|
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
|
|
|
REVISION OF ARM TENDON
|
Facility
|
IP
|
$958.00
|
|
|
Service Code
|
CPT 24310
|
| Hospital Charge Code |
6124310
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$261.53 |
| Max. Negotiated Rate |
$910.10 |
| Rate for Payer: Cash Price |
$574.80
|
| Rate for Payer: Cigna Commercial |
$814.30
|
| Rate for Payer: First Health Commercial |
$862.20
|
| Rate for Payer: First Health Workers Compensation |
$369.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$862.20
|
| Rate for Payer: GEHA Commercial |
$670.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$862.20
|
| Rate for Payer: Multiplan All |
$871.78
|
| Rate for Payer: OMNI Networks Commercial |
$670.60
|
| Rate for Payer: One Health Plan PPO/POS |
$862.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$910.10
|
| Rate for Payer: Three Rivers Provider Network All |
$718.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$890.94
|
| Rate for Payer: Zelis Auto |
$383.20
|
| Rate for Payer: Zelis Worker's Compensation |
$261.53
|
|
|
REVISION OF ARM TENDON
|
Facility
|
OP
|
$958.00
|
|
|
Service Code
|
CPT 24310
|
| Hospital Charge Code |
6124310
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$261.53 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$574.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$574.80
|
| Rate for Payer: Cash Price |
$574.80
|
| Rate for Payer: Cigna Commercial |
$814.30
|
| Rate for Payer: First Health Commercial |
$862.20
|
| Rate for Payer: First Health Workers Compensation |
$369.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$862.20
|
| Rate for Payer: GEHA Commercial |
$766.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$862.20
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$871.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$670.60
|
| Rate for Payer: One Health Plan PPO/POS |
$862.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$910.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$718.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$890.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$383.20
|
| 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 |
$261.53
|
|
|
REVISION OF BIG TOE
|
Facility
|
OP
|
$915.00
|
|
|
Service Code
|
CPT 28310
|
| Hospital Charge Code |
6128310
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$249.79 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$549.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cigna Commercial |
$777.75
|
| Rate for Payer: First Health Commercial |
$823.50
|
| Rate for Payer: First Health Workers Compensation |
$353.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$823.50
|
| Rate for Payer: GEHA Commercial |
$732.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$823.50
|
| 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 |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$832.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$640.50
|
| Rate for Payer: One Health Plan PPO/POS |
$823.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$869.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$686.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$850.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$366.00
|
| 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 |
$249.79
|
|
|
REVISION OF BIG TOE
|
Facility
|
IP
|
$915.00
|
|
|
Service Code
|
CPT 28310
|
| Hospital Charge Code |
6128310
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$249.79 |
| Max. Negotiated Rate |
$869.25 |
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cigna Commercial |
$777.75
|
| Rate for Payer: First Health Commercial |
$823.50
|
| Rate for Payer: First Health Workers Compensation |
$353.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$823.50
|
| Rate for Payer: GEHA Commercial |
$640.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$823.50
|
| Rate for Payer: Multiplan All |
$832.65
|
| Rate for Payer: OMNI Networks Commercial |
$640.50
|
| Rate for Payer: One Health Plan PPO/POS |
$823.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$869.25
|
| Rate for Payer: Three Rivers Provider Network All |
$686.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$850.95
|
| Rate for Payer: Zelis Auto |
$366.00
|
| Rate for Payer: Zelis Worker's Compensation |
$249.79
|
|
|
REVISION OF BLADDER & BOWEL
|
Facility
|
OP
|
$2,879.00
|
|
|
Service Code
|
CPT 51960
|
| Hospital Charge Code |
6151960
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$719.75 |
| Max. Negotiated Rate |
$2,735.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,727.40
|
| Rate for Payer: Cash Price |
$1,727.40
|
| Rate for Payer: Cigna Commercial |
$2,447.15
|
| Rate for Payer: First Health Commercial |
$2,591.10
|
| Rate for Payer: First Health Workers Compensation |
$1,111.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,591.10
|
| Rate for Payer: GEHA Commercial |
$2,303.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,591.10
|
| Rate for Payer: Humana ChoiceCare |
$748.54
|
| Rate for Payer: Multiplan All |
$2,619.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,727.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,015.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,591.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,735.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,159.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,533.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$719.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,677.47
