|
REVISION OF NECK MUSCLE
|
Facility
|
IP
|
$929.00
|
|
|
Service Code
|
CPT 21720
|
| Hospital Charge Code |
6121720
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$253.62 |
| Max. Negotiated Rate |
$882.55 |
| Rate for Payer: Cash Price |
$557.40
|
| Rate for Payer: Cigna Commercial |
$789.65
|
| Rate for Payer: First Health Commercial |
$836.10
|
| Rate for Payer: First Health Workers Compensation |
$358.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$836.10
|
| Rate for Payer: GEHA Commercial |
$650.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$836.10
|
| Rate for Payer: Multiplan All |
$845.39
|
| Rate for Payer: OMNI Networks Commercial |
$650.30
|
| Rate for Payer: One Health Plan PPO/POS |
$836.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$882.55
|
| Rate for Payer: Three Rivers Provider Network All |
$696.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$863.97
|
| Rate for Payer: Zelis Auto |
$371.60
|
| Rate for Payer: Zelis Worker's Compensation |
$253.62
|
|
|
REVISION OF NECK MUSCLE/RIB
|
Facility
|
OP
|
$1,169.00
|
|
|
Service Code
|
CPT 21705
|
| Hospital Charge Code |
6121705
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$292.25 |
| Max. Negotiated Rate |
$1,110.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$701.40
|
| Rate for Payer: Cash Price |
$701.40
|
| Rate for Payer: Cigna Commercial |
$993.65
|
| Rate for Payer: First Health Commercial |
$1,052.10
|
| Rate for Payer: First Health Workers Compensation |
$451.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,052.10
|
| Rate for Payer: GEHA Commercial |
$935.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,052.10
|
| Rate for Payer: Humana ChoiceCare |
$303.94
|
| Rate for Payer: Multiplan All |
$1,063.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$701.40
|
| Rate for Payer: OMNI Networks Commercial |
$818.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,052.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,110.55
|
| Rate for Payer: Three Rivers Provider Network All |
$876.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,028.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$292.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,087.17
|
| Rate for Payer: Zelis Auto |
$467.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$584.50
|
| Rate for Payer: Zelis Worker's Compensation |
$319.14
|
|
|
REVISION OF NECK MUSCLE/RIB
|
Facility
|
IP
|
$1,169.00
|
|
|
Service Code
|
CPT 21705
|
| Hospital Charge Code |
6121705
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$319.14 |
| Max. Negotiated Rate |
$1,110.55 |
| Rate for Payer: Cash Price |
$701.40
|
| Rate for Payer: Cigna Commercial |
$993.65
|
| Rate for Payer: First Health Commercial |
$1,052.10
|
| Rate for Payer: First Health Workers Compensation |
$451.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,052.10
|
| Rate for Payer: GEHA Commercial |
$818.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,052.10
|
| Rate for Payer: Multiplan All |
$1,063.79
|
| Rate for Payer: OMNI Networks Commercial |
$818.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,052.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,110.55
|
| Rate for Payer: Three Rivers Provider Network All |
$876.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,087.17
|
| Rate for Payer: Zelis Auto |
$467.60
|
| Rate for Payer: Zelis Worker's Compensation |
$319.14
|
|
|
REVISION OF NOSE
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
CPT 30120
|
| Hospital Charge Code |
6130120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$241.88 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$531.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$531.60
|
| Rate for Payer: Cash Price |
$531.60
|
| Rate for Payer: Cigna Commercial |
$753.10
|
| Rate for Payer: First Health Commercial |
$797.40
|
| Rate for Payer: First Health Workers Compensation |
$342.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$797.40
|
| Rate for Payer: GEHA Commercial |
$708.80
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$797.40
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$806.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$620.20
|
| Rate for Payer: One Health Plan PPO/POS |
$797.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$841.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$664.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$823.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$354.40
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$241.88
|
|
|
REVISION OF NOSE
|
Facility
|
IP
|
$1,910.00
|
|
|
Service Code
|
CPT 30430
|
| Hospital Charge Code |
6130430
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$521.43 |
| Max. Negotiated Rate |
$1,814.50 |
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Cigna Commercial |
$1,623.50
|
| Rate for Payer: First Health Commercial |
$1,719.00
|
| Rate for Payer: First Health Workers Compensation |
$737.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,719.00
|
| Rate for Payer: GEHA Commercial |
$1,337.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,719.00
|
| Rate for Payer: Multiplan All |
$1,738.10
|
| Rate for Payer: OMNI Networks Commercial |
$1,337.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,719.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,814.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,432.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,776.30
|
| Rate for Payer: Zelis Auto |
$764.00
|
| Rate for Payer: Zelis Worker's Compensation |
$521.43
|
|
|
REVISION OF NOSE
|
Facility
|
IP
|
$1,448.00
|
|
|
Service Code
|
CPT 30460
|
| Hospital Charge Code |
6130460
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$395.30 |
| Max. Negotiated Rate |
