|
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
|
|
|
REVISION OF UNSTABLE KNEECAP
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
CPT 27420
|
| Hospital Charge Code |
6127420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$416.32 |
| 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 |
$915.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cigna Commercial |
$1,296.25
|
| Rate for Payer: First Health Commercial |
$1,372.50
|
| Rate for Payer: First Health Workers Compensation |
$588.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,372.50
|
| Rate for Payer: GEHA Commercial |
$1,220.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,372.50
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,387.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,067.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,372.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,448.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,143.75
|
| 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 |
$1,418.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$610.00
|
| 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 |
$416.32
|
|
|
REVISION OF UNSTABLE KNEECAP
|
Facility
|
IP
|
$1,519.00
|
|
|
Service Code
|
CPT 27422
|
| Hospital Charge Code |
6127422
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$414.69 |
| Max. Negotiated Rate |
$1,443.05 |
| Rate for Payer: Cash Price |
$911.40
|
| Rate for Payer: Cigna Commercial |
$1,291.15
|
| Rate for Payer: First Health Commercial |
$1,367.10
|
| Rate for Payer: First Health Workers Compensation |
$586.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,367.10
|
| Rate for Payer: GEHA Commercial |
$1,063.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,367.10
|
| Rate for Payer: Multiplan All |
$1,382.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,063.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,367.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,443.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,139.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,412.67
|
| Rate for Payer: Zelis Auto |
$607.60
|
| Rate for Payer: Zelis Worker's Compensation |
$414.69
|
|
|
REVISION OF UNSTABLE KNEECAP
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
CPT 27420
|
| Hospital Charge Code |
6127420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$416.32 |
| Max. Negotiated Rate |
$1,448.75 |
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cigna Commercial |
$1,296.25
|
| Rate for Payer: First Health Commercial |
$1,372.50
|
| Rate for Payer: First Health Workers Compensation |
$588.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,372.50
|
| Rate for Payer: GEHA Commercial |
$1,067.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,372.50
|
| Rate for Payer: Multiplan All |
$1,387.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,067.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,372.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,448.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,143.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,418.25
|
| Rate for Payer: Zelis Auto |
$610.00
|
| Rate for Payer: Zelis Worker's Compensation |
$416.32
|
|
|
REVISION OF UNSTABLE KNEECAP
|
Facility
|
OP
|
$1,519.00
|
|
|
Service Code
|
CPT 27422
|
| Hospital Charge Code |
6127422
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$414.69 |
| 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 |
$911.40
|
| 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 |
$911.40
|
| Rate for Payer: Cash Price |
$911.40
|
| Rate for Payer: Cigna Commercial |
$1,291.15
|
| Rate for Payer: First Health Commercial |
$1,367.10
|
| Rate for Payer: First Health Workers Compensation |
$586.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,367.10
|
| Rate for Payer: GEHA Commercial |
$1,215.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,367.10
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,382.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,063.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,367.10
|
| 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 |
$1,443.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,139.25
|
| 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 |
$1,412.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$607.60
|
| 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 |
$414.69
|
|
|
REVISION OF URETER
|
Facility
|
OP
|
$1,922.00
|
|
|
Service Code
|
CPT 50700
|
| Hospital Charge Code |
6150700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$480.50 |
| Max. Negotiated Rate |
$1,825.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,153.20
|
| Rate for Payer: Cash Price |
$1,153.20
|
| Rate for Payer: Cigna Commercial |
$1,633.70
|
| Rate for Payer: First Health Commercial |
$1,729.80
|
| Rate for Payer: First Health Workers Compensation |
$742.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,729.80
|
| Rate for Payer: GEHA Commercial |
$1,537.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,729.80
|
| Rate for Payer: Humana ChoiceCare |
$499.72
|
| Rate for Payer: Multiplan All |
$1,749.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,153.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,345.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,729.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,825.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,441.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,691.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$480.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,787.46
|
| Rate for Payer: Zelis Auto |