|
| Rate for Payer: Zelis Auto |
$1,151.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,439.50
|
| Rate for Payer: Zelis Worker's Compensation |
$785.97
|
|
|
REVISION OF BLADDER & BOWEL
|
Facility
|
IP
|
$2,879.00
|
|
|
Service Code
|
CPT 51960
|
| Hospital Charge Code |
6151960
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$785.97 |
| Max. Negotiated Rate |
$2,735.05 |
| Rate for Payer: Cash Price |
$1,727.40
|
| Rate for Payer: Cigna Commercial |
$2,447.15
|
| Rate for Payer: First Health Commercial |
$2,591.10
|
| Rate for Payer: First Health Workers Compensation |
$1,111.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,591.10
|
| Rate for Payer: GEHA Commercial |
$2,015.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,591.10
|
| Rate for Payer: Multiplan All |
$2,619.89
|
| Rate for Payer: OMNI Networks Commercial |
$2,015.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,591.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,735.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,159.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,677.47
|
| Rate for Payer: Zelis Auto |
$1,151.60
|
| Rate for Payer: Zelis Worker's Compensation |
$785.97
|
|
|
REVISION OF BLADDER NECK
|
Facility
|
IP
|
$1,001.00
|
|
|
Service Code
|
CPT 52500
|
| Hospital Charge Code |
6152500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$273.27 |
| Max. Negotiated Rate |
$950.95 |
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cigna Commercial |
$850.85
|
| Rate for Payer: First Health Commercial |
$900.90
|
| Rate for Payer: First Health Workers Compensation |
$386.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$900.90
|
| Rate for Payer: GEHA Commercial |
$700.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$900.90
|
| Rate for Payer: Multiplan All |
$910.91
|
| Rate for Payer: OMNI Networks Commercial |
$700.70
|
| Rate for Payer: One Health Plan PPO/POS |
$900.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$950.95
|
| Rate for Payer: Three Rivers Provider Network All |
$750.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$930.93
|
| Rate for Payer: Zelis Auto |
$400.40
|
| Rate for Payer: Zelis Worker's Compensation |
$273.27
|
|
|
REVISION OF BLADDER NECK
|
Facility
|
OP
|
$1,001.00
|
|
|
Service Code
|
CPT 52500
|
| Hospital Charge Code |
6152500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$273.27 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$600.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cigna Commercial |
$850.85
|
| Rate for Payer: First Health Commercial |
$900.90
|
| Rate for Payer: First Health Workers Compensation |
$386.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$900.90
|
| Rate for Payer: GEHA Commercial |
$800.80
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$900.90
|
| 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 |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$910.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$700.70
|
| Rate for Payer: One Health Plan PPO/POS |
$900.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$950.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$750.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$930.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$400.40
|
| 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 |
$273.27
|
|
|
REVISION OF BLADDER/URETHRA
|
Facility
|
IP
|
$2,149.00
|
|
|
Service Code
|
CPT 51800
|
| Hospital Charge Code |
6151800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$586.68 |
| Max. Negotiated Rate |
$2,041.55 |
| Rate for Payer: Cash Price |
$1,289.40
|
| Rate for Payer: Cigna Commercial |
$1,826.65
|
| Rate for Payer: First Health Commercial |
$1,934.10
|
| Rate for Payer: First Health Workers Compensation |
$829.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,934.10
|
| Rate for Payer: GEHA Commercial |
$1,504.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,934.10
|
| Rate for Payer: Multiplan All |
$1,955.59
|
| Rate for Payer: OMNI Networks Commercial |
$1,504.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,934.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,041.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,611.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,998.57
|
| Rate for Payer: Zelis Auto |
$859.60
|
| Rate for Payer: Zelis Worker's Compensation |
$586.68
|
|
|
REVISION OF BLADDER/URETHRA
|
Facility
|
OP
|
$2,149.00
|
|
|
Service Code
|
CPT 51800
|
| Hospital Charge Code |
6151800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$537.25 |
| Max. Negotiated Rate |
$2,041.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,289.40
|
| Rate for Payer: Cash Price |
$1,289.40
|
| Rate for Payer: Cigna Commercial |
$1,826.65
|
| Rate for Payer: First Health Commercial |
$1,934.10
|
| Rate for Payer: First Health Workers Compensation |
$829.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,934.10
|
| Rate for Payer: GEHA Commercial |
$1,719.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,934.10
|
| Rate for Payer: Humana ChoiceCare |
$558.74
|
| Rate for Payer: Multiplan All |
$1,955.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,289.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,504.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,934.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,041.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,611.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,891.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$537.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,998.57
