|
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
|
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 PHARYNGEAL WALLS
|
Facility
|
IP
|
$4,965.00
|
|
|
Service Code
|
CPT 42894
|
| Hospital Charge Code |
6142894
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,355.44 |
| Max. Negotiated Rate |
$4,716.75 |
| Rate for Payer: Cash Price |
$2,979.00
|
| Rate for Payer: Cigna Commercial |
$4,220.25
|
| Rate for Payer: First Health Commercial |
$4,468.50
|
| Rate for Payer: First Health Workers Compensation |
$1,916.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,468.50
|
| Rate for Payer: GEHA Commercial |
$3,475.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,468.50
|
| Rate for Payer: Multiplan All |
$4,518.15
|
| Rate for Payer: OMNI Networks Commercial |
$3,475.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,468.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,716.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,723.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,617.45
|
| Rate for Payer: Zelis Auto |
$1,986.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,355.44
|
|
|
REVISION OF PHARYNGEAL WALLS
|
Facility
|
OP
|
$3,946.00
|
|
|
Service Code
|
CPT 42892
|
| Hospital Charge Code |
6142892
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,077.26 |
| 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 |
$2,367.60
|
| 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 |
$2,367.60
|
| Rate for Payer: Cash Price |
$2,367.60
|
| Rate for Payer: Cigna Commercial |
$3,354.10
|
| Rate for Payer: First Health Commercial |
$3,551.40
|
| Rate for Payer: First Health Workers Compensation |
$1,523.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,551.40
|
| Rate for Payer: GEHA Commercial |
$3,156.80
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,551.40
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$3,590.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,762.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,551.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,748.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$2,959.50
|
| 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 |
$3,669.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$1,578.40
|
| 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 |
$1,077.26
|
|
|
REVISION OF PHARYNGEAL WALLS
|
Facility
|
OP
|
$4,965.00
|
|
|
Service Code
|
CPT 42894
|
| Hospital Charge Code |
6142894
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,241.25 |
| Max. Negotiated Rate |
$4,716.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,979.00
|
| Rate for Payer: Cash Price |
$2,979.00
|
| Rate for Payer: Cigna Commercial |
$4,220.25
|
| Rate for Payer: First Health Commercial |
$4,468.50
|
| Rate for Payer: First Health Workers Compensation |
$1,916.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,468.50
|
| Rate for Payer: GEHA Commercial |
$3,972.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,468.50
|
| Rate for Payer: Humana ChoiceCare |
$1,290.90
|
| Rate for Payer: Multiplan All |
$4,518.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,979.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,475.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,468.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,716.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,723.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,369.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,241.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,617.45
|
| Rate for Payer: Zelis Auto |
$1,986.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,482.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,355.44
|
|
|
REVISION OF PHARYNGEAL WALLS
|
Facility
|
IP
|
$3,946.00
|
|
|
Service Code
|
CPT 42892
|
| Hospital Charge Code |
6142892
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,077.26 |
| Max. Negotiated Rate |
$3,748.70 |
| Rate for Payer: Cash Price |
$2,367.60
|
| Rate for Payer: Cigna Commercial |
$3,354.10
|
| Rate for Payer: First Health Commercial |
$3,551.40
|
| Rate for Payer: First Health Workers Compensation |
$1,523.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,551.40
|
| Rate for Payer: GEHA Commercial |
$2,762.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,551.40
|
| Rate for Payer: Multiplan All |
$3,590.86
|
| Rate for Payer: OMNI Networks Commercial |
$2,762.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,551.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,748.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,959.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,669.78
|
| Rate for Payer: Zelis Auto |
$1,578.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,077.26
|
|
|
REVISION OF RADIUS
|
Facility
|
IP
|
$1,541.00
|
|
|
Service Code
|
CPT 25355
|
| Hospital Charge Code |
6125355
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$420.69 |
| Max. Negotiated Rate |
$1,463.95 |
| Rate for Payer: Cash Price |
$924.60
|
| Rate for Payer: Cigna Commercial |
$1,309.85
|
| Rate for Payer: First Health Commercial |
$1,386.90
|
| Rate for Payer: First Health Workers Compensation |
$594.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,386.90
|
| Rate for Payer: GEHA Commercial |
$1,078.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,386.90
|
| Rate for Payer: Multiplan All |
$1,402.31
|
| Rate for Payer: OMNI Networks Commercial |
$1,078.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,386.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,463.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,155.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,433.13
|
| Rate for Payer: Zelis Auto |
$616.40
|
| Rate for Payer: Zelis Worker's Compensation |
$420.69
|
|
|
REVISION OF RADIUS
|
Facility
|
IP
|
$1,372.00
|
|
|
Service Code
|
CPT 25350
|
| Hospital Charge Code |
6125350
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$374.56 |
| Max. Negotiated Rate |
$1,303.40 |
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cigna Commercial |
