|
FISTULA REPAIR & COLOSTOMY
|
Facility
|
IP
|
$2,245.00
|
|
|
Service Code
|
CPT 57307
|
| Hospital Charge Code |
6157307
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$612.88 |
| Max. Negotiated Rate |
$2,132.75 |
| Rate for Payer: Cash Price |
$1,347.00
|
| Rate for Payer: Cigna Commercial |
$1,908.25
|
| Rate for Payer: First Health Commercial |
$2,020.50
|
| Rate for Payer: First Health Workers Compensation |
$866.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,020.50
|
| Rate for Payer: GEHA Commercial |
$1,571.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,020.50
|
| Rate for Payer: Multiplan All |
$2,042.95
|
| Rate for Payer: OMNI Networks Commercial |
$1,571.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,020.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,132.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,683.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,087.85
|
| Rate for Payer: Zelis Auto |
$898.00
|
| Rate for Payer: Zelis Worker's Compensation |
$612.88
|
|
|
FISTULA REPAIR & COLOSTOMY
|
Facility
|
OP
|
$2,245.00
|
|
|
Service Code
|
CPT 57307
|
| Hospital Charge Code |
6157307
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$561.25 |
| Max. Negotiated Rate |
$2,132.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,347.00
|
| Rate for Payer: Cash Price |
$1,347.00
|
| Rate for Payer: Cigna Commercial |
$1,908.25
|
| Rate for Payer: First Health Commercial |
$2,020.50
|
| Rate for Payer: First Health Workers Compensation |
$866.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,020.50
|
| Rate for Payer: GEHA Commercial |
$1,796.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,020.50
|
| Rate for Payer: Humana ChoiceCare |
$583.70
|
| Rate for Payer: Multiplan All |
$2,042.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,347.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,571.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,020.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,132.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,683.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,975.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$561.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,087.85
|
| Rate for Payer: Zelis Auto |
$898.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,122.50
|
| Rate for Payer: Zelis Worker's Compensation |
$612.88
|
|
|
FISTULA REPAIR TRANSPERINE
|
Facility
|
OP
|
$1,344.00
|
|
|
Service Code
|
CPT 57308
|
| Hospital Charge Code |
6157308
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$336.00 |
| Max. Negotiated Rate |
$1,276.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$806.40
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cigna Commercial |
$1,142.40
|
| Rate for Payer: First Health Commercial |
$1,209.60
|
| Rate for Payer: First Health Workers Compensation |
$518.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,209.60
|
| Rate for Payer: GEHA Commercial |
$1,075.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,209.60
|
| Rate for Payer: Humana ChoiceCare |
$349.44
|
| Rate for Payer: Multiplan All |
$1,223.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$806.40
|
| Rate for Payer: OMNI Networks Commercial |
$940.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,209.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,276.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,008.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,182.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$336.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,249.92
|
| Rate for Payer: Zelis Auto |
$537.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$672.00
|
| Rate for Payer: Zelis Worker's Compensation |
$366.91
|
|
|
FISTULA REPAIR TRANSPERINE
|
Facility
|
IP
|
$1,344.00
|
|
|
Service Code
|
CPT 57308
|
| Hospital Charge Code |
6157308
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$366.91 |
| Max. Negotiated Rate |
$1,276.80 |
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cigna Commercial |
$1,142.40
|
| Rate for Payer: First Health Commercial |
$1,209.60
|
| Rate for Payer: First Health Workers Compensation |
$518.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,209.60
|
| Rate for Payer: GEHA Commercial |
$940.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,209.60
|
| Rate for Payer: Multiplan All |
$1,223.04
|
| Rate for Payer: OMNI Networks Commercial |
$940.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,209.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,276.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,008.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,249.92
|
| Rate for Payer: Zelis Auto |
$537.60
|
| Rate for Payer: Zelis Worker's Compensation |
$366.91
|
|
|
FISTULECTOMY OF THIGH SUBQ
|
Facility
|
IP
|
$7,432.00
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
1917999
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,028.94 |
| Max. Negotiated Rate |
$7,060.40 |
| Rate for Payer: Cash Price |
$4,459.20
|
| Rate for Payer: Cigna Commercial |
$6,317.20
|
| Rate for Payer: First Health Commercial |
$6,688.80
|
| Rate for Payer: First Health Workers Compensation |
$2,869.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,688.80
|
| Rate for Payer: GEHA Commercial |
$5,202.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,688.80
|
| Rate for Payer: Multiplan All |
$6,763.12
|
| Rate for Payer: OMNI Networks Commercial |
$5,202.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,688.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,060.40
