|
CONS SED E/AD 15 MIN
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
CPT 99153
|
| Hospital Charge Code |
8199145
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$18.05 |
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$16.15
|
| Rate for Payer: First Health Commercial |
$17.10
|
| Rate for Payer: First Health Workers Compensation |
$7.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$17.10
|
| Rate for Payer: GEHA Commercial |
$13.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$17.10
|
| Rate for Payer: Multiplan All |
$17.29
|
| Rate for Payer: OMNI Networks Commercial |
$13.30
|
| Rate for Payer: One Health Plan PPO/POS |
$17.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$18.05
|
| Rate for Payer: Three Rivers Provider Network All |
$14.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17.67
|
| Rate for Payer: Zelis Auto |
$7.60
|
| Rate for Payer: Zelis Worker's Compensation |
$5.19
|
|
|
CONS SED E/AD 15 MIN
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
CPT 99153
|
| Hospital Charge Code |
8199145
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$18.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$16.15
|
| Rate for Payer: First Health Commercial |
$17.10
|
| Rate for Payer: First Health Workers Compensation |
$7.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$17.10
|
| Rate for Payer: GEHA Commercial |
$15.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$17.10
|
| Rate for Payer: Humana ChoiceCare |
$4.94
|
| Rate for Payer: Multiplan All |
$17.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.40
|
| Rate for Payer: OMNI Networks Commercial |
$13.30
|
| Rate for Payer: One Health Plan PPO/POS |
$17.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$18.05
|
| Rate for Payer: Three Rivers Provider Network All |
$14.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$17.67
|
| Rate for Payer: Zelis Auto |
$7.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.50
|
| Rate for Payer: Zelis Worker's Compensation |
$5.19
|
|
|
CONSTRUCT BLADDER OPENING
|
Facility
|
OP
|
$1,467.00
|
|
|
Service Code
|
CPT 51980
|
| Hospital Charge Code |
6151980
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$366.75 |
| Max. Negotiated Rate |
$1,393.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$880.20
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cigna Commercial |
$1,246.95
|
| Rate for Payer: First Health Commercial |
$1,320.30
|
| Rate for Payer: First Health Workers Compensation |
$566.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,320.30
|
| Rate for Payer: GEHA Commercial |
$1,173.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,320.30
|
| Rate for Payer: Humana ChoiceCare |
$381.42
|
| Rate for Payer: Multiplan All |
$1,334.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$880.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,026.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,320.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,393.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,100.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,290.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$366.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,364.31
|
| Rate for Payer: Zelis Auto |
$586.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$733.50
|
| Rate for Payer: Zelis Worker's Compensation |
$400.49
|
|
|
CONSTRUCT BLADDER OPENING
|
Facility
|
IP
|
$1,467.00
|
|
|
Service Code
|
CPT 51980
|
| Hospital Charge Code |
6151980
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$400.49 |
| Max. Negotiated Rate |
$1,393.65 |
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cigna Commercial |
$1,246.95
|
| Rate for Payer: First Health Commercial |
$1,320.30
|
| Rate for Payer: First Health Workers Compensation |
$566.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,320.30
|
| Rate for Payer: GEHA Commercial |
$1,026.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,320.30
|
| Rate for Payer: Multiplan All |
$1,334.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,026.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,320.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,393.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,100.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,364.31
|
| Rate for Payer: Zelis Auto |
$586.80
|
| Rate for Payer: Zelis Worker's Compensation |
$400.49
|
|
|
CONSTRUCT BOWEL BLADDER
|
Facility
|
IP
|
$2,719.00
|
|
|
Service Code
|
CPT 50820
|
| Hospital Charge Code |
6150820
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$742.29 |
| Max. Negotiated Rate |
$2,583.05 |
| Rate for Payer: Cash Price |
$1,631.40
|
| Rate for Payer: Cigna Commercial |
$2,311.15
|
| Rate for Payer: First Health Commercial |
$2,447.10
|
| Rate for Payer: First Health Workers Compensation |
$1,049.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,447.10
|
| Rate for Payer: GEHA Commercial |
$1,903.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,447.10
|
| Rate for Payer: Multiplan All |
$2,474.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,903.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,447.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,583.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,039.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,528.67
|
| Rate for Payer: Zelis Auto |
$1,087.60
|
| Rate for Payer: Zelis Worker's Compensation |
$742.29
|
|
|
CONSTRUCT BOWEL BLADDER
|
Facility
|
OP
|
$3,429.00
|
|
|
Service Code
|
CPT 50825
|
| Hospital Charge Code |
6150825
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$857.25 |
| Max. Negotiated Rate |
$3,257.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,057.40
|
| Rate for Payer: Cash Price |
$2,057.40
|
| Rate for Payer: Cigna Commercial |
$2,914.65
