|
REMOVE BONE FIXATION DEVICE
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
CPT 20694
|
| Hospital Charge Code |
6120694
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$235.05 |
| Max. Negotiated Rate |
$3,101.54 |
| 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 |
$516.60
|
| 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 |
$1,550.77
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cigna Commercial |
$731.85
|
| Rate for Payer: First Health Commercial |
$774.90
|
| Rate for Payer: First Health Workers Compensation |
$332.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$774.90
|
| Rate for Payer: GEHA Commercial |
$688.80
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$774.90
|
| Rate for Payer: Humana ChoiceCare |
$1,705.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,550.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,605.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$783.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$602.70
|
| Rate for Payer: One Health Plan PPO/POS |
$774.90
|
| 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 |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$817.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$645.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$800.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$344.40
|
| Rate for Payer: Zelis Medicare |
$1,318.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,860.92
|
| Rate for Payer: Zelis Worker's Compensation |
$235.05
|
|
|
REMOVE BONE FIXATION DEVICE
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
CPT 20694
|
| Hospital Charge Code |
6120694
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$235.05 |
| Max. Negotiated Rate |
$817.95 |
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cigna Commercial |
$731.85
|
| Rate for Payer: First Health Commercial |
$774.90
|
| Rate for Payer: First Health Workers Compensation |
$332.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$774.90
|
| Rate for Payer: GEHA Commercial |
$602.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$774.90
|
| Rate for Payer: Multiplan All |
$783.51
|
| Rate for Payer: OMNI Networks Commercial |
$602.70
|
| Rate for Payer: One Health Plan PPO/POS |
$774.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$817.95
|
| Rate for Payer: Three Rivers Provider Network All |
$645.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$800.73
|
| Rate for Payer: Zelis Auto |
$344.40
|
| Rate for Payer: Zelis Worker's Compensation |
$235.05
|
|
|
REMOVE BY LIGAT INT HEM GRPS
|
Facility
|
IP
|
$571.00
|
|
|
Service Code
|
CPT 46946
|
| Hospital Charge Code |
6146946
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$155.88 |
| Max. Negotiated Rate |
$542.45 |
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cigna Commercial |
$485.35
|
| Rate for Payer: First Health Commercial |
$513.90
|
| Rate for Payer: First Health Workers Compensation |
$220.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.90
|
| Rate for Payer: GEHA Commercial |
$399.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.90
|
| Rate for Payer: Multiplan All |
$519.61
|
| Rate for Payer: OMNI Networks Commercial |
$399.70
|
| Rate for Payer: One Health Plan PPO/POS |
$513.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$542.45
|
| Rate for Payer: Three Rivers Provider Network All |
$428.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.03
|
| Rate for Payer: Zelis Auto |
$228.40
|
| Rate for Payer: Zelis Worker's Compensation |
$155.88
|
|
|
REMOVE BY LIGAT INT HEM GRPS
|
Facility
|
OP
|
$571.00
|
|
|
Service Code
|
CPT 46946
|
| Hospital Charge Code |
6146946
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$155.88 |
| Max. Negotiated Rate |
$5,314.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,427.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$342.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,427.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,130.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,657.32
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cigna Commercial |
$485.35
|
| Rate for Payer: First Health Commercial |
$513.90
|
| Rate for Payer: First Health Workers Compensation |
$220.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$513.90
|
| Rate for Payer: GEHA Commercial |
$456.80
|
| Rate for Payer: GEHA Medicare |
$2,657.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$513.90
|
| Rate for Payer: Humana ChoiceCare |
$2,923.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,657.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,464.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,153.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,657.32
|
| Rate for Payer: Multiplan All |
$519.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,517.44
|
| Rate for Payer: OMNI Networks Commercial |
$399.70
|
| Rate for Payer: One Health Plan PPO/POS |
$513.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,331.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,153.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,657.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$542.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,314.64
|
| Rate for Payer: Three Rivers Provider Network All |
$428.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,604.17
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,153.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,657.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,657.32
|
| Rate for Payer: Zelis Auto |
$228.40
|
| Rate for Payer: Zelis Medicare |
