|
REMOVAL OF KNEE CARTILAGE
|
Facility
|
OP
|
$1,196.00
|
|
|
Service Code
|
CPT 27333
|
| Hospital Charge Code |
6127333
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$326.51 |
| 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 |
$717.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$717.60
|
| 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 |
$956.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,076.40
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,088.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$837.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,076.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,136.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$897.00
|
| 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 |
$1,112.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$478.40
|
| 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 |
$326.51
|
|
|
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 CYST
|
Facility
|
OP
|
$978.00
|
|
|
Service Code
|
CPT 27345
|
| Hospital Charge Code |
6127345
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$266.99 |
| 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 |
$586.80
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$586.80
|
| Rate for Payer: Cash Price |
$586.80
|
| Rate for Payer: Cigna Commercial |
$831.30
|
| Rate for Payer: First Health Commercial |
$880.20
|
| Rate for Payer: First Health Workers Compensation |
$377.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$880.20
|
| Rate for Payer: GEHA Commercial |
$782.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$880.20
|
| 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 |
$889.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$684.60
|
| Rate for Payer: One Health Plan PPO/POS |
$880.20
|
| 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 |
$929.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$733.50
|
| 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 |
$909.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$391.20
|
| 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 |
$266.99
|
|
|
REMOVAL OF KNEE CYST
|
Facility
|
IP
|
$978.00
|
|
|
Service Code
|
CPT 27345
|
| Hospital Charge Code |
6127345
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$266.99 |
| Max. Negotiated Rate |
$929.10 |
| Rate for Payer: Cash Price |
$586.80
|
| Rate for Payer: Cigna Commercial |
$831.30
|
| Rate for Payer: First Health Commercial |
$880.20
|
| Rate for Payer: First Health Workers Compensation |
$377.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$880.20
|
| Rate for Payer: GEHA Commercial |
$684.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$880.20
|
| Rate for Payer: Multiplan All |
$889.98
|
| Rate for Payer: OMNI Networks Commercial |
$684.60
|
| Rate for Payer: One Health Plan PPO/POS |
$880.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$929.10
|
| Rate for Payer: Three Rivers Provider Network All |
$733.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$909.54
|
| Rate for Payer: Zelis Auto |
$391.20
|
| Rate for Payer: Zelis Worker's Compensation |
$266.99
|
|
|
REMOVAL OF KNEE PROSTHESIS
|
Facility
|
IP
|
$2,477.00
|
|
|
Service Code
|
CPT 27488
|
| Hospital Charge Code |
6127488
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$676.22 |
| Max. Negotiated Rate |
$2,353.15 |
| Rate for Payer: Cash Price |
$1,486.20
|
| Rate for Payer: Cigna Commercial |
$2,105.45
|
| Rate for Payer: First Health Commercial |
$2,229.30
|
| Rate for Payer: First Health Workers Compensation |
$956.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,229.30
|
| Rate for Payer: GEHA Commercial |
$1,733.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,229.30
|
| Rate for Payer: Multiplan All |
$2,254.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,733.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,229.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,353.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,857.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,303.61
|
| Rate for Payer: Zelis Auto |
$990.80
|
| Rate for Payer: Zelis Worker's Compensation |
$676.22
|
|
|
REMOVAL OF KNEE PROSTHESIS
|
Facility
|
OP
|
$2,477.00
|
|
|
Service Code
|
CPT 27488
|
| Hospital Charge Code |
6127488
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$619.25 |
| Max. Negotiated Rate |
$2,353.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,486.20
|
| Rate for Payer: Cash Price |
$1,486.20
|
| Rate for Payer: Cigna Commercial |
$2,105.45
|
| Rate for Payer: First Health Commercial |
$2,229.30
|
| Rate for Payer: First Health Workers Compensation |
$956.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,229.30
|
| Rate for Payer: GEHA Commercial |
$1,981.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,229.30
|
| Rate for Payer: Humana ChoiceCare |
$644.02
|
| Rate for Payer: Multiplan All |
$2,254.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,486.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,733.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,229.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,353.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,857.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,179.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$619.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,303.61
|
| Rate for Payer: Zelis Auto |
$990.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,238.50
|
| Rate for Payer: Zelis Worker's Compensation |
$676.22
|
|
|
REMOVAL OF LARYNX
|
Facility
|
IP
|
$4,329.00
|
|
|
Service Code
|
CPT 31360
