|
NEPHROSTOGRAM
|
Facility
|
OP
|
$994.00
|
|
| Hospital Charge Code |
2401123
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$944.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$596.40
|
| Rate for Payer: Cash Price |
$596.40
|
| Rate for Payer: Cigna Commercial |
$844.90
|
| Rate for Payer: First Health Commercial |
$894.60
|
| Rate for Payer: First Health Workers Compensation |
$383.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$894.60
|
| Rate for Payer: GEHA Commercial |
$795.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$894.60
|
| Rate for Payer: Humana ChoiceCare |
$258.44
|
| Rate for Payer: Multiplan All |
$904.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$596.40
|
| Rate for Payer: OMNI Networks Commercial |
$695.80
|
| Rate for Payer: One Health Plan PPO/POS |
$894.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$944.30
|
| Rate for Payer: Three Rivers Provider Network All |
$745.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$874.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$248.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$924.42
|
| Rate for Payer: Zelis Auto |
$397.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$497.00
|
| Rate for Payer: Zelis Worker's Compensation |
$271.36
|
|
|
NEPHROSTOGRAM
|
Facility
|
IP
|
$994.00
|
|
| Hospital Charge Code |
2401123
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$271.36 |
| Max. Negotiated Rate |
$944.30 |
| Rate for Payer: Cash Price |
$596.40
|
| Rate for Payer: Cigna Commercial |
$844.90
|
| Rate for Payer: First Health Commercial |
$894.60
|
| Rate for Payer: First Health Workers Compensation |
$383.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$894.60
|
| Rate for Payer: GEHA Commercial |
$695.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$894.60
|
| Rate for Payer: Multiplan All |
$904.54
|
| Rate for Payer: OMNI Networks Commercial |
$695.80
|
| Rate for Payer: One Health Plan PPO/POS |
$894.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$944.30
|
| Rate for Payer: Three Rivers Provider Network All |
$745.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$924.42
|
| Rate for Payer: Zelis Auto |
$397.60
|
| Rate for Payer: Zelis Worker's Compensation |
$271.36
|
|
|
NEPHROST TUBE DILAT
|
Facility
|
IP
|
$4,907.00
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
2407181
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.25 |
| Max. Negotiated Rate |
$4,661.65 |
| Rate for Payer: Cash Price |
$2,944.20
|
| Rate for Payer: Cash Price |
$2,944.20
|
| Rate for Payer: Cigna Commercial |
$4,170.95
|
| Rate for Payer: First Health Commercial |
$4,416.30
|
| Rate for Payer: First Health Workers Compensation |
$143.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,416.30
|
| Rate for Payer: GEHA Commercial |
$3,434.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,416.30
|
| Rate for Payer: Multiplan All |
$4,465.37
|
| Rate for Payer: OMNI Networks Commercial |
$3,434.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,416.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,661.65
|
| Rate for Payer: Three Rivers Provider Network All |
$3,680.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,563.51
|
| Rate for Payer: Zelis Auto |
$1,962.80
|
| Rate for Payer: Zelis Worker's Compensation |
$101.25
|
|
|
NEPHROST TUBE DILAT
|
Facility
|
OP
|
$4,907.00
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
2407181
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.25 |
| Max. Negotiated Rate |
$4,661.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,722.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,944.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,722.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,364.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$2,944.20
|
| Rate for Payer: Cash Price |
$2,944.20
|
| Rate for Payer: Cigna Commercial |
$4,170.95
|
| Rate for Payer: First Health Commercial |
$4,416.30
|
| Rate for Payer: First Health Workers Compensation |
$143.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,416.30
|
| Rate for Payer: GEHA Commercial |
$3,925.60
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,416.30
|
| 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 |
$1,392.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$4,465.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$3,434.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,416.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,607.51
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.22
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,661.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$3,680.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Commercial |
$4,170.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,563.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$1,962.80
|
| 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 |
$101.25
|
|
|
NEPHROS TUBE EXCHANG
|
Facility
|
OP
|
$2,965.00
|
|
| Hospital Charge Code |
2407183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$741.25 |
| Max. Negotiated Rate |
$2,816.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,779.00
|
| Rate for Payer: Cash Price |
$1,779.00
|
| Rate for Payer: Cigna Commercial |
$2,520.25
|
| Rate for Payer: First Health Commercial |
$2,668.50
|
| Rate for Payer: First Health Workers Compensation |
$1,144.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,668.50
|