|
| Rate for Payer: First Health Commercial |
$3,086.10
|
| Rate for Payer: First Health Workers Compensation |
$1,323.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,086.10
|
| Rate for Payer: GEHA Commercial |
$2,743.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,086.10
|
| Rate for Payer: Humana ChoiceCare |
$891.54
|
| Rate for Payer: Multiplan All |
$3,120.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,057.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,400.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,086.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,257.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,571.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$857.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,188.97
|
| Rate for Payer: Zelis Auto |
$1,371.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,714.50
|
| Rate for Payer: Zelis Worker's Compensation |
$936.12
|
|
|
CONSTRUCT BOWEL BLADDER
|
Facility
|
OP
|
$2,719.00
|
|
|
Service Code
|
CPT 50820
|
| Hospital Charge Code |
6150820
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$679.75 |
| Max. Negotiated Rate |
$2,583.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,631.40
|
| Rate for Payer: Cash Price |
$1,631.40
|
| Rate for Payer: Cigna Commercial |
$2,311.15
|
| Rate for Payer: First Health Commercial |
$2,447.10
|
| Rate for Payer: First Health Workers Compensation |
$1,049.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,447.10
|
| Rate for Payer: GEHA Commercial |
$2,175.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,447.10
|
| Rate for Payer: Humana ChoiceCare |
$706.94
|
| Rate for Payer: Multiplan All |
$2,474.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,631.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,903.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,447.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,583.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,039.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,392.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$679.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,528.67
|
| Rate for Payer: Zelis Auto |
$1,087.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,359.50
|
| Rate for Payer: Zelis Worker's Compensation |
$742.29
|
|
|
CONSTRUCT BOWEL BLADDER
|
Facility
|
IP
|
$3,429.00
|
|
|
Service Code
|
CPT 50825
|
| Hospital Charge Code |
6150825
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$936.12 |
| Max. Negotiated Rate |
$3,257.55 |
| Rate for Payer: Cash Price |
$2,057.40
|
| Rate for Payer: Cigna Commercial |
$2,914.65
|
| Rate for Payer: First Health Commercial |
$3,086.10
|
| Rate for Payer: First Health Workers Compensation |
$1,323.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,086.10
|
| Rate for Payer: GEHA Commercial |
$2,400.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,086.10
|
| Rate for Payer: Multiplan All |
$3,120.39
|
| Rate for Payer: OMNI Networks Commercial |
$2,400.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,086.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,257.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,571.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,188.97
|
| Rate for Payer: Zelis Auto |
$1,371.60
|
| Rate for Payer: Zelis Worker's Compensation |
$936.12
|
|
|
CONSTRUCTION OF ABSENT ANUS
|
Facility
|
IP
|
$4,372.00
|
|
|
Service Code
|
CPT 46735
|
| Hospital Charge Code |
6146735
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,193.56 |
| Max. Negotiated Rate |
$4,153.40 |
| Rate for Payer: Cash Price |
$2,623.20
|
| Rate for Payer: Cigna Commercial |
$3,716.20
|
| Rate for Payer: First Health Commercial |
$3,934.80
|
| Rate for Payer: First Health Workers Compensation |
$1,688.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,934.80
|
| Rate for Payer: GEHA Commercial |
$3,060.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,934.80
|
| Rate for Payer: Multiplan All |
$3,978.52
|
| Rate for Payer: OMNI Networks Commercial |
$3,060.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,934.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,153.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,279.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,065.96
|
| Rate for Payer: Zelis Auto |
$1,748.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,193.56
|
|
|
CONSTRUCTION OF ABSENT ANUS
|
Facility
|
OP
|
$3,770.00
|
|
|
Service Code
|
CPT 46730
|
| Hospital Charge Code |
6146730
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$942.50 |
| Max. Negotiated Rate |
$3,581.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,262.00
|
| Rate for Payer: Cash Price |
$2,262.00
|
| Rate for Payer: Cigna Commercial |
$3,204.50
|
| Rate for Payer: First Health Commercial |
$3,393.00
|
| Rate for Payer: First Health Workers Compensation |
$1,455.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,393.00
|
| Rate for Payer: GEHA Commercial |
$3,016.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,393.00
|
| Rate for Payer: Humana ChoiceCare |
$980.20
|
| Rate for Payer: Multiplan All |
$3,430.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,262.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,639.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,393.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,581.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,827.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,317.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$942.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,506.10
|
| Rate for Payer: Zelis Auto |
$1,508.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,885.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,029.21
|
|
|
CONSTRUCTION OF ABSENT ANUS
|
Facility
|
OP
|