|
| Rate for Payer: Zelis Auto |
$859.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,074.50
|
| Rate for Payer: Zelis Worker's Compensation |
$586.68
|
|
|
REVISION OF CALF TENDON
|
Facility
|
OP
|
$1,336.00
|
|
|
Service Code
|
CPT 27687
|
| Hospital Charge Code |
6127687
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$364.73 |
| 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 |
$801.60
|
| 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 |
$801.60
|
| Rate for Payer: Cash Price |
$801.60
|
| Rate for Payer: Cigna Commercial |
$1,135.60
|
| Rate for Payer: First Health Commercial |
$1,202.40
|
| Rate for Payer: First Health Workers Compensation |
$515.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,202.40
|
| Rate for Payer: GEHA Commercial |
$1,068.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,202.40
|
| 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 |
$1,215.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$935.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,202.40
|
| 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 |
$1,269.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,002.00
|
| 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 |
$1,242.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$534.40
|
| 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 |
$364.73
|
|
|
REVISION OF CALF TENDON
|
Facility
|
IP
|
$1,336.00
|
|
|
Service Code
|
CPT 27687
|
| Hospital Charge Code |
6127687
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$364.73 |
| Max. Negotiated Rate |
$1,269.20 |
| Rate for Payer: Cash Price |
$801.60
|
| Rate for Payer: Cigna Commercial |
$1,135.60
|
| Rate for Payer: First Health Commercial |
$1,202.40
|
| Rate for Payer: First Health Workers Compensation |
$515.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,202.40
|
| Rate for Payer: GEHA Commercial |
$935.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,202.40
|
| Rate for Payer: Multiplan All |
$1,215.76
|
| Rate for Payer: OMNI Networks Commercial |
$935.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,202.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,269.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,002.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,242.48
|
| Rate for Payer: Zelis Auto |
$534.40
|
| Rate for Payer: Zelis Worker's Compensation |
$364.73
|
|
|
REVISION OF CERVIX
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
CPT 57720
|
| Hospital Charge Code |
6157720
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$210.48 |
| Max. Negotiated Rate |
$732.45 |
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cigna Commercial |
$655.35
|
| Rate for Payer: First Health Commercial |
$693.90
|
| Rate for Payer: First Health Workers Compensation |
$297.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$693.90
|
| Rate for Payer: GEHA Commercial |
$539.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$693.90
|
| Rate for Payer: Multiplan All |
$701.61
|
| Rate for Payer: OMNI Networks Commercial |
$539.70
|
| Rate for Payer: One Health Plan PPO/POS |
$693.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$732.45
|
| Rate for Payer: Three Rivers Provider Network All |
$578.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$717.03
|
| Rate for Payer: Zelis Auto |
$308.40
|
| Rate for Payer: Zelis Worker's Compensation |
$210.48
|
|
|
REVISION OF CERVIX
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
CPT 57700
|
| Hospital Charge Code |
6157700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$218.40 |
| 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 |
$480.00
|
| 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 |
$480.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna Commercial |
$680.00
|
| Rate for Payer: First Health Commercial |
$720.00
|
| Rate for Payer: First Health Workers Compensation |
$308.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$720.00
|
| Rate for Payer: GEHA Commercial |
$640.00
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$720.00
|
| 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 |
$728.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$560.00
|
| Rate for Payer: One Health Plan PPO/POS |
$720.00
|
| 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 |
$760.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$600.00
|
| 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 |
$744.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$320.00
|
| 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 |
$218.40
|
|
|
REVISION OF CERVIX
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT 57720
|
| Hospital Charge Code |
6157720
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$210.48 |
| 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 |
$462.60
|
| 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 |
$462.60
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cigna Commercial |
$655.35
|
| Rate for Payer: First Health Commercial |
$693.90
|
| Rate for Payer: First Health Workers Compensation |
$297.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$693.90
|
| Rate for Payer: GEHA Commercial |
$616.80
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$693.90
|
| 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 |
$701.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$539.70
|
| Rate for Payer: One Health Plan PPO/POS |
$693.90
|
| 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 |
$732.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$578.25
