|
REMOVAL OF ETHMOID SINUS
|
Facility
|
IP
|
$1,122.00
|
|
|
Service Code
|
CPT 31200
|
| Hospital Charge Code |
6131200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$306.31 |
| Max. Negotiated Rate |
$1,065.90 |
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cigna Commercial |
$953.70
|
| Rate for Payer: First Health Commercial |
$1,009.80
|
| Rate for Payer: First Health Workers Compensation |
$433.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,009.80
|
| Rate for Payer: GEHA Commercial |
$785.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,009.80
|
| Rate for Payer: Multiplan All |
$1,021.02
|
| Rate for Payer: OMNI Networks Commercial |
$785.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,009.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,065.90
|
| Rate for Payer: Three Rivers Provider Network All |
$841.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,043.46
|
| Rate for Payer: Zelis Auto |
$448.80
|
| Rate for Payer: Zelis Worker's Compensation |
$306.31
|
|
|
REMOVAL OF ETHMOID SINUS
|
Facility
|
OP
|
$1,122.00
|
|
|
Service Code
|
CPT 31200
|
| Hospital Charge Code |
6131200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$306.31 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$673.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cigna Commercial |
$953.70
|
| Rate for Payer: First Health Commercial |
$1,009.80
|
| Rate for Payer: First Health Workers Compensation |
$433.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,009.80
|
| Rate for Payer: GEHA Commercial |
$897.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,009.80
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,021.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$785.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,009.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,065.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$841.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,043.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$448.80
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$306.31
|
|
|
REMOVAL OF ETHMOID SINUS
|
Facility
|
IP
|
$1,783.00
|
|
|
Service Code
|
CPT 31205
|
| Hospital Charge Code |
6131205
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$486.76 |
| Max. Negotiated Rate |
$1,693.85 |
| Rate for Payer: Cash Price |
$1,069.80
|
| Rate for Payer: Cigna Commercial |
$1,515.55
|
| Rate for Payer: First Health Commercial |
$1,604.70
|
| Rate for Payer: First Health Workers Compensation |
$688.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,604.70
|
| Rate for Payer: GEHA Commercial |
$1,248.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,604.70
|
| Rate for Payer: Multiplan All |
$1,622.53
|
| Rate for Payer: OMNI Networks Commercial |
$1,248.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,604.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,693.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,337.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,658.19
|
| Rate for Payer: Zelis Auto |
$713.20
|
| Rate for Payer: Zelis Worker's Compensation |
$486.76
|
|
|
REMOVAL OF ETHMOID SINUS
|
Facility
|
OP
|
$1,488.00
|
|
|
Service Code
|
CPT 31201
|
| Hospital Charge Code |
6131201
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$406.22 |
| Max. Negotiated Rate |
$4,345.94 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$892.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,406.53
|
| Rate for Payer: Cash Price |
$892.80
|
| Rate for Payer: Cash Price |
$892.80
|
| Rate for Payer: Cigna Commercial |
$1,264.80
|
| Rate for Payer: First Health Commercial |
$1,339.20
|
| Rate for Payer: First Health Workers Compensation |
$574.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,339.20
|
| Rate for Payer: GEHA Commercial |
$1,190.40
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,339.20
|
| Rate for Payer: Humana ChoiceCare |
$1,547.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,406.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,362.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,406.53
|
| Rate for Payer: Multiplan All |
$1,354.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$1,041.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,339.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,406.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,413.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$1,116.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,406.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,383.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$595.20
|
| Rate for Payer: Zelis Medicare |
$1,195.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,687.84
|
| Rate for Payer: Zelis Worker's Compensation |
$406.22
|
|
|
REMOVAL OF ETHMOID SINUS
|
Facility
|
OP
|
$830.00
|
|
|
Service Code
|
CPT 31255
|
| Hospital Charge Code |
6131255
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$226.59 |
| Max. Negotiated Rate |
$13,146.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,959.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$498.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,959.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,344.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,573.16
|
| Rate for Payer: Cash Price |
$498.00
|
| Rate for Payer: Cash Price |
$498.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$747.00
|
| Rate for Payer: First Health Workers Compensation |
$320.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$747.00
|
| Rate for Payer: GEHA Commercial |
$664.00
|
| Rate for Payer: GEHA Medicare |
$6,573.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$747.00
|
| Rate for Payer: Humana ChoiceCare |
$7,230.48
|
| Rate for Payer: Humana Medicare Advantage |