$768.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$961.00
|
| Rate for Payer: Zelis Worker's Compensation |
$524.71
|
|
|
REVISION OF URETER
|
Facility
|
IP
|
$1,922.00
|
|
|
Service Code
|
CPT 50700
|
| Hospital Charge Code |
6150700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$524.71 |
| Max. Negotiated Rate |
$1,825.90 |
| Rate for Payer: Cash Price |
$1,153.20
|
| Rate for Payer: Cigna Commercial |
$1,633.70
|
| Rate for Payer: First Health Commercial |
$1,729.80
|
| Rate for Payer: First Health Workers Compensation |
$742.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,729.80
|
| Rate for Payer: GEHA Commercial |
$1,345.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,729.80
|
| Rate for Payer: Multiplan All |
$1,749.02
|
| Rate for Payer: OMNI Networks Commercial |
$1,345.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,729.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,825.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,441.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,787.46
|
| Rate for Payer: Zelis Auto |
$768.80
|
| Rate for Payer: Zelis Worker's Compensation |
$524.71
|
|
|
REVISION OF URETHRA
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
CPT 53450
|
| Hospital Charge Code |
6153450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$228.77 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$502.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,172.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,513.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cigna Commercial |
$712.30
|
| Rate for Payer: First Health Commercial |
$754.20
|
| Rate for Payer: First Health Workers Compensation |
$323.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$754.20
|
| Rate for Payer: GEHA Commercial |
$670.40
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$754.20
|
| 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 |
$2,564.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$762.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$586.60
|
| Rate for Payer: One Health Plan PPO/POS |
$754.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,961.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,564.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$796.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$628.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,564.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$779.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$335.20
|
| 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 |
$228.77
|
|
|
REVISION OF URETHRA
|
Facility
|
OP
|
$804.00
|
|
|
Service Code
|
CPT 57220
|
| Hospital Charge Code |
6157220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$219.49 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,548.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$482.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,548.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,603.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cigna Commercial |
$683.40
|
| Rate for Payer: First Health Commercial |
$723.60
|
| Rate for Payer: First Health Workers Compensation |
$310.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$723.60
|
| Rate for Payer: GEHA Commercial |
$643.20
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$723.60
|
| Rate for Payer: Humana ChoiceCare |
$5,156.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,687.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,874.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,676.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: Multiplan All |
$731.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: OMNI Networks Commercial |
$562.80
|
| Rate for Payer: One Health Plan PPO/POS |
$723.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,245.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,676.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$763.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: Three Rivers Provider Network All |
$603.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,676.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$747.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Auto |
$321.60
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| Rate for Payer: Zelis Worker's Compensation |
$219.49
|
|
|
REVISION OF URETHRA
|
Facility
|
OP
|
$939.00
|
|
|
Service Code
|
CPT 53460
|
| Hospital Charge Code |
6153460
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$256.35 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$563.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,056.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,628.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cigna Commercial |
$798.15
|
| Rate for Payer: First Health Commercial |
$845.10
|
| Rate for Payer: First Health Workers Compensation |
$362.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$845.10
|
| Rate for Payer: GEHA Commercial |
$751.20
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$845.10
|
| 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 |
$1,662.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$854.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$657.30
|
| Rate for Payer: One Health Plan PPO/POS |
$845.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,919.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,662.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$892.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$704.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,662.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$873.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$375.60