|
| 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 |
$717.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$308.40
|
| 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 |
$210.48
|
|
|
REVISION OF CERVIX
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
CPT 57700
|
| Hospital Charge Code |
6157700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna Commercial |
$680.00
|
| Rate for Payer: First Health Commercial |
$720.00
|
| Rate for Payer: First Health Workers Compensation |
$308.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$720.00
|
| Rate for Payer: GEHA Commercial |
$560.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$720.00
|
| Rate for Payer: Multiplan All |
$728.00
|
| Rate for Payer: OMNI Networks Commercial |
$560.00
|
| Rate for Payer: One Health Plan PPO/POS |
$720.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$760.00
|
| Rate for Payer: Three Rivers Provider Network All |
$600.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$744.00
|
| Rate for Payer: Zelis Auto |
$320.00
|
| Rate for Payer: Zelis Worker's Compensation |
$218.40
|
|
|
REVISION OF COLLAR BONE
|
Facility
|
IP
|
$1,687.00
|
|
|
Service Code
|
CPT 23480
|
| Hospital Charge Code |
6123480
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$460.55 |
| Max. Negotiated Rate |
$1,602.65 |
| Rate for Payer: Cash Price |
$1,012.20
|
| Rate for Payer: Cigna Commercial |
$1,433.95
|
| Rate for Payer: First Health Commercial |
$1,518.30
|
| Rate for Payer: First Health Workers Compensation |
$651.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,518.30
|
| Rate for Payer: GEHA Commercial |
$1,180.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,518.30
|
| Rate for Payer: Multiplan All |
$1,535.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,180.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,518.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,602.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,265.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,568.91
|
| Rate for Payer: Zelis Auto |
$674.80
|
| Rate for Payer: Zelis Worker's Compensation |
$460.55
|
|
|
REVISION OF COLLAR BONE
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
CPT 23485
|
| Hospital Charge Code |
6123485
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$536.45 |
| Max. Negotiated Rate |
$1,866.75 |
| Rate for Payer: Cash Price |
$1,179.00
|
| Rate for Payer: Cigna Commercial |
$1,670.25
|
| Rate for Payer: First Health Commercial |
$1,768.50
|
| Rate for Payer: First Health Workers Compensation |
$758.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,768.50
|
| Rate for Payer: GEHA Commercial |
$1,375.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,768.50
|
| Rate for Payer: Multiplan All |
$1,788.15
|
| Rate for Payer: OMNI Networks Commercial |
$1,375.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,768.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,866.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,473.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,827.45
|
| Rate for Payer: Zelis Auto |
$786.00
|
| Rate for Payer: Zelis Worker's Compensation |
$536.45
|
|
|
REVISION OF COLLAR BONE
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
CPT 23485
|
| Hospital Charge Code |
6123485
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$536.45 |
| Max. Negotiated Rate |
$24,435.12 |
| 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 |
$1,179.00
|
| 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 |
$12,217.56
|
| Rate for Payer: Cash Price |
$1,179.00
|
| Rate for Payer: Cash Price |
$1,179.00
|
| Rate for Payer: Cigna Commercial |
$1,670.25
|
| Rate for Payer: First Health Commercial |
$1,768.50
|
| Rate for Payer: First Health Workers Compensation |
$758.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,768.50
|
| Rate for Payer: GEHA Commercial |
$1,572.00
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,768.50
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,788.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,375.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,768.50
|
| 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 |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,866.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,473.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,827.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$786.00
|
| Rate for Payer: Zelis Medicare |
$10,384.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,661.07
|
| Rate for Payer: Zelis Worker's Compensation |
$536.45
|
|
|
REVISION OF COLLAR BONE
|
Facility
|
OP
|
$1,687.00
|
|
|
Service Code
|
CPT 23480
|
| Hospital Charge Code |
6123480
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$460.55 |
| 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 |
$1,012.20
|
| 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 |
$1,012.20
|
| Rate for Payer: Cash Price |
$1,012.20
|
| Rate for Payer: Cigna Commercial |
$1,433.95
|
| Rate for Payer: First Health Commercial |
$1,518.30
|
| Rate for Payer: First Health Workers Compensation |
$651.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,518.30
|
| Rate for Payer: GEHA Commercial |
$1,349.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,518.30
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,535.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,180.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,518.30
|
| 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 |
