|
REMOVAL OF HYDROCELE
|
Facility
|
IP
|
$867.00
|
|
|
Service Code
|
CPT 55040
|
| Hospital Charge Code |
6155040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.69 |
| Max. Negotiated Rate |
$823.65 |
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cigna Commercial |
$736.95
|
| Rate for Payer: First Health Commercial |
$780.30
|
| Rate for Payer: First Health Workers Compensation |
$334.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$780.30
|
| Rate for Payer: GEHA Commercial |
$606.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$780.30
|
| Rate for Payer: Multiplan All |
$788.97
|
| Rate for Payer: OMNI Networks Commercial |
$606.90
|
| Rate for Payer: One Health Plan PPO/POS |
$780.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$823.65
|
| Rate for Payer: Three Rivers Provider Network All |
$650.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$806.31
|
| Rate for Payer: Zelis Auto |
$346.80
|
| Rate for Payer: Zelis Worker's Compensation |
$236.69
|
|
|
REMOVAL OF HYDROCELE
|
Facility
|
OP
|
$867.00
|
|
|
Service Code
|
CPT 55040
|
| Hospital Charge Code |
6155040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.69 |
| Max. Negotiated Rate |
$6,701.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$520.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,560.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,350.98
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cigna Commercial |
$736.95
|
| Rate for Payer: First Health Commercial |
$780.30
|
| Rate for Payer: First Health Workers Compensation |
$334.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$780.30
|
| Rate for Payer: GEHA Commercial |
$693.60
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$780.30
|
| Rate for Payer: Humana ChoiceCare |
$3,686.08
|
| Rate for Payer: Humana Medicare Advantage |
$3,350.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,629.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,612.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,350.98
|
| Rate for Payer: Multiplan All |
$788.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: OMNI Networks Commercial |
$606.90
|
| Rate for Payer: One Health Plan PPO/POS |
$780.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,016.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,612.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,350.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$823.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: Three Rivers Provider Network All |
$650.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,283.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,612.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$806.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Auto |
$346.80
|
| Rate for Payer: Zelis Medicare |
$2,848.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,021.18
|
| Rate for Payer: Zelis Worker's Compensation |
$236.69
|
|
|
REMOVAL OF HYDROCELE
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
CPT 55500
|
| Hospital Charge Code |
6155500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$222.77 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$489.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$693.60
|
| Rate for Payer: First Health Commercial |
$734.40
|
| Rate for Payer: First Health Workers Compensation |
$315.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$734.40
|
| Rate for Payer: GEHA Commercial |
$652.80
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$734.40
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$742.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$571.20
|
| Rate for Payer: One Health Plan PPO/POS |
$734.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$775.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$612.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$758.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$326.40
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$222.77
|
|
|
REMOVAL OF HYDROCELE
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
CPT 55500
|
| Hospital Charge Code |
6155500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$222.77 |
| Max. Negotiated Rate |
$775.20 |
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$693.60
|
| Rate for Payer: First Health Commercial |
$734.40
|
| Rate for Payer: First Health Workers Compensation |
$315.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$734.40
|
| Rate for Payer: GEHA Commercial |
$571.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$734.40
|
| Rate for Payer: Multiplan All |
$742.56
|
| Rate for Payer: OMNI Networks Commercial |
$571.20
|
| Rate for Payer: One Health Plan PPO/POS |
$734.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$775.20
|
| Rate for Payer: Three Rivers Provider Network All |
$612.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$758.88
|
| Rate for Payer: Zelis Auto |
$326.40
|
| Rate for Payer: Zelis Worker's Compensation |
$222.77
|
|
|
REMOVAL OF HYDROCELES
|
Facility
|
OP
|
$1,046.00
|
|
|
Service Code
|
CPT 55041
|
| Hospital Charge Code |
6155041
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$285.56 |
| Max. Negotiated Rate |
$6,701.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$627.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,560.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,350.98
|
| Rate for Payer: Cash Price |
$627.60
|
| Rate for Payer: Cash Price |
$627.60
|
| Rate for Payer: Cigna Commercial |
$889.10
|
| Rate for Payer: First Health Commercial |
$941.40
|
| Rate for Payer: First Health Workers Compensation |