| Rate for Payer: GEHA Commercial |
$2,372.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,668.50
|
| Rate for Payer: Humana ChoiceCare |
$770.90
|
| Rate for Payer: Multiplan All |
$2,698.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,779.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,075.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,668.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,816.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,223.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,609.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$741.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,757.45
|
| Rate for Payer: Zelis Auto |
$1,186.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,482.50
|
| Rate for Payer: Zelis Worker's Compensation |
$809.45
|
|
|
NEPHROS TUBE EXCHANG
|
Facility
|
IP
|
$2,965.00
|
|
| Hospital Charge Code |
2407183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$809.45 |
| Max. Negotiated Rate |
$2,816.75 |
| Rate for Payer: Cash Price |
$1,779.00
|
| Rate for Payer: Cigna Commercial |
$2,520.25
|
| Rate for Payer: First Health Commercial |
$2,668.50
|
| Rate for Payer: First Health Workers Compensation |
$1,144.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,668.50
|
| Rate for Payer: GEHA Commercial |
$2,075.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,668.50
|
| Rate for Payer: Multiplan All |
$2,698.15
|
| Rate for Payer: OMNI Networks Commercial |
$2,075.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,668.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,816.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,223.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,757.45
|
| Rate for Payer: Zelis Auto |
$1,186.00
|
| Rate for Payer: Zelis Worker's Compensation |
$809.45
|
|
|
NERVE PALSY FASCIAL GRAFT
|
Facility
|
IP
|
$2,065.00
|
|
|
Service Code
|
CPT 15840
|
| Hospital Charge Code |
6115840
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$563.75 |
| Max. Negotiated Rate |
$1,961.75 |
| Rate for Payer: Cash Price |
$1,239.00
|
| Rate for Payer: Cigna Commercial |
$1,755.25
|
| Rate for Payer: First Health Commercial |
$1,858.50
|
| Rate for Payer: First Health Workers Compensation |
$797.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,858.50
|
| Rate for Payer: GEHA Commercial |
$1,445.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,858.50
|
| Rate for Payer: Multiplan All |
$1,879.15
|
| Rate for Payer: OMNI Networks Commercial |
$1,445.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,858.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,961.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,548.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,920.45
|
| Rate for Payer: Zelis Auto |
$826.00
|
| Rate for Payer: Zelis Worker's Compensation |
$563.75
|
|
|
NERVE PALSY FASCIAL GRAFT
|
Facility
|
OP
|
$2,065.00
|
|
|
Service Code
|
CPT 15840
|
| Hospital Charge Code |
6115840
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$563.75 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,239.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,476.24
|
| Rate for Payer: Cash Price |
$1,239.00
|
| Rate for Payer: Cash Price |
$1,239.00
|
| Rate for Payer: Cigna Commercial |
$1,755.25
|
| Rate for Payer: First Health Commercial |
$1,858.50
|
| Rate for Payer: First Health Workers Compensation |
$797.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,858.50
|
| Rate for Payer: GEHA Commercial |
$1,652.00
|
| Rate for Payer: GEHA Medicare |
$3,476.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,858.50
|
| Rate for Payer: Humana ChoiceCare |
$3,823.86
|
| Rate for Payer: Humana Medicare Advantage |
$3,476.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,840.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,476.24
|
| Rate for Payer: Multiplan All |
$1,879.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,909.61
|
| Rate for Payer: OMNI Networks Commercial |
$1,445.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,858.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,476.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,961.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,952.48
|
| Rate for Payer: Three Rivers Provider Network All |
$1,548.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,406.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,476.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,920.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,476.24
|
| Rate for Payer: Zelis Auto |
$826.00
|
| Rate for Payer: Zelis Medicare |
$2,954.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,171.49
|
| Rate for Payer: Zelis Worker's Compensation |
$563.75
|
|
|
NERVE PALSY MICROSURG GRAFT
|
Facility
|
IP
|
$5,424.00
|
|
|
Service Code
|
CPT 15842
|
| Hospital Charge Code |
6115842
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,480.75 |
| Max. Negotiated Rate |
$5,152.80 |
| Rate for Payer: Cash Price |
$3,254.40
|
| Rate for Payer: Cigna Commercial |
$4,610.40
|
| Rate for Payer: First Health Commercial |
$4,881.60
|
| Rate for Payer: First Health Workers Compensation |
$2,094.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,881.60
|
| Rate for Payer: GEHA Commercial |
$3,796.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,881.60
|
| Rate for Payer: Multiplan All |
$4,935.84
|
| Rate for Payer: OMNI Networks Commercial |