$2,258.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,188.78
|
| Rate for Payer: Zelis Worker's Compensation |
$155.88
|
|
|
REMOVE CAROTID BODY LESION
|
Facility
|
OP
|
$2,945.00
|
|
|
Service Code
|
CPT 60600
|
| Hospital Charge Code |
6160600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$736.25 |
| Max. Negotiated Rate |
$2,797.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,767.00
|
| Rate for Payer: Cash Price |
$1,767.00
|
| Rate for Payer: Cigna Commercial |
$2,503.25
|
| Rate for Payer: First Health Commercial |
$2,650.50
|
| Rate for Payer: First Health Workers Compensation |
$1,137.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,650.50
|
| Rate for Payer: GEHA Commercial |
$2,356.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,650.50
|
| Rate for Payer: Humana ChoiceCare |
$765.70
|
| Rate for Payer: Multiplan All |
$2,679.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,767.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,061.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,650.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,797.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,208.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,591.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$736.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,738.85
|
| Rate for Payer: Zelis Auto |
$1,178.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,472.50
|
| Rate for Payer: Zelis Worker's Compensation |
$803.99
|
|
|
REMOVE CAROTID BODY LESION
|
Facility
|
OP
|
$3,650.00
|
|
|
Service Code
|
CPT 60605
|
| Hospital Charge Code |
6160605
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$912.50 |
| Max. Negotiated Rate |
$3,467.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,190.00
|
| Rate for Payer: Cash Price |
$2,190.00
|
| Rate for Payer: Cigna Commercial |
$3,102.50
|
| Rate for Payer: First Health Commercial |
$3,285.00
|
| Rate for Payer: First Health Workers Compensation |
$1,409.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,285.00
|
| Rate for Payer: GEHA Commercial |
$2,920.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,285.00
|
| Rate for Payer: Humana ChoiceCare |
$949.00
|
| Rate for Payer: Multiplan All |
$3,321.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,190.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,555.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,285.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,467.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,737.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,212.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$912.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,394.50
|
| Rate for Payer: Zelis Auto |
$1,460.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,825.00
|
| Rate for Payer: Zelis Worker's Compensation |
$996.45
|
|
|
REMOVE CAROTID BODY LESION
|
Facility
|
IP
|
$3,650.00
|
|
|
Service Code
|
CPT 60605
|
| Hospital Charge Code |
6160605
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$996.45 |
| Max. Negotiated Rate |
$3,467.50 |
| Rate for Payer: Cash Price |
$2,190.00
|
| Rate for Payer: Cigna Commercial |
$3,102.50
|
| Rate for Payer: First Health Commercial |
$3,285.00
|
| Rate for Payer: First Health Workers Compensation |
$1,409.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,285.00
|
| Rate for Payer: GEHA Commercial |
$2,555.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,285.00
|
| Rate for Payer: Multiplan All |
$3,321.50
|
| Rate for Payer: OMNI Networks Commercial |
$2,555.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,285.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,467.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,737.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,394.50
|
| Rate for Payer: Zelis Auto |
$1,460.00
|
| Rate for Payer: Zelis Worker's Compensation |
$996.45
|
|
|
REMOVE CAROTID BODY LESION
|
Facility
|
IP
|
$2,945.00
|
|
|
Service Code
|
CPT 60600
|
| Hospital Charge Code |
6160600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$803.99 |
| Max. Negotiated Rate |
$2,797.75 |
| Rate for Payer: Cash Price |
$1,767.00
|
| Rate for Payer: Cigna Commercial |
$2,503.25
|
| Rate for Payer: First Health Commercial |
$2,650.50
|
| Rate for Payer: First Health Workers Compensation |
$1,137.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,650.50
|
| Rate for Payer: GEHA Commercial |
$2,061.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,650.50
|
| Rate for Payer: Multiplan All |
$2,679.95
|
| Rate for Payer: OMNI Networks Commercial |
$2,061.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,650.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,797.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,208.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,738.85
|
| Rate for Payer: Zelis Auto |
$1,178.00
|
| Rate for Payer: Zelis Worker's Compensation |
$803.99
|
|
|
REMOVE CARTILAGE FOR GRAFT
|
Facility
|
IP
|
$979.00
|
|
|
Service Code
|
CPT 20912
|
| Hospital Charge Code |
6120912
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$267.27 |
| Max. Negotiated Rate |
$930.05 |
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cigna Commercial |
$832.15
|
| Rate for Payer: First Health Commercial |
$881.10
|
| Rate for Payer: First Health Workers Compensation |
$377.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$881.10
|
| Rate for Payer: GEHA Commercial |
$685.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$881.10
|
| Rate for Payer: Multiplan All |
$890.89
|
| Rate for Payer: OMNI Networks Commercial |
$685.30
|
| Rate for Payer: One Health Plan PPO/POS |
