|
REMOVE EXOSTOSIS MANDIBLE
|
Facility
|
IP
|
$754.00
|
|
|
Service Code
|
CPT 21031
|
| Hospital Charge Code |
6121031
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$205.84 |
| Max. Negotiated Rate |
$716.30 |
| Rate for Payer: Cash Price |
$452.40
|
| Rate for Payer: Cigna Commercial |
$640.90
|
| Rate for Payer: First Health Commercial |
$678.60
|
| Rate for Payer: First Health Workers Compensation |
$291.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$678.60
|
| Rate for Payer: GEHA Commercial |
$527.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$678.60
|
| Rate for Payer: Multiplan All |
$686.14
|
| Rate for Payer: OMNI Networks Commercial |
$527.80
|
| Rate for Payer: One Health Plan PPO/POS |
$678.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$716.30
|
| Rate for Payer: Three Rivers Provider Network All |
$565.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$701.22
|
| Rate for Payer: Zelis Auto |
$301.60
|
| Rate for Payer: Zelis Worker's Compensation |
$205.84
|
|
|
REMOVE EXOSTOSIS MANDIBLE
|
Facility
|
OP
|
$754.00
|
|
|
Service Code
|
CPT 21031
|
| Hospital Charge Code |
6121031
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$205.84 |
| 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 |
$452.40
|
| 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 |
$452.40
|
| Rate for Payer: Cash Price |
$452.40
|
| Rate for Payer: Cigna Commercial |
$640.90
|
| Rate for Payer: First Health Commercial |
$678.60
|
| Rate for Payer: First Health Workers Compensation |
$291.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$678.60
|
| Rate for Payer: GEHA Commercial |
$603.20
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$678.60
|
| 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 |
$686.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$527.80
|
| Rate for Payer: One Health Plan PPO/POS |
$678.60
|
| 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 |
$716.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$565.50
|
| 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 |
$701.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$301.60
|
| 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 |
$205.84
|
|
|
REMOVE EXOSTOSIS MAXILLA
|
Facility
|
OP
|
$748.00
|
|
|
Service Code
|
CPT 21032
|
| Hospital Charge Code |
6121032
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$204.20 |
| 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 |
$448.80
|
| 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 |
$448.80
|
| Rate for Payer: Cash Price |
$448.80
|
| Rate for Payer: Cigna Commercial |
$635.80
|
| Rate for Payer: First Health Commercial |
$673.20
|
| Rate for Payer: First Health Workers Compensation |
$288.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$673.20
|
| Rate for Payer: GEHA Commercial |
$598.40
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$673.20
|
| 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 |
$680.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$523.60
|
| Rate for Payer: One Health Plan PPO/POS |
$673.20
|
| 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 |
$710.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$561.00
|
| 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 |
$695.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$299.20
|
| 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 |
$204.20
|
|
|
REMOVE EXOSTOSIS MAXILLA
|
Facility
|
IP
|
$748.00
|
|
|
Service Code
|
CPT 21032
|
| Hospital Charge Code |
6121032
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$204.20 |
| Max. Negotiated Rate |
$710.60 |
| Rate for Payer: Cash Price |
$448.80
|
| Rate for Payer: Cigna Commercial |
$635.80
|
| Rate for Payer: First Health Commercial |
$673.20
|
| Rate for Payer: First Health Workers Compensation |
$288.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$673.20
|
| Rate for Payer: GEHA Commercial |
$523.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$673.20
|
| Rate for Payer: Multiplan All |
$680.68
|
| Rate for Payer: OMNI Networks Commercial |
$523.60
|
| Rate for Payer: One Health Plan PPO/POS |
$673.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$710.60
|
| Rate for Payer: Three Rivers Provider Network All |
$561.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$695.64
|
| Rate for Payer: Zelis Auto |
$299.20
|
| Rate for Payer: Zelis Worker's Compensation |
$204.20
|
|
|
REMOVE EXTERNAL EAR, PARTIAL
|
Facility
|
IP
|
$818.00
|
|
|
Service Code
|
CPT 69110
|
| Hospital Charge Code |
6169110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$223.31 |
| Max. Negotiated Rate |
$777.10 |
| Rate for Payer: Cash Price |
$490.80
|
| Rate for Payer: Cigna Commercial |
$695.30
|
| Rate for Payer: First Health Commercial |
$736.20
|
| Rate for Payer: First Health Workers Compensation |
$315.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$736.20
