|
FUSION OF SHOULDER JOINT
|
Facility
|
OP
|
$2,600.00
|
|
|
Service Code
|
CPT 23802
|
| Hospital Charge Code |
6123802
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$709.80 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,560.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: Cash Price |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,560.00
|
| Rate for Payer: Cigna Commercial |
$2,210.00
|
| Rate for Payer: First Health Commercial |
$2,340.00
|
| Rate for Payer: First Health Workers Compensation |
$1,003.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,340.00
|
| Rate for Payer: GEHA Commercial |
$2,080.00
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,340.00
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$2,366.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,820.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,340.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,470.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,950.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,418.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$1,040.00
|
| Rate for Payer: Zelis Medicare |
$10,384.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,661.07
|
| Rate for Payer: Zelis Worker's Compensation |
$709.80
|
|
|
FUSION OF SHOULDER JOINT
|
Facility
|
IP
|
$2,600.00
|
|
|
Service Code
|
CPT 23802
|
| Hospital Charge Code |
6123802
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$709.80 |
| Max. Negotiated Rate |
$2,470.00 |
| Rate for Payer: Cash Price |
$1,560.00
|
| Rate for Payer: Cigna Commercial |
$2,210.00
|
| Rate for Payer: First Health Commercial |
$2,340.00
|
| Rate for Payer: First Health Workers Compensation |
$1,003.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,340.00
|
| Rate for Payer: GEHA Commercial |
$1,820.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,340.00
|
| Rate for Payer: Multiplan All |
$2,366.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,820.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,340.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,470.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,950.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,418.00
|
| Rate for Payer: Zelis Auto |
$1,040.00
|
| Rate for Payer: Zelis Worker's Compensation |
$709.80
|
|
|
FUSION OF SHOULDER JOINT
|
Facility
|
IP
|
$2,114.00
|
|
|
Service Code
|
CPT 23800
|
| Hospital Charge Code |
6123800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$577.12 |
| Max. Negotiated Rate |
$2,008.30 |
| Rate for Payer: Cash Price |
$1,268.40
|
| Rate for Payer: Cigna Commercial |
$1,796.90
|
| Rate for Payer: First Health Commercial |
$1,902.60
|
| Rate for Payer: First Health Workers Compensation |
$816.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,902.60
|
| Rate for Payer: GEHA Commercial |
$1,479.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,902.60
|
| Rate for Payer: Multiplan All |
$1,923.74
|
| Rate for Payer: OMNI Networks Commercial |
$1,479.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,902.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,008.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,585.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,966.02
|
| Rate for Payer: Zelis Auto |
$845.60
|
| Rate for Payer: Zelis Worker's Compensation |
$577.12
|
|
|
FUSION OF SPERMATIC DUCTS
|
Facility
|
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 54900
|
| Hospital Charge Code |
6154900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$473.38 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,040.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Cigna Commercial |
$1,473.90
|
| Rate for Payer: First Health Commercial |
$1,560.60
|
| Rate for Payer: First Health Workers Compensation |
$669.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,560.60
|
| Rate for Payer: GEHA Commercial |
$1,387.20
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,560.60
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$1,577.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$1,213.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,560.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,647.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$1,300.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,612.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$693.60
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$473.38
|
|
|
FUSION OF SPERMATIC DUCTS
|
Facility
|
IP
|
$2,290.00
|
|
|
Service Code
|
CPT 54901
|
| Hospital Charge Code |
6154901
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$625.17 |
| Max. Negotiated Rate |
$2,175.50 |
| Rate for Payer: Cash Price |
$1,374.00
|
| Rate for Payer: Cigna Commercial |
$1,946.50
|
| Rate for Payer: First Health Commercial |
$2,061.00
|
| Rate for Payer: First Health Workers Compensation |
$884.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,061.00
|
| Rate for Payer: GEHA Commercial |
$1,603.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,061.00
|
| Rate for Payer: Multiplan All |
$2,083.90
|
| Rate for Payer: OMNI Networks Commercial |
$1,603.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,061.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,175.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,717.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,129.70
|
| Rate for Payer: Zelis Auto |
$916.00
|
