|
REVISE URETHRA STAGE 1
|
Facility
|
IP
|
$1,650.00
|
|
|
Service Code
|
CPT 53400
|
| Hospital Charge Code |
6153400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$450.45 |
| Max. Negotiated Rate |
$1,567.50 |
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna Commercial |
$1,402.50
|
| Rate for Payer: First Health Commercial |
$1,485.00
|
| Rate for Payer: First Health Workers Compensation |
$637.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,485.00
|
| Rate for Payer: GEHA Commercial |
$1,155.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,485.00
|
| Rate for Payer: Multiplan All |
$1,501.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,155.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,485.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,567.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,237.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,534.50
|
| Rate for Payer: Zelis Auto |
$660.00
|
| Rate for Payer: Zelis Worker's Compensation |
$450.45
|
|
|
REVISE URETHRA STAGE 1
|
Facility
|
OP
|
$1,650.00
|
|
|
Service Code
|
CPT 53400
|
| Hospital Charge Code |
6153400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$450.45 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$990.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,513.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cash Price |
$990.00
|
| Rate for Payer: Cigna Commercial |
$1,402.50
|
| Rate for Payer: First Health Commercial |
$1,485.00
|
| Rate for Payer: First Health Workers Compensation |
$637.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,485.00
|
| Rate for Payer: GEHA Commercial |
$1,320.00
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,485.00
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,564.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$1,501.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,155.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,485.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,961.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,564.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,567.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,237.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,564.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,534.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$660.00
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$450.45
|
|
|
REVISE URETHRA STAGE 2
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
CPT 53405
|
| Hospital Charge Code |
6153405
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cigna Commercial |
$1,530.00
|
| Rate for Payer: First Health Commercial |
$1,620.00
|
| Rate for Payer: First Health Workers Compensation |
$694.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,620.00
|
| Rate for Payer: GEHA Commercial |
$1,260.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,620.00
|
| Rate for Payer: Multiplan All |
$1,638.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,260.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,620.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,710.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,350.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,674.00
|
| Rate for Payer: Zelis Auto |
$720.00
|
| Rate for Payer: Zelis Worker's Compensation |
$491.40
|
|
|
REVISE URETHRA STAGE 2
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
CPT 53405
|
| Hospital Charge Code |
6153405
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,080.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,513.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cigna Commercial |
$1,530.00
|
| Rate for Payer: First Health Commercial |
$1,620.00
|
| Rate for Payer: First Health Workers Compensation |
$694.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,620.00
|
| Rate for Payer: GEHA Commercial |
$1,440.00
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,620.00
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,564.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$1,638.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,260.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,620.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,961.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,564.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,710.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,350.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,564.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,674.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$720.00
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$491.40
|
|
|
REVISE URINE FLOW
|
Facility
|
IP
|
$3,749.00
|
|
|
Service Code
|
CPT 50830
|
| Hospital Charge Code |
6150830
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,023.48 |
| Max. Negotiated Rate |
$3,561.55 |
| Rate for Payer: Cash Price |
$2,249.40
|
| Rate for Payer: Cigna Commercial |
$3,186.65
|
| Rate for Payer: First Health Commercial |
$3,374.10
|
| Rate for Payer: First Health Workers Compensation |
$1,447.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,374.10
|
| Rate for Payer: GEHA Commercial |
$2,624.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,374.10
|
| Rate for Payer: Multiplan All |
$3,411.59
|
| Rate for Payer: OMNI Networks Commercial |
$2,624.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,374.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,561.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,811.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,486.57
|
| Rate for Payer: Zelis Auto |
$1,499.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,023.48
|
|
|
REVISE URINE FLOW
|
Facility
|
OP
|
$3,749.00
|
|
|
Service Code
|
CPT 50830
|
| Hospital Charge Code |
6150830