$881.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$930.05
|
| Rate for Payer: Three Rivers Provider Network All |
$734.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$910.47
|
| Rate for Payer: Zelis Auto |
$391.60
|
| Rate for Payer: Zelis Worker's Compensation |
$267.27
|
|
|
REMOVE CARTILAGE FOR GRAFT
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
CPT 20910
|
| Hospital Charge Code |
6120910
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$228.23 |
| Max. Negotiated Rate |
$2,419.71 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$501.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$593.14
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cigna Commercial |
$710.60
|
| Rate for Payer: First Health Commercial |
$752.40
|
| Rate for Payer: First Health Workers Compensation |
$322.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$752.40
|
| Rate for Payer: GEHA Commercial |
$668.80
|
| Rate for Payer: GEHA Medicare |
$593.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$752.40
|
| Rate for Payer: Humana ChoiceCare |
$652.45
|
| Rate for Payer: Humana Medicare Advantage |
$593.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$996.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$593.14
|
| Rate for Payer: Multiplan All |
$760.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,008.34
|
| Rate for Payer: OMNI Networks Commercial |
$585.20
|
| Rate for Payer: One Health Plan PPO/POS |
$752.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$593.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$794.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,186.28
|
| Rate for Payer: Three Rivers Provider Network All |
$627.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$581.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$593.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$777.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$593.14
|
| Rate for Payer: Zelis Auto |
$334.40
|
| Rate for Payer: Zelis Medicare |
$504.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$711.77
|
| Rate for Payer: Zelis Worker's Compensation |
$228.23
|
|
|
REMOVE CARTILAGE FOR GRAFT
|
Facility
|
OP
|
$979.00
|
|
|
Service Code
|
CPT 20912
|
| Hospital Charge Code |
6120912
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$267.27 |
| Max. Negotiated Rate |
$7,094.82 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$587.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,547.41
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cash Price |
$587.40
|
| Rate for Payer: Cigna Commercial |
$832.15
|
| Rate for Payer: First Health Commercial |
$881.10
|
| Rate for Payer: First Health Workers Compensation |
$377.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$881.10
|
| Rate for Payer: GEHA Commercial |
$783.20
|
| Rate for Payer: GEHA Medicare |
$3,547.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$881.10
|
| Rate for Payer: Humana ChoiceCare |
$3,902.15
|
| Rate for Payer: Humana Medicare Advantage |
$3,547.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,959.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,547.41
|
| Rate for Payer: Multiplan All |
$890.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,030.60
|
| Rate for Payer: OMNI Networks Commercial |
$685.30
|
| Rate for Payer: One Health Plan PPO/POS |
$881.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,547.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$930.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,094.82
|
| Rate for Payer: Three Rivers Provider Network All |
$734.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,476.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,547.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$910.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,547.41
|
| Rate for Payer: Zelis Auto |
$391.60
|
| Rate for Payer: Zelis Medicare |
$3,015.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,256.89
|
| Rate for Payer: Zelis Worker's Compensation |
$267.27
|
|
|
REMOVE CARTILAGE FOR GRAFT
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
CPT 20910
|
| Hospital Charge Code |
6120910
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$228.23 |
| Max. Negotiated Rate |
$794.20 |
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cigna Commercial |
$710.60
|
| Rate for Payer: First Health Commercial |
$752.40
|
| Rate for Payer: First Health Workers Compensation |
$322.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$752.40
|
| Rate for Payer: GEHA Commercial |
$585.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$752.40
|
| Rate for Payer: Multiplan All |
$760.76
|
| Rate for Payer: OMNI Networks Commercial |
$585.20
|
| Rate for Payer: One Health Plan PPO/POS |
$752.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$794.20
|
| Rate for Payer: Three Rivers Provider Network All |
$627.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$777.48
|
| Rate for Payer: Zelis Auto |
$334.40
|
| Rate for Payer: Zelis Worker's Compensation |
$228.23
|
|
|
REMOVE CERVIX REPAIR BOWEL
|
Facility
|
IP
|
$1,149.00
|
|
|
Service Code
|
CPT 57556
|
| Hospital Charge Code |
6157556
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$313.68 |
| Max. Negotiated Rate |
$1,091.55 |
| Rate for Payer: Cash Price |
$689.40
|
| Rate for Payer: Cigna Commercial |
$976.65
|
| Rate for Payer: First Health Commercial |
$1,034.10
|
| Rate for Payer: First Health Workers Compensation |
$443.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,034.10
|
| Rate for Payer: GEHA Commercial |
$804.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,034.10
