|
REMOVAL OF WRIST PROSTHESIS
|
Facility
|
OP
|
$1,470.00
|
|
|
Service Code
|
CPT 25251
|
| Hospital Charge Code |
6125251
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$401.31 |
| 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 |
$882.00
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$882.00
|
| Rate for Payer: Cash Price |
$882.00
|
| Rate for Payer: Cigna Commercial |
$1,249.50
|
| Rate for Payer: First Health Commercial |
$1,323.00
|
| Rate for Payer: First Health Workers Compensation |
$567.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,323.00
|
| Rate for Payer: GEHA Commercial |
$1,176.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,323.00
|
| 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 |
$1,337.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,029.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,323.00
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,396.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,102.50
|
| 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 |
$1,367.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$588.00
|
| 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 |
$401.31
|
|
|
REMOVAL OF WRIST PROSTHESIS
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
CPT 25250
|
| Hospital Charge Code |
6125250
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$289.38 |
| Max. Negotiated Rate |
$3,212.40 |
| 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 |
$636.00
|
| 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 |
$1,519.65
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Cigna Commercial |
$901.00
|
| Rate for Payer: First Health Commercial |
$954.00
|
| Rate for Payer: First Health Workers Compensation |
$409.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$954.00
|
| Rate for Payer: GEHA Commercial |
$848.00
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$954.00
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$964.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$742.00
|
| Rate for Payer: One Health Plan PPO/POS |
$954.00
|
| 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 |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,007.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$795.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$985.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$424.00
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$289.38
|
|
|
REMOVAL OF WRIST PROSTHESIS
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
CPT 25250
|
| Hospital Charge Code |
6125250
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$289.38 |
| Max. Negotiated Rate |
$1,007.00 |
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Cigna Commercial |
$901.00
|
| Rate for Payer: First Health Commercial |
$954.00
|
| Rate for Payer: First Health Workers Compensation |
$409.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$954.00
|
| Rate for Payer: GEHA Commercial |
$742.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$954.00
|
| Rate for Payer: Multiplan All |
$964.60
|
| Rate for Payer: OMNI Networks Commercial |
$742.00
|
| Rate for Payer: One Health Plan PPO/POS |
$954.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,007.00
|
| Rate for Payer: Three Rivers Provider Network All |
$795.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$985.80
|
| Rate for Payer: Zelis Auto |
$424.00
|
| Rate for Payer: Zelis Worker's Compensation |
$289.38
|
|
|
REMOVAL OF WRIST PROSTHESIS
|
Facility
|
IP
|
$1,470.00
|
|
|
Service Code
|
CPT 25251
|
| Hospital Charge Code |
6125251
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$401.31 |
| Max. Negotiated Rate |
$1,396.50 |
| Rate for Payer: Cash Price |
$882.00
|
| Rate for Payer: Cigna Commercial |
$1,249.50
|
| Rate for Payer: First Health Commercial |
$1,323.00
|
| Rate for Payer: First Health Workers Compensation |
$567.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,323.00
|
| Rate for Payer: GEHA Commercial |
$1,029.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,323.00
|
| Rate for Payer: Multiplan All |
$1,337.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,029.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,323.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,396.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,102.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,367.10
|
| Rate for Payer: Zelis Auto |
$588.00
|
| Rate for Payer: Zelis Worker's Compensation |
$401.31
|
|
|
REMOVAL OR REVISION OF SLING FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)
|
Facility
|
OP
|
$6,038.18
|
|
|
Service Code
|
CPT 57287
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,192.97 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,768.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,768.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,192.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: First Health Workers Compensation |
$3,885.57
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,237.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,583.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,237.63
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,237.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$2,747.37
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
8229700
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$52.42 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$74.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Worker's Compensation |
$52.42
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT 29705
|
| Hospital Charge Code |
8229705
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$54.05 |
| Max. Negotiated Rate |
$504.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$118.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$84.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$252.18
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: First Health Workers Compensation |
$76.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$158.40
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| Rate for Payer: Humana ChoiceCare |
$277.40
|
| Rate for Payer: Humana Medicare Advantage |
$252.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$423.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$86.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$252.18
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$99.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$86.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$252.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$247.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$79.20
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$54.05
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 29710
|
| Hospital Charge Code |
8229710
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$504.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$220.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$187.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$252.18