|
| Hospital Charge Code |
6131360
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,181.82 |
| Max. Negotiated Rate |
$4,112.55 |
| Rate for Payer: Cash Price |
$2,597.40
|
| Rate for Payer: Cigna Commercial |
$3,679.65
|
| Rate for Payer: First Health Commercial |
$3,896.10
|
| Rate for Payer: First Health Workers Compensation |
$1,671.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,896.10
|
| Rate for Payer: GEHA Commercial |
$3,030.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,896.10
|
| Rate for Payer: Multiplan All |
$3,939.39
|
| Rate for Payer: OMNI Networks Commercial |
$3,030.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,896.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,112.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,246.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,025.97
|
| Rate for Payer: Zelis Auto |
$1,731.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,181.82
|
|
|
REMOVAL OF LARYNX
|
Facility
|
IP
|
$5,358.00
|
|
|
Service Code
|
CPT 31365
|
| Hospital Charge Code |
6131365
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,462.73 |
| Max. Negotiated Rate |
$5,090.10 |
| Rate for Payer: Cash Price |
$3,214.80
|
| Rate for Payer: Cigna Commercial |
$4,554.30
|
| Rate for Payer: First Health Commercial |
$4,822.20
|
| Rate for Payer: First Health Workers Compensation |
$2,068.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,822.20
|
| Rate for Payer: GEHA Commercial |
$3,750.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,822.20
|
| Rate for Payer: Multiplan All |
$4,875.78
|
| Rate for Payer: OMNI Networks Commercial |
$3,750.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,822.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,090.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,018.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,982.94
|
| Rate for Payer: Zelis Auto |
$2,143.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,462.73
|
|
|
REMOVAL OF LARYNX
|
Facility
|
OP
|
$5,358.00
|
|
|
Service Code
|
CPT 31365
|
| Hospital Charge Code |
6131365
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,339.50 |
| Max. Negotiated Rate |
$5,090.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,214.80
|
| Rate for Payer: Cash Price |
$3,214.80
|
| Rate for Payer: Cigna Commercial |
$4,554.30
|
| Rate for Payer: First Health Commercial |
$4,822.20
|
| Rate for Payer: First Health Workers Compensation |
$2,068.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,822.20
|
| Rate for Payer: GEHA Commercial |
$4,286.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,822.20
|
| Rate for Payer: Humana ChoiceCare |
$1,393.08
|
| Rate for Payer: Multiplan All |
$4,875.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,214.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,750.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,822.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,090.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,018.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,715.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,339.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,982.94
|
| Rate for Payer: Zelis Auto |
$2,143.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,679.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,462.73
|
|
|
REMOVAL OF LARYNX
|
Facility
|
OP
|
$4,329.00
|
|
|
Service Code
|
CPT 31360
|
| Hospital Charge Code |
6131360
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,082.25 |
| Max. Negotiated Rate |
$4,112.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,597.40
|
| Rate for Payer: Cash Price |
$2,597.40
|
| Rate for Payer: Cigna Commercial |
$3,679.65
|
| Rate for Payer: First Health Commercial |
$3,896.10
|
| Rate for Payer: First Health Workers Compensation |
$1,671.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,896.10
|
| Rate for Payer: GEHA Commercial |
$3,463.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,896.10
|
| Rate for Payer: Humana ChoiceCare |
$1,125.54
|
| Rate for Payer: Multiplan All |
$3,939.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,597.40
|
| Rate for Payer: OMNI Networks Commercial |
$3,030.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,896.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,112.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,246.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,809.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,082.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,025.97
|
| Rate for Payer: Zelis Auto |
$1,731.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,164.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,181.82
|
|
|
REMOVAL OF LARYNX LESION
|
Facility
|
OP
|
$2,650.00
|
|
|
Service Code
|
CPT 31300
|
| Hospital Charge Code |
6131300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$723.45 |
| 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 |
$1,590.00
|
| 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 |
$1,590.00
|
| Rate for Payer: Cash Price |
$1,590.00
|
| Rate for Payer: Cigna Commercial |
$2,252.50
|
| Rate for Payer: First Health Commercial |
$2,385.00
|
| Rate for Payer: First Health Workers Compensation |
$1,023.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,385.00
|
| Rate for Payer: GEHA Commercial |
$2,120.00
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,385.00
|
| 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 |
$2,411.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$1,855.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,385.00
|