$403.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$941.40
|
| Rate for Payer: GEHA Commercial |
$836.80
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$941.40
|
| Rate for Payer: Humana ChoiceCare |
$3,686.08
|
| Rate for Payer: Humana Medicare Advantage |
$3,350.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,629.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,612.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,350.98
|
| Rate for Payer: Multiplan All |
$951.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: OMNI Networks Commercial |
$732.20
|
| Rate for Payer: One Health Plan PPO/POS |
$941.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,016.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,612.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,350.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$993.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: Three Rivers Provider Network All |
$784.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,283.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,612.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$972.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Auto |
$418.40
|
| Rate for Payer: Zelis Medicare |
$2,848.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,021.18
|
| Rate for Payer: Zelis Worker's Compensation |
$285.56
|
|
|
REMOVAL OF HYDROCELES
|
Facility
|
IP
|
$1,046.00
|
|
|
Service Code
|
CPT 55041
|
| Hospital Charge Code |
6155041
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$285.56 |
| Max. Negotiated Rate |
$993.70 |
| Rate for Payer: Cash Price |
$627.60
|
| Rate for Payer: Cigna Commercial |
$889.10
|
| Rate for Payer: First Health Commercial |
$941.40
|
| Rate for Payer: First Health Workers Compensation |
$403.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$941.40
|
| Rate for Payer: GEHA Commercial |
$732.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$941.40
|
| Rate for Payer: Multiplan All |
$951.86
|
| Rate for Payer: OMNI Networks Commercial |
$732.20
|
| Rate for Payer: One Health Plan PPO/POS |
$941.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$993.70
|
| Rate for Payer: Three Rivers Provider Network All |
$784.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$972.78
|
| Rate for Payer: Zelis Auto |
$418.40
|
| Rate for Payer: Zelis Worker's Compensation |
$285.56
|
|
|
REMOVAL OF IMPLANT; DEEP (EG, BURIED WIRE, PIN, SCREW, METAL BAND, NAIL, ROD OR PLATE)
|
Facility
|
OP
|
$5,435.26
|
|
|
Service Code
|
CPT 20680
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,166.97 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,735.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,735.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,166.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: First Health Workers Compensation |
$3,497.59
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,211.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,553.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,211.10
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,211.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$2,473.04
|
|
|
REMOVAL OF IMPLANT FROM HAND
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT 26320
|
| Hospital Charge Code |
6126320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$238.88 |
| 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 |
$525.00
|
| 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 |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$743.75
|
| Rate for Payer: First Health Commercial |
$787.50
|
| Rate for Payer: First Health Workers Compensation |
$337.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$787.50
|
| Rate for Payer: GEHA Commercial |
$700.00
|
| Rate for Payer: GEHA Medicare |
$1,538.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$787.50
|
| 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 |
$796.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,615.42
|
| Rate for Payer: OMNI Networks Commercial |
$612.50
|
| Rate for Payer: One Health Plan PPO/POS |
$787.50
|
| 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 |
$831.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,076.96
|
| Rate for Payer: Three Rivers Provider Network All |
$656.25
|
| 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 |
$813.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,538.48
|
| Rate for Payer: Zelis Auto |
$350.00
|
| 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 |
$238.88
|
|
|
REMOVAL OF IMPLANT FROM HAND
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
CPT 26320
|
| Hospital Charge Code |
6126320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$238.88 |
| Max. Negotiated Rate |
$831.25 |
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$743.75
|
| Rate for Payer: First Health Commercial |
$787.50
|
| Rate for Payer: First Health Workers Compensation |
$337.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$787.50
|
| Rate for Payer: GEHA Commercial |
$612.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$787.50
|
| Rate for Payer: Multiplan All |
$796.25
|
| Rate for Payer: OMNI Networks Commercial |
$612.50
|
| Rate for Payer: One Health Plan PPO/POS |
$787.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$831.25
|
| Rate for Payer: Three Rivers Provider Network All |
$656.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$813.75
|
| Rate for Payer: Zelis Auto |
$350.00
|
| Rate for Payer: Zelis Worker's Compensation |
$238.88
|
|
|
REMOVAL OF INTRANASAL LESION
|
Facility
|
IP
|
$1,011.00
|
|
|
Service Code
|
CPT 30117
|
| Hospital Charge Code |
6130117
