|
REMOVAL OF GALLBLADDER
|
Facility
|
OP
|
$2,900.00
|
|
|
Service Code
|
CPT 47620
|
| Hospital Charge Code |
6147620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$725.00 |
| Max. Negotiated Rate |
$2,755.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,740.00
|
| Rate for Payer: Cash Price |
$1,740.00
|
| Rate for Payer: Cigna Commercial |
$2,465.00
|
| Rate for Payer: First Health Commercial |
$2,610.00
|
| Rate for Payer: First Health Workers Compensation |
$1,119.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,610.00
|
| Rate for Payer: GEHA Commercial |
$2,320.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,610.00
|
| Rate for Payer: Humana ChoiceCare |
$754.00
|
| Rate for Payer: Multiplan All |
$2,639.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,740.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,030.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,610.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,755.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,175.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,552.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$725.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,697.00
|
| Rate for Payer: Zelis Auto |
$1,160.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,450.00
|
| Rate for Payer: Zelis Worker's Compensation |
$791.70
|
|
|
REMOVAL OF GALLBLADDER
|
Facility
|
IP
|
$2,363.00
|
|
|
Service Code
|
CPT 47605
|
| Hospital Charge Code |
6147605
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$645.10 |
| Max. Negotiated Rate |
$2,244.85 |
| Rate for Payer: Cash Price |
$1,417.80
|
| Rate for Payer: Cigna Commercial |
$2,008.55
|
| Rate for Payer: First Health Commercial |
$2,126.70
|
| Rate for Payer: First Health Workers Compensation |
$912.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,126.70
|
| Rate for Payer: GEHA Commercial |
$1,654.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,126.70
|
| Rate for Payer: Multiplan All |
$2,150.33
|
| Rate for Payer: OMNI Networks Commercial |
$1,654.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,126.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,244.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,772.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,197.59
|
| Rate for Payer: Zelis Auto |
$945.20
|
| Rate for Payer: Zelis Worker's Compensation |
$645.10
|
|
|
REMOVAL OF GALLBLADDER
|
Facility
|
IP
|
$2,642.00
|
|
|
Service Code
|
CPT 47610
|
| Hospital Charge Code |
6147610
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$721.27 |
| Max. Negotiated Rate |
$2,509.90 |
| Rate for Payer: Cash Price |
$1,585.20
|
| Rate for Payer: Cigna Commercial |
$2,245.70
|
| Rate for Payer: First Health Commercial |
$2,377.80
|
| Rate for Payer: First Health Workers Compensation |
$1,020.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,377.80
|
| Rate for Payer: GEHA Commercial |
$1,849.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,377.80
|
| Rate for Payer: Multiplan All |
$2,404.22
|
| Rate for Payer: OMNI Networks Commercial |
$1,849.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,377.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,509.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,981.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,457.06
|
| Rate for Payer: Zelis Auto |
$1,056.80
|
| Rate for Payer: Zelis Worker's Compensation |
$721.27
|
|
|
REMOVAL OF GALLBLADDER
|
Facility
|
IP
|
$2,243.00
|
|
|
Service Code
|
CPT 47600
|
| Hospital Charge Code |
6147600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$612.34 |
| Max. Negotiated Rate |
$2,130.85 |
| Rate for Payer: Cash Price |
$1,345.80
|
| Rate for Payer: Cigna Commercial |
$1,906.55
|
| Rate for Payer: First Health Commercial |
$2,018.70
|
| Rate for Payer: First Health Workers Compensation |
$866.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,018.70
|
| Rate for Payer: GEHA Commercial |
$1,570.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,018.70
|
| Rate for Payer: Multiplan All |
$2,041.13
|
| Rate for Payer: OMNI Networks Commercial |
$1,570.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,018.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,130.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,682.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,085.99
|
| Rate for Payer: Zelis Auto |
$897.20
|
| Rate for Payer: Zelis Worker's Compensation |
$612.34
|
|
|
REMOVAL OF GALLBLADDER
|
Facility
|
OP
|
$2,243.00
|
|
|
Service Code
|
CPT 47600
|
| Hospital Charge Code |
6147600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$560.75 |
| Max. Negotiated Rate |
$2,130.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,345.80
|
| Rate for Payer: Cash Price |
$1,345.80
|
| Rate for Payer: Cigna Commercial |
$1,906.55
|
| Rate for Payer: First Health Commercial |
$2,018.70
|
| Rate for Payer: First Health Workers Compensation |
$866.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,018.70
|
| Rate for Payer: GEHA Commercial |
$1,794.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,018.70
|
| Rate for Payer: Humana ChoiceCare |
$583.18
|
| Rate for Payer: Multiplan All |
$2,041.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,345.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,570.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,018.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,130.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,682.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,973.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$560.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,085.99