|
| Rate for Payer: GEHA Commercial |
$572.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$736.20
|
| Rate for Payer: Multiplan All |
$744.38
|
| Rate for Payer: OMNI Networks Commercial |
$572.60
|
| Rate for Payer: One Health Plan PPO/POS |
$736.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$777.10
|
| Rate for Payer: Three Rivers Provider Network All |
$613.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$760.74
|
| Rate for Payer: Zelis Auto |
$327.20
|
| Rate for Payer: Zelis Worker's Compensation |
$223.31
|
|
|
REMOVE EXTERNAL EAR, PARTIAL
|
Facility
|
OP
|
$818.00
|
|
|
Service Code
|
CPT 69110
|
| Hospital Charge Code |
6169110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$223.31 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$490.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,769.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,401.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$490.80
|
| Rate for Payer: Cash Price |
$490.80
|
| Rate for Payer: Cigna Commercial |
$695.30
|
| Rate for Payer: First Health Commercial |
$736.20
|
| Rate for Payer: First Health Workers Compensation |
$315.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$736.20
|
| Rate for Payer: GEHA Commercial |
$654.40
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$736.20
|
| 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 |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$744.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$572.60
|
| Rate for Payer: One Health Plan PPO/POS |
$736.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,651.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,430.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$777.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$613.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$760.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$327.20
|
| 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 |
$223.31
|
|
|
REMOVE FB EXT EYE; CORNL WO LAMP
|
Facility
|
OP
|
$9,384.00
|
|
| Hospital Charge Code |
8165275
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,346.00 |
| Max. Negotiated Rate |
$8,914.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,630.40
|
| Rate for Payer: Cash Price |
$5,630.40
|
| Rate for Payer: Cigna Commercial |
$7,976.40
|
| Rate for Payer: First Health Commercial |
$8,445.60
|
| Rate for Payer: First Health Workers Compensation |
$3,623.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,445.60
|
| Rate for Payer: GEHA Commercial |
$7,507.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,445.60
|
| Rate for Payer: Humana ChoiceCare |
$2,439.84
|
| Rate for Payer: Multiplan All |
$8,539.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,630.40
|
| Rate for Payer: OMNI Networks Commercial |
$6,568.80
|
| Rate for Payer: One Health Plan PPO/POS |
$8,445.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,914.80
|
| Rate for Payer: Three Rivers Provider Network All |
$7,038.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,257.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,346.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,727.12
|
| Rate for Payer: Zelis Auto |
$3,753.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,692.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2,561.83
|
|
|
REMOVE FB EXT EYE; CORNL WO LAMP
|
Facility
|
IP
|
$9,384.00
|
|
| Hospital Charge Code |
8165275
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,561.83 |
| Max. Negotiated Rate |
$8,914.80 |
| Rate for Payer: Cash Price |
$5,630.40
|
| Rate for Payer: Cigna Commercial |
$7,976.40
|
| Rate for Payer: First Health Commercial |
$8,445.60
|
| Rate for Payer: First Health Workers Compensation |
$3,623.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,445.60
|
| Rate for Payer: GEHA Commercial |
$6,568.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,445.60
|
| Rate for Payer: Multiplan All |
$8,539.44
|
| Rate for Payer: OMNI Networks Commercial |
$6,568.80
|
| Rate for Payer: One Health Plan PPO/POS |
$8,445.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,914.80
|
| Rate for Payer: Three Rivers Provider Network All |
$7,038.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,727.12
|
| Rate for Payer: Zelis Auto |
$3,753.60
|
| Rate for Payer: Zelis Worker's Compensation |
$2,561.83
|
|
|
REMOVE FEMUR LESION
|
Facility
|
OP
|
$1,229.00
|
|
|
Service Code
|
CPT 27355
|
| Hospital Charge Code |
6127355
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$335.52 |
| 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 |
$737.40
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$737.40
|
| Rate for Payer: Cash Price |
$737.40
|
| Rate for Payer: Cigna Commercial |
$1,044.65
|
| Rate for Payer: First Health Commercial |
$1,106.10
|