|
| Rate for Payer: Three Rivers Provider Network All |
$5,574.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,911.76
|
| Rate for Payer: Zelis Auto |
$2,972.80
|
| Rate for Payer: Zelis Worker's Compensation |
$2,028.94
|
|
|
FISTULECTOMY OF THIGH SUBQ
|
Facility
|
OP
|
$803.00
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
20317999
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$762.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$481.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$481.80
|
| Rate for Payer: Cash Price |
$481.80
|
| Rate for Payer: Cigna Commercial |
$682.55
|
| Rate for Payer: First Health Commercial |
$722.70
|
| Rate for Payer: First Health Workers Compensation |
$310.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$722.70
|
| Rate for Payer: GEHA Commercial |
$642.40
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$722.70
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$730.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$562.10
|
| Rate for Payer: One Health Plan PPO/POS |
$722.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$762.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$602.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$746.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$321.20
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$219.22
|
|
|
FISTULECTOMY OF THIGH SUBQ
|
Facility
|
OP
|
$7,432.00
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
1917999
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$7,060.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,459.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$4,459.20
|
| Rate for Payer: Cash Price |
$4,459.20
|
| Rate for Payer: Cigna Commercial |
$6,317.20
|
| Rate for Payer: First Health Commercial |
$6,688.80
|
| Rate for Payer: First Health Workers Compensation |
$2,869.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,688.80
|
| Rate for Payer: GEHA Commercial |
$5,945.60
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,688.80
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$6,763.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$5,202.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,688.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,060.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$5,574.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,911.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$2,972.80
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$2,028.94
|
|
|
FISTULECTOMY OF THIGH SUBQ
|
Facility
|
IP
|
$803.00
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
20317999
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$219.22 |
| Max. Negotiated Rate |
$762.85 |
| Rate for Payer: Cash Price |
$481.80
|
| Rate for Payer: Cigna Commercial |
$682.55
|
| Rate for Payer: First Health Commercial |
$722.70
|
| Rate for Payer: First Health Workers Compensation |
$310.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$722.70
|
| Rate for Payer: GEHA Commercial |
$562.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$722.70
|
| Rate for Payer: Multiplan All |
$730.73
|
| Rate for Payer: OMNI Networks Commercial |
$562.10
|
| Rate for Payer: One Health Plan PPO/POS |
$722.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$762.85
|
| Rate for Payer: Three Rivers Provider Network All |
$602.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$746.79
|
| Rate for Payer: Zelis Auto |
$321.20
|
| Rate for Payer: Zelis Worker's Compensation |
$219.22
|
|
|
FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPOR
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
23500037
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.10 |
| Max. Negotiated Rate |
$355.30 |
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$317.90
|
| Rate for Payer: First Health Commercial |
$336.60
|
| Rate for Payer: First Health Workers Compensation |
$144.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$336.60
|
| Rate for Payer: GEHA Commercial |
$261.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$336.60
|
| Rate for Payer: Multiplan All |
$340.34
|
| Rate for Payer: OMNI Networks Commercial |
$261.80
|
| Rate for Payer: One Health Plan PPO/POS |
$336.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$355.30
|
| Rate for Payer: Three Rivers Provider Network All |
$280.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$347.82
|
| Rate for Payer: Zelis Auto |
$149.60
|
| Rate for Payer: Zelis Worker's Compensation |
$102.10
|
|
|
FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPOR
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
6157160
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$382.04 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$86.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$122.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$191.02
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$122.40
|
| Rate for Payer: First Health Commercial |
$129.60
|
| Rate for Payer: First Health Workers Compensation |
$55.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$129.60
|
| Rate for Payer: GEHA Commercial |
$115.20
|
| Rate for Payer: GEHA Medicare |
$191.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$129.60
|
| Rate for Payer: Humana ChoiceCare |
$210.12
|
| Rate for Payer: Humana Medicare Advantage |
$191.02
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$320.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$124.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$191.02