$1,375.60 |
| Rate for Payer: Cash Price |
$868.80
|
| Rate for Payer: Cigna Commercial |
$1,230.80
|
| Rate for Payer: First Health Commercial |
$1,303.20
|
| Rate for Payer: First Health Workers Compensation |
$559.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,303.20
|
| Rate for Payer: GEHA Commercial |
$1,013.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,303.20
|
| Rate for Payer: Multiplan All |
$1,317.68
|
| Rate for Payer: OMNI Networks Commercial |
$1,013.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,303.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,375.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,086.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,346.64
|
| Rate for Payer: Zelis Auto |
$579.20
|
| Rate for Payer: Zelis Worker's Compensation |
$395.30
|
|
|
REVISION OF NOSE
|
Facility
|
IP
|
$3,027.00
|
|
|
Service Code
|
CPT 30450
|
| Hospital Charge Code |
6130450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$826.37 |
| Max. Negotiated Rate |
$2,875.65 |
| Rate for Payer: Cash Price |
$1,816.20
|
| Rate for Payer: Cigna Commercial |
$2,572.95
|
| Rate for Payer: First Health Commercial |
$2,724.30
|
| Rate for Payer: First Health Workers Compensation |
$1,168.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,724.30
|
| Rate for Payer: GEHA Commercial |
$2,118.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,724.30
|
| Rate for Payer: Multiplan All |
$2,754.57
|
| Rate for Payer: OMNI Networks Commercial |
$2,118.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,724.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,875.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,270.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,815.11
|
| Rate for Payer: Zelis Auto |
$1,210.80
|
| Rate for Payer: Zelis Worker's Compensation |
$826.37
|
|
|
REVISION OF NOSE
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
CPT 30120
|
| Hospital Charge Code |
6130120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$241.88 |
| Max. Negotiated Rate |
$841.70 |
| Rate for Payer: Cash Price |
$531.60
|
| Rate for Payer: Cigna Commercial |
$753.10
|
| Rate for Payer: First Health Commercial |
$797.40
|
| Rate for Payer: First Health Workers Compensation |
$342.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$797.40
|
| Rate for Payer: GEHA Commercial |
$620.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$797.40
|
| Rate for Payer: Multiplan All |
$806.26
|
| Rate for Payer: OMNI Networks Commercial |
$620.20
|
| Rate for Payer: One Health Plan PPO/POS |
$797.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$841.70
|
| Rate for Payer: Three Rivers Provider Network All |
$664.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$823.98
|
| Rate for Payer: Zelis Auto |
$354.40
|
| Rate for Payer: Zelis Worker's Compensation |
$241.88
|
|
|
REVISION OF NOSE
|
Facility
|
OP
|
$2,231.00
|
|
|
Service Code
|
CPT 30435
|
| Hospital Charge Code |
6130435
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$609.06 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,338.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,338.60
|
| Rate for Payer: Cash Price |
$1,338.60
|
| Rate for Payer: Cigna Commercial |
$1,896.35
|
| Rate for Payer: First Health Commercial |
$2,007.90
|
| Rate for Payer: First Health Workers Compensation |
$861.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,007.90
|
| Rate for Payer: GEHA Commercial |
$1,784.80
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,007.90
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$2,030.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,561.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,007.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,119.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,673.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,074.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$892.40
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$609.06
|
|
|
REVISION OF NOSE
|
Facility
|
IP
|
$2,231.00
|
|
|
Service Code
|
CPT 30435
|
| Hospital Charge Code |
6130435
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$609.06 |
| Max. Negotiated Rate |
$2,119.45 |
| Rate for Payer: Cash Price |
$1,338.60
|
| Rate for Payer: Cigna Commercial |
$1,896.35
|
| Rate for Payer: First Health Commercial |
$2,007.90
|
| Rate for Payer: First Health Workers Compensation |
$861.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,007.90
|
| Rate for Payer: GEHA Commercial |
$1,561.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,007.90
|
| Rate for Payer: Multiplan All |
$2,030.21
|
| Rate for Payer: OMNI Networks Commercial |
$1,561.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,007.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,119.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,673.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,074.83
|
| Rate for Payer: Zelis Auto |
$892.40
|
| Rate for Payer: Zelis Worker's Compensation |
$609.06
|
|
|
REVISION OF NOSE
|
Facility
|
OP
|
$1,910.00
|
|
|
Service Code
|
CPT 30430
|
| Hospital Charge Code |
6130430
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$521.43 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,369.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,146.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,369.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6,630.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Cigna Commercial |
$1,623.50
|
| Rate for Payer: First Health Commercial |
$1,719.00
|
| Rate for Payer: First Health Workers Compensation |
$737.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,719.00
|
| Rate for Payer: GEHA Commercial |
$1,528.00