|
| Rate for Payer: Zelis Auto |
$897.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,121.50
|
| Rate for Payer: Zelis Worker's Compensation |
$612.34
|
|
|
REMOVAL OF HEAD OF HUMERUS
|
Facility
|
OP
|
$1,543.00
|
|
|
Service Code
|
CPT 23195
|
| Hospital Charge Code |
6123195
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$421.24 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$925.80
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$925.80
|
| Rate for Payer: Cash Price |
$925.80
|
| Rate for Payer: Cigna Commercial |
$1,311.55
|
| Rate for Payer: First Health Commercial |
$1,388.70
|
| Rate for Payer: First Health Workers Compensation |
$595.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,388.70
|
| Rate for Payer: GEHA Commercial |
$1,234.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,388.70
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,404.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,080.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,388.70
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,465.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,157.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,434.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$617.20
|
| 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 |
$421.24
|
|
|
REMOVAL OF HEAD OF HUMERUS
|
Facility
|
IP
|
$1,543.00
|
|
|
Service Code
|
CPT 23195
|
| Hospital Charge Code |
6123195
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$421.24 |
| Max. Negotiated Rate |
$1,465.85 |
| Rate for Payer: Cash Price |
$925.80
|
| Rate for Payer: Cigna Commercial |
$1,311.55
|
| Rate for Payer: First Health Commercial |
$1,388.70
|
| Rate for Payer: First Health Workers Compensation |
$595.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,388.70
|
| Rate for Payer: GEHA Commercial |
$1,080.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,388.70
|
| Rate for Payer: Multiplan All |
$1,404.13
|
| Rate for Payer: OMNI Networks Commercial |
$1,080.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,388.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,465.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,157.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,434.99
|
| Rate for Payer: Zelis Auto |
$617.20
|
| Rate for Payer: Zelis Worker's Compensation |
$421.24
|
|
|
REMOVAL OF HEAD OF RADIUS
|
Facility
|
OP
|
$1,033.00
|
|
|
Service Code
|
CPT 24130
|
| Hospital Charge Code |
6124130
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$282.01 |
| 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 |
$619.80
|
| 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 |
$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 |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$929.70
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$940.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| 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 |
$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 |
$981.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$774.75
|
| 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 |
$960.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$413.20
|
| 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 |
$282.01
|
|
|
REMOVAL OF HEAD OF RADIUS
|
Facility
|
IP
|
$1,033.00
|
|
|
Service Code
|
CPT 24130
|
| Hospital Charge Code |
6124130
|
|
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 HEEL BONE
|
Facility
|
IP
|
$1,737.21
|
|
|
Service Code
|
CPT 28118
|
| Hospital Charge Code |
6128118
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$474.26 |
| Max. Negotiated Rate |
$1,650.35 |
| Rate for Payer: Cash Price |
$1,042.33
|
| Rate for Payer: Cigna Commercial |
$1,476.63
|
| Rate for Payer: First Health Commercial |
$1,563.49
|
| Rate for Payer: First Health Workers Compensation |
$670.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,563.49
|
| Rate for Payer: GEHA Commercial |
$1,216.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,563.49
|
| Rate for Payer: Multiplan All |
$1,580.86
|
| Rate for Payer: OMNI Networks Commercial |
$1,216.05
|
| Rate for Payer: One Health Plan PPO/POS |
$1,563.49
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,650.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,302.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,615.61
|
| Rate for Payer: Zelis Auto |
$694.88
|
| Rate for Payer: Zelis Worker's Compensation |
$474.26
|
|
|
REMOVAL OF HEEL BONE
|
Facility
|
OP
|
$1,737.21
|
|
|
Service Code
|
CPT 28118
|
| Hospital Charge Code |
6128118
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$474.26 |
| 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 |
$1,042.33
|
| 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 |
$1,042.33
|
| Rate for Payer: Cash Price |
$1,042.33
|
| Rate for Payer: Cigna Commercial |
$1,476.63
|
| Rate for Payer: First Health Commercial |
$1,563.49
|
| Rate for Payer: First Health Workers Compensation |
$670.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,563.49
|
| Rate for Payer: GEHA Commercial |
$1,389.77
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,563.49
|
| 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 |
$1,580.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,216.05