| 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 |
$2,517.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$1,987.50
|
| 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 |
$2,464.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$1,060.00
|
| 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 |
$723.45
|
|
|
REMOVAL OF LARYNX LESION
|
Facility
|
IP
|
$2,650.00
|
|
|
Service Code
|
CPT 31300
|
| Hospital Charge Code |
6131300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$723.45 |
| Max. Negotiated Rate |
$2,517.50 |
| Rate for Payer: Cash Price |
$1,590.00
|
| Rate for Payer: Cigna Commercial |
$2,252.50
|
| Rate for Payer: First Health Commercial |
$2,385.00
|
| Rate for Payer: First Health Workers Compensation |
$1,023.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,385.00
|
| Rate for Payer: GEHA Commercial |
$1,855.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,385.00
|
| Rate for Payer: Multiplan All |
$2,411.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,855.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,385.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,517.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,987.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,464.50
|
| Rate for Payer: Zelis Auto |
$1,060.00
|
| Rate for Payer: Zelis Worker's Compensation |
$723.45
|
|
|
REMOVAL OF LARYNX LESION
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 31512
|
| Hospital Charge Code |
6131512
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$109.47 |
| Max. Negotiated Rate |
$7,001.82 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,189.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$240.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,189.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,734.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,500.91
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cigna Commercial |
$340.85
|
| Rate for Payer: First Health Commercial |
$360.90
|
| Rate for Payer: First Health Workers Compensation |
$154.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.90
|
| Rate for Payer: GEHA Commercial |
$320.80
|
| Rate for Payer: GEHA Medicare |
$3,500.91
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.90
|
| Rate for Payer: Humana ChoiceCare |
$3,851.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,500.91
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,881.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,770.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,500.91
|
| Rate for Payer: Multiplan All |
$364.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,951.55
|
| Rate for Payer: OMNI Networks Commercial |
$280.70
|
| Rate for Payer: One Health Plan PPO/POS |
$360.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,043.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,770.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,500.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,001.82
|
| Rate for Payer: Three Rivers Provider Network All |
$300.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,430.89
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,770.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,500.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,500.91
|
| Rate for Payer: Zelis Auto |
$160.40
|
| Rate for Payer: Zelis Medicare |
$2,975.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,201.09
|
| Rate for Payer: Zelis Worker's Compensation |
$109.47
|
|
|
REMOVAL OF LARYNX LESION
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT 31512
|
| Hospital Charge Code |
6131512
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$109.47 |
| Max. Negotiated Rate |
$380.95 |
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cigna Commercial |
$340.85
|
| Rate for Payer: First Health Commercial |
$360.90
|
| Rate for Payer: First Health Workers Compensation |
$154.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.90
|
| Rate for Payer: GEHA Commercial |
$280.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.90
|
| Rate for Payer: Multiplan All |
$364.91
|
| Rate for Payer: OMNI Networks Commercial |
$280.70
|
| Rate for Payer: One Health Plan PPO/POS |
$360.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.95
|
| Rate for Payer: Three Rivers Provider Network All |
$300.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.93
|
| Rate for Payer: Zelis Auto |
$160.40
|
| Rate for Payer: Zelis Worker's Compensation |
$109.47
|
|
|
REMOVAL OF LARYNX LESION
|
Facility
|
IP
|
$536.00
|
|
|
Service Code
|
CPT 31578
|
| Hospital Charge Code |
6131578
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$146.33 |
| Max. Negotiated Rate |
$509.20 |
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cigna Commercial |
$455.60
|
| Rate for Payer: First Health Commercial |
$482.40
|
| Rate for Payer: First Health Workers Compensation |
$206.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$482.40
|
| Rate for Payer: GEHA Commercial |
$375.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$482.40
|
| Rate for Payer: Multiplan All |
$487.76
|
| Rate for Payer: OMNI Networks Commercial |
$375.20
|
| Rate for Payer: One Health Plan PPO/POS |
$482.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$509.20
|
| Rate for Payer: Three Rivers Provider Network All |
$402.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$498.48
|
| Rate for Payer: Zelis Auto |
$214.40
|
| Rate for Payer: Zelis Worker's Compensation |
$146.33
|
|
|
REMOVAL OF LARYNX LESION
|
Facility
|
OP
|
$536.00
|
|
|
Service Code
|
CPT 31578
|
| Hospital Charge Code |
6131578