$4,372.00
|
|
|
Service Code
|
CPT 46735
|
| Hospital Charge Code |
6146735
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,093.00 |
| Max. Negotiated Rate |
$4,153.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,623.20
|
| Rate for Payer: Cash Price |
$2,623.20
|
| Rate for Payer: Cigna Commercial |
$3,716.20
|
| Rate for Payer: First Health Commercial |
$3,934.80
|
| Rate for Payer: First Health Workers Compensation |
$1,688.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,934.80
|
| Rate for Payer: GEHA Commercial |
$3,497.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,934.80
|
| Rate for Payer: Humana ChoiceCare |
$1,136.72
|
| Rate for Payer: Multiplan All |
$3,978.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,623.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,060.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,934.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,153.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,279.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,847.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,093.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,065.96
|
| Rate for Payer: Zelis Auto |
$1,748.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,186.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,193.56
|
|
|
CONSTRUCTION OF ABSENT ANUS
|
Facility
|
IP
|
$3,770.00
|
|
|
Service Code
|
CPT 46730
|
| Hospital Charge Code |
6146730
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,029.21 |
| Max. Negotiated Rate |
$3,581.50 |
| Rate for Payer: Cash Price |
$2,262.00
|
| Rate for Payer: Cigna Commercial |
$3,204.50
|
| Rate for Payer: First Health Commercial |
$3,393.00
|
| Rate for Payer: First Health Workers Compensation |
$1,455.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,393.00
|
| Rate for Payer: GEHA Commercial |
$2,639.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,393.00
|
| Rate for Payer: Multiplan All |
$3,430.70
|
| Rate for Payer: OMNI Networks Commercial |
$2,639.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,393.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,581.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,827.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,506.10
|
| Rate for Payer: Zelis Auto |
$1,508.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,029.21
|
|
|
CONSTRUCTION OF ABSENT ANUS
|
Facility
|
IP
|
$4,501.00
|
|
|
Service Code
|
CPT 46740
|
| Hospital Charge Code |
6146740
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,228.77 |
| Max. Negotiated Rate |
$4,275.95 |
| Rate for Payer: Cash Price |
$2,700.60
|
| Rate for Payer: Cigna Commercial |
$3,825.85
|
| Rate for Payer: First Health Commercial |
$4,050.90
|
| Rate for Payer: First Health Workers Compensation |
$1,737.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,050.90
|
| Rate for Payer: GEHA Commercial |
$3,150.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,050.90
|
| Rate for Payer: Multiplan All |
$4,095.91
|
| Rate for Payer: OMNI Networks Commercial |
$3,150.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,050.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,275.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,375.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,185.93
|
| Rate for Payer: Zelis Auto |
$1,800.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,228.77
|
|
|
CONSTRUCTION OF ABSENT ANUS
|
Facility
|
OP
|
$4,501.00
|
|
|
Service Code
|
CPT 46740
|
| Hospital Charge Code |
6146740
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,125.25 |
| Max. Negotiated Rate |
$4,275.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,700.60
|
| Rate for Payer: Cash Price |
$2,700.60
|
| Rate for Payer: Cigna Commercial |
$3,825.85
|
| Rate for Payer: First Health Commercial |
$4,050.90
|
| Rate for Payer: First Health Workers Compensation |
$1,737.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,050.90
|
| Rate for Payer: GEHA Commercial |
$3,600.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,050.90
|
| Rate for Payer: Humana ChoiceCare |
$1,170.26
|
| Rate for Payer: Multiplan All |
$4,095.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,700.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,150.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,050.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,275.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,375.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,960.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,125.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,185.93
|
| Rate for Payer: Zelis Auto |
$1,800.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,250.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,228.77
|
|
|
CONSTRUCTION OF VAGINA
|
Facility
|
OP
|
$1,240.00
|
|
|
Service Code
|
CPT 57291
|
| Hospital Charge Code |
6157291
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$338.52 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$744.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cigna Commercial |
$1,054.00
|
| Rate for Payer: First Health Commercial |
$1,116.00
|
| Rate for Payer: First Health Workers Compensation |
$478.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,116.00
|
| Rate for Payer: GEHA Commercial |
$992.00
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,116.00
|
| 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 |
$2,882.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: Multiplan All |
$1,128.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: OMNI Networks Commercial |
$868.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,116.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,328.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,882.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,178.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: Three Rivers Provider Network All |