| Rate for Payer: Zelis Worker's Compensation |
$625.17
|
|
|
FUSION OF SPERMATIC DUCTS
|
Facility
|
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 54900
|
| Hospital Charge Code |
6154900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$473.38 |
| Max. Negotiated Rate |
$1,647.30 |
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Cigna Commercial |
$1,473.90
|
| Rate for Payer: First Health Commercial |
$1,560.60
|
| Rate for Payer: First Health Workers Compensation |
$669.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,560.60
|
| Rate for Payer: GEHA Commercial |
$1,213.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,560.60
|
| Rate for Payer: Multiplan All |
$1,577.94
|
| Rate for Payer: OMNI Networks Commercial |
$1,213.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,560.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,647.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,300.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,612.62
|
| Rate for Payer: Zelis Auto |
$693.60
|
| Rate for Payer: Zelis Worker's Compensation |
$473.38
|
|
|
FUSION OF SPERMATIC DUCTS
|
Facility
|
OP
|
$2,290.00
|
|
|
Service Code
|
CPT 54901
|
| Hospital Charge Code |
6154901
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$625.17 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,374.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$1,374.00
|
| Rate for Payer: Cash Price |
$1,374.00
|
| Rate for Payer: Cigna Commercial |
$1,946.50
|
| Rate for Payer: First Health Commercial |
$2,061.00
|
| Rate for Payer: First Health Workers Compensation |
$884.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,061.00
|
| Rate for Payer: GEHA Commercial |
$1,832.00
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,061.00
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$2,083.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,603.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,061.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,175.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,717.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,129.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$916.00
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$625.17
|
|
|
FUSION OF STOMACH AND BOWEL
|
Facility
|
IP
|
$2,826.00
|
|
|
Service Code
|
CPT 43820
|
| Hospital Charge Code |
6143820
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$771.50 |
| Max. Negotiated Rate |
$2,684.70 |
| Rate for Payer: Cash Price |
$1,695.60
|
| Rate for Payer: Cigna Commercial |
$2,402.10
|
| Rate for Payer: First Health Commercial |
$2,543.40
|
| Rate for Payer: First Health Workers Compensation |
$1,091.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,543.40
|
| Rate for Payer: GEHA Commercial |
$1,978.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,543.40
|
| Rate for Payer: Multiplan All |
$2,571.66
|
| Rate for Payer: OMNI Networks Commercial |
$1,978.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,543.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,684.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,119.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,628.18
|
| Rate for Payer: Zelis Auto |
$1,130.40
|
| Rate for Payer: Zelis Worker's Compensation |
$771.50
|
|
|
FUSION OF STOMACH AND BOWEL
|
Facility
|
IP
|
$2,142.00
|
|
|
Service Code
|
CPT 43810
|
| Hospital Charge Code |
6143810
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$584.77 |
| Max. Negotiated Rate |
$2,034.90 |
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: Cigna Commercial |
$1,820.70
|
| Rate for Payer: First Health Commercial |
$1,927.80
|
| Rate for Payer: First Health Workers Compensation |
$827.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,927.80
|
| Rate for Payer: GEHA Commercial |
$1,499.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,927.80
|
| Rate for Payer: Multiplan All |
$1,949.22
|
| Rate for Payer: OMNI Networks Commercial |
$1,499.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,927.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,034.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,606.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,992.06
|
| Rate for Payer: Zelis Auto |
$856.80
|
| Rate for Payer: Zelis Worker's Compensation |
$584.77
|
|
|
FUSION OF STOMACH AND BOWEL
|
Facility
|
OP
|
$2,751.00
|
|
|
Service Code
|
CPT 43825
|
| Hospital Charge Code |
6143825
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$687.75 |
| Max. Negotiated Rate |
$2,613.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,650.60
|
| Rate for Payer: Cash Price |
$1,650.60
|
| Rate for Payer: Cigna Commercial |
$2,338.35
|
| Rate for Payer: First Health Commercial |
$2,475.90
|
| Rate for Payer: First Health Workers Compensation |
$1,062.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,475.90
|
| Rate for Payer: GEHA Commercial |
$2,200.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,475.90
|
| Rate for Payer: Humana ChoiceCare |
$715.26
|
| Rate for Payer: Multiplan All |
$2,503.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,650.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,925.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,475.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,613.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,063.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,420.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$687.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,558.43