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,719.00
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6,765.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,738.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,337.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,719.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7,811.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6,765.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,814.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,432.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6,765.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,776.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$764.00
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$521.43
|
|
|
REVISION OF NOSE
|
Facility
|
OP
|
$3,162.00
|
|
|
Service Code
|
CPT 30462
|
| Hospital Charge Code |
6130462
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$863.23 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,897.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,897.20
|
| Rate for Payer: Cash Price |
$1,897.20
|
| Rate for Payer: Cigna Commercial |
$2,687.70
|
| Rate for Payer: First Health Commercial |
$2,845.80
|
| Rate for Payer: First Health Workers Compensation |
$1,220.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,845.80
|
| Rate for Payer: GEHA Commercial |
$2,529.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,845.80
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$2,877.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,213.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,845.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,003.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$2,371.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,940.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$1,264.80
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$863.23
|
|
|
REVISION OF NOSE
|
Facility
|
OP
|
$3,027.00
|
|
|
Service Code
|
CPT 30450
|
| Hospital Charge Code |
6130450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$826.37 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,816.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,816.20
|
| Rate for Payer: Cash Price |
$1,816.20
|
| Rate for Payer: Cigna Commercial |
$2,572.95
|
| Rate for Payer: First Health Commercial |
$2,724.30
|
| Rate for Payer: First Health Workers Compensation |
$1,168.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,724.30
|
| Rate for Payer: GEHA Commercial |
$2,421.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,724.30
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$2,754.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,118.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,724.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,875.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$2,270.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,815.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$1,210.80
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$826.37
|
|
|
REVISION OF NOSE
|
Facility
|
OP
|
$1,448.00
|
|
|
Service Code
|
CPT 30460
|
| Hospital Charge Code |
6130460
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$395.30 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$868.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$868.80
|
| Rate for Payer: Cash Price |
$868.80
|
| Rate for Payer: Cigna Commercial |
$1,230.80
|
| Rate for Payer: First Health Commercial |
$1,303.20
|
| Rate for Payer: First Health Workers Compensation |
$559.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,303.20
|
| Rate for Payer: GEHA Commercial |
$1,158.40
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,303.20
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,317.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,013.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,303.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,375.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,086.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,346.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$579.20
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$395.30
|
|
|
REVISION OF NOSE
|
Facility
|
IP
|
$3,162.00
|
|
|
Service Code
|
CPT 30462
|
| Hospital Charge Code |
6130462
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$863.23 |
| Max. Negotiated Rate |
$3,003.90 |
| Rate for Payer: Cash Price |
$1,897.20
|
| Rate for Payer: Cigna Commercial |
$2,687.70
|
| Rate for Payer: First Health Commercial |
$2,845.80
|
| Rate for Payer: First Health Workers Compensation |
$1,220.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,845.80
|
| Rate for Payer: GEHA Commercial |
$2,213.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,845.80
|
| Rate for Payer: Multiplan All |
$2,877.42
|
| Rate for Payer: OMNI Networks Commercial |
$2,213.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,845.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,003.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,371.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,940.66
|
| Rate for Payer: Zelis Auto |
$1,264.80
|
| Rate for Payer: Zelis Worker's Compensation |
$863.23
|
|
|
REVISION OF PELVIS
|
Facility
|
IP
|
$2,957.00
|
|
|
Service Code
|
CPT 27158
|
| Hospital Charge Code |
6127158
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$807.26 |
| Max. Negotiated Rate |
$2,809.15 |
| Rate for Payer: Cash Price |
$1,774.20
|
| Rate for Payer: Cigna Commercial |
$2,513.45
|
| Rate for Payer: First Health Commercial |
$2,661.30
|
| Rate for Payer: First Health Workers Compensation |
$1,141.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,661.30
|
| Rate for Payer: GEHA Commercial |