$1,166.20
|
| Rate for Payer: First Health Commercial |
$1,234.80
|
| Rate for Payer: First Health Workers Compensation |
$529.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,234.80
|
| Rate for Payer: GEHA Commercial |
$960.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,234.80
|
| Rate for Payer: Multiplan All |
$1,248.52
|
| Rate for Payer: OMNI Networks Commercial |
$960.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,234.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,303.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,029.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,275.96
|
| Rate for Payer: Zelis Auto |
$548.80
|
| Rate for Payer: Zelis Worker's Compensation |
$374.56
|
|
|
REVISION OF RADIUS
|
Facility
|
OP
|
$1,541.00
|
|
|
Service Code
|
CPT 25355
|
| Hospital Charge Code |
6125355
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$420.69 |
| Max. Negotiated Rate |
$6,161.78 |
| 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 |
$924.60
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$924.60
|
| Rate for Payer: Cash Price |
$924.60
|
| Rate for Payer: Cigna Commercial |
$1,309.85
|
| Rate for Payer: First Health Commercial |
$1,386.90
|
| Rate for Payer: First Health Workers Compensation |
$594.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,386.90
|
| Rate for Payer: GEHA Commercial |
$1,232.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,386.90
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,402.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,078.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,386.90
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,463.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,155.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,433.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$616.40
|
| 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 |
$420.69
|
|
|
REVISION OF RADIUS
|
Facility
|
OP
|
$1,372.00
|
|
|
Service Code
|
CPT 25350
|
| Hospital Charge Code |
6125350
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$374.56 |
| 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 |
$823.20
|
| 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 |
$823.20
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cigna Commercial |
$1,166.20
|
| Rate for Payer: First Health Commercial |
$1,234.80
|
| Rate for Payer: First Health Workers Compensation |
$529.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,234.80
|
| Rate for Payer: GEHA Commercial |
$1,097.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,234.80
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,248.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$960.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,234.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,303.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,029.00
|
| 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 |
$1,275.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$548.80
|
| 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 |
$374.56
|
|
|
REVISION OF SCIATIC NERVE
|
Facility
|
IP
|
$1,177.00
|
|
|
Service Code
|
CPT 64712
|
| Hospital Charge Code |
6164712
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$321.32 |
| Max. Negotiated Rate |
$1,118.15 |
| Rate for Payer: Cash Price |
$706.20
|
| Rate for Payer: Cigna Commercial |
$1,000.45
|
| Rate for Payer: First Health Commercial |
$1,059.30
|
| Rate for Payer: First Health Workers Compensation |
$454.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,059.30
|
| Rate for Payer: GEHA Commercial |
$823.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,059.30
|
| Rate for Payer: Multiplan All |
$1,071.07
|
| Rate for Payer: OMNI Networks Commercial |
$823.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,059.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,118.15
|
| Rate for Payer: Three Rivers Provider Network All |
$882.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,094.61
|
| Rate for Payer: Zelis Auto |
$470.80
|
| Rate for Payer: Zelis Worker's Compensation |
$321.32
|
|
|
REVISION OF SCIATIC NERVE
|
Facility
|
OP
|
$1,177.00
|
|
|
Service Code
|
CPT 64712
|
| Hospital Charge Code |
6164712
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$321.32 |
| 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 |
$706.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$706.20
|
| Rate for Payer: Cash Price |
$706.20
|
| Rate for Payer: Cigna Commercial |
$1,000.45
|
| Rate for Payer: First Health Commercial |
$1,059.30
|
| Rate for Payer: First Health Workers Compensation |
$454.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,059.30
|
| Rate for Payer: GEHA Commercial |
$941.60
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,059.30
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$1,071.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$823.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,059.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,118.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$882.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,094.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$470.80
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$321.32
|
|
|
REVISION OF SCROTUM
|
Facility
|
OP
|
$1,424.00
|
|
|
Service Code
|
CPT 55180
|
| Hospital Charge Code |
6155180
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$388.75 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$854.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cigna Commercial |
$1,210.40
|
| Rate for Payer: First Health Commercial |
$1,281.60
|
| Rate for Payer: First Health Workers Compensation |
$549.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,281.60
|
| Rate for Payer: GEHA Commercial |
$1,139.20
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,281.60
|