|
| Rate for Payer: Zelis Auto |
$1,100.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,375.50
|
| Rate for Payer: Zelis Worker's Compensation |
$751.02
|
|
|
FUSION OF STOMACH AND BOWEL
|
Facility
|
IP
|
$2,751.00
|
|
|
Service Code
|
CPT 43825
|
| Hospital Charge Code |
6143825
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$751.02 |
| Max. Negotiated Rate |
$2,613.45 |
| Rate for Payer: Cash Price |
$1,650.60
|
| Rate for Payer: Cigna Commercial |
$2,338.35
|
| Rate for Payer: First Health Commercial |
$2,475.90
|
| Rate for Payer: First Health Workers Compensation |
$1,062.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,475.90
|
| Rate for Payer: GEHA Commercial |
$1,925.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,475.90
|
| Rate for Payer: Multiplan All |
$2,503.41
|
| Rate for Payer: OMNI Networks Commercial |
$1,925.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,475.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,613.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,063.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,558.43
|
| Rate for Payer: Zelis Auto |
$1,100.40
|
| Rate for Payer: Zelis Worker's Compensation |
$751.02
|
|
|
FUSION OF STOMACH AND BOWEL
|
Facility
|
OP
|
$2,826.00
|
|
|
Service Code
|
CPT 43820
|
| Hospital Charge Code |
6143820
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$706.50 |
| Max. Negotiated Rate |
$2,684.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,695.60
|
| Rate for Payer: Cash Price |
$1,695.60
|
| Rate for Payer: Cigna Commercial |
$2,402.10
|
| Rate for Payer: First Health Commercial |
$2,543.40
|
| Rate for Payer: First Health Workers Compensation |
$1,091.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,543.40
|
| Rate for Payer: GEHA Commercial |
$2,260.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,543.40
|
| Rate for Payer: Humana ChoiceCare |
$734.76
|
| Rate for Payer: Multiplan All |
$2,571.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,695.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,978.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,543.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,684.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,119.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,486.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$706.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,628.18
|
| Rate for Payer: Zelis Auto |
$1,130.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,413.00
|
| Rate for Payer: Zelis Worker's Compensation |
$771.50
|
|
|
FUSION OF STOMACH AND BOWEL
|
Facility
|
OP
|
$2,142.00
|
|
|
Service Code
|
CPT 43810
|
| Hospital Charge Code |
6143810
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$535.50 |
| Max. Negotiated Rate |
$2,034.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,285.20
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: Cigna Commercial |
$1,820.70
|
| Rate for Payer: First Health Commercial |
$1,927.80
|
| Rate for Payer: First Health Workers Compensation |
$827.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,927.80
|
| Rate for Payer: GEHA Commercial |
$1,713.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,927.80
|
| Rate for Payer: Humana ChoiceCare |
$556.92
|
| Rate for Payer: Multiplan All |
$1,949.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,285.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,499.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,927.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,034.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,606.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,884.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$535.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,992.06
|
| Rate for Payer: Zelis Auto |
$856.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,071.00
|
| Rate for Payer: Zelis Worker's Compensation |
$584.77
|
|
|
FUSION OF TENDONS AT WRIST
|
Facility
|
IP
|
$1,386.00
|
|
|
Service Code
|
CPT 25300
|
| Hospital Charge Code |
6125300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$378.38 |
| Max. Negotiated Rate |
$1,316.70 |
| Rate for Payer: Cash Price |
$831.60
|
| Rate for Payer: Cigna Commercial |
$1,178.10
|
| Rate for Payer: First Health Commercial |
$1,247.40
|
| Rate for Payer: First Health Workers Compensation |
$535.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,247.40
|
| Rate for Payer: GEHA Commercial |
$970.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,247.40
|
| Rate for Payer: Multiplan All |
$1,261.26
|
| Rate for Payer: OMNI Networks Commercial |
$970.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,247.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,316.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,039.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,288.98
|
| Rate for Payer: Zelis Auto |
$554.40
|
| Rate for Payer: Zelis Worker's Compensation |
$378.38
|
|
|
FUSION OF TENDONS AT WRIST
|
Facility
|
IP
|
$1,309.00
|
|
|
Service Code
|
CPT 25301
|
| Hospital Charge Code |
6125301
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$357.36 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: First Health Workers Compensation |
$505.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$916.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: Zelis Auto |