|
| Rate for Payer: Multiplan All |
$1,045.59
|
| Rate for Payer: OMNI Networks Commercial |
$804.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,034.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,091.55
|
| Rate for Payer: Three Rivers Provider Network All |
$861.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,068.57
|
| Rate for Payer: Zelis Auto |
$459.60
|
| Rate for Payer: Zelis Worker's Compensation |
$313.68
|
|
|
REMOVE CERVIX REPAIR BOWEL
|
Facility
|
OP
|
$1,149.00
|
|
|
Service Code
|
CPT 57556
|
| Hospital Charge Code |
6157556
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$313.68 |
| Max. Negotiated Rate |
$9,566.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,548.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$689.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,548.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,603.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,783.32
|
| Rate for Payer: Cash Price |
$689.40
|
| Rate for Payer: Cash Price |
$689.40
|
| Rate for Payer: Cigna Commercial |
$976.65
|
| Rate for Payer: First Health Commercial |
$1,034.10
|
| Rate for Payer: First Health Workers Compensation |
$443.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,034.10
|
| Rate for Payer: GEHA Commercial |
$919.20
|
| Rate for Payer: GEHA Medicare |
$4,783.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,034.10
|
| Rate for Payer: Humana ChoiceCare |
$5,261.65
|
| Rate for Payer: Humana Medicare Advantage |
$4,783.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,035.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,676.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,783.32
|
| Rate for Payer: Multiplan All |
$1,045.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,131.64
|
| Rate for Payer: OMNI Networks Commercial |
$804.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,034.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,245.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,676.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,783.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,091.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,566.64
|
| Rate for Payer: Three Rivers Provider Network All |
$861.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,687.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,676.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,783.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,068.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,783.32
|
| Rate for Payer: Zelis Auto |
$459.60
|
| Rate for Payer: Zelis Medicare |
$4,065.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,739.98
|
| Rate for Payer: Zelis Worker's Compensation |
$313.68
|
|
|
REMOVE CERVIX/REPAIR PELVIS
|
Facility
|
OP
|
$1,729.00
|
|
|
Service Code
|
CPT 57545
|
| Hospital Charge Code |
6157545
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$432.25 |
| Max. Negotiated Rate |
$1,642.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,037.40
|
| Rate for Payer: Cash Price |
$1,037.40
|
| Rate for Payer: Cigna Commercial |
$1,469.65
|
| Rate for Payer: First Health Commercial |
$1,556.10
|
| Rate for Payer: First Health Workers Compensation |
$667.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,556.10
|
| Rate for Payer: GEHA Commercial |
$1,383.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,556.10
|
| Rate for Payer: Humana ChoiceCare |
$449.54
|
| Rate for Payer: Multiplan All |
$1,573.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,037.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,210.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,556.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,642.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,296.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,521.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$432.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,607.97
|
| Rate for Payer: Zelis Auto |
$691.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$864.50
|
| Rate for Payer: Zelis Worker's Compensation |
$472.02
|
|
|
REMOVE CERVIX/REPAIR PELVIS
|
Facility
|
IP
|
$1,729.00
|
|
|
Service Code
|
CPT 57545
|
| Hospital Charge Code |
6157545
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$472.02 |
| Max. Negotiated Rate |
$1,642.55 |
| Rate for Payer: Cash Price |
$1,037.40
|
| Rate for Payer: Cigna Commercial |
$1,469.65
|
| Rate for Payer: First Health Commercial |
$1,556.10
|
| Rate for Payer: First Health Workers Compensation |
$667.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,556.10
|
| Rate for Payer: GEHA Commercial |
$1,210.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,556.10
|
| Rate for Payer: Multiplan All |
$1,573.39
|
| Rate for Payer: OMNI Networks Commercial |
$1,210.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,556.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,642.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,296.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,607.97
|
| Rate for Payer: Zelis Auto |
$691.60
|
| Rate for Payer: Zelis Worker's Compensation |
$472.02
|
|
|
REMOVE CERVIX/REPAIR VAGINA
|
Facility
|
IP
|
$1,214.00
|
|
|
Service Code
|
CPT 57555
|
| Hospital Charge Code |
6157555
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$331.42 |
| Max. Negotiated Rate |
$1,153.30 |
| Rate for Payer: Cash Price |
$728.40
|
| Rate for Payer: Cigna Commercial |
$1,031.90
|
| Rate for Payer: First Health Commercial |
$1,092.60
|
| Rate for Payer: First Health Workers Compensation |