$930.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,153.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Auto |
$496.00
|
| 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 |
$338.52
|
|
|
CONSTRUCTION OF VAGINA
|
Facility
|
IP
|
$1,240.00
|
|
|
Service Code
|
CPT 57291
|
| Hospital Charge Code |
6157291
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$338.52 |
| Max. Negotiated Rate |
$1,178.00 |
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cigna Commercial |
$1,054.00
|
| Rate for Payer: First Health Commercial |
$1,116.00
|
| Rate for Payer: First Health Workers Compensation |
$478.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,116.00
|
| Rate for Payer: GEHA Commercial |
$868.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,116.00
|
| Rate for Payer: Multiplan All |
$1,128.40
|
| Rate for Payer: OMNI Networks Commercial |
$868.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,116.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,178.00
|
| Rate for Payer: Three Rivers Provider Network All |
$930.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,153.20
|
| Rate for Payer: Zelis Auto |
$496.00
|
| Rate for Payer: Zelis Worker's Compensation |
$338.52
|
|
|
CONSTRUCT THUMB REPLACEMENT
|
Facility
|
OP
|
$3,123.00
|
|
|
Service Code
|
CPT 26550
|
| Hospital Charge Code |
6126550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$852.58 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,873.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,873.80
|
| Rate for Payer: Cash Price |
$1,873.80
|
| Rate for Payer: Cigna Commercial |
$2,654.55
|
| Rate for Payer: First Health Commercial |
$2,810.70
|
| Rate for Payer: First Health Workers Compensation |
$1,205.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,810.70
|
| Rate for Payer: GEHA Commercial |
$2,498.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,810.70
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$2,841.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$2,186.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,810.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,966.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$2,342.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,904.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$1,249.20
|
| 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 |
$852.58
|
|
|
CONSTRUCT THUMB REPLACEMENT
|
Facility
|
IP
|
$3,123.00
|
|
|
Service Code
|
CPT 26550
|
| Hospital Charge Code |
6126550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$852.58 |
| Max. Negotiated Rate |
$2,966.85 |
| Rate for Payer: Cash Price |
$1,873.80
|
| Rate for Payer: Cigna Commercial |
$2,654.55
|
| Rate for Payer: First Health Commercial |
$2,810.70
|
| Rate for Payer: First Health Workers Compensation |
$1,205.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,810.70
|
| Rate for Payer: GEHA Commercial |
$2,186.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,810.70
|
| Rate for Payer: Multiplan All |
$2,841.93
|
| Rate for Payer: OMNI Networks Commercial |
$2,186.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,810.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,966.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,342.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,904.39
|
| Rate for Payer: Zelis Auto |
$1,249.20
|
| Rate for Payer: Zelis Worker's Compensation |
$852.58
|
|
|
CONSTRUCT VAGINA WITH GRAFT
|
Facility
|
OP
|
$1,673.00
|
|
|
Service Code
|
CPT 57292
|
| Hospital Charge Code |
6157292
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$456.73 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,003.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: Cash Price |
$1,003.80
|
| Rate for Payer: Cash Price |
$1,003.80
|
| Rate for Payer: Cigna Commercial |
$1,422.05
|
| Rate for Payer: First Health Commercial |
$1,505.70
|
| Rate for Payer: First Health Workers Compensation |
$645.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,505.70
|
| Rate for Payer: GEHA Commercial |
$1,338.40
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,505.70
|
| 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 |
$2,882.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: Multiplan All |
$1,522.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,171.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,505.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,328.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,882.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,589.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: Three Rivers Provider Network All |
$1,254.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,555.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Auto |
$669.20
|
| 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 |
$456.73
|
|
|
CONSTRUCT VAGINA WITH GRAFT
|
Facility
|
IP
|
$1,673.00
|
|
|
Service Code
|
CPT 57292
|
| Hospital Charge Code |
6157292
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$456.73 |
| Max. Negotiated Rate |
$1,589.35 |
| Rate for Payer: Cash Price |
$1,003.80
|
| Rate for Payer: Cigna Commercial |
$1,422.05
|
| Rate for Payer: First Health Commercial |
$1,505.70
|
| Rate for Payer: First Health Workers Compensation |
$645.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,505.70
|
| Rate for Payer: GEHA Commercial |
$1,171.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,505.70
|
| Rate for Payer: Multiplan All |
$1,522.43
|
| Rate for Payer: OMNI Networks Commercial |
$1,171.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,505.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,589.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,254.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,555.89