$523.60
|
| Rate for Payer: Zelis Worker's Compensation |
$357.36
|
|
|
FUSION OF TENDONS AT WRIST
|
Facility
|
OP
|
$1,309.00
|
|
|
Service Code
|
CPT 25301
|
| Hospital Charge Code |
6125301
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$357.36 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$785.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: First Health Workers Compensation |
$505.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$1,047.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$523.60
|
| 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 |
$357.36
|
|
|
FUSION OF TENDONS AT WRIST
|
Facility
|
OP
|
$1,386.00
|
|
|
Service Code
|
CPT 25300
|
| Hospital Charge Code |
6125300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$378.38 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$831.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$831.60
|
| Rate for Payer: Cash Price |
$831.60
|
| Rate for Payer: Cigna Commercial |
$1,178.10
|
| Rate for Payer: First Health Commercial |
$1,247.40
|
| Rate for Payer: First Health Workers Compensation |
$535.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,247.40
|
| Rate for Payer: GEHA Commercial |
$1,108.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,247.40
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,261.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$970.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,247.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,316.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,039.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,288.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$554.40
|
| 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 |
$378.38
|
|
|
FUSION OF THUMB
|
Facility
|
IP
|
$1,433.00
|
|
|
Service Code
|
CPT 26841
|
| Hospital Charge Code |
6126841
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$391.21 |
| Max. Negotiated Rate |
$1,361.35 |
| Rate for Payer: Cash Price |
$859.80
|
| Rate for Payer: Cigna Commercial |
$1,218.05
|
| Rate for Payer: First Health Commercial |
$1,289.70
|
| Rate for Payer: First Health Workers Compensation |
$553.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,289.70
|
| Rate for Payer: GEHA Commercial |
$1,003.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,289.70
|
| Rate for Payer: Multiplan All |
$1,304.03
|
| Rate for Payer: OMNI Networks Commercial |
$1,003.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,289.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,361.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,074.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,332.69
|
| Rate for Payer: Zelis Auto |
$573.20
|
| Rate for Payer: Zelis Worker's Compensation |
$391.21
|
|
|
FUSION OF THUMB
|
Facility
|
OP
|
$1,433.00
|
|
|
Service Code
|
CPT 26841
|
| Hospital Charge Code |
6126841
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$391.21 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$859.80
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$859.80
|
| Rate for Payer: Cash Price |
$859.80
|
| Rate for Payer: Cigna Commercial |
$1,218.05
|
| Rate for Payer: First Health Commercial |
$1,289.70
|
| Rate for Payer: First Health Workers Compensation |
$553.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,289.70
|
| Rate for Payer: GEHA Commercial |
$1,146.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,289.70
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,304.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,003.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,289.70
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,361.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,074.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,332.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$573.20
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$391.21
|
|
|
FUSION OF TIBIOFIBULAR JOINT
|
Facility
|
OP
|
$1,402.00
|
|
|
Service Code
|
CPT 27871
|
| Hospital Charge Code |
6127871
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$382.75 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$841.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7,100.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$1,191.70
|
| Rate for Payer: First Health Commercial |
$1,261.80
|
| Rate for Payer: First Health Workers Compensation |
$541.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,261.80
|
| Rate for Payer: GEHA Commercial |
$1,121.60
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,261.80
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,275.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$981.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,261.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8,365.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7,245.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,331.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,051.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,303.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$560.80
|
| Rate for Payer: Zelis Medicare |
$10,384.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,661.07
|
| Rate for Payer: Zelis Worker's Compensation |
$382.75
|
|
|
FUSION OF TIBIOFIBULAR JOINT
|
Facility
|
IP
|
$1,402.00
|
|
|
Service Code
|
CPT 27871
|
| Hospital Charge Code |
6127871