|
| Rate for Payer: Multiplan All |
$131.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$324.73
|
| Rate for Payer: OMNI Networks Commercial |
$100.80
|
| Rate for Payer: One Health Plan PPO/POS |
$129.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$144.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$124.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$191.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$136.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$382.04
|
| Rate for Payer: Three Rivers Provider Network All |
$108.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$124.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$133.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$191.02
|
| Rate for Payer: Zelis Auto |
$57.60
|
| Rate for Payer: Zelis Medicare |
$162.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$229.22
|
| Rate for Payer: Zelis Worker's Compensation |
$39.31
|
|
|
FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPOR
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
6157160
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$122.40
|
| Rate for Payer: First Health Commercial |
$129.60
|
| Rate for Payer: First Health Workers Compensation |
$55.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$129.60
|
| Rate for Payer: GEHA Commercial |
$100.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$129.60
|
| Rate for Payer: Multiplan All |
$131.04
|
| Rate for Payer: OMNI Networks Commercial |
$100.80
|
| Rate for Payer: One Health Plan PPO/POS |
$129.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$136.80
|
| Rate for Payer: Three Rivers Provider Network All |
$108.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$133.92
|
| Rate for Payer: Zelis Auto |
$57.60
|
| Rate for Payer: Zelis Worker's Compensation |
$39.31
|
|
|
FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPOR
|
Facility
|
OP
|
$208.29
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
7257160
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$56.86 |
| Max. Negotiated Rate |
$382.04 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$124.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$122.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$191.02
|
| Rate for Payer: Cash Price |
$124.97
|
| Rate for Payer: Cash Price |
$124.97
|
| Rate for Payer: Cigna Commercial |
$177.05
|
| Rate for Payer: First Health Commercial |
$187.46
|
| Rate for Payer: First Health Workers Compensation |
$80.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$187.46
|
| Rate for Payer: GEHA Commercial |
$166.63
|
| Rate for Payer: GEHA Medicare |
$191.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$187.46
|
| Rate for Payer: Humana ChoiceCare |
$210.12
|
| Rate for Payer: Humana Medicare Advantage |
$191.02
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$320.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$124.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$191.02
|
| Rate for Payer: Multiplan All |
$189.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$324.73
|
| Rate for Payer: OMNI Networks Commercial |
$145.80
|
| Rate for Payer: One Health Plan PPO/POS |
$187.46
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$144.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$124.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$191.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$197.88
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$382.04
|
| Rate for Payer: Three Rivers Provider Network All |
$156.22
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$124.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$193.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$191.02
|
| Rate for Payer: Zelis Auto |
$83.32
|
| Rate for Payer: Zelis Medicare |
$162.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$229.22
|
| Rate for Payer: Zelis Worker's Compensation |
$56.86
|
|
|
FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPOR
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
23500037
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.10 |
| Max. Negotiated Rate |
$382.04 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$224.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$122.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$191.02
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$317.90
|
| Rate for Payer: First Health Commercial |
$336.60
|
| Rate for Payer: First Health Workers Compensation |
$144.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$336.60
|
| Rate for Payer: GEHA Commercial |
$299.20
|
| Rate for Payer: GEHA Medicare |
$191.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$336.60
|
| Rate for Payer: Humana ChoiceCare |
$210.12
|
| Rate for Payer: Humana Medicare Advantage |
$191.02
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$320.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$124.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$191.02
|
| Rate for Payer: Multiplan All |
$340.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$324.73
|
| Rate for Payer: OMNI Networks Commercial |
$261.80
|
| Rate for Payer: One Health Plan PPO/POS |
$336.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$144.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$124.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$191.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$355.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$382.04
|
| Rate for Payer: Three Rivers Provider Network All |
