|
EXTENSIVE MASTOID SURGERY
|
Facility
|
IP
|
$3,369.00
|
|
|
Service Code
|
CPT 69530
|
| Hospital Charge Code |
6169530
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$919.74 |
| Max. Negotiated Rate |
$3,200.55 |
| Rate for Payer: Cash Price |
$2,021.40
|
| Rate for Payer: Cigna Commercial |
$2,863.65
|
| Rate for Payer: First Health Commercial |
$3,032.10
|
| Rate for Payer: First Health Workers Compensation |
$1,300.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,032.10
|
| Rate for Payer: GEHA Commercial |
$2,358.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,032.10
|
| Rate for Payer: Multiplan All |
$3,065.79
|
| Rate for Payer: OMNI Networks Commercial |
$2,358.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,032.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,200.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,526.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,133.17
|
| Rate for Payer: Zelis Auto |
$1,347.60
|
| Rate for Payer: Zelis Worker's Compensation |
$919.74
|
|
|
EXTENSIVE MASTOID SURGERY
|
Facility
|
OP
|
$3,369.00
|
|
|
Service Code
|
CPT 69530
|
| Hospital Charge Code |
6169530
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$919.74 |
| 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 |
$2,021.40
|
| 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 |
$2,021.40
|
| Rate for Payer: Cash Price |
$2,021.40
|
| Rate for Payer: Cigna Commercial |
$2,863.65
|
| Rate for Payer: First Health Commercial |
$3,032.10
|
| Rate for Payer: First Health Workers Compensation |
$1,300.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,032.10
|
| Rate for Payer: GEHA Commercial |
$2,695.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,032.10
|
| 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 |
$3,065.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,358.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,032.10
|
| 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 |
$3,200.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$2,526.75
|
| 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 |
$3,133.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$1,347.60
|
| 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 |
$919.74
|
|
|
EXTENSIVE MASTOID SURGERY
|
Facility
|
IP
|
$2,487.00
|
|
|
Service Code
|
CPT 69511
|
| Hospital Charge Code |
6169511
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$678.95 |
| Max. Negotiated Rate |
$2,362.65 |
| Rate for Payer: Cash Price |
$1,492.20
|
| Rate for Payer: Cigna Commercial |
$2,113.95
|
| Rate for Payer: First Health Commercial |
$2,238.30
|
| Rate for Payer: First Health Workers Compensation |
$960.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,238.30
|
| Rate for Payer: GEHA Commercial |
$1,740.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,238.30
|
| Rate for Payer: Multiplan All |
$2,263.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,740.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,238.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,362.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,865.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,312.91
|
| Rate for Payer: Zelis Auto |
$994.80
|
| Rate for Payer: Zelis Worker's Compensation |
$678.95
|
|
|
EXTENSIVE MASTOID SURGERY
|
Facility
|
OP
|
$2,487.00
|
|
|
Service Code
|
CPT 69511
|
| Hospital Charge Code |
6169511
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$678.95 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,492.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,492.20
|
| Rate for Payer: Cash Price |
$1,492.20
|
| Rate for Payer: Cigna Commercial |
$2,113.95
|
| Rate for Payer: First Health Commercial |
$2,238.30
|
| Rate for Payer: First Health Workers Compensation |
$960.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,238.30
|
| Rate for Payer: GEHA Commercial |
$1,989.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,238.30
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$2,263.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,740.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,238.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,362.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,865.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,312.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$994.80
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$678.95
|
|
|
EXTENSIVE PROSTATE SURGERY
|
Facility
|
IP
|
$2,820.00
|
|
|
Service Code
|
CPT 55845
|
| Hospital Charge Code |
6155845
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$769.86 |
| Max. Negotiated Rate |
$2,679.00 |
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cigna Commercial |
$2,397.00
|
| Rate for Payer: First Health Commercial |
$2,538.00
|
| Rate for Payer: First Health Workers Compensation |
$1,088.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,538.00
|
| Rate for Payer: GEHA Commercial |
$1,974.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,538.00
|
| Rate for Payer: Multiplan All |
$2,566.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,974.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,538.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,679.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,115.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,622.60
|
| Rate for Payer: Zelis Auto |
$1,128.00
|
| Rate for Payer: Zelis Worker's Compensation |
$769.86
|
|
|
EXTENSIVE PROSTATE SURGERY
|
Facility
|
IP
|
$2,379.00
|
|
|
Service Code
|
CPT 55862
|
| Hospital Charge Code |
6155862
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$649.47 |
| Max. Negotiated Rate |
$2,260.05 |
| Rate for Payer: Cash Price |
$1,427.40
|
| Rate for Payer: Cigna Commercial |
$2,022.15
|
| Rate for Payer: First Health Commercial |