|
| Rate for Payer: One Health Plan PPO/POS |
$1,563.49
|
| 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 |
$1,650.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,302.91
|
| 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 |
$1,615.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$694.88
|
| 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 |
$474.26
|
|
|
REMOVAL OF HEEL SPUR
|
Facility
|
IP
|
$1,451.37
|
|
|
Service Code
|
CPT 28119
|
| Hospital Charge Code |
6128119
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$396.22 |
| Max. Negotiated Rate |
$1,378.80 |
| Rate for Payer: Cash Price |
$870.82
|
| Rate for Payer: Cigna Commercial |
$1,233.66
|
| Rate for Payer: First Health Commercial |
$1,306.23
|
| Rate for Payer: First Health Workers Compensation |
$560.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,306.23
|
| Rate for Payer: GEHA Commercial |
$1,015.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,306.23
|
| Rate for Payer: Multiplan All |
$1,320.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,015.96
|
| Rate for Payer: One Health Plan PPO/POS |
$1,306.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,378.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,088.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,349.77
|
| Rate for Payer: Zelis Auto |
$580.55
|
| Rate for Payer: Zelis Worker's Compensation |
$396.22
|
|
|
REMOVAL OF HEEL SPUR
|
Facility
|
OP
|
$1,451.37
|
|
|
Service Code
|
CPT 28119
|
| Hospital Charge Code |
6128119
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$396.22 |
| 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 |
$870.82
|
| 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 |
$870.82
|
| Rate for Payer: Cash Price |
$870.82
|
| Rate for Payer: Cigna Commercial |
$1,233.66
|
| Rate for Payer: First Health Commercial |
$1,306.23
|
| Rate for Payer: First Health Workers Compensation |
$560.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,306.23
|
| Rate for Payer: GEHA Commercial |
$1,161.10
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,306.23
|
| 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 |
$1,320.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,015.96
|
| Rate for Payer: One Health Plan PPO/POS |
$1,306.23
|
| 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 |
$1,378.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,088.53
|
| 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 |
$1,349.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$580.55
|
| 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 |
$396.22
|
|
|
REMOVAL OF HIP JOINT LINING
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
CPT 27054
|
| Hospital Charge Code |
6127054
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$1,330.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$840.00
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cigna Commercial |
$1,190.00
|
| Rate for Payer: First Health Commercial |
$1,260.00
|
| Rate for Payer: First Health Workers Compensation |
$540.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,260.00
|
| Rate for Payer: GEHA Commercial |
$1,120.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,260.00
|
| Rate for Payer: Humana ChoiceCare |
$364.00
|
| Rate for Payer: Multiplan All |
$1,274.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$840.00
|
| Rate for Payer: OMNI Networks Commercial |
$980.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,260.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,330.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,050.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,232.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$350.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,302.00
|
| Rate for Payer: Zelis Auto |
$560.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$700.00
|
| Rate for Payer: Zelis Worker's Compensation |
$382.20
|
|
|
REMOVAL OF HIP JOINT LINING
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
CPT 27054
|
| Hospital Charge Code |
6127054
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$382.20 |
| Max. Negotiated Rate |
$1,330.00 |
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cigna Commercial |
$1,190.00
|
| Rate for Payer: First Health Commercial |
$1,260.00
|
| Rate for Payer: First Health Workers Compensation |
$540.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,260.00
|
| Rate for Payer: GEHA Commercial |
$980.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,260.00
|
| Rate for Payer: Multiplan All |
$1,274.00
|
| Rate for Payer: OMNI Networks Commercial |
$980.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,260.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,330.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,050.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,302.00
|
| Rate for Payer: Zelis Auto |
$560.00
|
| Rate for Payer: Zelis Worker's Compensation |
$382.20
|
|
|
REMOVAL OF HIP PROSTHESIS
|
Facility
|
IP
|
$1,704.00
|
|
|
Service Code
|
CPT 27090
|
| Hospital Charge Code |
6127090
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$465.19 |
| Max. Negotiated Rate |
$1,618.80 |
| Rate for Payer: Cash Price |
$1,022.40
|
| Rate for Payer: Cigna Commercial |
$1,448.40
|
| Rate for Payer: First Health Commercial |
$1,533.60
|
| Rate for Payer: First Health Workers Compensation |
$657.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,533.60