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$937.25 |
| Max. Negotiated Rate |
$3,561.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,249.40
|
| Rate for Payer: Cash Price |
$2,249.40
|
| Rate for Payer: Cigna Commercial |
$3,186.65
|
| Rate for Payer: First Health Commercial |
$3,374.10
|
| Rate for Payer: First Health Workers Compensation |
$1,447.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,374.10
|
| Rate for Payer: GEHA Commercial |
$2,999.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,374.10
|
| Rate for Payer: Humana ChoiceCare |
$974.74
|
| Rate for Payer: Multiplan All |
$3,411.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,249.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,624.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,374.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,561.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,811.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,299.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$937.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,486.57
|
| Rate for Payer: Zelis Auto |
$1,499.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,874.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,023.48
|
|
|
REVISE VAG GRAFT OPEN ABD
|
Facility
|
IP
|
$1,929.00
|
|
|
Service Code
|
CPT 57296
|
| Hospital Charge Code |
6157296
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$526.62 |
| Max. Negotiated Rate |
$1,832.55 |
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cigna Commercial |
$1,639.65
|
| Rate for Payer: First Health Commercial |
$1,736.10
|
| Rate for Payer: First Health Workers Compensation |
$744.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,736.10
|
| Rate for Payer: GEHA Commercial |
$1,350.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,736.10
|
| Rate for Payer: Multiplan All |
$1,755.39
|
| Rate for Payer: OMNI Networks Commercial |
$1,350.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,736.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,832.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,446.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,793.97
|
| Rate for Payer: Zelis Auto |
$771.60
|
| Rate for Payer: Zelis Worker's Compensation |
$526.62
|
|
|
REVISE VAG GRAFT OPEN ABD
|
Facility
|
OP
|
$1,929.00
|
|
|
Service Code
|
CPT 57296
|
| Hospital Charge Code |
6157296
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$482.25 |
| Max. Negotiated Rate |
$1,832.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,157.40
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cigna Commercial |
$1,639.65
|
| Rate for Payer: First Health Commercial |
$1,736.10
|
| Rate for Payer: First Health Workers Compensation |
$744.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,736.10
|
| Rate for Payer: GEHA Commercial |
$1,543.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,736.10
|
| Rate for Payer: Humana ChoiceCare |
$501.54
|
| Rate for Payer: Multiplan All |
$1,755.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,157.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,350.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,736.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,832.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,446.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,697.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$482.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,793.97
|
| Rate for Payer: Zelis Auto |
$771.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$964.50
|
| Rate for Payer: Zelis Worker's Compensation |
$526.62
|
|
|
REVISE VAG GRAFT VIA VAGINA
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 57295
|
| Hospital Charge Code |
6157295
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$263.99 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$580.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$580.20
|
| Rate for Payer: Cash Price |
$580.20
|
| Rate for Payer: Cigna Commercial |
$821.95
|
| Rate for Payer: First Health Commercial |
$870.30
|
| Rate for Payer: First Health Workers Compensation |
$373.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$870.30
|
| Rate for Payer: GEHA Commercial |
$773.60
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$870.30
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$879.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$676.90
|
| Rate for Payer: One Health Plan PPO/POS |
$870.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$918.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$725.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$899.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$386.80
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$263.99
|
|
|
REVISE VAG GRAFT VIA VAGINA
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 57295
|
| Hospital Charge Code |
6157295
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$263.99 |
| Max. Negotiated Rate |
$918.65 |
| Rate for Payer: Cash Price |
$580.20
|
| Rate for Payer: Cigna Commercial |
$821.95
|
| Rate for Payer: First Health Commercial |
$870.30
|
| Rate for Payer: First Health Workers Compensation |
$373.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$870.30
|
| Rate for Payer: GEHA Commercial |
$676.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$870.30
|
| Rate for Payer: Multiplan All |
$879.97
|
| Rate for Payer: OMNI Networks Commercial |
$676.90
|
| Rate for Payer: One Health Plan PPO/POS |
$870.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$918.65
|
| Rate for Payer: Three Rivers Provider Network All |
$725.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$899.31
|
| Rate for Payer: Zelis Auto |
$386.80
|
| Rate for Payer: Zelis Worker's Compensation |
$263.99
|
|
|
REVISE WRIST/FOREARM TENDON
|
Facility
|
OP
|
$1,143.00