| Rate for Payer: First Health Workers Compensation |
$474.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,106.10
|
| Rate for Payer: GEHA Commercial |
$983.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,106.10
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,118.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$860.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,106.10
|
| 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 |
$1,167.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$921.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,142.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$491.60
|
| 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 |
$335.52
|
|
|
REMOVE FEMUR LESION
|
Facility
|
IP
|
$1,229.00
|
|
|
Service Code
|
CPT 27355
|
| Hospital Charge Code |
6127355
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$335.52 |
| Max. Negotiated Rate |
$1,167.55 |
| Rate for Payer: Cash Price |
$737.40
|
| Rate for Payer: Cigna Commercial |
$1,044.65
|
| Rate for Payer: First Health Commercial |
$1,106.10
|
| Rate for Payer: First Health Workers Compensation |
$474.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,106.10
|
| Rate for Payer: GEHA Commercial |
$860.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,106.10
|
| Rate for Payer: Multiplan All |
$1,118.39
|
| Rate for Payer: OMNI Networks Commercial |
$860.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,106.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,167.55
|
| Rate for Payer: Three Rivers Provider Network All |
$921.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,142.97
|
| Rate for Payer: Zelis Auto |
$491.60
|
| Rate for Payer: Zelis Worker's Compensation |
$335.52
|
|
|
REMOVE FEMUR LESION/BURSA
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
CPT 27062
|
| Hospital Charge Code |
6127062
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$253.89 |
| 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 |
$558.00
|
| 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 |
$558.00
|
| Rate for Payer: Cash Price |
$558.00
|
| Rate for Payer: Cigna Commercial |
$790.50
|
| Rate for Payer: First Health Commercial |
$837.00
|
| Rate for Payer: First Health Workers Compensation |
$359.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$837.00
|
| Rate for Payer: GEHA Commercial |
$744.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$837.00
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$846.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$651.00
|
| Rate for Payer: One Health Plan PPO/POS |
$837.00
|
| 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 |
$883.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$697.50
|
| 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 |
$864.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$372.00
|
| 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 |
$253.89
|
|
|
REMOVE FEMUR LESION/BURSA
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
CPT 27062
|
| Hospital Charge Code |
6127062
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$253.89 |
| Max. Negotiated Rate |
$883.50 |
| Rate for Payer: Cash Price |
$558.00
|
| Rate for Payer: Cigna Commercial |
$790.50
|
| Rate for Payer: First Health Commercial |
$837.00
|
| Rate for Payer: First Health Workers Compensation |
$359.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$837.00
|
| Rate for Payer: GEHA Commercial |
$651.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$837.00
|
| Rate for Payer: Multiplan All |
$846.30
|
| Rate for Payer: OMNI Networks Commercial |
$651.00
|
| Rate for Payer: One Health Plan PPO/POS |
$837.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$883.50
|
| Rate for Payer: Three Rivers Provider Network All |
$697.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$864.90
|
| Rate for Payer: Zelis Auto |
$372.00
|
| Rate for Payer: Zelis Worker's Compensation |
$253.89
|
|
|
REMOVE FEMUR LESION/FIXATION
|
Facility
|
OP
|
$727.00
|
|
|
Service Code
|
CPT 27358
|
| Hospital Charge Code |
6127358
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$189.02 |
| 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 |
$436.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Cash Price |
$436.20
|
| Rate for Payer: Cash Price |
$436.20
|
| Rate for Payer: Cigna Commercial |
$617.95
|
| Rate for Payer: First Health Commercial |
$654.30
|
| Rate for Payer: First Health Workers Compensation |
$280.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$654.30
|
| Rate for Payer: GEHA Commercial |
$581.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$654.30
|
| Rate for Payer: Humana ChoiceCare |
$189.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Multiplan All |
$661.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$436.20
|
| Rate for Payer: OMNI Networks Commercial |
$508.90
|