$2,069.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,661.30
|
| Rate for Payer: Multiplan All |
$2,690.87
|
| Rate for Payer: OMNI Networks Commercial |
$2,069.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,661.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,809.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,217.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,750.01
|
| Rate for Payer: Zelis Auto |
$1,182.80
|
| Rate for Payer: Zelis Worker's Compensation |
$807.26
|
|
|
REVISION OF PELVIS
|
Facility
|
OP
|
$2,957.00
|
|
|
Service Code
|
CPT 27158
|
| Hospital Charge Code |
6127158
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$739.25 |
| Max. Negotiated Rate |
$2,809.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,774.20
|
| Rate for Payer: Cash Price |
$1,774.20
|
| Rate for Payer: Cigna Commercial |
$2,513.45
|
| Rate for Payer: First Health Commercial |
$2,661.30
|
| Rate for Payer: First Health Workers Compensation |
$1,141.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,661.30
|
| Rate for Payer: GEHA Commercial |
$2,365.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,661.30
|
| Rate for Payer: Humana ChoiceCare |
$768.82
|
| Rate for Payer: Multiplan All |
$2,690.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,774.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,069.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,661.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,809.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,217.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,602.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$739.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,750.01
|
| Rate for Payer: Zelis Auto |
$1,182.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,478.50
|
| Rate for Payer: Zelis Worker's Compensation |
$807.26
|
|
|
REVISION OF PENIS
|
Facility
|
IP
|
$1,315.00
|
|
|
Service Code
|
CPT 54430
|
| Hospital Charge Code |
6154430
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$359.00 |
| Max. Negotiated Rate |
$1,249.25 |
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cigna Commercial |
$1,117.75
|
| Rate for Payer: First Health Commercial |
$1,183.50
|
| Rate for Payer: First Health Workers Compensation |
$507.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,183.50
|
| Rate for Payer: GEHA Commercial |
$920.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,183.50
|
| Rate for Payer: Multiplan All |
$1,196.65
|
| Rate for Payer: OMNI Networks Commercial |
$920.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,183.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,249.25
|
| Rate for Payer: Three Rivers Provider Network All |
$986.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,222.95
|
| Rate for Payer: Zelis Auto |
$526.00
|
| Rate for Payer: Zelis Worker's Compensation |
$359.00
|
|
|
REVISION OF PENIS
|
Facility
|
IP
|
$1,544.00
|
|
|
Service Code
|
CPT 54304
|
| Hospital Charge Code |
6154304
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$421.51 |
| Max. Negotiated Rate |
$1,466.80 |
| Rate for Payer: Cash Price |
$926.40
|
| Rate for Payer: Cigna Commercial |
$1,312.40
|
| Rate for Payer: First Health Commercial |
$1,389.60
|
| Rate for Payer: First Health Workers Compensation |
$596.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,389.60
|
| Rate for Payer: GEHA Commercial |
$1,080.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,389.60
|
| Rate for Payer: Multiplan All |
$1,405.04
|
| Rate for Payer: OMNI Networks Commercial |
$1,080.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,389.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,466.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,158.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,435.92
|
| Rate for Payer: Zelis Auto |
$617.60
|
| Rate for Payer: Zelis Worker's Compensation |
$421.51
|
|
|
REVISION OF PENIS
|
Facility
|
IP
|
$1,317.00
|
|
|
Service Code
|
CPT 54300
|
| Hospital Charge Code |
6154300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$359.54 |
| Max. Negotiated Rate |
$1,251.15 |
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Cigna Commercial |
$1,119.45
|
| Rate for Payer: First Health Commercial |
$1,185.30
|
| Rate for Payer: First Health Workers Compensation |
$508.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,185.30
|
| Rate for Payer: GEHA Commercial |
$921.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,185.30
|
| Rate for Payer: Multiplan All |
$1,198.47
|
| Rate for Payer: OMNI Networks Commercial |
$921.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,185.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,251.15
|
| Rate for Payer: Three Rivers Provider Network All |
$987.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,224.81
|
| Rate for Payer: Zelis Auto |
$526.80
|
| Rate for Payer: Zelis Worker's Compensation |
$359.54
|
|
|
REVISION OF PENIS
|
Facility
|
OP
|
$1,317.00
|
|
|
Service Code
|
CPT 54300
|
| Hospital Charge Code |
6154300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$359.54 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$790.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,794.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Cigna Commercial |
$1,119.45
|
| Rate for Payer: First Health Commercial |
$1,185.30
|
| Rate for Payer: First Health Workers Compensation |
$508.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,185.30
|
| Rate for Payer: GEHA Commercial |
$1,053.60
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,185.30