$6,573.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,042.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,392.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,573.16
|
| Rate for Payer: Multiplan All |
$755.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,174.37
|
| Rate for Payer: OMNI Networks Commercial |
$581.00
|
| Rate for Payer: One Health Plan PPO/POS |
$747.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,762.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,392.37
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,573.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$788.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,146.32
|
| Rate for Payer: Three Rivers Provider Network All |
$622.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,441.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,392.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,573.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$771.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,573.16
|
| Rate for Payer: Zelis Auto |
$332.00
|
| Rate for Payer: Zelis Medicare |
$5,587.19
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,887.79
|
| Rate for Payer: Zelis Worker's Compensation |
$226.59
|
|
|
REMOVAL OF FALLOPIAN TUBE
|
Facility
|
OP
|
$2,375.04
|
|
|
Service Code
|
CPT 58700
|
| Hospital Charge Code |
6158700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$593.76 |
| Max. Negotiated Rate |
$2,256.29 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,425.02
|
| Rate for Payer: Cash Price |
$1,425.02
|
| Rate for Payer: Cigna Commercial |
$2,018.78
|
| Rate for Payer: First Health Commercial |
$2,137.54
|
| Rate for Payer: First Health Workers Compensation |
$917.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,137.54
|
| Rate for Payer: GEHA Commercial |
$1,900.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,137.54
|
| Rate for Payer: Humana ChoiceCare |
$617.51
|
| Rate for Payer: Multiplan All |
$2,161.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,425.02
|
| Rate for Payer: OMNI Networks Commercial |
$1,662.53
|
| Rate for Payer: One Health Plan PPO/POS |
$2,137.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,256.29
|
| Rate for Payer: Three Rivers Provider Network All |
$1,781.28
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,090.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$593.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,208.79
|
| Rate for Payer: Zelis Auto |
$950.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,187.52
|
| Rate for Payer: Zelis Worker's Compensation |
$648.39
|
|
|
REMOVAL OF FALLOPIAN TUBE
|
Facility
|
IP
|
$2,375.04
|
|
|
Service Code
|
CPT 58700
|
| Hospital Charge Code |
6158700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$648.39 |
| Max. Negotiated Rate |
$2,256.29 |
| Rate for Payer: Cash Price |
$1,425.02
|
| Rate for Payer: Cigna Commercial |
$2,018.78
|
| Rate for Payer: First Health Commercial |
$2,137.54
|
| Rate for Payer: First Health Workers Compensation |
$917.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,137.54
|
| Rate for Payer: GEHA Commercial |
$1,662.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,137.54
|
| Rate for Payer: Multiplan All |
$2,161.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,662.53
|
| Rate for Payer: One Health Plan PPO/POS |
$2,137.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,256.29
|
| Rate for Payer: Three Rivers Provider Network All |
$1,781.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,208.79
|
| Rate for Payer: Zelis Auto |
$950.02
|
| Rate for Payer: Zelis Worker's Compensation |
$648.39
|
|
|
REMOVAL OF FASCIA FOR GRAFT
|
Facility
|
IP
|
$1,033.00
|
|
|
Service Code
|
CPT 20922
|
| Hospital Charge Code |
6120922
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$282.01 |
| Max. Negotiated Rate |
$981.35 |
| Rate for Payer: Cash Price |
$619.80
|
| Rate for Payer: Cigna Commercial |
$878.05
|
| Rate for Payer: First Health Commercial |
$929.70
|
| Rate for Payer: First Health Workers Compensation |
$398.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$929.70
|
| Rate for Payer: GEHA Commercial |
$723.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$929.70
|
| Rate for Payer: Multiplan All |
$940.03
|
| Rate for Payer: OMNI Networks Commercial |
$723.10
|
| Rate for Payer: One Health Plan PPO/POS |
$929.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$981.35
|
| Rate for Payer: Three Rivers Provider Network All |
$774.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$960.69
|
| Rate for Payer: Zelis Auto |
$413.20
|
| Rate for Payer: Zelis Worker's Compensation |
$282.01
|
|
|
REMOVAL OF FASCIA FOR GRAFT
|
Facility
|
OP
|
$1,033.00
|
|
|
Service Code
|
CPT 20922
|
| Hospital Charge Code |
6120922
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$282.01 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$619.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,285.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$619.80
|
| Rate for Payer: Cash Price |
$619.80
|
| Rate for Payer: Cigna Commercial |
$878.05
|
| Rate for Payer: First Health Commercial |
$929.70
|
| Rate for Payer: First Health Workers Compensation |
$398.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$929.70
|
| Rate for Payer: GEHA Commercial |
$826.40
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$929.70
|
| 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 |
$1,312.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$940.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$723.10
|
| Rate for Payer: One Health Plan PPO/POS |
$929.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,515.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,312.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$981.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$774.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,312.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$960.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$413.20