|
| Rate for Payer: GEHA Commercial |
$1,192.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,533.60
|
| Rate for Payer: Multiplan All |
$1,550.64
|
| Rate for Payer: OMNI Networks Commercial |
$1,192.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,533.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,618.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,278.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,584.72
|
| Rate for Payer: Zelis Auto |
$681.60
|
| Rate for Payer: Zelis Worker's Compensation |
$465.19
|
|
|
REMOVAL OF HIP PROSTHESIS
|
Facility
|
OP
|
$1,704.00
|
|
|
Service Code
|
CPT 27090
|
| Hospital Charge Code |
6127090
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$426.00 |
| Max. Negotiated Rate |
$1,618.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,022.40
|
| Rate for Payer: Cash Price |
$1,022.40
|
| Rate for Payer: Cigna Commercial |
$1,448.40
|
| Rate for Payer: First Health Commercial |
$1,533.60
|
| Rate for Payer: First Health Workers Compensation |
$657.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,533.60
|
| Rate for Payer: GEHA Commercial |
$1,363.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,533.60
|
| Rate for Payer: Humana ChoiceCare |
$443.04
|
| Rate for Payer: Multiplan All |
$1,550.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,022.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,192.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,533.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,618.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,278.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,499.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$426.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,584.72
|
| Rate for Payer: Zelis Auto |
$681.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$852.00
|
| Rate for Payer: Zelis Worker's Compensation |
$465.19
|
|
|
REMOVAL OF HIP PROSTHESIS
|
Facility
|
IP
|
$3,307.00
|
|
|
Service Code
|
CPT 27091
|
| Hospital Charge Code |
6127091
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$902.81 |
| Max. Negotiated Rate |
$3,141.65 |
| Rate for Payer: Cash Price |
$1,984.20
|
| Rate for Payer: Cigna Commercial |
$2,810.95
|
| Rate for Payer: First Health Commercial |
$2,976.30
|
| Rate for Payer: First Health Workers Compensation |
$1,276.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,976.30
|
| Rate for Payer: GEHA Commercial |
$2,314.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,976.30
|
| Rate for Payer: Multiplan All |
$3,009.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,314.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,976.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,141.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,480.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,075.51
|
| Rate for Payer: Zelis Auto |
$1,322.80
|
| Rate for Payer: Zelis Worker's Compensation |
$902.81
|
|
|
REMOVAL OF HIP PROSTHESIS
|
Facility
|
OP
|
$3,307.00
|
|
|
Service Code
|
CPT 27091
|
| Hospital Charge Code |
6127091
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$826.75 |
| Max. Negotiated Rate |
$3,141.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,984.20
|
| Rate for Payer: Cash Price |
$1,984.20
|
| Rate for Payer: Cigna Commercial |
$2,810.95
|
| Rate for Payer: First Health Commercial |
$2,976.30
|
| Rate for Payer: First Health Workers Compensation |
$1,276.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,976.30
|
| Rate for Payer: GEHA Commercial |
$2,645.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,976.30
|
| Rate for Payer: Humana ChoiceCare |
$859.82
|
| Rate for Payer: Multiplan All |
$3,009.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,984.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,314.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,976.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,141.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,480.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,910.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$826.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,075.51
|
| Rate for Payer: Zelis Auto |
$1,322.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,653.50
|
| Rate for Payer: Zelis Worker's Compensation |
$902.81
|
|
|
REMOVAL OF HUMERUS LESION
|
Facility
|
IP
|
$1,382.00
|
|
|
Service Code
|
CPT 23156
|
| Hospital Charge Code |
6123156
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$377.29 |
| Max. Negotiated Rate |
$1,312.90 |
| Rate for Payer: Cash Price |
$829.20
|
| Rate for Payer: Cigna Commercial |
$1,174.70
|
| Rate for Payer: First Health Commercial |
$1,243.80
|
| Rate for Payer: First Health Workers Compensation |
$533.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,243.80
|
| Rate for Payer: GEHA Commercial |
$967.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,243.80
|
| Rate for Payer: Multiplan All |
$1,257.62
|
| Rate for Payer: OMNI Networks Commercial |
$967.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,243.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,312.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,036.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,285.26
|
| Rate for Payer: Zelis Auto |
$552.80
|
| Rate for Payer: Zelis Worker's Compensation |
$377.29
|
|
|
REMOVAL OF HUMERUS LESION
|
Facility
|
OP
|
$1,627.00
|
|
|
Service Code
|
CPT 23155
|
| Hospital Charge Code |
