge Code |
6164719
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$277.64 |
| Max. Negotiated Rate |
$966.15 |
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Cigna Commercial |
$864.45
|
| Rate for Payer: First Health Commercial |
$915.30
|
| Rate for Payer: First Health Workers Compensation |
$392.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$915.30
|
| Rate for Payer: GEHA Commercial |
$711.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$915.30
|
| Rate for Payer: Multiplan All |
$925.47
|
| Rate for Payer: OMNI Networks Commercial |
$711.90
|
| Rate for Payer: One Health Plan PPO/POS |
$915.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$966.15
|
| Rate for Payer: Three Rivers Provider Network All |
$762.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$945.81
|
| Rate for Payer: Zelis Auto |
$406.80
|
| Rate for Payer: Zelis Worker's Compensation |
$277.64
|
|
|
REVISE URETER
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
CPT 50727
|
| Hospital Charge Code |
6150727
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$283.92 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,024.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$624.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,024.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,603.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cigna Commercial |
$884.00
|
| Rate for Payer: First Health Commercial |
$936.00
|
| Rate for Payer: First Health Workers Compensation |
$401.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$936.00
|
| Rate for Payer: GEHA Commercial |
$832.00
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$936.00
|
| 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 |
$1,636.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$946.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$728.00
|
| Rate for Payer: One Health Plan PPO/POS |
$936.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,889.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,636.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$988.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$780.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,636.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$967.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$416.00
|
| 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 |
$283.92
|
|
|
REVISE URETER
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
CPT 50728
|
| Hospital Charge Code |
6150728
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$360.25 |
| Max. Negotiated Rate |
$1,368.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$864.60
|
| Rate for Payer: Cash Price |
$864.60
|
| Rate for Payer: Cigna Commercial |
$1,224.85
|
| Rate for Payer: First Health Commercial |
$1,296.90
|
| Rate for Payer: First Health Workers Compensation |
$556.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,296.90
|
| Rate for Payer: GEHA Commercial |
$1,152.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,296.90
|
| Rate for Payer: Humana ChoiceCare |
$374.66
|
| Rate for Payer: Multiplan All |
$1,311.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$864.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,008.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,296.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,368.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,080.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,268.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$360.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,340.13
|
| Rate for Payer: Zelis Auto |
$576.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$720.50
|
| Rate for Payer: Zelis Worker's Compensation |
$393.39
|
|
|
REVISE URETER
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
CPT 50728
|
| Hospital Charge Code |
6150728
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$393.39 |
| Max. Negotiated Rate |
$1,368.95 |
| Rate for Payer: Cash Price |
$864.60
|
| Rate for Payer: Cigna Commercial |
$1,224.85
|
| Rate for Payer: First Health Commercial |
$1,296.90
|
| Rate for Payer: First Health Workers Compensation |
$556.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,296.90
|
| Rate for Payer: GEHA Commercial |
$1,008.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,296.90
|
| Rate for Payer: Multiplan All |
$1,311.31
|
| Rate for Payer: OMNI Networks Commercial |
$1,008.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,296.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,368.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,080.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,340.13
|
| Rate for Payer: Zelis Auto |
$576.40
|
| Rate for Payer: Zelis Worker's Compensation |
$393.39
|
|
|
REVISE URETER
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
CPT 50727
|
| Hospital Charge Code |
6150727
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$283.92 |
| Max. Negotiated Rate |
$988.00 |
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cigna Commercial |
$884.00
|
| Rate for Payer: First Health Commercial |
$936.00
|
| Rate for Payer: First Health Workers Compensation |
$401.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$936.00
|
| Rate for Payer: GEHA Commercial |
$728.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$936.00
|
| Rate for Payer: Multiplan All |
$946.40
|
| Rate for Payer: OMNI Networks Commercial |
$728.00
|
| Rate for Payer: One Health Plan PPO/POS |
$936.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$988.00
|
| Rate for Payer: Three Rivers Provider Network All |
$780.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$967.20
|
| Rate for Payer: Zelis Auto |
$416.00
|
| Rate for Payer: Zelis Worker's Compensation |
$283.92
|
|