$2,141.10
|
| Rate for Payer: First Health Workers Compensation |
$918.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,141.10
|
| Rate for Payer: GEHA Commercial |
$1,665.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,141.10
|
| Rate for Payer: Multiplan All |
$2,164.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,665.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,141.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,260.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,784.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,212.47
|
| Rate for Payer: Zelis Auto |
$951.60
|
| Rate for Payer: Zelis Worker's Compensation |
$649.47
|
|
|
EXTENSIVE PROSTATE SURGERY
|
Facility
|
OP
|
$3,326.00
|
|
|
Service Code
|
CPT 55812
|
| Hospital Charge Code |
6155812
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$831.50 |
| Max. Negotiated Rate |
$3,159.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,995.60
|
| Rate for Payer: Cash Price |
$1,995.60
|
| Rate for Payer: Cigna Commercial |
$2,827.10
|
| Rate for Payer: First Health Commercial |
$2,993.40
|
| Rate for Payer: First Health Workers Compensation |
$1,284.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,993.40
|
| Rate for Payer: GEHA Commercial |
$2,660.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,993.40
|
| Rate for Payer: Humana ChoiceCare |
$864.76
|
| Rate for Payer: Multiplan All |
$3,026.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,995.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,328.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,993.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,159.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,494.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,926.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$831.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,093.18
|
| Rate for Payer: Zelis Auto |
$1,330.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,663.00
|
| Rate for Payer: Zelis Worker's Compensation |
$908.00
|
|
|
EXTENSIVE PROSTATE SURGERY
|
Facility
|
OP
|
$2,420.00
|
|
|
Service Code
|
CPT 55840
|
| Hospital Charge Code |
6155840
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$605.00 |
| Max. Negotiated Rate |
$2,299.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,452.00
|
| Rate for Payer: Cash Price |
$1,452.00
|
| Rate for Payer: Cigna Commercial |
$2,057.00
|
| Rate for Payer: First Health Commercial |
$2,178.00
|
| Rate for Payer: First Health Workers Compensation |
$934.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,178.00
|
| Rate for Payer: GEHA Commercial |
$1,936.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,178.00
|
| Rate for Payer: Humana ChoiceCare |
$629.20
|
| Rate for Payer: Multiplan All |
$2,202.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,452.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,694.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,178.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,299.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,815.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,129.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$605.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,250.60
|
| Rate for Payer: Zelis Auto |
$968.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,210.00
|
| Rate for Payer: Zelis Worker's Compensation |
$660.66
|
|
|
EXTENSIVE PROSTATE SURGERY
|
Facility
|
IP
|
$3,664.00
|
|
|
Service Code
|
CPT 55815
|
| Hospital Charge Code |
6155815
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,000.27 |
| Max. Negotiated Rate |
$3,480.80 |
| Rate for Payer: Cash Price |
$2,198.40
|
| Rate for Payer: Cigna Commercial |
$3,114.40
|
| Rate for Payer: First Health Commercial |
$3,297.60
|
| Rate for Payer: First Health Workers Compensation |
$1,414.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,297.60
|
| Rate for Payer: GEHA Commercial |
$2,564.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,297.60
|
| Rate for Payer: Multiplan All |
$3,334.24
|
| Rate for Payer: OMNI Networks Commercial |
$2,564.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,297.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,480.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,748.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,407.52
|
| Rate for Payer: Zelis Auto |
$1,465.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,000.27
|
|
|
EXTENSIVE PROSTATE SURGERY
|
Facility
|
OP
|
$2,729.00
|
|
|
Service Code
|
CPT 55810
|
| Hospital Charge Code |
6155810
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$682.25 |
| Max. Negotiated Rate |
$2,592.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,637.40
|
| Rate for Payer: Cash Price |
$1,637.40
|
| Rate for Payer: Cigna Commercial |
$2,319.65
|
| Rate for Payer: First Health Commercial |
$2,456.10
|
| Rate for Payer: First Health Workers Compensation |
$1,053.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,456.10
|
| Rate for Payer: GEHA Commercial |
$2,183.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,456.10
|
| Rate for Payer: Humana ChoiceCare |
$709.54
|
| Rate for Payer: Multiplan All |
$2,483.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,637.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,910.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,456.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,592.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,046.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,401.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$682.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,537.97
|
| Rate for Payer: Zelis Auto |
$1,091.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,364.50
|
| Rate for Payer: Zelis Worker's Compensation |