$280.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$124.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$347.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$191.02
|
| Rate for Payer: Zelis Auto |
$149.60
|
| Rate for Payer: Zelis Medicare |
$162.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$229.22
|
| Rate for Payer: Zelis Worker's Compensation |
$102.10
|
|
|
FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPOR
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
9357160
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$80.26 |
| Max. Negotiated Rate |
$382.04 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$122.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$191.02
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$249.90
|
| Rate for Payer: First Health Commercial |
$264.60
|
| Rate for Payer: First Health Workers Compensation |
$113.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$264.60
|
| Rate for Payer: GEHA Commercial |
$235.20
|
| Rate for Payer: GEHA Medicare |
$191.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$264.60
|
| Rate for Payer: Humana ChoiceCare |
$210.12
|
| Rate for Payer: Humana Medicare Advantage |
$191.02
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$320.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$124.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$191.02
|
| Rate for Payer: Multiplan All |
$267.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$324.73
|
| Rate for Payer: OMNI Networks Commercial |
$205.80
|
| Rate for Payer: One Health Plan PPO/POS |
$264.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$144.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$124.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$191.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$279.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$382.04
|
| Rate for Payer: Three Rivers Provider Network All |
$220.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$124.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$273.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$191.02
|
| Rate for Payer: Zelis Auto |
$117.60
|
| Rate for Payer: Zelis Medicare |
$162.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$229.22
|
| Rate for Payer: Zelis Worker's Compensation |
$80.26
|
|
|
FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPOR
|
Facility
|
IP
|
$208.29
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
8557160
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$56.86 |
| Max. Negotiated Rate |
$197.88 |
| Rate for Payer: Cash Price |
$124.97
|
| Rate for Payer: Cigna Commercial |
$177.05
|
| Rate for Payer: First Health Commercial |
$187.46
|
| Rate for Payer: First Health Workers Compensation |
$80.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$187.46
|
| Rate for Payer: GEHA Commercial |
$145.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$187.46
|
| Rate for Payer: Multiplan All |
$189.54
|
| Rate for Payer: OMNI Networks Commercial |
$145.80
|
| Rate for Payer: One Health Plan PPO/POS |
$187.46
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$197.88
|
| Rate for Payer: Three Rivers Provider Network All |
$156.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$193.71
|
| Rate for Payer: Zelis Auto |
$83.32
|
| Rate for Payer: Zelis Worker's Compensation |
$56.86
|
|
|
FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPOR
|
Facility
|
OP
|
$208.29
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
8557160
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$56.86 |
| Max. Negotiated Rate |
$382.04 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$124.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$122.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$191.02
|
| Rate for Payer: Cash Price |
$124.97
|
| Rate for Payer: Cash Price |
$124.97
|
| Rate for Payer: Cigna Commercial |
$177.05
|
| Rate for Payer: First Health Commercial |
$187.46
|
| Rate for Payer: First Health Workers Compensation |
$80.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$187.46
|
| Rate for Payer: GEHA Commercial |
$166.63
|
| Rate for Payer: GEHA Medicare |
$191.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$187.46
|
| Rate for Payer: Humana ChoiceCare |
$210.12
|
| Rate for Payer: Humana Medicare Advantage |
$191.02
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$320.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$124.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$191.02
|
| Rate for Payer: Multiplan All |
$189.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$324.73
|
| Rate for Payer: OMNI Networks Commercial |
$145.80
|
| Rate for Payer: One Health Plan PPO/POS |
$187.46
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$144.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$124.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$191.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$197.88
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$382.04
|
| Rate for Payer: Three Rivers Provider Network All |
$156.22
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$124.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$193.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$191.02
|
| Rate for Payer: Zelis Auto |
$83.32
|
| Rate for Payer: Zelis Medicare |
$162.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$229.22
|
| Rate for Payer: Zelis Worker's Compensation |
$56.86
|
|
|
FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPOR
|
Facility
|
IP
|
$208.29