|
|
|
Service Code
|
CPT 25280
|
| Hospital Charge Code |
6125280
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$312.04 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$685.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cigna Commercial |
$971.55
|
| Rate for Payer: First Health Commercial |
$1,028.70
|
| Rate for Payer: First Health Workers Compensation |
$441.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,028.70
|
| Rate for Payer: GEHA Commercial |
$914.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,028.70
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,040.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$800.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,028.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,085.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$857.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,062.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$457.20
|
| 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 |
$312.04
|
|
|
REVISE WRIST/FOREARM TENDON
|
Facility
|
IP
|
$1,143.00
|
|
|
Service Code
|
CPT 25280
|
| Hospital Charge Code |
6125280
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$312.04 |
| Max. Negotiated Rate |
$1,085.85 |
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cigna Commercial |
$971.55
|
| Rate for Payer: First Health Commercial |
$1,028.70
|
| Rate for Payer: First Health Workers Compensation |
$441.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,028.70
|
| Rate for Payer: GEHA Commercial |
$800.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,028.70
|
| Rate for Payer: Multiplan All |
$1,040.13
|
| Rate for Payer: OMNI Networks Commercial |
$800.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,028.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,085.85
|
| Rate for Payer: Three Rivers Provider Network All |
$857.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,062.99
|
| Rate for Payer: Zelis Auto |
$457.20
|
| Rate for Payer: Zelis Worker's Compensation |
$312.04
|
|
|
REVISE WRIST JOINT
|
Facility
|
IP
|
$1,719.00
|
|
|
Service Code
|
CPT 25332
|
| Hospital Charge Code |
6125332
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$469.29 |
| Max. Negotiated Rate |
$1,633.05 |
| Rate for Payer: Cash Price |
$1,031.40
|
| Rate for Payer: Cigna Commercial |
$1,461.15
|
| Rate for Payer: First Health Commercial |
$1,547.10
|
| Rate for Payer: First Health Workers Compensation |
$663.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,547.10
|
| Rate for Payer: GEHA Commercial |
$1,203.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,547.10
|
| Rate for Payer: Multiplan All |
$1,564.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,203.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,547.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,633.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,289.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,598.67
|
| Rate for Payer: Zelis Auto |
$687.60
|
| Rate for Payer: Zelis Worker's Compensation |
$469.29
|
|
|
REVISE WRIST JOINT
|
Facility
|
OP
|
$1,719.00
|
|
|
Service Code
|
CPT 25332
|
| Hospital Charge Code |
6125332
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$469.29 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,033.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,031.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,033.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,194.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,031.40
|
| Rate for Payer: Cash Price |
$1,031.40
|
| Rate for Payer: Cigna Commercial |
$1,461.15
|
| Rate for Payer: First Health Commercial |
$1,547.10
|
| Rate for Payer: First Health Workers Compensation |
$663.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,547.10
|
| Rate for Payer: GEHA Commercial |
$1,375.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,547.10
|
| 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 |
$3,260.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,564.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,203.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,547.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,764.14
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,260.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,633.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,289.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,260.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,598.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$687.60
|
| 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 |
$469.29
|
|
|
REVISION GASTROPLASTY
|
Facility
|
IP
|
$4,061.00
|
|
|
Service Code
|
CPT 43848
|
| Hospital Charge Code |
6143848
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,108.65 |
| Max. Negotiated Rate |
$3,857.95 |
| Rate for Payer: Cash Price |
$2,436.60
|
| Rate for Payer: Cigna Commercial |
$3,451.85
|
| Rate for Payer: First Health Commercial |
$3,654.90
|
| Rate for Payer: First Health Workers Compensation |
$1,567.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,654.90
|
| Rate for Payer: GEHA Commercial |
$2,842.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,654.90
|
| Rate for Payer: Multiplan All |
$3,695.51
|
| Rate for Payer: OMNI Networks Commercial |
$2,842.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,654.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,857.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,045.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,776.73
|
| Rate for Payer: Zelis Auto |
$1,624.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,108.65
|
|
|
REVISION GASTROPLASTY
|
Facility
|
OP
|
$4,061.00
|
|
|
Service Code
|
CPT 43848
|
| Hospital Charge Code |
6143848
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,015.25 |