$3,796.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,881.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,152.80
|
| Rate for Payer: Three Rivers Provider Network All |
$4,068.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,044.32
|
| Rate for Payer: Zelis Auto |
$2,169.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,480.75
|
|
|
NERVE PALSY MICROSURG GRAFT
|
Facility
|
OP
|
$5,424.00
|
|
|
Service Code
|
CPT 15842
|
| Hospital Charge Code |
6115842
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,476.39 |
| Max. Negotiated Rate |
$5,152.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,254.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$3,254.40
|
| Rate for Payer: Cash Price |
$3,254.40
|
| Rate for Payer: Cigna Commercial |
$4,610.40
|
| Rate for Payer: First Health Commercial |
$4,881.60
|
| Rate for Payer: First Health Workers Compensation |
$2,094.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,881.60
|
| Rate for Payer: GEHA Commercial |
$4,339.20
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,881.60
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$4,935.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$3,796.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,881.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,152.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$4,068.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,044.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$2,169.60
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$1,480.75
|
|
|
NERVE PALSY MUSCLE GRAFT
|
Facility
|
IP
|
$3,341.00
|
|
|
Service Code
|
CPT 15841
|
| Hospital Charge Code |
6115841
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$912.09 |
| Max. Negotiated Rate |
$3,173.95 |
| Rate for Payer: Cash Price |
$2,004.60
|
| Rate for Payer: Cigna Commercial |
$2,839.85
|
| Rate for Payer: First Health Commercial |
$3,006.90
|
| Rate for Payer: First Health Workers Compensation |
$1,289.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,006.90
|
| Rate for Payer: GEHA Commercial |
$2,338.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,006.90
|
| Rate for Payer: Multiplan All |
$3,040.31
|
| Rate for Payer: OMNI Networks Commercial |
$2,338.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,006.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,173.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,505.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,107.13
|
| Rate for Payer: Zelis Auto |
$1,336.40
|
| Rate for Payer: Zelis Worker's Compensation |
$912.09
|
|
|
NERVE PALSY MUSCLE GRAFT
|
Facility
|
OP
|
$3,341.00
|
|
|
Service Code
|
CPT 15841
|
| Hospital Charge Code |
6115841
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$912.09 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,004.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,476.24
|
| Rate for Payer: Cash Price |
$2,004.60
|
| Rate for Payer: Cash Price |
$2,004.60
|
| Rate for Payer: Cigna Commercial |
$2,839.85
|
| Rate for Payer: First Health Commercial |
$3,006.90
|
| Rate for Payer: First Health Workers Compensation |
$1,289.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,006.90
|
| Rate for Payer: GEHA Commercial |
$2,672.80
|
| Rate for Payer: GEHA Medicare |
$3,476.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,006.90
|
| Rate for Payer: Humana ChoiceCare |
$3,823.86
|
| Rate for Payer: Humana Medicare Advantage |
$3,476.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,840.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,476.24
|
| Rate for Payer: Multiplan All |
$3,040.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,909.61
|
| Rate for Payer: OMNI Networks Commercial |
$2,338.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,006.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,476.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,173.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,952.48
|
| Rate for Payer: Three Rivers Provider Network All |
$2,505.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,406.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,476.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,107.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,476.24
|
| Rate for Payer: Zelis Auto |
$1,336.40
|
| Rate for Payer: Zelis Medicare |
$2,954.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,171.49
|
| Rate for Payer: Zelis Worker's Compensation |
$912.09
|
|
|
NERVE SURGERY
|
Facility
|
OP
|
$657.00
|
|
|
Service Code
|
CPT 64859
|
| Hospital Charge Code |
6164859
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$170.82 |
| Max. Negotiated Rate |
$3,769.41 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,769.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$394.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,769.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,986.13
|
| Rate for Payer: Cash Price |
$394.20
|
| Rate for Payer: Cash Price |
$394.20
|
| Rate for Payer: Cigna Commercial |
$558.45
|
| Rate for Payer: First Health Commercial |
$591.30
|
| Rate for Payer: First Health Workers Compensation |
$253.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$591.30
|
| Rate for Payer: GEHA Commercial |
$525.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$591.30
|
| Rate for Payer: Humana ChoiceCare |
$170.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,046.94
|
| Rate for Payer: Multiplan All |
$597.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$394.20