| 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 |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$1,295.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$996.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,281.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,352.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,068.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,324.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$569.60
|
| 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 |
$388.75
|
|
|
REVISION OF SCROTUM
|
Facility
|
IP
|
$1,424.00
|
|
|
Service Code
|
CPT 55180
|
| Hospital Charge Code |
6155180
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$388.75 |
| Max. Negotiated Rate |
$1,352.80 |
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cigna Commercial |
$1,210.40
|
| Rate for Payer: First Health Commercial |
$1,281.60
|
| Rate for Payer: First Health Workers Compensation |
$549.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,281.60
|
| Rate for Payer: GEHA Commercial |
$996.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,281.60
|
| Rate for Payer: Multiplan All |
$1,295.84
|
| Rate for Payer: OMNI Networks Commercial |
$996.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,281.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,352.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,068.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,324.32
|
| Rate for Payer: Zelis Auto |
$569.60
|
| Rate for Payer: Zelis Worker's Compensation |
$388.75
|
|
|
REVISION OF SCROTUM
|
Facility
|
OP
|
$928.00
|
|
|
Service Code
|
CPT 55175
|
| Hospital Charge Code |
6155175
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$253.34 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$556.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cigna Commercial |
$788.80
|
| Rate for Payer: First Health Commercial |
$835.20
|
| Rate for Payer: First Health Workers Compensation |
$358.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$835.20
|
| Rate for Payer: GEHA Commercial |
$742.40
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$835.20
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$844.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$649.60
|
| Rate for Payer: One Health Plan PPO/POS |
$835.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$881.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$696.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$863.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$371.20
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$253.34
|
|
|
REVISION OF SCROTUM
|
Facility
|
IP
|
$928.00
|
|
|
Service Code
|
CPT 55175
|
| Hospital Charge Code |
6155175
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$253.34 |
| Max. Negotiated Rate |
$881.60 |
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cigna Commercial |
$788.80
|
| Rate for Payer: First Health Commercial |
$835.20
|
| Rate for Payer: First Health Workers Compensation |
$358.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$835.20
|
| Rate for Payer: GEHA Commercial |
$649.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$835.20
|
| Rate for Payer: Multiplan All |
$844.48
|
| Rate for Payer: OMNI Networks Commercial |
$649.60
|
| Rate for Payer: One Health Plan PPO/POS |
$835.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$881.60
|
| Rate for Payer: Three Rivers Provider Network All |
$696.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$863.04
|
| Rate for Payer: Zelis Auto |
$371.20
|
| Rate for Payer: Zelis Worker's Compensation |
$253.34
|
|
|
REVISION OF TESTIS
|
Facility
|
IP
|
$914.00
|
|
|
Service Code
|
CPT 54660
|
| Hospital Charge Code |
6154660
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$249.52 |
| Max. Negotiated Rate |
$868.30 |
| Rate for Payer: Cash Price |
$548.40
|
| Rate for Payer: Cigna Commercial |
$776.90
|
| Rate for Payer: First Health Commercial |
$822.60
|
| Rate for Payer: First Health Workers Compensation |
$352.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$822.60
|
| Rate for Payer: GEHA Commercial |
$639.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$822.60
|
| Rate for Payer: Multiplan All |
$831.74
|
| Rate for Payer: OMNI Networks Commercial |
$639.80
|
| Rate for Payer: One Health Plan PPO/POS |
$822.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$868.30
|
| Rate for Payer: Three Rivers Provider Network All |
$685.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$850.02
|
| Rate for Payer: Zelis Auto |
$365.60
|
| Rate for Payer: Zelis Worker's Compensation |
$249.52
|
|
|
REVISION OF TESTIS
|
Facility
|
OP
|
$914.00
|
|
|
Service Code
|
CPT 54660
|
| Hospital Charge Code |
6154660
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$249.52 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$548.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$548.40
|
| Rate for Payer: Cash Price |
$548.40
|
| Rate for Payer: Cigna Commercial |
$776.90
|
| Rate for Payer: First Health Commercial |
$822.60
|
| Rate for Payer: First Health Workers Compensation |
$352.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$822.60
|
| Rate for Payer: GEHA Commercial |
$731.20
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$822.60
|
| 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 |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$831.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$639.80
|
| Rate for Payer: One Health Plan PPO/POS |
$822.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$868.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$685.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$850.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$365.60
|
| 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 |
$249.52
|
|
|
REVISION OF THIGH MUSCLES
|
Facility
|
IP
|
$1,514.00
|
|
|
Service Code
|
CPT 27430
|
| Hospital Charge Code |
6127430
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$413.32 |
| Max. Negotiated Rate |
$1,438.30 |
| Rate for Payer: Cash Price |
$908.40
|
| Rate for Payer: Cigna Commercial |
$1,286.90
|