| Max. Negotiated Rate |
$3,857.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,436.60
|
| Rate for Payer: Cash Price |
$2,436.60
|
| Rate for Payer: Cigna Commercial |
$3,451.85
|
| Rate for Payer: First Health Commercial |
$3,654.90
|
| Rate for Payer: First Health Workers Compensation |
$1,567.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,654.90
|
| Rate for Payer: GEHA Commercial |
$3,248.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,654.90
|
| Rate for Payer: Humana ChoiceCare |
$1,055.86
|
| Rate for Payer: Multiplan All |
$3,695.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,436.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,842.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,654.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,857.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,045.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,573.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,015.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,776.73
|
| Rate for Payer: Zelis Auto |
$1,624.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,030.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,108.65
|
|
|
REVISION OF AMPUTATION
|
Facility
|
OP
|
$2,297.00
|
|
|
Service Code
|
CPT 24935
|
| Hospital Charge Code |
6124935
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$627.08 |
| 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 |
$1,378.20
|
| 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 |
$1,378.20
|
| Rate for Payer: Cash Price |
$1,378.20
|
| Rate for Payer: Cigna Commercial |
$1,952.45
|
| Rate for Payer: First Health Commercial |
$2,067.30
|
| Rate for Payer: First Health Workers Compensation |
$886.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,067.30
|
| Rate for Payer: GEHA Commercial |
$1,837.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,067.30
|
| 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 |
$2,090.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,607.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,067.30
|
| 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 |
$2,182.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,722.75
|
| 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 |
$2,136.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$918.80
|
| 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 |
$627.08
|
|
|
REVISION OF AMPUTATION
|
Facility
|
IP
|
$2,297.00
|
|
|
Service Code
|
CPT 24935
|
| Hospital Charge Code |
6124935
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$627.08 |
| Max. Negotiated Rate |
$2,182.15 |
| Rate for Payer: Cash Price |
$1,378.20
|
| Rate for Payer: Cigna Commercial |
$1,952.45
|
| Rate for Payer: First Health Commercial |
$2,067.30
|
| Rate for Payer: First Health Workers Compensation |
$886.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,067.30
|
| Rate for Payer: GEHA Commercial |
$1,607.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,067.30
|
| Rate for Payer: Multiplan All |
$2,090.27
|
| Rate for Payer: OMNI Networks Commercial |
$1,607.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,067.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,182.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,722.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,136.21
|
| Rate for Payer: Zelis Auto |
$918.80
|
| Rate for Payer: Zelis Worker's Compensation |
$627.08
|
|
|
REVISION OF ANKLE JOINT
|
Facility
|
OP
|
$1,219.00
|
|
|
Service Code
|
CPT 27700
|
| Hospital Charge Code |
6127700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$332.79 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,033.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$731.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,033.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,194.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$731.40
|
| Rate for Payer: Cash Price |
$731.40
|
| Rate for Payer: Cigna Commercial |
$1,036.15
|
| Rate for Payer: First Health Commercial |
$1,097.10
|
| Rate for Payer: First Health Workers Compensation |
$470.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,097.10
|
| Rate for Payer: GEHA Commercial |
$975.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,097.10
|
| 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 |
$3,260.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,109.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$853.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,097.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,764.14
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,260.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,158.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$914.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,260.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,133.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$487.60
|
| 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 |
$332.79
|
|
|
REVISION OF ANKLE JOINT
|
Facility
|
IP
|
$1,219.00
|
|
|
Service Code
|
CPT 27700
|
| Hospital Charge Code |
6127700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$332.79 |
| Max. Negotiated Rate |
$1,158.05 |
| Rate for Payer: Cash Price |
$731.40
|
| Rate for Payer: Cigna Commercial |
$1,036.15
|
| Rate for Payer: First Health Commercial |
$1,097.10
|
| Rate for Payer: First Health Workers Compensation |
$470.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,097.10
|
| Rate for Payer: GEHA Commercial |
$853.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,097.10
|
| Rate for Payer: Multiplan All |
$1,109.29
|
| Rate for Payer: OMNI Networks Commercial |
$853.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,097.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,158.05
|