6123155
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$444.17 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$976.20
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$976.20
|
| Rate for Payer: Cash Price |
$976.20
|
| Rate for Payer: Cigna Commercial |
$1,382.95
|
| Rate for Payer: First Health Commercial |
$1,464.30
|
| Rate for Payer: First Health Workers Compensation |
$628.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,464.30
|
| Rate for Payer: GEHA Commercial |
$1,301.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,464.30
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,480.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,138.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,464.30
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,545.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,220.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,513.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$650.80
|
| 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 |
$444.17
|
|
|
REMOVAL OF HUMERUS LESION
|
Facility
|
OP
|
$1,342.00
|
|
|
Service Code
|
CPT 23150
|
| Hospital Charge Code |
6123150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$366.37 |
| 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 |
$805.20
|
| 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 |
$805.20
|
| Rate for Payer: Cash Price |
$805.20
|
| Rate for Payer: Cigna Commercial |
$1,140.70
|
| Rate for Payer: First Health Commercial |
$1,207.80
|
| Rate for Payer: First Health Workers Compensation |
$518.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,207.80
|
| Rate for Payer: GEHA Commercial |
$1,073.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,207.80
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,221.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$939.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,207.80
|
| 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 |
$1,274.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,006.50
|
| 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 |
$1,248.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$536.80
|
| 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 |
$366.37
|
|
|
REMOVAL OF HUMERUS LESION
|
Facility
|
OP
|
$1,382.00
|
|
|
Service Code
|
CPT 23156
|
| Hospital Charge Code |
6123156
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$377.29 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$829.20
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$829.20
|
| Rate for Payer: Cash Price |
$829.20
|
| Rate for Payer: Cigna Commercial |
$1,174.70
|
| Rate for Payer: First Health Commercial |
$1,243.80
|
| Rate for Payer: First Health Workers Compensation |
$533.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,243.80
|
| Rate for Payer: GEHA Commercial |
$1,105.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,243.80
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,257.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$967.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,243.80
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,312.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,036.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,285.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$552.80
|
| 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 |
$377.29
|
|
|
REMOVAL OF HUMERUS LESION
|
Facility
|
IP
|
$1,342.00
|
|
|
Service Code
|
CPT 23150
|
| Hospital Charge Code |
6123150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$366.37 |
| Max. Negotiated Rate |
$1,274.90 |
| Rate for Payer: Cash Price |
$805.20
|
| Rate for Payer: Cigna Commercial |
$1,140.70
|
| Rate for Payer: First Health Commercial |
$1,207.80
|
| Rate for Payer: First Health Workers Compensation |
$518.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,207.80
|
| Rate for Payer: GEHA Commercial |
$939.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,207.80
|
| Rate for Payer: Multiplan All |
$1,221.22
|
| Rate for Payer: OMNI Networks Commercial |
$939.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,207.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,274.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,006.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,248.06
|
| Rate for Payer: Zelis Auto |
$536.80
|
| Rate for Payer: Zelis Worker's Compensation |
$366.37
|
|
|
REMOVAL OF HUMERUS LESION
|
Facility
|
IP
|
$1,627.00
|
|
|
Service Code
|
CPT 23155
|
| Hospital Charge Code |
6123155
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$444.17 |
| Max. Negotiated Rate |
$1,545.65 |
| Rate for Payer: Cash Price |
$976.20
|
| Rate for Payer: Cigna Commercial |
$1,382.95
|
| Rate for Payer: First Health Commercial |
$1,464.30
|
| Rate for Payer: First Health Workers Compensation |
$628.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,464.30
|
| Rate for Payer: GEHA Commercial |
$1,138.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,464.30
|
| Rate for Payer: Multiplan All |
$1,480.57
|
| Rate for Payer: OMNI Networks Commercial |
$1,138.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,464.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,545.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,220.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,513.11
|
| Rate for Payer: Zelis Auto |
$650.80
|
| Rate for Payer: Zelis Worker's Compensation |
$444.17
|
|