$1,602.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,265.25
|
| 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 |
$1,568.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$674.80
|
| 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 |
$460.55
|
|
|
REVISION OF COLOSTOMY
|
Facility
|
OP
|
$2,482.00
|
|
|
Service Code
|
CPT 44346
|
| Hospital Charge Code |
6144346
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$620.50 |
| Max. Negotiated Rate |
$2,357.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,489.20
|
| Rate for Payer: Cash Price |
$1,489.20
|
| Rate for Payer: Cigna Commercial |
$2,109.70
|
| Rate for Payer: First Health Commercial |
$2,233.80
|
| Rate for Payer: First Health Workers Compensation |
$958.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,233.80
|
| Rate for Payer: GEHA Commercial |
$1,985.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,233.80
|
| Rate for Payer: Humana ChoiceCare |
$645.32
|
| Rate for Payer: Multiplan All |
$2,258.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,489.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,737.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,233.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,357.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,861.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,184.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$620.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,308.26
|
| Rate for Payer: Zelis Auto |
$992.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,241.00
|
| Rate for Payer: Zelis Worker's Compensation |
$677.59
|
|
|
REVISION OF COLOSTOMY
|
Facility
|
IP
|
$2,482.00
|
|
|
Service Code
|
CPT 44346
|
| Hospital Charge Code |
6144346
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$677.59 |
| Max. Negotiated Rate |
$2,357.90 |
| Rate for Payer: Cash Price |
$1,489.20
|
| Rate for Payer: Cigna Commercial |
$2,109.70
|
| Rate for Payer: First Health Commercial |
$2,233.80
|
| Rate for Payer: First Health Workers Compensation |
$958.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,233.80
|
| Rate for Payer: GEHA Commercial |
$1,737.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,233.80
|
| Rate for Payer: Multiplan All |
$2,258.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,737.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,233.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,357.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,861.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,308.26
|
| Rate for Payer: Zelis Auto |
$992.80
|
| Rate for Payer: Zelis Worker's Compensation |
$677.59
|
|
|
REVISION OF COLOSTOMY
|
Facility
|
IP
|
$2,204.00
|
|
|
Service Code
|
CPT 44345
|
| Hospital Charge Code |
6144345
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$601.69 |
| Max. Negotiated Rate |
$2,093.80 |
| Rate for Payer: Cash Price |
$1,322.40
|
| Rate for Payer: Cigna Commercial |
$1,873.40
|
| Rate for Payer: First Health Commercial |
$1,983.60
|
| Rate for Payer: First Health Workers Compensation |
$850.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,983.60
|
| Rate for Payer: GEHA Commercial |
$1,542.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,983.60
|
| Rate for Payer: Multiplan All |
$2,005.64
|
| Rate for Payer: OMNI Networks Commercial |
$1,542.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,983.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,093.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,653.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,049.72
|
| Rate for Payer: Zelis Auto |
$881.60
|
| Rate for Payer: Zelis Worker's Compensation |
$601.69
|
|
|
REVISION OF COLOSTOMY
|
Facility
|
OP
|
$1,301.00
|
|
|
Service Code
|
CPT 44340
|
| Hospital Charge Code |
6144340
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$355.17 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$780.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,476.24
|
| Rate for Payer: Cash Price |
$780.60
|
| Rate for Payer: Cash Price |
$780.60
|
| Rate for Payer: Cigna Commercial |
$1,105.85
|
| Rate for Payer: First Health Commercial |
$1,170.90
|
| Rate for Payer: First Health Workers Compensation |
$502.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,170.90
|
| Rate for Payer: GEHA Commercial |
$1,040.80
|
| Rate for Payer: GEHA Medicare |
$3,476.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,170.90
|
| Rate for Payer: Humana ChoiceCare |
$3,823.86
|
| Rate for Payer: Humana Medicare Advantage |
$3,476.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,840.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,476.24
|
| Rate for Payer: Multiplan All |
$1,183.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,909.61
|
| Rate for Payer: OMNI Networks Commercial |
$910.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,170.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,476.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,235.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,952.48
|
| Rate for Payer: Three Rivers Provider Network All |
$975.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,406.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,476.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,209.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,476.24
|
| Rate for Payer: Zelis Auto |
$520.40
|
| Rate for Payer: Zelis Medicare |
$2,954.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,171.49
|
| Rate for Payer: Zelis Worker's Compensation |
$355.17
|
|