|
| Rate for Payer: OMNI Networks Commercial |
$459.90
|
| Rate for Payer: One Health Plan PPO/POS |
$591.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,518.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,046.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$624.15
|
| Rate for Payer: Three Rivers Provider Network All |
$492.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$578.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,046.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$611.01
|
| Rate for Payer: Zelis Auto |
$262.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$328.50
|
| Rate for Payer: Zelis Worker's Compensation |
$179.36
|
|
|
NERVE SURGERY
|
Facility
|
IP
|
$657.00
|
|
|
Service Code
|
CPT 64859
|
| Hospital Charge Code |
6164859
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$179.36 |
| Max. Negotiated Rate |
$624.15 |
| Rate for Payer: Cash Price |
$394.20
|
| Rate for Payer: Cigna Commercial |
$558.45
|
| Rate for Payer: First Health Commercial |
$591.30
|
| Rate for Payer: First Health Workers Compensation |
$253.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$591.30
|
| Rate for Payer: GEHA Commercial |
$459.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$591.30
|
| Rate for Payer: Multiplan All |
$597.87
|
| Rate for Payer: OMNI Networks Commercial |
$459.90
|
| Rate for Payer: One Health Plan PPO/POS |
$591.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$624.15
|
| Rate for Payer: Three Rivers Provider Network All |
$492.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$611.01
|
| Rate for Payer: Zelis Auto |
$262.80
|
| Rate for Payer: Zelis Worker's Compensation |
$179.36
|
|
|
NEURECTOMY FOOT
|
Facility
|
IP
|
$958.00
|
|
|
Service Code
|
CPT 28055
|
| Hospital Charge Code |
6128055
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$261.53 |
| Max. Negotiated Rate |
$910.10 |
| Rate for Payer: Cash Price |
$574.80
|
| Rate for Payer: Cigna Commercial |
$814.30
|
| Rate for Payer: First Health Commercial |
$862.20
|
| Rate for Payer: First Health Workers Compensation |
$369.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$862.20
|
| Rate for Payer: GEHA Commercial |
$670.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$862.20
|
| Rate for Payer: Multiplan All |
$871.78
|
| Rate for Payer: OMNI Networks Commercial |
$670.60
|
| Rate for Payer: One Health Plan PPO/POS |
$862.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$910.10
|
| Rate for Payer: Three Rivers Provider Network All |
$718.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$890.94
|
| Rate for Payer: Zelis Auto |
$383.20
|
| Rate for Payer: Zelis Worker's Compensation |
$261.53
|
|
|
NEURECTOMY FOOT
|
Facility
|
OP
|
$958.00
|
|
|
Service Code
|
CPT 28055
|
| Hospital Charge Code |
6128055
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$261.53 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$574.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$574.80
|
| Rate for Payer: Cash Price |
$574.80
|
| Rate for Payer: Cigna Commercial |
$814.30
|
| Rate for Payer: First Health Commercial |
$862.20
|
| Rate for Payer: First Health Workers Compensation |
$369.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$862.20
|
| Rate for Payer: GEHA Commercial |
$766.40
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$862.20
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$871.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$670.60
|
| Rate for Payer: One Health Plan PPO/POS |
$862.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$910.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$718.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$890.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$383.20
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$261.53
|
|
|
NEURECTOMY HAMSTRING
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
CPT 27325
|
| Hospital Charge Code |
6127325
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$304.39 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$669.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cigna Commercial |
$947.75
|
| Rate for Payer: First Health Commercial |
$1,003.50
|
| Rate for Payer: First Health Workers Compensation |
$430.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,003.50
|
| Rate for Payer: GEHA Commercial |
$892.00
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,003.50
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$1,014.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$780.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,003.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,059.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$836.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,036.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$446.00
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$304.39
|
|
|
NEURECTOMY HAMSTRING
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
CPT 27325
|
| Hospital Charge Code |
6127325
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$304.39 |
| Max. Negotiated Rate |
$1,059.25 |
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cigna Commercial |
$947.75
|
| Rate for Payer: First Health Commercial |
$1,003.50
|
| Rate for Payer: First Health Workers Compensation |
$430.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,003.50
|
| Rate for Payer: GEHA Commercial |