$468.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,092.60
|
| Rate for Payer: GEHA Commercial |
$849.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,092.60
|
| Rate for Payer: Multiplan All |
$1,104.74
|
| Rate for Payer: OMNI Networks Commercial |
$849.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,092.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,153.30
|
| Rate for Payer: Three Rivers Provider Network All |
$910.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,129.02
|
| Rate for Payer: Zelis Auto |
$485.60
|
| Rate for Payer: Zelis Worker's Compensation |
$331.42
|
|
|
REMOVE CERVIX/REPAIR VAGINA
|
Facility
|
OP
|
$1,214.00
|
|
|
Service Code
|
CPT 57555
|
| Hospital Charge Code |
6157555
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$331.42 |
| Max. Negotiated Rate |
$9,566.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$728.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,783.32
|
| Rate for Payer: Cash Price |
$728.40
|
| Rate for Payer: Cash Price |
$728.40
|
| Rate for Payer: Cigna Commercial |
$1,031.90
|
| Rate for Payer: First Health Commercial |
$1,092.60
|
| Rate for Payer: First Health Workers Compensation |
$468.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,092.60
|
| Rate for Payer: GEHA Commercial |
$971.20
|
| Rate for Payer: GEHA Medicare |
$4,783.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,092.60
|
| Rate for Payer: Humana ChoiceCare |
$5,261.65
|
| Rate for Payer: Humana Medicare Advantage |
$4,783.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,035.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,882.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,783.32
|
| Rate for Payer: Multiplan All |
$1,104.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,131.64
|
| Rate for Payer: OMNI Networks Commercial |
$849.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,092.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,328.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,882.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,783.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,153.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,566.64
|
| Rate for Payer: Three Rivers Provider Network All |
$910.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,687.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,783.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,129.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,783.32
|
| Rate for Payer: Zelis Auto |
$485.60
|
| Rate for Payer: Zelis Medicare |
$4,065.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,739.98
|
| Rate for Payer: Zelis Worker's Compensation |
$331.42
|
|
|
REMOVE COLLAR BONE LESION
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
CPT 23170
|
| Hospital Charge Code |
6123170
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$309.58 |
| Max. Negotiated Rate |
$6,287.92 |
| 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 |
$680.40
|
| 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 |
$3,143.96
|
| Rate for Payer: Cash Price |
$680.40
|
| Rate for Payer: Cash Price |
$680.40
|
| Rate for Payer: Cigna Commercial |
$963.90
|
| Rate for Payer: First Health Commercial |
$1,020.60
|
| Rate for Payer: First Health Workers Compensation |
$437.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,020.60
|
| Rate for Payer: GEHA Commercial |
$907.20
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,020.60
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$1,031.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$793.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,020.60
|
| 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 |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,077.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$850.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,054.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$453.60
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$309.58
|
|
|
REMOVE COLLAR BONE LESION
|
Facility
|
OP
|
$1,366.00
|
|
|
Service Code
|
CPT 23180
|
| Hospital Charge Code |
6123180
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$372.92 |
| Max. Negotiated Rate |
$13,844.26 |
| 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 |
$819.60
|
| 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 |
$6,922.13
|
| Rate for Payer: Cash Price |
$819.60
|
| Rate for Payer: Cash Price |
$819.60
|
| Rate for Payer: Cigna Commercial |
$1,161.10
|
| Rate for Payer: First Health Commercial |
$1,229.40
|
| Rate for Payer: First Health Workers Compensation |
$527.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,229.40
|
| Rate for Payer: GEHA Commercial |
$1,092.80
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,229.40
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,243.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$956.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,229.40
|
| 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 |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,297.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,024.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,270.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$546.40
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$372.92
|
|
|
REMOVE COLLAR BONE LESION
|
Facility
|
IP
|
$1,134.00
|
|
|
Service Code
|
CPT 23170
|
| Hospital Charge Code |
6123170
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$309.58 |
| Max. Negotiated Rate |
$1,077.30 |
| Rate for Payer: Cash Price |
$680.40
|
| Rate for Payer: Cigna Commercial |
$963.90
|
| Rate for Payer: First Health Commercial |