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$382.75 |
| Max. Negotiated Rate |
$1,331.90 |
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$1,191.70
|
| Rate for Payer: First Health Commercial |
$1,261.80
|
| Rate for Payer: First Health Workers Compensation |
$541.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,261.80
|
| Rate for Payer: GEHA Commercial |
$981.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,261.80
|
| Rate for Payer: Multiplan All |
$1,275.82
|
| Rate for Payer: OMNI Networks Commercial |
$981.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,261.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,331.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,051.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,303.86
|
| Rate for Payer: Zelis Auto |
$560.80
|
| Rate for Payer: Zelis Worker's Compensation |
$382.75
|
|
|
FUSION OF TOES
|
Facility
|
IP
|
$893.00
|
|
|
Service Code
|
CPT 28280
|
| Hospital Charge Code |
6128280
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$243.79 |
| Max. Negotiated Rate |
$848.35 |
| Rate for Payer: Cash Price |
$535.80
|
| Rate for Payer: Cigna Commercial |
$759.05
|
| Rate for Payer: First Health Commercial |
$803.70
|
| Rate for Payer: First Health Workers Compensation |
$344.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$803.70
|
| Rate for Payer: GEHA Commercial |
$625.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$803.70
|
| Rate for Payer: Multiplan All |
$812.63
|
| Rate for Payer: OMNI Networks Commercial |
$625.10
|
| Rate for Payer: One Health Plan PPO/POS |
$803.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$848.35
|
| Rate for Payer: Three Rivers Provider Network All |
$669.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$830.49
|
| Rate for Payer: Zelis Auto |
$357.20
|
| Rate for Payer: Zelis Worker's Compensation |
$243.79
|
|
|
FUSION OF TOES
|
Facility
|
OP
|
$893.00
|
|
|
Service Code
|
CPT 28280
|
| Hospital Charge Code |
6128280
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$243.79 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$535.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$535.80
|
| Rate for Payer: Cash Price |
$535.80
|
| Rate for Payer: Cigna Commercial |
$759.05
|
| Rate for Payer: First Health Commercial |
$803.70
|
| Rate for Payer: First Health Workers Compensation |
$344.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$803.70
|
| Rate for Payer: GEHA Commercial |
$714.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$803.70
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$812.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$625.10
|
| Rate for Payer: One Health Plan PPO/POS |
$803.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$848.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$669.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$830.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$357.20
|
| 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 |
$243.79
|
|
|
FUSION OF URETER & BOWEL
|
Facility
|
IP
|
$2,607.00
|
|
|
Service Code
|
CPT 50810
|
| Hospital Charge Code |
6150810
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$711.71 |
| Max. Negotiated Rate |
$2,476.65 |
| Rate for Payer: Cash Price |
$1,564.20
|
| Rate for Payer: Cigna Commercial |
$2,215.95
|
| Rate for Payer: First Health Commercial |
$2,346.30
|
| Rate for Payer: First Health Workers Compensation |
$1,006.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,346.30
|
| Rate for Payer: GEHA Commercial |
$1,824.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,346.30
|
| Rate for Payer: Multiplan All |
$2,372.37
|
| Rate for Payer: OMNI Networks Commercial |
$1,824.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,346.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,476.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,955.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,424.51
|
| Rate for Payer: Zelis Auto |
$1,042.80
|
| Rate for Payer: Zelis Worker's Compensation |
$711.71
|
|
|
FUSION OF URETER & BOWEL
|
Facility
|
OP
|
$2,607.00
|
|
|
Service Code
|
CPT 50810
|
| Hospital Charge Code |
6150810
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$651.75 |
| Max. Negotiated Rate |
$2,476.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,564.20
|
| Rate for Payer: Cash Price |
$1,564.20
|
| Rate for Payer: Cigna Commercial |
$2,215.95
|
| Rate for Payer: First Health Commercial |
$2,346.30
|
| Rate for Payer: First Health Workers Compensation |
$1,006.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,346.30
|
| Rate for Payer: GEHA Commercial |
$2,085.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,346.30
|
| Rate for Payer: Humana ChoiceCare |
$677.82
|
| Rate for Payer: Multiplan All |
$2,372.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,564.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,824.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,346.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,476.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,955.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,294.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$651.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,424.51
|
| Rate for Payer: Zelis Auto |
$1,042.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,303.50
|
| Rate for Payer: Zelis Worker's Compensation |
$711.71
|
|