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$146.33 |
| Max. Negotiated Rate |
$7,001.82 |
| 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 |
$321.60
|
| 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 |
$3,500.91
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cigna Commercial |
$455.60
|
| Rate for Payer: First Health Commercial |
$482.40
|
| Rate for Payer: First Health Workers Compensation |
$206.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$482.40
|
| Rate for Payer: GEHA Commercial |
$428.80
|
| Rate for Payer: GEHA Medicare |
$3,500.91
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$482.40
|
| Rate for Payer: Humana ChoiceCare |
$3,851.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,500.91
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,881.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,392.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,500.91
|
| Rate for Payer: Multiplan All |
$487.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,951.55
|
| Rate for Payer: OMNI Networks Commercial |
$375.20
|
| Rate for Payer: One Health Plan PPO/POS |
$482.40
|
| 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 |
$3,500.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$509.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,001.82
|
| Rate for Payer: Three Rivers Provider Network All |
$402.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,430.89
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,392.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,500.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$498.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,500.91
|
| Rate for Payer: Zelis Auto |
$214.40
|
| Rate for Payer: Zelis Medicare |
$2,975.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,201.09
|
| Rate for Payer: Zelis Worker's Compensation |
$146.33
|
|
|
REMOVAL OF LARYNX & PHARYNX
|
Facility
|
OP
|
$5,968.00
|
|
|
Service Code
|
CPT 31390
|
| Hospital Charge Code |
6131390
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,492.00 |
| Max. Negotiated Rate |
$5,669.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,580.80
|
| Rate for Payer: Cash Price |
$3,580.80
|
| Rate for Payer: Cigna Commercial |
$5,072.80
|
| Rate for Payer: First Health Commercial |
$5,371.20
|
| Rate for Payer: First Health Workers Compensation |
$2,304.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,371.20
|
| Rate for Payer: GEHA Commercial |
$4,774.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,371.20
|
| Rate for Payer: Humana ChoiceCare |
$1,551.68
|
| Rate for Payer: Multiplan All |
$5,430.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,580.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,177.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,371.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,669.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,476.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,251.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,492.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,550.24
|
| Rate for Payer: Zelis Auto |
$2,387.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,984.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,629.26
|
|
|
REMOVAL OF LARYNX & PHARYNX
|
Facility
|
IP
|
$5,968.00
|
|
|
Service Code
|
CPT 31390
|
| Hospital Charge Code |
6131390
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,629.26 |
| Max. Negotiated Rate |
$5,669.60 |
| Rate for Payer: Cash Price |
$3,580.80
|
| Rate for Payer: Cigna Commercial |
$5,072.80
|
| Rate for Payer: First Health Commercial |
$5,371.20
|
| Rate for Payer: First Health Workers Compensation |
$2,304.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,371.20
|
| Rate for Payer: GEHA Commercial |
$4,177.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,371.20
|
| Rate for Payer: Multiplan All |
$5,430.88
|
| Rate for Payer: OMNI Networks Commercial |
$4,177.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,371.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,669.60
|
| Rate for Payer: Three Rivers Provider Network All |
$4,476.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,550.24
|
| Rate for Payer: Zelis Auto |
$2,387.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,629.26
|
|
|
REMOVAL OF LUNG LESION(S)
|
Facility
|
IP
|
$2,101.00
|
|
|
Service Code
|
CPT 32140
|
| Hospital Charge Code |
6132140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$573.57 |
| Max. Negotiated Rate |
$1,995.95 |
| Rate for Payer: Cash Price |
$1,260.60
|
| Rate for Payer: Cigna Commercial |
$1,785.85
|
| Rate for Payer: First Health Commercial |
$1,890.90
|
| Rate for Payer: First Health Workers Compensation |
$811.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,890.90
|
| Rate for Payer: GEHA Commercial |
$1,470.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,890.90
|
| Rate for Payer: Multiplan All |
$1,911.91
|
| Rate for Payer: OMNI Networks Commercial |
$1,470.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,890.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,995.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,575.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,953.93
|
| Rate for Payer: Zelis Auto |
$840.40
|
| Rate for Payer: Zelis Worker's Compensation |
$573.57
|
|
|
REMOVAL OF LUNG LESION(S)
|
Facility
|
OP
|
$2,101.00
|
|
|
Service Code
|
CPT 32140
|
| Hospital Charge Code |
6132140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$525.25 |
| Max. Negotiated Rate |
$1,995.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,260.60
|
| Rate for Payer: Cash Price |