$745.02
|
|
|
EXTENSIVE PROSTATE SURGERY
|
Facility
|
IP
|
$2,418.00
|
|
|
Service Code
|
CPT 55842
|
| Hospital Charge Code |
6155842
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$660.11 |
| Max. Negotiated Rate |
$2,297.10 |
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cigna Commercial |
$2,055.30
|
| Rate for Payer: First Health Commercial |
$2,176.20
|
| Rate for Payer: First Health Workers Compensation |
$933.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,176.20
|
| Rate for Payer: GEHA Commercial |
$1,692.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,176.20
|
| Rate for Payer: Multiplan All |
$2,200.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,692.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,176.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,297.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,813.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,248.74
|
| Rate for Payer: Zelis Auto |
$967.20
|
| Rate for Payer: Zelis Worker's Compensation |
$660.11
|
|
|
EXTENSIVE PROSTATE SURGERY
|
Facility
|
IP
|
$2,756.00
|
|
|
Service Code
|
CPT 55865
|
| Hospital Charge Code |
6155865
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$752.39 |
| Max. Negotiated Rate |
$2,618.20 |
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cigna Commercial |
$2,342.60
|
| Rate for Payer: First Health Commercial |
$2,480.40
|
| Rate for Payer: First Health Workers Compensation |
$1,064.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,480.40
|
| Rate for Payer: GEHA Commercial |
$1,929.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,480.40
|
| Rate for Payer: Multiplan All |
$2,507.96
|
| Rate for Payer: OMNI Networks Commercial |
$1,929.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,480.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,618.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,067.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,563.08
|
| Rate for Payer: Zelis Auto |
$1,102.40
|
| Rate for Payer: Zelis Worker's Compensation |
$752.39
|
|
|
EXTENSIVE PROSTATE SURGERY
|
Facility
|
OP
|
$2,379.00
|
|
|
Service Code
|
CPT 55862
|
| Hospital Charge Code |
6155862
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$594.75 |
| Max. Negotiated Rate |
$2,260.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,427.40
|
| Rate for Payer: Cash Price |
$1,427.40
|
| Rate for Payer: Cigna Commercial |
$2,022.15
|
| Rate for Payer: First Health Commercial |
$2,141.10
|
| Rate for Payer: First Health Workers Compensation |
$918.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,141.10
|
| Rate for Payer: GEHA Commercial |
$1,903.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,141.10
|
| Rate for Payer: Humana ChoiceCare |
$618.54
|
| Rate for Payer: Multiplan All |
$2,164.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,427.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,665.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,141.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,260.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,784.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,093.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$594.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,212.47
|
| Rate for Payer: Zelis Auto |
$951.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,189.50
|
| Rate for Payer: Zelis Worker's Compensation |
$649.47
|
|
|
EXTENSIVE PROSTATE SURGERY
|
Facility
|
OP
|
$3,664.00
|
|
|
Service Code
|
CPT 55815
|
| Hospital Charge Code |
6155815
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$916.00 |
| Max. Negotiated Rate |
$3,480.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,198.40
|
| Rate for Payer: Cash Price |
$2,198.40
|
| Rate for Payer: Cigna Commercial |
$3,114.40
|
| Rate for Payer: First Health Commercial |
$3,297.60
|
| Rate for Payer: First Health Workers Compensation |
$1,414.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,297.60
|
| Rate for Payer: GEHA Commercial |
$2,931.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,297.60
|
| Rate for Payer: Humana ChoiceCare |
$952.64
|
| Rate for Payer: Multiplan All |
$3,334.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,198.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,564.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,297.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,480.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,748.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,224.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$916.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,407.52
|
| Rate for Payer: Zelis Auto |
$1,465.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,832.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,000.27
|
|
|
EXTENSIVE PROSTATE SURGERY
|
Facility
|
IP
|
$3,326.00
|
|
|
Service Code
|
CPT 55812
|
| Hospital Charge Code |
6155812
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$908.00 |
| Max. Negotiated Rate |
$3,159.70 |
| Rate for Payer: Cash Price |
$1,995.60
|
| Rate for Payer: Cigna Commercial |
$2,827.10
|
| Rate for Payer: First Health Commercial |
$2,993.40
|
| Rate for Payer: First Health Workers Compensation |
$1,284.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,993.40
|
| Rate for Payer: GEHA Commercial |
$2,328.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,993.40
|
| Rate for Payer: Multiplan All |
$3,026.66
|
| Rate for Payer: OMNI Networks Commercial |
$2,328.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,993.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,159.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,494.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,093.18
|
| Rate for Payer: Zelis Auto |
$1,330.40
|