| Rate for Payer: First Health Commercial |
$1,362.60
|
| Rate for Payer: First Health Workers Compensation |
$584.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,362.60
|
| Rate for Payer: GEHA Commercial |
$1,059.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,362.60
|
| Rate for Payer: Multiplan All |
$1,377.74
|
| Rate for Payer: OMNI Networks Commercial |
$1,059.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,362.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,438.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,135.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,408.02
|
| Rate for Payer: Zelis Auto |
$605.60
|
| Rate for Payer: Zelis Worker's Compensation |
$413.32
|
|
|
REVISION OF THIGH MUSCLES
|
Facility
|
OP
|
$1,514.00
|
|
|
Service Code
|
CPT 27430
|
| Hospital Charge Code |
6127430
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$413.32 |
| 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 |
$908.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$908.40
|
| Rate for Payer: Cash Price |
$908.40
|
| Rate for Payer: Cigna Commercial |
$1,286.90
|
| Rate for Payer: First Health Commercial |
$1,362.60
|
| Rate for Payer: First Health Workers Compensation |
$584.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,362.60
|
| Rate for Payer: GEHA Commercial |
$1,211.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,362.60
|
| 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 |
$1,377.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,059.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,362.60
|
| 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 |
$1,438.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,135.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,408.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$605.60
|
| 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 |
$413.32
|
|
|
REVISION OF TOE
|
Facility
|
IP
|
$813.00
|
|
|
Service Code
|
CPT 28312
|
| Hospital Charge Code |
6128312
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$221.95 |
| Max. Negotiated Rate |
$772.35 |
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Cigna Commercial |
$691.05
|
| Rate for Payer: First Health Commercial |
$731.70
|
| Rate for Payer: First Health Workers Compensation |
$313.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$731.70
|
| Rate for Payer: GEHA Commercial |
$569.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$731.70
|
| Rate for Payer: Multiplan All |
$739.83
|
| Rate for Payer: OMNI Networks Commercial |
$569.10
|
| Rate for Payer: One Health Plan PPO/POS |
$731.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$772.35
|
| Rate for Payer: Three Rivers Provider Network All |
$609.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$756.09
|
| Rate for Payer: Zelis Auto |
$325.20
|
| Rate for Payer: Zelis Worker's Compensation |
$221.95
|
|
|
REVISION OF TOE
|
Facility
|
OP
|
$813.00
|
|
|
Service Code
|
CPT 28312
|
| Hospital Charge Code |
6128312
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$221.95 |
| Max. Negotiated Rate |
$6,161.78 |
| 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 |
$487.80
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Cash Price |
$487.80
|
| Rate for Payer: Cigna Commercial |
$691.05
|
| Rate for Payer: First Health Commercial |
$731.70
|
| Rate for Payer: First Health Workers Compensation |
$313.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$731.70
|
| Rate for Payer: GEHA Commercial |
$650.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$731.70
|
| 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 |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$739.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$569.10
|
| Rate for Payer: One Health Plan PPO/POS |
$731.70
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$772.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$609.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$756.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$325.20
|
| 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 |
$221.95
|
|
|
REVISION OF TOTAL HIP ARTHROPLASTY; BOTH COMPONENTS, WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT
|
Facility
|
OP
|
$5,785.82
|
|
|
Service Code
|
CPT 27134
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,090.99 |
| Max. Negotiated Rate |
$5,785.82 |
| Rate for Payer: First Health Workers Compensation |
$5,785.82
|
| Rate for Payer: Zelis Worker's Compensation |
$4,090.99
|
|
|
REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; FEMORAL AND ENTIRE TIBIAL COMPONENT
|
Facility
|
OP
|
$5,323.82
|
|
|
Service Code
|
CPT 27487
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,764.32 |
| Max. Negotiated Rate |
$5,323.82 |
| Rate for Payer: First Health Workers Compensation |
$5,323.82
|
| Rate for Payer: Zelis Worker's Compensation |
$3,764.32
|
|
|
REVISION OF ULNA
|
Facility
|
OP
|
$1,332.00
|
|
|
Service Code
|
CPT 25360
|
| Hospital Charge Code |
6125360
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$363.64 |
| 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 |
$799.20
|
| 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 |
$799.20
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cigna Commercial |
$1,132.20
|
| Rate for Payer: First Health Commercial |
$1,198.80
|
| Rate for Payer: First Health Workers Compensation |
$514.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,198.80
|
| Rate for Payer: GEHA Commercial |
$1,065.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,198.80
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,212.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$932.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,198.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,265.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$999.00
|
| 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 |
$1,238.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$532.80
|
| 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 |
$363.64
|
|