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$276.00 |
| Max. Negotiated Rate |
$960.45 |
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$859.35
|
| Rate for Payer: First Health Commercial |
$909.90
|
| Rate for Payer: First Health Workers Compensation |
$390.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$909.90
|
| Rate for Payer: GEHA Commercial |
$707.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$909.90
|
| Rate for Payer: Multiplan All |
$920.01
|
| Rate for Payer: OMNI Networks Commercial |
$707.70
|
| Rate for Payer: One Health Plan PPO/POS |
$909.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$960.45
|
| Rate for Payer: Three Rivers Provider Network All |
$758.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$940.23
|
| Rate for Payer: Zelis Auto |
$404.40
|
| Rate for Payer: Zelis Worker's Compensation |
$276.00
|
|
|
REMOVAL OF INTRANASAL LESION
|
Facility
|
OP
|
$1,557.00
|
|
|
Service Code
|
CPT 30118
|
| Hospital Charge Code |
6130118
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$425.06 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$934.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$934.20
|
| Rate for Payer: Cash Price |
$934.20
|
| Rate for Payer: Cigna Commercial |
$1,323.45
|
| Rate for Payer: First Health Commercial |
$1,401.30
|
| Rate for Payer: First Health Workers Compensation |
$601.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,401.30
|
| Rate for Payer: GEHA Commercial |
$1,245.60
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,401.30
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$1,416.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$1,089.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,401.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,479.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$1,167.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,448.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$622.80
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$425.06
|
|
|
REMOVAL OF INTRANASAL LESION
|
Facility
|
IP
|
$1,557.00
|
|
|
Service Code
|
CPT 30118
|
| Hospital Charge Code |
6130118
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$425.06 |
| Max. Negotiated Rate |
$1,479.15 |
| Rate for Payer: Cash Price |
$934.20
|
| Rate for Payer: Cigna Commercial |
$1,323.45
|
| Rate for Payer: First Health Commercial |
$1,401.30
|
| Rate for Payer: First Health Workers Compensation |
$601.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,401.30
|
| Rate for Payer: GEHA Commercial |
$1,089.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,401.30
|
| Rate for Payer: Multiplan All |
$1,416.87
|
| Rate for Payer: OMNI Networks Commercial |
$1,089.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,401.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,479.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,167.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,448.01
|
| Rate for Payer: Zelis Auto |
$622.80
|
| Rate for Payer: Zelis Worker's Compensation |
$425.06
|
|
|
REMOVAL OF INTRANASAL LESION
|
Facility
|
OP
|
$1,011.00
|
|
|
Service Code
|
CPT 30117
|
| Hospital Charge Code |
6130117
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$276.00 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$606.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$859.35
|
| Rate for Payer: First Health Commercial |
$909.90
|
| Rate for Payer: First Health Workers Compensation |
$390.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$909.90
|
| Rate for Payer: GEHA Commercial |
$808.80
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$909.90
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$920.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$707.70
|
| Rate for Payer: One Health Plan PPO/POS |
$909.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$960.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$758.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$940.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$404.40
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$276.00
|
|
|
REMOVAL OF ISCHIAL BURSA
|
Facility
|
OP
|
$943.00
|
|
|
Service Code
|
CPT 27060
|
| Hospital Charge Code |
6127060
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$257.44 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$565.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cigna Commercial |
$801.55
|
| Rate for Payer: First Health Commercial |
$848.70
|
| Rate for Payer: First Health Workers Compensation |
$364.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$848.70
|
| Rate for Payer: GEHA Commercial |
$754.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$848.70
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$858.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$660.10
|
| Rate for Payer: One Health Plan PPO/POS |
$848.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$895.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$707.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$876.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$377.20
|
| 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 |
$257.44
|
|
|
REMOVAL OF ISCHIAL BURSA
|
Facility
|
IP
|
$943.00
|
|
|
Service Code
|
CPT 27060
|
| Hospital Charge Code |
6127060
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$257.44 |
| Max. Negotiated Rate |
$895.85 |
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cigna Commercial |
$801.55
|
| Rate for Payer: First Health Commercial |
$848.70
|
| Rate for Payer: First Health Workers Compensation |
$364.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$848.70
|