|
| 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 |
$282.01
|
|
|
REMOVAL OF FASCIA FOR GRAFT
|
Facility
|
OP
|
$1,005.00
|
|
|
Service Code
|
CPT 20920
|
| Hospital Charge Code |
6120920
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$274.37 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$603.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,285.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cigna Commercial |
$854.25
|
| Rate for Payer: First Health Commercial |
$904.50
|
| Rate for Payer: First Health Workers Compensation |
$388.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$904.50
|
| Rate for Payer: GEHA Commercial |
$804.00
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$904.50
|
| 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 |
$1,312.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$914.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$703.50
|
| Rate for Payer: One Health Plan PPO/POS |
$904.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,515.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,312.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$954.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$753.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,312.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$934.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$402.00
|
| 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 |
$274.37
|
|
|
REMOVAL OF FASCIA FOR GRAFT
|
Facility
|
IP
|
$1,005.00
|
|
|
Service Code
|
CPT 20920
|
| Hospital Charge Code |
6120920
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$274.37 |
| Max. Negotiated Rate |
$954.75 |
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cigna Commercial |
$854.25
|
| Rate for Payer: First Health Commercial |
$904.50
|
| Rate for Payer: First Health Workers Compensation |
$388.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$904.50
|
| Rate for Payer: GEHA Commercial |
$703.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$904.50
|
| Rate for Payer: Multiplan All |
$914.55
|
| Rate for Payer: OMNI Networks Commercial |
$703.50
|
| Rate for Payer: One Health Plan PPO/POS |
$904.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$954.75
|
| Rate for Payer: Three Rivers Provider Network All |
$753.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$934.65
|
| Rate for Payer: Zelis Auto |
$402.00
|
| Rate for Payer: Zelis Worker's Compensation |
$274.37
|
|
|
REMOVAL OF FINGER LESION
|
Facility
|
IP
|
$892.00
|
|
|
Service Code
|
CPT 26210
|
| Hospital Charge Code |
6126210
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$243.52 |
| Max. Negotiated Rate |
$847.40 |
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cigna Commercial |
$758.20
|
| Rate for Payer: First Health Commercial |
$802.80
|
| Rate for Payer: First Health Workers Compensation |
$344.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$802.80
|
| Rate for Payer: GEHA Commercial |
$624.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$802.80
|
| Rate for Payer: Multiplan All |
$811.72
|
| Rate for Payer: OMNI Networks Commercial |
$624.40
|
| Rate for Payer: One Health Plan PPO/POS |
$802.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$847.40
|
| Rate for Payer: Three Rivers Provider Network All |
$669.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$829.56
|
| Rate for Payer: Zelis Auto |
$356.80
|
| Rate for Payer: Zelis Worker's Compensation |
$243.52
|
|
|
REMOVAL OF FINGER LESION
|
Facility
|
OP
|
$892.00
|
|
|
Service Code
|
CPT 26210
|
| Hospital Charge Code |
6126210
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$243.52 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$535.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cigna Commercial |
$758.20
|
| Rate for Payer: First Health Commercial |
$802.80
|
| Rate for Payer: First Health Workers Compensation |
$344.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$802.80
|
| Rate for Payer: GEHA Commercial |
$713.60
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$802.80
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$811.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$624.40
|
| Rate for Payer: One Health Plan PPO/POS |
$802.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$847.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$669.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$829.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$356.80
|
| 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 |
$243.52
|
|
|
REMOVAL OF FINGER TENDON
|
Facility
|
OP
|
$892.00
|
|
|
Service Code
|
CPT 26180
|
| Hospital Charge Code |
6126180
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$243.52 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$535.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cigna Commercial |
$758.20
|
| Rate for Payer: First Health Commercial |
$802.80
|
| Rate for Payer: First Health Workers Compensation |
$344.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$802.80
|
| Rate for Payer: GEHA Commercial |
$713.60
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$802.80
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$811.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$624.40
|
| Rate for Payer: One Health Plan PPO/POS |
$802.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$847.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$669.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$829.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$356.80
|
| 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 |
$243.52
|
|
|
REMOVAL OF FINGER TENDON
|
Facility
|
IP
|
$892.00
|
|
|
Service Code
|
CPT 26180
|
| Hospital Charge Code |
6126180