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,851.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$1,198.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$921.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,185.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,291.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,851.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,251.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$987.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,851.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,224.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$526.80
|
| 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 |
$359.54
|
|
|
REVISION OF PENIS
|
Facility
|
IP
|
$852.00
|
|
|
Service Code
|
CPT 54435
|
| Hospital Charge Code |
6154435
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$232.60 |
| Max. Negotiated Rate |
$809.40 |
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cigna Commercial |
$724.20
|
| Rate for Payer: First Health Commercial |
$766.80
|
| Rate for Payer: First Health Workers Compensation |
$328.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$766.80
|
| Rate for Payer: GEHA Commercial |
$596.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$766.80
|
| Rate for Payer: Multiplan All |
$775.32
|
| Rate for Payer: OMNI Networks Commercial |
$596.40
|
| Rate for Payer: One Health Plan PPO/POS |
$766.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$809.40
|
| Rate for Payer: Three Rivers Provider Network All |
$639.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$792.36
|
| Rate for Payer: Zelis Auto |
$340.80
|
| Rate for Payer: Zelis Worker's Compensation |
$232.60
|
|
|
REVISION OF PENIS
|
Facility
|
OP
|
$1,544.00
|
|
|
Service Code
|
CPT 54304
|
| Hospital Charge Code |
6154304
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$421.51 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$926.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,794.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$926.40
|
| Rate for Payer: Cash Price |
$926.40
|
| Rate for Payer: Cigna Commercial |
$1,312.40
|
| Rate for Payer: First Health Commercial |
$1,389.60
|
| Rate for Payer: First Health Workers Compensation |
$596.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,389.60
|
| Rate for Payer: GEHA Commercial |
$1,235.20
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,389.60
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,851.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$1,405.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,080.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,389.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,291.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,851.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,466.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,158.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,851.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,435.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$617.60
|
| 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 |
$421.51
|
|
|
REVISION OF PENIS
|
Facility
|
OP
|
$1,315.00
|
|
|
Service Code
|
CPT 54430
|
| Hospital Charge Code |
6154430
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$328.75 |
| Max. Negotiated Rate |
$1,249.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$789.00
|
| Rate for Payer: Cash Price |
$789.00
|
| Rate for Payer: Cigna Commercial |
$1,117.75
|
| Rate for Payer: First Health Commercial |
$1,183.50
|
| Rate for Payer: First Health Workers Compensation |
$507.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,183.50
|
| Rate for Payer: GEHA Commercial |
$1,052.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,183.50
|
| Rate for Payer: Humana ChoiceCare |
$341.90
|
| Rate for Payer: Multiplan All |
$1,196.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$789.00
|
| Rate for Payer: OMNI Networks Commercial |
$920.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,183.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,249.25
|
| Rate for Payer: Three Rivers Provider Network All |
$986.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,157.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$328.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,222.95
|
| Rate for Payer: Zelis Auto |
$526.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$657.50
|
| Rate for Payer: Zelis Worker's Compensation |
$359.00
|
|
|
REVISION OF PENIS
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
CPT 54420
|
| Hospital Charge Code |
6154420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$395.85 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$870.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,794.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$870.00
|
| Rate for Payer: Cash Price |
$870.00
|
| Rate for Payer: Cigna Commercial |
$1,232.50
|
| Rate for Payer: First Health Commercial |
$1,305.00
|
| Rate for Payer: First Health Workers Compensation |
$559.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,305.00
|
| Rate for Payer: GEHA Commercial |
$1,160.00
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,305.00
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,851.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$1,319.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,015.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,305.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,291.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,851.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,377.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,087.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,851.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,348.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$580.00
|
| 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 |
$395.85
|
|