| Rate for Payer: GEHA Commercial |
$660.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$848.70
|
| Rate for Payer: Multiplan All |
$858.13
|
| Rate for Payer: OMNI Networks Commercial |
$660.10
|
| Rate for Payer: One Health Plan PPO/POS |
$848.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$895.85
|
| Rate for Payer: Three Rivers Provider Network All |
$707.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$876.99
|
| Rate for Payer: Zelis Auto |
$377.20
|
| Rate for Payer: Zelis Worker's Compensation |
$257.44
|
|
|
REMOVAL OF JAW BONE LESION
|
Facility
|
IP
|
$1,806.00
|
|
|
Service Code
|
CPT 21044
|
| Hospital Charge Code |
6121044
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$493.04 |
| Max. Negotiated Rate |
$1,715.70 |
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cigna Commercial |
$1,535.10
|
| Rate for Payer: First Health Commercial |
$1,625.40
|
| Rate for Payer: First Health Workers Compensation |
$697.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,625.40
|
| Rate for Payer: GEHA Commercial |
$1,264.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,625.40
|
| Rate for Payer: Multiplan All |
$1,643.46
|
| Rate for Payer: OMNI Networks Commercial |
$1,264.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,625.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,715.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,354.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,679.58
|
| Rate for Payer: Zelis Auto |
$722.40
|
| Rate for Payer: Zelis Worker's Compensation |
$493.04
|
|
|
REMOVAL OF JAW BONE LESION
|
Facility
|
OP
|
$1,806.00
|
|
|
Service Code
|
CPT 21044
|
| Hospital Charge Code |
6121044
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$493.04 |
| 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 |
$1,083.60
|
| 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 |
$1,083.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cigna Commercial |
$1,535.10
|
| Rate for Payer: First Health Commercial |
$1,625.40
|
| Rate for Payer: First Health Workers Compensation |
$697.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,625.40
|
| Rate for Payer: GEHA Commercial |
$1,444.80
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,625.40
|
| 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 |
$1,643.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,264.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,625.40
|
| 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 |
$1,715.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,354.50
|
| 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 |
$1,679.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$722.40
|
| 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 |
$493.04
|
|
|
REMOVAL OF JAW JOINT
|
Facility
|
OP
|
$1,727.00
|
|
|
Service Code
|
CPT 21050
|
| Hospital Charge Code |
6121050
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$471.47 |
| 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 |
$1,036.20
|
| 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 |
$1,036.20
|
| Rate for Payer: Cash Price |
$1,036.20
|
| Rate for Payer: Cigna Commercial |
$1,467.95
|
| Rate for Payer: First Health Commercial |
$1,554.30
|
| Rate for Payer: First Health Workers Compensation |
$666.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,554.30
|
| Rate for Payer: GEHA Commercial |
$1,381.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,554.30
|
| 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 |
$1,571.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,208.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,554.30
|
| 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 |
$1,640.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,295.25
|
| 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 |
$1,606.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$690.80
|
| 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 |
$471.47
|
|
|
REMOVAL OF JAW JOINT
|
Facility
|
IP
|
$1,727.00
|
|
|
Service Code
|
CPT 21050
|
| Hospital Charge Code |
6121050
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$471.47 |
| Max. Negotiated Rate |
$1,640.65 |
| Rate for Payer: Cash Price |
$1,036.20
|
| Rate for Payer: Cigna Commercial |
$1,467.95
|
| Rate for Payer: First Health Commercial |
$1,554.30
|
| Rate for Payer: First Health Workers Compensation |
$666.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,554.30
|
| Rate for Payer: GEHA Commercial |
$1,208.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,554.30
|
| Rate for Payer: Multiplan All |
$1,571.57
|
| Rate for Payer: OMNI Networks Commercial |
$1,208.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,554.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,640.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,295.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,606.11
|
| Rate for Payer: Zelis Auto |
$690.80
|
| Rate for Payer: Zelis Worker's Compensation |
$471.47
|
|
|
REMOVAL OF KNEECAP
|
Facility
|
OP
|
$1,330.00
|
|
|
Service Code
|
CPT 27350
|
| Hospital Charge Code |
6127350
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$363.09 |
| 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 |
$798.00
|
| 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 |
$798.00
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$1,130.50
|
| Rate for Payer: First Health Commercial |
$1,197.00
|
| Rate for Payer: First Health Workers Compensation |
$513.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,197.00
|
| Rate for Payer: GEHA Commercial |
$1,064.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,197.00