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cigna Commercial |
$312.80
|
| Rate for Payer: First Health Commercial |
$331.20
|
| Rate for Payer: First Health Workers Compensation |
$142.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$331.20
|
| Rate for Payer: GEHA Commercial |
$294.40
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$331.20
|
| Rate for Payer: Humana ChoiceCare |
$277.40
|
| Rate for Payer: Humana Medicare Advantage |
$252.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$423.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$191.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$252.18
|
| Rate for Payer: Multiplan All |
$334.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$257.60
|
| Rate for Payer: One Health Plan PPO/POS |
$331.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$221.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$191.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$252.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$349.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$276.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$247.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$191.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$342.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$147.20
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$100.46
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 29710
|
| Hospital Charge Code |
8229710
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$349.60 |
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cigna Commercial |
$312.80
|
| Rate for Payer: First Health Commercial |
$331.20
|
| Rate for Payer: First Health Workers Compensation |
$142.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$331.20
|
| Rate for Payer: GEHA Commercial |
$257.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$331.20
|
| Rate for Payer: Multiplan All |
$334.88
|
| Rate for Payer: OMNI Networks Commercial |
$257.60
|
| Rate for Payer: One Health Plan PPO/POS |
$331.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$349.60
|
| Rate for Payer: Three Rivers Provider Network All |
$276.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$342.24
|
| Rate for Payer: Zelis Auto |
$147.20
|
| Rate for Payer: Zelis Worker's Compensation |
$100.46
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
8229700
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$52.42 |
| Max. Negotiated Rate |
$504.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$84.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$252.18
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$74.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$153.60
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Humana ChoiceCare |
$277.40
|
| Rate for Payer: Humana Medicare Advantage |
$252.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$423.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$86.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$252.18
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$99.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$86.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$252.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$247.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$52.42
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 29705
|
| Hospital Charge Code |
8229705
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$54.05 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: First Health Workers Compensation |
$76.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$138.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: Zelis Auto |
$79.20
|
| Rate for Payer: Zelis Worker's Compensation |
$54.05
|
|
|
REMOVAL SHOULDER FOREIGN BODY DEEP SUBFA
|
Facility
|
IP
|
$1,432.00
|
|
|
Service Code
|
CPT 23333
|
| Hospital Charge Code |
21600499
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$390.94 |
| Max. Negotiated Rate |
$1,360.40 |
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Cigna Commercial |
$1,217.20
|
| Rate for Payer: First Health Commercial |
$1,288.80
|
| Rate for Payer: First Health Workers Compensation |
$552.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,288.80
|
| Rate for Payer: GEHA Commercial |
$1,002.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,288.80
|
| Rate for Payer: Multiplan All |
$1,303.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,002.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,288.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,360.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,074.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,331.76
|
| Rate for Payer: Zelis Auto |
$572.80
|
| Rate for Payer: Zelis Worker's Compensation |
$390.94
|
|
|
REMOVAL SHOULDER FOREIGN BODY DEEP SUBFA
|
Facility
|
OP
|
$1,432.00
|
|
|
Service Code
|
CPT 23333
|
| Hospital Charge Code |
21600499
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$390.94 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$891.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$859.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$891.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$706.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Cigna Commercial |
$1,217.20
|
| Rate for Payer: First Health Commercial |
$1,288.80
|
| Rate for Payer: First Health Workers Compensation |
$552.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,288.80
|
| Rate for Payer: GEHA Commercial |
$1,145.60
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,288.80
|
| 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 |
$720.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$1,303.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,002.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,288.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$832.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$720.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,360.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,074.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$720.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,331.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$572.80
|
| 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 |
$390.94
|
|
|
REMOVAL SKN TAGS MLT FIBRQ TAGS EA 10
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
20300051
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$56.05 |
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$50.15
|
| Rate for Payer: First Health Commercial |
$53.10
|
| Rate for Payer: First Health Workers Compensation |
$22.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$53.10
|
| Rate for Payer: GEHA Commercial |
$41.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$53.10
|
| Rate for Payer: Multiplan All |
$53.69
|