| Rate for Payer: Three Rivers Provider Network All |
$914.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,133.67
|
| Rate for Payer: Zelis Auto |
$487.60
|
| Rate for Payer: Zelis Worker's Compensation |
$332.79
|
|
|
REVISION OF ARM MUSCLES
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
CPT 24330
|
| Hospital Charge Code |
6124330
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$401.86 |
| 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 |
$883.20
|
| 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 |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna Commercial |
$1,251.20
|
| Rate for Payer: First Health Commercial |
$1,324.80
|
| Rate for Payer: First Health Workers Compensation |
$568.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,324.80
|
| Rate for Payer: GEHA Commercial |
$1,177.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,324.80
|
| 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 |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,339.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,030.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,324.80
|
| 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 |
$1,398.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,104.00
|
| 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 |
$1,368.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$588.80
|
| 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 |
$401.86
|
|
|
REVISION OF ARM MUSCLES
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
CPT 24330
|
| Hospital Charge Code |
6124330
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$401.86 |
| Max. Negotiated Rate |
$1,398.40 |
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna Commercial |
$1,251.20
|
| Rate for Payer: First Health Commercial |
$1,324.80
|
| Rate for Payer: First Health Workers Compensation |
$568.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,324.80
|
| Rate for Payer: GEHA Commercial |
$1,030.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,324.80
|
| Rate for Payer: Multiplan All |
$1,339.52
|
| Rate for Payer: OMNI Networks Commercial |
$1,030.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,324.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,398.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,104.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,368.96
|
| Rate for Payer: Zelis Auto |
$588.80
|
| Rate for Payer: Zelis Worker's Compensation |
$401.86
|
|
|
REVISION OF ARM MUSCLES
|
Facility
|
OP
|
$1,615.00
|
|
|
Service Code
|
CPT 24331
|
| Hospital Charge Code |
6124331
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$440.89 |
| 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 |
$969.00
|
| 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 |
$969.00
|
| Rate for Payer: Cash Price |
$969.00
|
| Rate for Payer: Cigna Commercial |
$1,372.75
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: First Health Workers Compensation |
$623.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,453.50
|
| Rate for Payer: GEHA Commercial |
$1,292.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,453.50
|
| 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 |
$1,469.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,130.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,453.50
|
| 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 |
$1,534.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,211.25
|
| 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 |
$1,501.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$646.00
|
| 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 |
$440.89
|
|
|
REVISION OF ARM MUSCLES
|
Facility
|
IP
|
$1,615.00
|
|
|
Service Code
|
CPT 24331
|
| Hospital Charge Code |
6124331
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$440.89 |
| Max. Negotiated Rate |
$1,534.25 |
| Rate for Payer: Cash Price |
$969.00
|
| Rate for Payer: Cigna Commercial |
$1,372.75
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: First Health Workers Compensation |
$623.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,453.50
|
| Rate for Payer: GEHA Commercial |
$1,130.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,453.50
|
| Rate for Payer: Multiplan All |
$1,469.65
|
| Rate for Payer: OMNI Networks Commercial |
$1,130.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,453.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,534.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,211.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,501.95
|
| Rate for Payer: Zelis Auto |
$646.00
|
| Rate for Payer: Zelis Worker's Compensation |
$440.89
|
|
|
REVISION OF ARM NERVE(S)
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
CPT 64713
|
| Hospital Charge Code |
6164713
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$409.50 |
| 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 |
$900.00
|
| 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 |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,275.00
|
| Rate for Payer: First Health Commercial |
$1,350.00
|
| Rate for Payer: First Health Workers Compensation |
$579.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,350.00
|
| Rate for Payer: GEHA Commercial |
$1,200.00
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,350.00
|
| 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 |
$1,365.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,050.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,350.00
|
| 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 |
$1,425.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$1,125.00
|
| 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 |
$1,395.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$600.00
|
| 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 |
$409.50
|
|