$1,260.60
|
| Rate for Payer: Cigna Commercial |
$1,785.85
|
| Rate for Payer: First Health Commercial |
$1,890.90
|
| Rate for Payer: First Health Workers Compensation |
$811.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,890.90
|
| Rate for Payer: GEHA Commercial |
$1,680.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,890.90
|
| Rate for Payer: Humana ChoiceCare |
$546.26
|
| Rate for Payer: Multiplan All |
$1,911.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,260.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,470.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,890.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,995.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,575.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,848.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$525.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,953.93
|
| Rate for Payer: Zelis Auto |
$840.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,050.50
|
| Rate for Payer: Zelis Worker's Compensation |
$573.57
|
|
|
REMOVAL OF LUNG LESION(S)
|
Facility
|
OP
|
$2,116.00
|
|
|
Service Code
|
CPT 32150
|
| Hospital Charge Code |
6132150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$529.00 |
| Max. Negotiated Rate |
$2,010.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,269.60
|
| Rate for Payer: Cash Price |
$1,269.60
|
| Rate for Payer: Cigna Commercial |
$1,798.60
|
| Rate for Payer: First Health Commercial |
$1,904.40
|
| Rate for Payer: First Health Workers Compensation |
$816.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,904.40
|
| Rate for Payer: GEHA Commercial |
$1,692.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,904.40
|
| Rate for Payer: Humana ChoiceCare |
$550.16
|
| Rate for Payer: Multiplan All |
$1,925.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,269.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,481.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,904.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,010.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,587.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,862.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$529.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,967.88
|
| Rate for Payer: Zelis Auto |
$846.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,058.00
|
| Rate for Payer: Zelis Worker's Compensation |
$577.67
|
|
|
REMOVAL OF LUNG LESION(S)
|
Facility
|
IP
|
$2,116.00
|
|
|
Service Code
|
CPT 32150
|
| Hospital Charge Code |
6132150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$577.67 |
| Max. Negotiated Rate |
$2,010.20 |
| Rate for Payer: Cash Price |
$1,269.60
|
| Rate for Payer: Cigna Commercial |
$1,798.60
|
| Rate for Payer: First Health Commercial |
$1,904.40
|
| Rate for Payer: First Health Workers Compensation |
$816.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,904.40
|
| Rate for Payer: GEHA Commercial |
$1,481.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,904.40
|
| Rate for Payer: Multiplan All |
$1,925.56
|
| Rate for Payer: OMNI Networks Commercial |
$1,481.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,904.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,010.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,587.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,967.88
|
| Rate for Payer: Zelis Auto |
$846.40
|
| Rate for Payer: Zelis Worker's Compensation |
$577.67
|
|
|
REMOVAL OF METATARSAL
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT 28140
|
| Hospital Charge Code |
6128140
|
|
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
|
|
|
REMOVAL OF METATARSAL
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT 28140
|
| Hospital Charge Code |
6128140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$247.61 |
| 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 |
$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 |
$3,080.89
|
| 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 |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$816.30
|
| 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 |
$825.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$861.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$680.25
|
| 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 |
$843.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$362.80
|
| 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 |
$247.61
|
|
|
REMOVAL OF METATARSAL HEADS
|
Facility
|
OP
|
$1,709.00
|
|
|
Service Code
|
CPT 28114
|
| Hospital Charge Code |
6128114
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$466.56 |
| 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 |
$1,025.40
|
| 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 |
$1,025.40
|
| Rate for Payer: Cash Price |
$1,025.40
|
| Rate for Payer: Cigna Commercial |
$1,452.65
|
| Rate for Payer: First Health Commercial |
$1,538.10
|
| Rate for Payer: First Health Workers Compensation |
$659.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,538.10
|
| Rate for Payer: GEHA Commercial |
$1,367.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,538.10
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,555.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,196.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,538.10
|
| 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 |
$1,623.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,281.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,589.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$683.60
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$466.56
|
|