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
7257160
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$56.86 |
| Max. Negotiated Rate |
$197.88 |
| Rate for Payer: Cash Price |
$124.97
|
| Rate for Payer: Cigna Commercial |
$177.05
|
| Rate for Payer: First Health Commercial |
$187.46
|
| Rate for Payer: First Health Workers Compensation |
$80.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$187.46
|
| Rate for Payer: GEHA Commercial |
$145.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$187.46
|
| Rate for Payer: Multiplan All |
$189.54
|
| Rate for Payer: OMNI Networks Commercial |
$145.80
|
| Rate for Payer: One Health Plan PPO/POS |
$187.46
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$197.88
|
| Rate for Payer: Three Rivers Provider Network All |
$156.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$193.71
|
| Rate for Payer: Zelis Auto |
$83.32
|
| Rate for Payer: Zelis Worker's Compensation |
$56.86
|
|
|
FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPOR
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
9357160
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$80.26 |
| Max. Negotiated Rate |
$279.30 |
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$249.90
|
| Rate for Payer: First Health Commercial |
$264.60
|
| Rate for Payer: First Health Workers Compensation |
$113.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$264.60
|
| Rate for Payer: GEHA Commercial |
$205.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$264.60
|
| Rate for Payer: Multiplan All |
$267.54
|
| Rate for Payer: OMNI Networks Commercial |
$205.80
|
| Rate for Payer: One Health Plan PPO/POS |
$264.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$279.30
|
| Rate for Payer: Three Rivers Provider Network All |
$220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$273.42
|
| Rate for Payer: Zelis Auto |
$117.60
|
| Rate for Payer: Zelis Worker's Compensation |
$80.26
|
|
|
FITTING OF DIAPHRAGM/CAP
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 57170
|
| Hospital Charge Code |
6157170
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$382.04 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$13.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$89.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$13.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$10.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$191.02
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$126.65
|
| Rate for Payer: First Health Commercial |
$134.10
|
| Rate for Payer: First Health Workers Compensation |
$57.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$134.10
|
| Rate for Payer: GEHA Commercial |
$119.20
|
| Rate for Payer: GEHA Medicare |
$191.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$134.10
|
| Rate for Payer: Humana ChoiceCare |
$210.12
|
| Rate for Payer: Humana Medicare Advantage |
$191.02
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$320.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$10.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$191.02
|
| Rate for Payer: Multiplan All |
$135.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$324.73
|
| Rate for Payer: OMNI Networks Commercial |
$104.30
|
| Rate for Payer: One Health Plan PPO/POS |
$134.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$12.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$10.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$191.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$141.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$382.04
|
| Rate for Payer: Three Rivers Provider Network All |
$111.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$10.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$138.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$191.02
|
| Rate for Payer: Zelis Auto |
$59.60
|
| Rate for Payer: Zelis Medicare |
$162.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$229.22
|
| Rate for Payer: Zelis Worker's Compensation |
$40.68
|
|
|
FITTING OF DIAPHRAGM/CAP
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT 57170
|
| Hospital Charge Code |
6157170
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$40.68 |
| Max. Negotiated Rate |
$141.55 |
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$126.65
|
| Rate for Payer: First Health Commercial |
$134.10
|
| Rate for Payer: First Health Workers Compensation |
$57.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$134.10
|
| Rate for Payer: GEHA Commercial |
$104.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$134.10
|
| Rate for Payer: Multiplan All |
$135.59
|
| Rate for Payer: OMNI Networks Commercial |
$104.30
|
| Rate for Payer: One Health Plan PPO/POS |
$134.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$141.55
|
| Rate for Payer: Three Rivers Provider Network All |
$111.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$138.57
|
| Rate for Payer: Zelis Auto |
$59.60
|
| Rate for Payer: Zelis Worker's Compensation |
$40.68
|
|
|
FIXATION DEVICE ABSORBATACK 30
|
Facility
|
OP
|
$2,541.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7003255
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$635.25 |
| Max. Negotiated Rate |
$2,413.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,524.60
|
| Rate for Payer: Cash Price |
$1,524.60
|
| Rate for Payer: Cigna Commercial |
$2,159.85
|
| Rate for Payer: First Health Commercial |
$2,286.90
|
| Rate for Payer: First Health Workers Compensation |
$981.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,286.90
|