| Rate for Payer: Zelis Worker's Compensation |
$908.00
|
|
|
EXTENSIVE PROSTATE SURGERY
|
Facility
|
IP
|
$2,729.00
|
|
|
Service Code
|
CPT 55810
|
| Hospital Charge Code |
6155810
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$745.02 |
| Max. Negotiated Rate |
$2,592.55 |
| Rate for Payer: Cash Price |
$1,637.40
|
| Rate for Payer: Cigna Commercial |
$2,319.65
|
| Rate for Payer: First Health Commercial |
$2,456.10
|
| Rate for Payer: First Health Workers Compensation |
$1,053.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,456.10
|
| Rate for Payer: GEHA Commercial |
$1,910.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,456.10
|
| Rate for Payer: Multiplan All |
$2,483.39
|
| Rate for Payer: OMNI Networks Commercial |
$1,910.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,456.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,592.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,046.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,537.97
|
| Rate for Payer: Zelis Auto |
$1,091.60
|
| Rate for Payer: Zelis Worker's Compensation |
$745.02
|
|
|
EXTENSIVE PROSTATE SURGERY
|
Facility
|
OP
|
$2,418.00
|
|
|
Service Code
|
CPT 55842
|
| Hospital Charge Code |
6155842
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$2,297.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,450.80
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cigna Commercial |
$2,055.30
|
| Rate for Payer: First Health Commercial |
$2,176.20
|
| Rate for Payer: First Health Workers Compensation |
$933.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,176.20
|
| Rate for Payer: GEHA Commercial |
$1,934.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,176.20
|
| Rate for Payer: Humana ChoiceCare |
$628.68
|
| Rate for Payer: Multiplan All |
$2,200.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,450.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,692.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,176.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,297.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,813.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,127.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$604.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,248.74
|
| Rate for Payer: Zelis Auto |
$967.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,209.00
|
| Rate for Payer: Zelis Worker's Compensation |
$660.11
|
|
|
EXTENSIVE PROSTATE SURGERY
|
Facility
|
OP
|
$2,820.00
|
|
|
Service Code
|
CPT 55845
|
| Hospital Charge Code |
6155845
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$2,679.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,692.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cigna Commercial |
$2,397.00
|
| Rate for Payer: First Health Commercial |
$2,538.00
|
| Rate for Payer: First Health Workers Compensation |
$1,088.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,538.00
|
| Rate for Payer: GEHA Commercial |
$2,256.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,538.00
|
| Rate for Payer: Humana ChoiceCare |
$733.20
|
| Rate for Payer: Multiplan All |
$2,566.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,692.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,974.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,538.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,679.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,115.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,481.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$705.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,622.60
|
| Rate for Payer: Zelis Auto |
$1,128.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,410.00
|
| Rate for Payer: Zelis Worker's Compensation |
$769.86
|
|
|
EXTENSIVE PROSTATE SURGERY
|
Facility
|
IP
|
$2,420.00
|
|
|
Service Code
|
CPT 55840
|
| Hospital Charge Code |
6155840
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$660.66 |
| Max. Negotiated Rate |
$2,299.00 |
| Rate for Payer: Cash Price |
$1,452.00
|
| Rate for Payer: Cigna Commercial |
$2,057.00
|
| Rate for Payer: First Health Commercial |
$2,178.00
|
| Rate for Payer: First Health Workers Compensation |
$934.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,178.00
|
| Rate for Payer: GEHA Commercial |
$1,694.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,178.00
|
| Rate for Payer: Multiplan All |
$2,202.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,694.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,178.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,299.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,815.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,250.60
|
| Rate for Payer: Zelis Auto |
$968.00
|
| Rate for Payer: Zelis Worker's Compensation |
$660.66
|
|
|
EXTENSIVE PROSTATE SURGERY
|
Facility
|
OP
|
$2,756.00
|
|
|
Service Code
|
CPT 55865
|
| Hospital Charge Code |
6155865
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$689.00 |
| Max. Negotiated Rate |
$2,618.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cigna Commercial |
$2,342.60
|
| Rate for Payer: First Health Commercial |
$2,480.40
|
| Rate for Payer: First Health Workers Compensation |
$1,064.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,480.40
|
| Rate for Payer: GEHA Commercial |
$2,204.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,480.40
|
| Rate for Payer: Humana ChoiceCare |
$716.56
|
| Rate for Payer: Multiplan All |
$2,507.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,653.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,929.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,480.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,618.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,067.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,425.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$689.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,563.08