|
| 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 |
$256.35
|
|
|
REVISION OF URETHRA
|
Facility
|
IP
|
$804.00
|
|
|
Service Code
|
CPT 57220
|
| Hospital Charge Code |
6157220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$219.49 |
| Max. Negotiated Rate |
$763.80 |
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cigna Commercial |
$683.40
|
| Rate for Payer: First Health Commercial |
$723.60
|
| Rate for Payer: First Health Workers Compensation |
$310.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$723.60
|
| Rate for Payer: GEHA Commercial |
$562.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$723.60
|
| Rate for Payer: Multiplan All |
$731.64
|
| Rate for Payer: OMNI Networks Commercial |
$562.80
|
| Rate for Payer: One Health Plan PPO/POS |
$723.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$763.80
|
| Rate for Payer: Three Rivers Provider Network All |
$603.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$747.72
|
| Rate for Payer: Zelis Auto |
$321.60
|
| Rate for Payer: Zelis Worker's Compensation |
$219.49
|
|
|
REVISION OF URETHRA
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
CPT 53450
|
| Hospital Charge Code |
6153450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$228.77 |
| Max. Negotiated Rate |
$796.10 |
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cigna Commercial |
$712.30
|
| Rate for Payer: First Health Commercial |
$754.20
|
| Rate for Payer: First Health Workers Compensation |
$323.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$754.20
|
| Rate for Payer: GEHA Commercial |
$586.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$754.20
|
| Rate for Payer: Multiplan All |
$762.58
|
| Rate for Payer: OMNI Networks Commercial |
$586.60
|
| Rate for Payer: One Health Plan PPO/POS |
$754.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$796.10
|
| Rate for Payer: Three Rivers Provider Network All |
$628.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$779.34
|
| Rate for Payer: Zelis Auto |
$335.20
|
| Rate for Payer: Zelis Worker's Compensation |
$228.77
|
|
|
REVISION OF URETHRA
|
Facility
|
IP
|
$939.00
|
|
|
Service Code
|
CPT 53460
|
| Hospital Charge Code |
6153460
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$256.35 |
| Max. Negotiated Rate |
$892.05 |
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cigna Commercial |
$798.15
|
| Rate for Payer: First Health Commercial |
$845.10
|
| Rate for Payer: First Health Workers Compensation |
$362.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$845.10
|
| Rate for Payer: GEHA Commercial |
$657.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$845.10
|
| Rate for Payer: Multiplan All |
$854.49
|
| Rate for Payer: OMNI Networks Commercial |
$657.30
|
| Rate for Payer: One Health Plan PPO/POS |
$845.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$892.05
|
| Rate for Payer: Three Rivers Provider Network All |
$704.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$873.27
|
| Rate for Payer: Zelis Auto |
$375.60
|
| Rate for Payer: Zelis Worker's Compensation |
$256.35
|
|
|
REVISION OF URINARY TRACT
|
Facility
|
OP
|
$2,301.00
|
|
|
Service Code
|
CPT 51820
|
| Hospital Charge Code |
6151820
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$575.25 |
| Max. Negotiated Rate |
$2,185.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,380.60
|
| Rate for Payer: Cash Price |
$1,380.60
|
| Rate for Payer: Cigna Commercial |
$1,955.85
|
| Rate for Payer: First Health Commercial |
$2,070.90
|
| Rate for Payer: First Health Workers Compensation |
$888.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,070.90
|
| Rate for Payer: GEHA Commercial |
$1,840.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,070.90
|
| Rate for Payer: Humana ChoiceCare |
$598.26
|
| Rate for Payer: Multiplan All |
$2,093.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,380.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,610.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,070.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,185.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,725.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,024.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$575.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,139.93
|
| Rate for Payer: Zelis Auto |
$920.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,150.50
|
| Rate for Payer: Zelis Worker's Compensation |
$628.17
|
|
|
REVISION OF URINARY TRACT
|
Facility
|
IP
|
$2,301.00
|
|
|
Service Code
|
CPT 51820
|
| Hospital Charge Code |
6151820
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$628.17 |
| Max. Negotiated Rate |
$2,185.95 |
| Rate for Payer: Cash Price |
$1,380.60
|
| Rate for Payer: Cigna Commercial |
$1,955.85
|
| Rate for Payer: First Health Commercial |
$2,070.90
|
| Rate for Payer: First Health Workers Compensation |
$888.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,070.90
|
| Rate for Payer: GEHA Commercial |
$1,610.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,070.90
|
| Rate for Payer: Multiplan All |
$2,093.91
|
| Rate for Payer: OMNI Networks Commercial |
$1,610.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,070.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,185.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,725.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,139.93
|
| Rate for Payer: Zelis Auto |
$920.40
|
| Rate for Payer: Zelis Worker's Compensation |
$628.17
|
|
|
REVISION OF WRIST JOINT
|
Facility
|
IP
|
$1,257.00
|
|
|
Service Code
|
CPT 25455
|
| Hospital Charge Code |
6125455
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$343.16 |