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$243.52 |
| Max. Negotiated Rate |
$847.40 |
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cigna Commercial |
$758.20
|
| Rate for Payer: First Health Commercial |
$802.80
|
| Rate for Payer: First Health Workers Compensation |
$344.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$802.80
|
| Rate for Payer: GEHA Commercial |
$624.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$802.80
|
| Rate for Payer: Multiplan All |
$811.72
|
| Rate for Payer: OMNI Networks Commercial |
$624.40
|
| Rate for Payer: One Health Plan PPO/POS |
$802.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$847.40
|
| Rate for Payer: Three Rivers Provider Network All |
$669.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$829.56
|
| Rate for Payer: Zelis Auto |
$356.80
|
| Rate for Payer: Zelis Worker's Compensation |
$243.52
|
|
|
REMOVAL OF FIXATION DEVICE
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 20665
|
| Hospital Charge Code |
6120665
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$75.08 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: First Health Workers Compensation |
$106.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$192.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Worker's Compensation |
$75.08
|
|
|
REMOVAL OF FIXATION DEVICE
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 20665
|
| Hospital Charge Code |
6120665
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$75.08 |
| Max. Negotiated Rate |
$757.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$378.90
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: First Health Workers Compensation |
$106.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$220.00
|
| Rate for Payer: GEHA Medicare |
$378.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Humana ChoiceCare |
$416.79
|
| Rate for Payer: Humana Medicare Advantage |
$378.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$636.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$378.90
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.13
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$378.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$757.80
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$378.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$378.90
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Medicare |
$322.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.68
|
| Rate for Payer: Zelis Worker's Compensation |
$75.08
|
|
|
REMOVAL OF FOOT FASCIA
|
Facility
|
OP
|
$832.00
|
|
|
Service Code
|
CPT 28062
|
| Hospital Charge Code |
6128062
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$227.14 |
| 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 |
$499.20
|
| 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 |
$499.20
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cigna Commercial |
$707.20
|
| Rate for Payer: First Health Commercial |
$748.80
|
| Rate for Payer: First Health Workers Compensation |
$321.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$748.80
|
| Rate for Payer: GEHA Commercial |
$665.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$748.80
|
| 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 |
$757.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$582.40
|
| Rate for Payer: One Health Plan PPO/POS |
$748.80
|
| 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 |
$790.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$624.00
|
| 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 |
$773.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$332.80
|
| 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 |
$227.14
|
|
|
REMOVAL OF FOOT FASCIA
|
Facility
|
IP
|
$832.00
|
|
|
Service Code
|
CPT 28062
|
| Hospital Charge Code |
6128062
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$227.14 |
| Max. Negotiated Rate |
$790.40 |
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cigna Commercial |
$707.20
|
| Rate for Payer: First Health Commercial |
$748.80
|
| Rate for Payer: First Health Workers Compensation |
$321.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$748.80
|
| Rate for Payer: GEHA Commercial |
$582.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$748.80
|
| Rate for Payer: Multiplan All |
$757.12
|
| Rate for Payer: OMNI Networks Commercial |
$582.40
|
| Rate for Payer: One Health Plan PPO/POS |
$748.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$790.40
|
| Rate for Payer: Three Rivers Provider Network All |
$624.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$773.76
|
| Rate for Payer: Zelis Auto |
$332.80
|
| Rate for Payer: Zelis Worker's Compensation |
$227.14
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
IP
|
$802.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
6128192
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$218.95 |
| Max. Negotiated Rate |
$761.90 |
| Rate for Payer: Cash Price |
$481.20
|
| Rate for Payer: Cigna Commercial |
$681.70
|
| Rate for Payer: First Health Commercial |
$721.80
|
| Rate for Payer: First Health Workers Compensation |
$309.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$721.80
|
| Rate for Payer: GEHA Commercial |
$561.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$721.80
|
| Rate for Payer: Multiplan All |
$729.82
|
| Rate for Payer: OMNI Networks Commercial |
$561.40
|
| Rate for Payer: One Health Plan PPO/POS |
$721.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$761.90
|
| Rate for Payer: Three Rivers Provider Network All |
$601.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$745.86
|
| Rate for Payer: Zelis Auto |
$320.80
|
| Rate for Payer: Zelis Worker's Compensation |
$218.95
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
OP
|
$802.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
6128192
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$218.95 |