| Rate for Payer: OMNI Networks Commercial |
$41.30
|
| Rate for Payer: One Health Plan PPO/POS |
$53.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$56.05
|
| Rate for Payer: Three Rivers Provider Network All |
$44.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$54.87
|
| Rate for Payer: Zelis Auto |
$23.60
|
| Rate for Payer: Zelis Worker's Compensation |
$16.11
|
|
|
REMOVAL SKN TAGS MLT FIBRQ TAGS EA 10
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
21511201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$56.05 |
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$50.15
|
| Rate for Payer: First Health Commercial |
$53.10
|
| Rate for Payer: First Health Workers Compensation |
$22.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$53.10
|
| Rate for Payer: GEHA Commercial |
$41.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$53.10
|
| Rate for Payer: Multiplan All |
$53.69
|
| Rate for Payer: OMNI Networks Commercial |
$41.30
|
| Rate for Payer: One Health Plan PPO/POS |
$53.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$56.05
|
| Rate for Payer: Three Rivers Provider Network All |
$44.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$54.87
|
| Rate for Payer: Zelis Auto |
$23.60
|
| Rate for Payer: Zelis Worker's Compensation |
$16.11
|
|
|
REMOVAL SKN TAGS MLT FIBRQ TAGS EA 10
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
20300051
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$88.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$35.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$50.15
|
| Rate for Payer: First Health Commercial |
$53.10
|
| Rate for Payer: First Health Workers Compensation |
$22.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$53.10
|
| Rate for Payer: GEHA Commercial |
$47.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$53.10
|
| Rate for Payer: Humana ChoiceCare |
$15.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Multiplan All |
$53.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.40
|
| Rate for Payer: OMNI Networks Commercial |
$41.30
|
| Rate for Payer: One Health Plan PPO/POS |
$53.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$56.05
|
| Rate for Payer: Three Rivers Provider Network All |
$44.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$51.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$54.87
|
| Rate for Payer: Zelis Auto |
$23.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$29.50
|
| Rate for Payer: Zelis Worker's Compensation |
$16.11
|
|
|
REMOVAL SKN TAGS MLT FIBRQ TAGS EA 10
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
21600024
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$56.05 |
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$50.15
|
| Rate for Payer: First Health Commercial |
$53.10
|
| Rate for Payer: First Health Workers Compensation |
$22.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$53.10
|
| Rate for Payer: GEHA Commercial |
$41.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$53.10
|
| Rate for Payer: Multiplan All |
$53.69
|
| Rate for Payer: OMNI Networks Commercial |
$41.30
|
| Rate for Payer: One Health Plan PPO/POS |
$53.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$56.05
|
| Rate for Payer: Three Rivers Provider Network All |
$44.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$54.87
|
| Rate for Payer: Zelis Auto |
$23.60
|
| Rate for Payer: Zelis Worker's Compensation |
$16.11
|
|
|
REMOVAL SKN TAGS MLT FIBRQ TAGS EA 10
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
25500024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$88.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$35.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$50.15
|
| Rate for Payer: First Health Commercial |
$53.10
|
| Rate for Payer: First Health Workers Compensation |
$22.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$53.10
|
| Rate for Payer: GEHA Commercial |
$47.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$53.10
|
| Rate for Payer: Humana ChoiceCare |
$15.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Multiplan All |
$53.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.40
|
| Rate for Payer: OMNI Networks Commercial |
$41.30
|
| Rate for Payer: One Health Plan PPO/POS |
$53.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$56.05
|
| Rate for Payer: Three Rivers Provider Network All |
$44.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$51.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$54.87
|
| Rate for Payer: Zelis Auto |
$23.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$29.50
|
| Rate for Payer: Zelis Worker's Compensation |
$16.11
|
|
|
REMOVAL SKN TAGS MLT FIBRQ TAGS EA 10
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
25500024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$56.05 |
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$50.15
|
| Rate for Payer: First Health Commercial |
$53.10
|
| Rate for Payer: First Health Workers Compensation |
$22.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$53.10
|
| Rate for Payer: GEHA Commercial |
$41.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$53.10
|
| Rate for Payer: Multiplan All |
$53.69
|
| Rate for Payer: OMNI Networks Commercial |
$41.30
|
| Rate for Payer: One Health Plan PPO/POS |
$53.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$56.05
|
| Rate for Payer: Three Rivers Provider Network All |
$44.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$54.87
|
| Rate for Payer: Zelis Auto |
$23.60
|
| Rate for Payer: Zelis Worker's Compensation |
$16.11
|
|
|
REMOVAL SKN TAGS MLT FIBRQ TAGS EA 10
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
21511201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$88.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$35.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$50.15
|
| Rate for Payer: First Health Commercial |
$53.10
|
| Rate for Payer: First Health Workers Compensation |
$22.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$53.10
|
| Rate for Payer: GEHA Commercial |
$47.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$53.10
|
| Rate for Payer: Humana ChoiceCare |
$15.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Multiplan All |
$53.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.40
|
| Rate for Payer: OMNI Networks Commercial |
$41.30
|
| Rate for Payer: One Health Plan PPO/POS |
$53.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$56.05
|
| Rate for Payer: Three Rivers Provider Network All |
$44.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$51.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$54.87
|
| Rate for Payer: Zelis Auto |
$23.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$29.50
|
| Rate for Payer: Zelis Worker's Compensation |
$16.11
|
|
|
REMOVAL SKN TAGS MLT FIBRQ TAGS EA 10
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
21600024