|
| Rate for Payer: Zelis Auto |
$669.20
|
| Rate for Payer: Zelis Worker's Compensation |
$456.73
|
|
|
CONT AIRWAY PRESSURE DEVICE
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT E0601
|
| Hospital Charge Code |
3000013
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.25 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$102.85
|
| Rate for Payer: First Health Commercial |
$108.90
|
| Rate for Payer: First Health Workers Compensation |
$46.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.90
|
| Rate for Payer: GEHA Commercial |
$96.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.90
|
| Rate for Payer: Humana ChoiceCare |
$31.46
|
| Rate for Payer: Multiplan All |
$110.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$72.60
|
| Rate for Payer: OMNI Networks Commercial |
$84.70
|
| Rate for Payer: One Health Plan PPO/POS |
$108.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.95
|
| Rate for Payer: Three Rivers Provider Network All |
$90.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$106.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$112.53
|
| Rate for Payer: Zelis Auto |
$48.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$60.50
|
| Rate for Payer: Zelis Worker's Compensation |
$33.03
|
|
|
CONT AIRWAY PRESSURE DEVICE
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT E0601
|
| Hospital Charge Code |
3000012
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.03 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$102.85
|
| Rate for Payer: First Health Commercial |
$108.90
|
| Rate for Payer: First Health Workers Compensation |
$46.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.90
|
| Rate for Payer: GEHA Commercial |
$84.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.90
|
| Rate for Payer: Multiplan All |
$110.11
|
| Rate for Payer: OMNI Networks Commercial |
$84.70
|
| Rate for Payer: One Health Plan PPO/POS |
$108.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.95
|
| Rate for Payer: Three Rivers Provider Network All |
$90.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$112.53
|
| Rate for Payer: Zelis Auto |
$48.40
|
| Rate for Payer: Zelis Worker's Compensation |
$33.03
|
|
|
CONT AIRWAY PRESSURE DEVICE
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT E0601
|
| Hospital Charge Code |
3000013
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.03 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$102.85
|
| Rate for Payer: First Health Commercial |
$108.90
|
| Rate for Payer: First Health Workers Compensation |
$46.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.90
|
| Rate for Payer: GEHA Commercial |
$84.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.90
|
| Rate for Payer: Multiplan All |
$110.11
|
| Rate for Payer: OMNI Networks Commercial |
$84.70
|
| Rate for Payer: One Health Plan PPO/POS |
$108.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.95
|
| Rate for Payer: Three Rivers Provider Network All |
$90.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$112.53
|
| Rate for Payer: Zelis Auto |
$48.40
|
| Rate for Payer: Zelis Worker's Compensation |
$33.03
|
|
|
CONT AIRWAY PRESSURE DEVICE
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT E0601
|
| Hospital Charge Code |
3000012
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.25 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$102.85
|
| Rate for Payer: First Health Commercial |
$108.90
|
| Rate for Payer: First Health Workers Compensation |
$46.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.90
|
| Rate for Payer: GEHA Commercial |
$96.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.90
|
| Rate for Payer: Humana ChoiceCare |
$31.46
|
| Rate for Payer: Multiplan All |
$110.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$72.60
|
| Rate for Payer: OMNI Networks Commercial |
$84.70
|
| Rate for Payer: One Health Plan PPO/POS |
$108.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.95
|
| Rate for Payer: Three Rivers Provider Network All |
$90.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$106.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$112.53
|
| Rate for Payer: Zelis Auto |
$48.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$60.50
|
| Rate for Payer: Zelis Worker's Compensation |
$33.03
|
|
|
CONT GLUC MNTR PHYS/QHP PROVIDED EQUIP
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 95250
|
| Hospital Charge Code |
8595250
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.37
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$365.50
|
| Rate for Payer: First Health Commercial |
$387.00
|
| Rate for Payer: First Health Workers Compensation |
$166.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.00
|
| Rate for Payer: GEHA Commercial |
$344.00
|
| Rate for Payer: GEHA Medicare |
$122.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.00
|
| Rate for Payer: Humana ChoiceCare |
$134.61
|
| Rate for Payer: Humana Medicare Advantage |
$122.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.37
|
| Rate for Payer: Multiplan All |
$391.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.03
|
| Rate for Payer: OMNI Networks Commercial |
$301.00
|
| Rate for Payer: One Health Plan PPO/POS |
$387.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$408.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.74
|
| Rate for Payer: Three Rivers Provider Network All |
$322.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$399.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.37
|
| Rate for Payer: Zelis Auto |
$172.00
|
| Rate for Payer: Zelis Medicare |
$104.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.84
|
| Rate for Payer: Zelis Worker's Compensation |
$117.39
|
|