$1,020.60
|
| Rate for Payer: First Health Workers Compensation |
$437.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,020.60
|
| Rate for Payer: GEHA Commercial |
$793.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,020.60
|
| Rate for Payer: Multiplan All |
$1,031.94
|
| Rate for Payer: OMNI Networks Commercial |
$793.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,020.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,077.30
|
| Rate for Payer: Three Rivers Provider Network All |
$850.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,054.62
|
| Rate for Payer: Zelis Auto |
$453.60
|
| Rate for Payer: Zelis Worker's Compensation |
$309.58
|
|
|
REMOVE COLLAR BONE LESION
|
Facility
|
IP
|
$1,366.00
|
|
|
Service Code
|
CPT 23180
|
| Hospital Charge Code |
6123180
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$372.92 |
| Max. Negotiated Rate |
$1,297.70 |
| Rate for Payer: Cash Price |
$819.60
|
| Rate for Payer: Cigna Commercial |
$1,161.10
|
| Rate for Payer: First Health Commercial |
$1,229.40
|
| Rate for Payer: First Health Workers Compensation |
$527.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,229.40
|
| Rate for Payer: GEHA Commercial |
$956.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,229.40
|
| Rate for Payer: Multiplan All |
$1,243.06
|
| Rate for Payer: OMNI Networks Commercial |
$956.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,229.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,297.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,024.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,270.38
|
| Rate for Payer: Zelis Auto |
$546.40
|
| Rate for Payer: Zelis Worker's Compensation |
$372.92
|
|
|
REMOVE CORONOID PROCESS
|
Facility
|
OP
|
$1,253.00
|
|
|
Service Code
|
CPT 21070
|
| Hospital Charge Code |
6121070
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$342.07 |
| Max. Negotiated Rate |
$11,464.32 |
| 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 |
$751.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,732.16
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cigna Commercial |
$1,065.05
|
| Rate for Payer: First Health Commercial |
$1,127.70
|
| Rate for Payer: First Health Workers Compensation |
$483.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,127.70
|
| Rate for Payer: GEHA Commercial |
$1,002.40
|
| Rate for Payer: GEHA Medicare |
$5,732.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,127.70
|
| Rate for Payer: Humana ChoiceCare |
$6,305.38
|
| Rate for Payer: Humana Medicare Advantage |
$5,732.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,630.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,732.16
|
| Rate for Payer: Multiplan All |
$1,140.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,744.67
|
| Rate for Payer: OMNI Networks Commercial |
$877.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,127.70
|
| 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 |
$5,732.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,190.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,464.32
|
| Rate for Payer: Three Rivers Provider Network All |
$939.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,617.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,732.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,165.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,732.16
|
| Rate for Payer: Zelis Auto |
$501.20
|
| Rate for Payer: Zelis Medicare |
$4,872.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,878.59
|
| Rate for Payer: Zelis Worker's Compensation |
$342.07
|
|
|
REMOVE CORONOID PROCESS
|
Facility
|
IP
|
$1,253.00
|
|
|
Service Code
|
CPT 21070
|
| Hospital Charge Code |
6121070
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$342.07 |
| Max. Negotiated Rate |
$1,190.35 |
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cigna Commercial |
$1,065.05
|
| Rate for Payer: First Health Commercial |
$1,127.70
|
| Rate for Payer: First Health Workers Compensation |
$483.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,127.70
|
| Rate for Payer: GEHA Commercial |
$877.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,127.70
|
| Rate for Payer: Multiplan All |
$1,140.23
|
| Rate for Payer: OMNI Networks Commercial |
$877.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,127.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,190.35
|
| Rate for Payer: Three Rivers Provider Network All |
$939.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,165.29
|
| Rate for Payer: Zelis Auto |
$501.20
|
| Rate for Payer: Zelis Worker's Compensation |
$342.07
|
|
|
REMOVE DIGIT NERVE LESION
|
Facility
|
IP
|
$999.00
|
|
|
Service Code
|
CPT 64776
|
| Hospital Charge Code |
6164776
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$272.73 |
| Max. Negotiated Rate |
$949.05 |
| Rate for Payer: Cash Price |
$599.40
|
| Rate for Payer: Cigna Commercial |
$849.15
|
| Rate for Payer: First Health Commercial |
$899.10
|
| Rate for Payer: First Health Workers Compensation |
$385.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$899.10
|
| Rate for Payer: GEHA Commercial |
$699.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$899.10
|
| Rate for Payer: Multiplan All |
$909.09
|
| Rate for Payer: OMNI Networks Commercial |
$699.30
|
| Rate for Payer: One Health Plan PPO/POS |
$899.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$949.05
|
| Rate for Payer: Three Rivers Provider Network All |
$749.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$929.07
|
| Rate for Payer: Zelis Auto |
$399.60
|
| Rate for Payer: Zelis Worker's Compensation |
$272.73
|
|