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$88.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$35.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$50.15
|
| Rate for Payer: First Health Commercial |
$53.10
|
| Rate for Payer: First Health Workers Compensation |
$22.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$53.10
|
| Rate for Payer: GEHA Commercial |
$47.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$53.10
|
| Rate for Payer: Humana ChoiceCare |
$15.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Multiplan All |
$53.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.40
|
| Rate for Payer: OMNI Networks Commercial |
$41.30
|
| Rate for Payer: One Health Plan PPO/POS |
$53.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$56.05
|
| Rate for Payer: Three Rivers Provider Network All |
$44.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$51.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$54.87
|
| Rate for Payer: Zelis Auto |
$23.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$29.50
|
| Rate for Payer: Zelis Worker's Compensation |
$16.11
|
|
|
REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONI
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
6133286
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$76.99 |
| Max. Negotiated Rate |
$1,336.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$869.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$169.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$869.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$688.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$239.70
|
| Rate for Payer: First Health Commercial |
$253.80
|
| Rate for Payer: First Health Workers Compensation |
$108.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$253.80
|
| Rate for Payer: GEHA Commercial |
$225.60
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$253.80
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$702.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$256.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$197.40
|
| Rate for Payer: One Health Plan PPO/POS |
$253.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$811.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$702.45
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$267.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$211.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$702.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$262.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$112.80
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$76.99
|
|
|
REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONI
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
6133286
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$76.99 |
| Max. Negotiated Rate |
$267.90 |
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$239.70
|
| Rate for Payer: First Health Commercial |
$253.80
|
| Rate for Payer: First Health Workers Compensation |
$108.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$253.80
|
| Rate for Payer: GEHA Commercial |
$197.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$253.80
|
| Rate for Payer: Multiplan All |
$256.62
|
| Rate for Payer: OMNI Networks Commercial |
$197.40
|
| Rate for Payer: One Health Plan PPO/POS |
$253.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$267.90
|
| Rate for Payer: Three Rivers Provider Network All |
$211.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$262.26
|
| Rate for Payer: Zelis Auto |
$112.80
|
| Rate for Payer: Zelis Worker's Compensation |
$76.99
|
|
|
REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONI
|
Facility
|
OP
|
$4,828.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
4210023
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$567.88 |
| Max. Negotiated Rate |
$4,586.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$869.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,896.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$869.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$688.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$668.09
|
| Rate for Payer: Cash Price |
$2,896.80
|
| Rate for Payer: Cash Price |
$2,896.80
|
| Rate for Payer: Cigna Commercial |
$4,103.80
|
| Rate for Payer: First Health Commercial |
$4,345.20
|
| Rate for Payer: First Health Workers Compensation |
$859.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,345.20
|
| Rate for Payer: GEHA Commercial |
$3,862.40
|
| Rate for Payer: GEHA Medicare |
$668.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,345.20
|
| Rate for Payer: Humana ChoiceCare |
$734.90
|
| Rate for Payer: Humana Medicare Advantage |
$668.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,122.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$702.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$668.09
|
| Rate for Payer: Multiplan All |
$4,393.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,135.75
|
| Rate for Payer: OMNI Networks Commercial |
$3,379.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,345.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$811.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$702.45
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$668.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,586.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,336.18
|
| Rate for Payer: Three Rivers Provider Network All |
$3,621.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$654.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$702.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$668.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,490.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$668.09
|
| Rate for Payer: Zelis Auto |
$1,931.20
|
| Rate for Payer: Zelis Medicare |
$567.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$801.71
|
| Rate for Payer: Zelis Worker's Compensation |
$607.96
|
|
|
REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONI
|
Facility
|
IP
|
$4,828.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
4210023
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,318.04 |
| Max. Negotiated Rate |
$4,586.60 |
| Rate for Payer: Cash Price |
$2,896.80
|
| Rate for Payer: Cigna Commercial |
$4,103.80
|
| Rate for Payer: First Health Commercial |
$4,345.20
|
| Rate for Payer: First Health Workers Compensation |
$1,864.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,345.20
|
| Rate for Payer: GEHA Commercial |
$3,379.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,345.20
|
| Rate for Payer: Multiplan All |
$4,393.48
|
| Rate for Payer: OMNI Networks Commercial |
$3,379.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,345.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,586.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,621.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,490.04
|
| Rate for Payer: Zelis Auto |
$1,931.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,318.04
|
|