| Rate for Payer: GEHA Commercial |
$2,032.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,286.90
|
| Rate for Payer: Humana ChoiceCare |
$660.66
|
| Rate for Payer: Multiplan All |
$2,312.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,524.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,778.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,286.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,413.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,905.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,236.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$635.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,363.13
|
| Rate for Payer: Zelis Auto |
$1,016.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,270.50
|
| Rate for Payer: Zelis Worker's Compensation |
$693.69
|
|
|
FIXATION DEVICE ABSORBATACK 30
|
Facility
|
IP
|
$2,541.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7003255
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$693.69 |
| Max. Negotiated Rate |
$2,413.95 |
| Rate for Payer: Cash Price |
$1,524.60
|
| Rate for Payer: Cigna Commercial |
$2,159.85
|
| Rate for Payer: First Health Commercial |
$2,286.90
|
| Rate for Payer: First Health Workers Compensation |
$981.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,286.90
|
| Rate for Payer: GEHA Commercial |
$1,778.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,286.90
|
| Rate for Payer: Multiplan All |
$2,312.31
|
| Rate for Payer: OMNI Networks Commercial |
$1,778.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,286.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,413.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,905.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,363.13
|
| Rate for Payer: Zelis Auto |
$1,016.40
|
| Rate for Payer: Zelis Worker's Compensation |
$693.69
|
|
|
FIXATION OF ANKLE JOINT
|
Facility
|
OP
|
$536.00
|
|
|
Service Code
|
CPT 27860
|
| Hospital Charge Code |
6127860
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$146.33 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$321.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,224.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cigna Commercial |
$455.60
|
| Rate for Payer: First Health Commercial |
$482.40
|
| Rate for Payer: First Health Workers Compensation |
$206.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$482.40
|
| Rate for Payer: GEHA Commercial |
$428.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$482.40
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,249.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$487.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$375.20
|
| Rate for Payer: One Health Plan PPO/POS |
$482.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,443.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,249.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$509.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$402.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,249.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$498.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$214.40
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$146.33
|
|
|
FIXATION OF ANKLE JOINT
|
Facility
|
IP
|
$536.00
|
|
|
Service Code
|
CPT 27860
|
| Hospital Charge Code |
6127860
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$146.33 |
| Max. Negotiated Rate |
$509.20 |
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cigna Commercial |
$455.60
|
| Rate for Payer: First Health Commercial |
$482.40
|
| Rate for Payer: First Health Workers Compensation |
$206.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$482.40
|
| Rate for Payer: GEHA Commercial |
$375.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$482.40
|
| Rate for Payer: Multiplan All |
$487.76
|
| Rate for Payer: OMNI Networks Commercial |
$375.20
|
| Rate for Payer: One Health Plan PPO/POS |
$482.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$509.20
|
| Rate for Payer: Three Rivers Provider Network All |
$402.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$498.48
|
| Rate for Payer: Zelis Auto |
$214.40
|
| Rate for Payer: Zelis Worker's Compensation |
$146.33
|
|
|
FIXATION OF KNEE JOINT
|
Facility
|
OP
|
$461.00
|
|
|
Service Code
|
CPT 27570
|
| Hospital Charge Code |
6127570
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$125.85 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$276.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,224.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cigna Commercial |
$391.85
|
| Rate for Payer: First Health Commercial |
$414.90
|
| Rate for Payer: First Health Workers Compensation |
$177.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$414.90
|
| Rate for Payer: GEHA Commercial |
$368.80
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$414.90
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,249.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$419.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$322.70
|
| Rate for Payer: One Health Plan PPO/POS |
$414.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,443.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,249.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$437.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$345.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,249.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$428.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$184.40
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$125.85
|
|