|
| Rate for Payer: Zelis Auto |
$1,102.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,378.00
|
| Rate for Payer: Zelis Worker's Compensation |
$752.39
|
|
|
EXTENSIVE REPAIR OF VAGINA
|
Facility
|
IP
|
$2,581.71
|
|
|
Service Code
|
CPT 57265
|
| Hospital Charge Code |
6157265
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$704.81 |
| Max. Negotiated Rate |
$2,452.62 |
| Rate for Payer: Cash Price |
$1,549.03
|
| Rate for Payer: Cigna Commercial |
$2,194.45
|
| Rate for Payer: First Health Commercial |
$2,323.54
|
| Rate for Payer: First Health Workers Compensation |
$996.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,323.54
|
| Rate for Payer: GEHA Commercial |
$1,807.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,323.54
|
| Rate for Payer: Multiplan All |
$2,349.36
|
| Rate for Payer: OMNI Networks Commercial |
$1,807.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,323.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,452.62
|
| Rate for Payer: Three Rivers Provider Network All |
$1,936.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,400.99
|
| Rate for Payer: Zelis Auto |
$1,032.68
|
| Rate for Payer: Zelis Worker's Compensation |
$704.81
|
|
|
EXTENSIVE REPAIR OF VAGINA
|
Facility
|
OP
|
$2,581.71
|
|
|
Service Code
|
CPT 57265
|
| Hospital Charge Code |
6157265
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$704.81 |
| 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 |
$1,549.03
|
| 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 |
$1,549.03
|
| Rate for Payer: Cash Price |
$1,549.03
|
| Rate for Payer: Cigna Commercial |
$2,194.45
|
| Rate for Payer: First Health Commercial |
$2,323.54
|
| Rate for Payer: First Health Workers Compensation |
$996.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,323.54
|
| Rate for Payer: GEHA Commercial |
$2,065.37
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,323.54
|
| 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 |
$2,349.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,807.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,323.54
|
| 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 |
$2,452.62
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: Three Rivers Provider Network All |
$1,936.28
|
| 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 |
$2,400.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Auto |
$1,032.68
|
| 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 |
$704.81
|
|
|
EXTENSIVE SURGERY OF THROAT
|
Facility
|
IP
|
$2,098.00
|
|
|
Service Code
|
CPT 42842
|
| Hospital Charge Code |
6142842
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$572.75 |
| Max. Negotiated Rate |
$1,993.10 |
| Rate for Payer: Cash Price |
$1,258.80
|
| Rate for Payer: Cigna Commercial |
$1,783.30
|
| Rate for Payer: First Health Commercial |
$1,888.20
|
| Rate for Payer: First Health Workers Compensation |
$810.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,888.20
|
| Rate for Payer: GEHA Commercial |
$1,468.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,888.20
|
| Rate for Payer: Multiplan All |
$1,909.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,468.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,888.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,993.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,573.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,951.14
|
| Rate for Payer: Zelis Auto |
$839.20
|
| Rate for Payer: Zelis Worker's Compensation |
$572.75
|
|
|
EXTENSIVE SURGERY OF THROAT
|
Facility
|
OP
|
$2,884.00
|
|
|
Service Code
|
CPT 42844
|
| Hospital Charge Code |
6142844
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$787.33 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,730.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,730.40
|
| Rate for Payer: Cash Price |
$1,730.40
|
| Rate for Payer: Cigna Commercial |
$2,451.40
|
| Rate for Payer: First Health Commercial |
$2,595.60
|
| Rate for Payer: First Health Workers Compensation |
$1,113.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,595.60
|
| Rate for Payer: GEHA Commercial |
$2,307.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,595.60
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$2,624.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,018.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,595.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,739.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$2,163.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,682.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$1,153.60
|
| 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 |
$787.33
|
|
|
EXTENSIVE SURGERY OF THROAT
|
Facility
|
IP
|
$2,884.00
|
|
|
Service Code
|
CPT 42844
|
| Hospital Charge Code |
6142844
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$787.33 |
| Max. Negotiated Rate |
$2,739.80 |
| Rate for Payer: Cash Price |
$1,730.40
|
| Rate for Payer: Cigna Commercial |
$2,451.40
|
| Rate for Payer: First Health Commercial |
$2,595.60
|
| Rate for Payer: First Health Workers Compensation |
$1,113.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,595.60
|
| Rate for Payer: GEHA Commercial |
$2,018.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,595.60
|
| Rate for Payer: Multiplan All |
$2,624.44
|
| Rate for Payer: OMNI Networks Commercial |
$2,018.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,595.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,739.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,163.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,682.12
|
| Rate for Payer: Zelis Auto |
$1,153.60
|
| Rate for Payer: Zelis Worker's Compensation |
$787.33
|
|