|
| 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 |
$1,210.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$931.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,197.00
|
| 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 |
$1,263.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$997.50
|
| 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 |
$1,236.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$532.00
|
| 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 |
$363.09
|
|
|
REMOVAL OF KNEECAP
|
Facility
|
IP
|
$1,330.00
|
|
|
Service Code
|
CPT 27350
|
| Hospital Charge Code |
6127350
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$363.09 |
| Max. Negotiated Rate |
$1,263.50 |
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$1,130.50
|
| Rate for Payer: First Health Commercial |
$1,197.00
|
| Rate for Payer: First Health Workers Compensation |
$513.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,197.00
|
| Rate for Payer: GEHA Commercial |
$931.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,197.00
|
| Rate for Payer: Multiplan All |
$1,210.30
|
| Rate for Payer: OMNI Networks Commercial |
$931.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,197.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,263.50
|
| Rate for Payer: Three Rivers Provider Network All |
$997.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,236.90
|
| Rate for Payer: Zelis Auto |
$532.00
|
| Rate for Payer: Zelis Worker's Compensation |
$363.09
|
|
|
REMOVAL OF KNEECAP BURSA
|
Facility
|
IP
|
$942.00
|
|
|
Service Code
|
CPT 27340
|
| Hospital Charge Code |
6127340
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$257.17 |
| Max. Negotiated Rate |
$894.90 |
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Cigna Commercial |
$800.70
|
| Rate for Payer: First Health Commercial |
$847.80
|
| Rate for Payer: First Health Workers Compensation |
$363.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$847.80
|
| Rate for Payer: GEHA Commercial |
$659.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$847.80
|
| Rate for Payer: Multiplan All |
$857.22
|
| Rate for Payer: OMNI Networks Commercial |
$659.40
|
| Rate for Payer: One Health Plan PPO/POS |
$847.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$894.90
|
| Rate for Payer: Three Rivers Provider Network All |
$706.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$876.06
|
| Rate for Payer: Zelis Auto |
$376.80
|
| Rate for Payer: Zelis Worker's Compensation |
$257.17
|
|
|
REMOVAL OF KNEECAP BURSA
|
Facility
|
OP
|
$942.00
|
|
|
Service Code
|
CPT 27340
|
| Hospital Charge Code |
6127340
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$257.17 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$565.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Cigna Commercial |
$800.70
|
| Rate for Payer: First Health Commercial |
$847.80
|
| Rate for Payer: First Health Workers Compensation |
$363.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$847.80
|
| Rate for Payer: GEHA Commercial |
$753.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$847.80
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$857.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$659.40
|
| Rate for Payer: One Health Plan PPO/POS |
$847.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$894.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$706.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$876.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$376.80
|
| 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 |
$257.17
|
|
|
REMOVAL OF KNEE CARTILAGE
|
Facility
|
IP
|
$1,196.00
|
|
|
Service Code
|
CPT 27333
|
| Hospital Charge Code |
6127333
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$326.51 |
| Max. Negotiated Rate |
$1,136.20 |
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cigna Commercial |
$1,016.60
|
| Rate for Payer: First Health Commercial |
$1,076.40
|
| Rate for Payer: First Health Workers Compensation |
$461.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,076.40
|
| Rate for Payer: GEHA Commercial |
$837.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,076.40
|
| Rate for Payer: Multiplan All |
$1,088.36
|
| Rate for Payer: OMNI Networks Commercial |
$837.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,076.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,136.20
|
| Rate for Payer: Three Rivers Provider Network All |
$897.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,112.28
|
| Rate for Payer: Zelis Auto |
$478.40
|
| Rate for Payer: Zelis Worker's Compensation |
$326.51
|
|
|
REMOVAL OF KNEE CARTILAGE
|
Facility
|
IP
|
$1,308.00
|
|
|
Service Code
|
CPT 27332
|
| Hospital Charge Code |
6127332
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$357.08 |
| Max. Negotiated Rate |
$1,242.60 |
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cigna Commercial |
$1,111.80
|
| Rate for Payer: First Health Commercial |
$1,177.20
|
| Rate for Payer: First Health Workers Compensation |
$505.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,177.20
|
| Rate for Payer: GEHA Commercial |
$915.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,177.20
|
| Rate for Payer: Multiplan All |
$1,190.28
|
| Rate for Payer: OMNI Networks Commercial |
$915.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,177.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,242.60
|
| Rate for Payer: Three Rivers Provider Network All |
$981.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,216.44
|
| Rate for Payer: Zelis Auto |
$523.20
|
| Rate for Payer: Zelis Worker's Compensation |
$357.08
|
|