| Max. Negotiated Rate |
$1,194.15 |
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Cigna Commercial |
$1,068.45
|
| Rate for Payer: First Health Commercial |
$1,131.30
|
| Rate for Payer: First Health Workers Compensation |
$485.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,131.30
|
| Rate for Payer: GEHA Commercial |
$879.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,131.30
|
| Rate for Payer: Multiplan All |
$1,143.87
|
| Rate for Payer: OMNI Networks Commercial |
$879.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,131.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,194.15
|
| Rate for Payer: Three Rivers Provider Network All |
$942.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,169.01
|
| Rate for Payer: Zelis Auto |
$502.80
|
| Rate for Payer: Zelis Worker's Compensation |
$343.16
|
|
|
REVISION OF WRIST JOINT
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
CPT 25450
|
| Hospital Charge Code |
6125450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$289.38 |
| 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 |
$636.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Cigna Commercial |
$901.00
|
| Rate for Payer: First Health Commercial |
$954.00
|
| Rate for Payer: First Health Workers Compensation |
$409.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$954.00
|
| Rate for Payer: GEHA Commercial |
$848.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$954.00
|
| 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 |
$964.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$742.00
|
| Rate for Payer: One Health Plan PPO/POS |
$954.00
|
| 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 |
$1,007.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$795.00
|
| 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 |
$985.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$424.00
|
| 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 |
$289.38
|
|
|
REVISION OF WRIST JOINT
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
CPT 25450
|
| Hospital Charge Code |
6125450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$289.38 |
| Max. Negotiated Rate |
$1,007.00 |
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Cigna Commercial |
$901.00
|
| Rate for Payer: First Health Commercial |
$954.00
|
| Rate for Payer: First Health Workers Compensation |
$409.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$954.00
|
| Rate for Payer: GEHA Commercial |
$742.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$954.00
|
| Rate for Payer: Multiplan All |
$964.60
|
| Rate for Payer: OMNI Networks Commercial |
$742.00
|
| Rate for Payer: One Health Plan PPO/POS |
$954.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,007.00
|
| Rate for Payer: Three Rivers Provider Network All |
$795.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$985.80
|
| Rate for Payer: Zelis Auto |
$424.00
|
| Rate for Payer: Zelis Worker's Compensation |
$289.38
|
|
|
REVISION OF WRIST JOINT
|
Facility
|
OP
|
$1,257.00
|
|
|
Service Code
|
CPT 25455
|
| Hospital Charge Code |
6125455
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$343.16 |
| 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 |
$754.20
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Cigna Commercial |
$1,068.45
|
| Rate for Payer: First Health Commercial |
$1,131.30
|
| Rate for Payer: First Health Workers Compensation |
$485.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,131.30
|
| Rate for Payer: GEHA Commercial |
$1,005.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,131.30
|
| 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 |
$1,143.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$879.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,131.30
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,194.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$942.75
|
| 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 |
$1,169.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$502.80
|
| 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 |
$343.16
|
|
|
REVISION/REMOVAL OF KNEECAP
|
Facility
|
IP
|
$1,535.00
|
|
|
Service Code
|
CPT 27424
|
| Hospital Charge Code |
6127424
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$419.06 |
| Max. Negotiated Rate |
$1,458.25 |
| Rate for Payer: Cash Price |
$921.00
|
| Rate for Payer: Cigna Commercial |
$1,304.75
|
| Rate for Payer: First Health Commercial |
$1,381.50
|
| Rate for Payer: First Health Workers Compensation |
$592.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,381.50
|
| Rate for Payer: GEHA Commercial |
$1,074.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,381.50
|
| Rate for Payer: Multiplan All |
$1,396.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,074.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,381.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,458.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,151.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,427.55
|
| Rate for Payer: Zelis Auto |
$614.00
|
| Rate for Payer: Zelis Worker's Compensation |
$419.06
|
|
|
REVISION/REMOVAL OF KNEECAP
|
Facility
|
OP
|
$1,535.00
|
|
|
Service Code
|
CPT 27424
|
| Hospital Charge Code |
6127424
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$419.06 |
| 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 |
$921.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$921.00
|
| Rate for Payer: Cash Price |
$921.00
|
| Rate for Payer: Cigna Commercial |
$1,304.75
|
| Rate for Payer: First Health Commercial |
$1,381.50
|
| Rate for Payer: First Health Workers Compensation |
$592.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,381.50