| Max. Negotiated Rate |
$3,076.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$481.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,538.48
|
| Rate for Payer: Cash Price |
$481.20
|
| Rate for Payer: Cash Price |
$481.20
|
| Rate for Payer: Cigna Commercial |
$681.70
|
| Rate for Payer: First Health Commercial |
$721.80
|
| Rate for Payer: First Health Workers Compensation |
$309.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$721.80
|
| Rate for Payer: GEHA Commercial |
$641.60
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$721.80
|
| Rate for Payer: Humana ChoiceCare |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$1,538.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,584.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,538.48
|
| Rate for Payer: Multiplan All |
$729.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$561.40
|
| Rate for Payer: One Health Plan PPO/POS |
$721.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,538.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$761.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$601.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,507.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,538.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$745.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$320.80
|
| Rate for Payer: Zelis Medicare |
$1,307.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,846.18
|
| Rate for Payer: Zelis Worker's Compensation |
$218.95
|
|
|
REMOVAL OF FOOT JOINT LINING
|
Facility
|
OP
|
$846.00
|
|
|
Service Code
|
CPT 28072
|
| Hospital Charge Code |
6128072
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$230.96 |
| 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 |
$507.60
|
| 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 |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$719.10
|
| Rate for Payer: First Health Commercial |
$761.40
|
| Rate for Payer: First Health Workers Compensation |
$326.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$761.40
|
| Rate for Payer: GEHA Commercial |
$676.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$761.40
|
| 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 |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$769.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$592.20
|
| Rate for Payer: One Health Plan PPO/POS |
$761.40
|
| 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 |
$803.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$634.50
|
| 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 |
$786.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$338.40
|
| 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 |
$230.96
|
|
|
REMOVAL OF FOOT JOINT LINING
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT 28070
|
| Hospital Charge Code |
6128070
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$247.61 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$544.20
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cigna Commercial |
$770.95
|
| Rate for Payer: First Health Commercial |
$816.30
|
| Rate for Payer: First Health Workers Compensation |
$350.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$816.30
|
| Rate for Payer: GEHA Commercial |
$725.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$816.30
|
| 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 |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$825.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$634.90
|
| Rate for Payer: One Health Plan PPO/POS |
$816.30
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$861.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$680.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$843.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$362.80
|
| 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 |
$247.61
|
|
|
REMOVAL OF FOOT JOINT LINING
|
Facility
|
IP
|
$846.00
|
|
|
Service Code
|
CPT 28072
|
| Hospital Charge Code |
6128072
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$230.96 |
| Max. Negotiated Rate |
$803.70 |
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$719.10
|
| Rate for Payer: First Health Commercial |
$761.40
|
| Rate for Payer: First Health Workers Compensation |
$326.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$761.40
|
| Rate for Payer: GEHA Commercial |
$592.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$761.40
|
| Rate for Payer: Multiplan All |
$769.86
|
| Rate for Payer: OMNI Networks Commercial |
$592.20
|
| Rate for Payer: One Health Plan PPO/POS |
$761.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$803.70
|
| Rate for Payer: Three Rivers Provider Network All |
$634.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$786.78
|
| Rate for Payer: Zelis Auto |
$338.40
|
| Rate for Payer: Zelis Worker's Compensation |
$230.96
|
|
|
REMOVAL OF FOOT JOINT LINING
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT 28070
|
| Hospital Charge Code |
6128070
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$247.61 |
| Max. Negotiated Rate |
$861.65 |
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cigna Commercial |
$770.95
|
| Rate for Payer: First Health Commercial |
$816.30
|
| Rate for Payer: First Health Workers Compensation |
$350.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$816.30
|
| Rate for Payer: GEHA Commercial |
$634.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$816.30
|
| Rate for Payer: Multiplan All |
$825.37
|
| Rate for Payer: OMNI Networks Commercial |
$634.90
|
| Rate for Payer: One Health Plan PPO/POS |
$816.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$861.65
|
| Rate for Payer: Three Rivers Provider Network All |
$680.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$843.51
|
| Rate for Payer: Zelis Auto |
$362.80
|
| Rate for Payer: Zelis Worker's Compensation |
$247.61
|
|