$780.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,003.50
|
| Rate for Payer: Multiplan All |
$1,014.65
|
| Rate for Payer: OMNI Networks Commercial |
$780.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,003.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,059.25
|
| Rate for Payer: Three Rivers Provider Network All |
$836.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,036.95
|
| Rate for Payer: Zelis Auto |
$446.00
|
| Rate for Payer: Zelis Worker's Compensation |
$304.39
|
|
|
NEURECTOMY POPLITEAL
|
Facility
|
IP
|
$1,058.00
|
|
|
Service Code
|
CPT 27326
|
| Hospital Charge Code |
6127326
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$288.83 |
| Max. Negotiated Rate |
$1,005.10 |
| Rate for Payer: Cash Price |
$634.80
|
| Rate for Payer: Cigna Commercial |
$899.30
|
| Rate for Payer: First Health Commercial |
$952.20
|
| Rate for Payer: First Health Workers Compensation |
$408.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$952.20
|
| Rate for Payer: GEHA Commercial |
$740.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$952.20
|
| Rate for Payer: Multiplan All |
$962.78
|
| Rate for Payer: OMNI Networks Commercial |
$740.60
|
| Rate for Payer: One Health Plan PPO/POS |
$952.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,005.10
|
| Rate for Payer: Three Rivers Provider Network All |
$793.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$983.94
|
| Rate for Payer: Zelis Auto |
$423.20
|
| Rate for Payer: Zelis Worker's Compensation |
$288.83
|
|
|
NEURECTOMY POPLITEAL
|
Facility
|
OP
|
$1,058.00
|
|
|
Service Code
|
CPT 27326
|
| Hospital Charge Code |
6127326
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$288.83 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$634.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$634.80
|
| Rate for Payer: Cash Price |
$634.80
|
| Rate for Payer: Cigna Commercial |
$899.30
|
| Rate for Payer: First Health Commercial |
$952.20
|
| Rate for Payer: First Health Workers Compensation |
$408.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$952.20
|
| Rate for Payer: GEHA Commercial |
$846.40
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$952.20
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$962.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$740.60
|
| Rate for Payer: One Health Plan PPO/POS |
$952.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,005.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$793.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$983.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$423.20
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$288.83
|
|
|
neuromyelitis optica IgG abs REF004210
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2200439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$20.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Worker's Compensation |
$14.31
|
|
|
neuromyelitis optica IgG abs REF004210
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2200439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$20.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: GEHA Medicare |
$17.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Humana ChoiceCare |
$19.00
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.27
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29.36
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$29.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34.54
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.92
|
| Rate for Payer: United Healthcare Commercial |
$142.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.27
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Medicare |
$14.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.72
|
| Rate for Payer: Zelis Worker's Compensation |
$14.31
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL
|
Facility
|
OP
|
$3,708.46
|
|
|
Service Code
|
CPT 64721
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,499.44 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: First Health Workers Compensation |
$2,386.39
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$1,687.35
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT ELBOW
|
Facility
|
OP
|
$3,708.46
|
|
|
Service Code
|
CPT 64718
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,499.44 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: First Health Workers Compensation |
$2,386.39
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$1,687.35
|
|
|
NEUROVASCULAR PEDICLE FLAP
|
Facility
|
IP
|
$1,879.00
|
|
|
Service Code
|
CPT 15750
|
| Hospital Charge Code |
6115750
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$512.97 |
| Max. Negotiated Rate |
$1,785.05 |
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$1,597.15
|
| Rate for Payer: First Health Commercial |
$1,691.10
|
| Rate for Payer: First Health Workers Compensation |
$725.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,691.10
|
| Rate for Payer: GEHA Commercial |
$1,315.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,691.10
|
| Rate for Payer: Multiplan All |
$1,709.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,315.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,691.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,785.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,409.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,747.47
|
| Rate for Payer: Zelis Auto |
$751.60
|
| Rate for Payer: Zelis Worker's Compensation |
$512.97
|
|