|
| Rate for Payer: GEHA Commercial |
$1,228.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,381.50
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,396.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,074.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,381.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,458.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,151.25
|
| 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 |
$1,427.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$614.00
|
| 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 |
$419.06
|
|
|
REVIS RECONST SHOULDER JOINT
|
Facility
|
OP
|
$3,367.00
|
|
|
Service Code
|
CPT 23473
|
| Hospital Charge Code |
6123473
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$919.19 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$13,613.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,020.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$13,613.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$10,784.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: Cash Price |
$2,020.20
|
| Rate for Payer: Cash Price |
$2,020.20
|
| Rate for Payer: Cigna Commercial |
$2,861.95
|
| Rate for Payer: First Health Commercial |
$3,030.30
|
| Rate for Payer: First Health Workers Compensation |
$1,300.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,030.30
|
| Rate for Payer: GEHA Commercial |
$2,693.60
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,030.30
|
| 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 |
$11,004.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$3,063.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$2,356.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,030.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$12,706.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11,004.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,198.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$2,525.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11,004.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,131.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$1,346.80
|
| 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 |
$919.19
|
|
|
REVIS RECONST SHOULDER JOINT
|
Facility
|
OP
|
$5,530.00
|
|
|
Service Code
|
CPT 23474
|
| Hospital Charge Code |
6123474
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,382.50 |
| Max. Negotiated Rate |
$5,253.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,318.00
|
| Rate for Payer: Cash Price |
$3,318.00
|
| Rate for Payer: Cigna Commercial |
$4,700.50
|
| Rate for Payer: First Health Commercial |
$4,977.00
|
| Rate for Payer: First Health Workers Compensation |
$2,135.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,977.00
|
| Rate for Payer: GEHA Commercial |
$4,424.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,977.00
|
| Rate for Payer: Humana ChoiceCare |
$1,437.80
|
| Rate for Payer: Multiplan All |
$5,032.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,318.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,871.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,977.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,253.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,147.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,866.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,382.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,142.90
|
| Rate for Payer: Zelis Auto |
$2,212.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,765.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,509.69
|
|
|
REVIS RECONST SHOULDER JOINT
|
Facility
|
IP
|
$5,530.00
|
|
|
Service Code
|
CPT 23474
|
| Hospital Charge Code |
6123474
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,509.69 |
| Max. Negotiated Rate |
$5,253.50 |
| Rate for Payer: Cash Price |
$3,318.00
|
| Rate for Payer: Cigna Commercial |
$4,700.50
|
| Rate for Payer: First Health Commercial |
$4,977.00
|
| Rate for Payer: First Health Workers Compensation |
$2,135.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,977.00
|
| Rate for Payer: GEHA Commercial |
$3,871.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,977.00
|
| Rate for Payer: Multiplan All |
$5,032.30
|
| Rate for Payer: OMNI Networks Commercial |
$3,871.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,977.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,253.50
|
| Rate for Payer: Three Rivers Provider Network All |
$4,147.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,142.90
|
| Rate for Payer: Zelis Auto |
$2,212.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,509.69
|
|
|
REVIS RECONST SHOULDER JOINT
|
Facility
|
IP
|
$3,367.00
|
|
|
Service Code
|
CPT 23473
|
| Hospital Charge Code |
6123473
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$919.19 |
| Max. Negotiated Rate |
$3,198.65 |
| Rate for Payer: Cash Price |
$2,020.20
|
| Rate for Payer: Cigna Commercial |
$2,861.95
|
| Rate for Payer: First Health Commercial |
$3,030.30
|
| Rate for Payer: First Health Workers Compensation |
$1,300.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,030.30
|
| Rate for Payer: GEHA Commercial |
$2,356.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,030.30
|
| Rate for Payer: Multiplan All |
$3,063.97
|
| Rate for Payer: OMNI Networks Commercial |
$2,356.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,030.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,198.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,525.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,131.31
|
| Rate for Payer: Zelis Auto |
$1,346.80
|
| Rate for Payer: Zelis Worker's Compensation |
$919.19
|
|