| Rate for Payer: One Health Plan PPO/POS |
$654.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$690.65
|
| Rate for Payer: Three Rivers Provider Network All |
$545.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$639.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$676.11
|
| Rate for Payer: Zelis Auto |
$290.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$363.50
|
| Rate for Payer: Zelis Worker's Compensation |
$198.47
|
|
|
REMOVE FEMUR LESION/FIXATION
|
Facility
|
IP
|
$727.00
|
|
|
Service Code
|
CPT 27358
|
| Hospital Charge Code |
6127358
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$198.47 |
| Max. Negotiated Rate |
$690.65 |
| Rate for Payer: Cash Price |
$436.20
|
| Rate for Payer: Cigna Commercial |
$617.95
|
| Rate for Payer: First Health Commercial |
$654.30
|
| Rate for Payer: First Health Workers Compensation |
$280.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$654.30
|
| Rate for Payer: GEHA Commercial |
$508.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$654.30
|
| Rate for Payer: Multiplan All |
$661.57
|
| Rate for Payer: OMNI Networks Commercial |
$508.90
|
| Rate for Payer: One Health Plan PPO/POS |
$654.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$690.65
|
| Rate for Payer: Three Rivers Provider Network All |
$545.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$676.11
|
| Rate for Payer: Zelis Auto |
$290.80
|
| Rate for Payer: Zelis Worker's Compensation |
$198.47
|
|
|
REMOVE FEMUR LESION/GRAFT
|
Facility
|
IP
|
$1,669.00
|
|
|
Service Code
|
CPT 27357
|
| Hospital Charge Code |
6127357
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$455.64 |
| Max. Negotiated Rate |
$1,585.55 |
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cigna Commercial |
$1,418.65
|
| Rate for Payer: First Health Commercial |
$1,502.10
|
| Rate for Payer: First Health Workers Compensation |
$644.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,502.10
|
| Rate for Payer: GEHA Commercial |
$1,168.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,502.10
|
| Rate for Payer: Multiplan All |
$1,518.79
|
| Rate for Payer: OMNI Networks Commercial |
$1,168.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,502.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,585.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,251.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,552.17
|
| Rate for Payer: Zelis Auto |
$667.60
|
| Rate for Payer: Zelis Worker's Compensation |
$455.64
|
|
|
REMOVE FEMUR LESION/GRAFT
|
Facility
|
OP
|
$2,190.45
|
|
|
Service Code
|
CPT 27356
|
| Hospital Charge Code |
6127356
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$597.99 |
| Max. Negotiated Rate |
$24,435.12 |
| 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 |
$1,314.27
|
| 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 |
$12,217.56
|
| Rate for Payer: Cash Price |
$1,314.27
|
| Rate for Payer: Cash Price |
$1,314.27
|
| Rate for Payer: Cigna Commercial |
$1,861.88
|
| Rate for Payer: First Health Commercial |
$1,971.40
|
| Rate for Payer: First Health Workers Compensation |
$845.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,971.40
|
| Rate for Payer: GEHA Commercial |
$1,752.36
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,971.40
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,993.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,533.32
|
| Rate for Payer: One Health Plan PPO/POS |
$1,971.40
|
| 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 |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,080.93
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,642.84
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,037.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$876.18
|
| Rate for Payer: Zelis Medicare |
$10,384.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,661.07
|
| Rate for Payer: Zelis Worker's Compensation |
$597.99
|
|
|
REMOVE FEMUR LESION/GRAFT
|
Facility
|
IP
|
$2,190.45
|
|
|
Service Code
|
CPT 27356
|
| Hospital Charge Code |
6127356
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$597.99 |
| Max. Negotiated Rate |
$2,080.93 |
| Rate for Payer: Cash Price |
$1,314.27
|
| Rate for Payer: Cigna Commercial |
$1,861.88
|
| Rate for Payer: First Health Commercial |
$1,971.40
|
| Rate for Payer: First Health Workers Compensation |
$845.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,971.40
|
| Rate for Payer: GEHA Commercial |
$1,533.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,971.40
|
| Rate for Payer: Multiplan All |
$1,993.31
|
| Rate for Payer: OMNI Networks Commercial |
$1,533.32
|
| Rate for Payer: One Health Plan PPO/POS |
$1,971.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,080.93
|
| Rate for Payer: Three Rivers Provider Network All |
$1,642.84
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,037.12
|
| Rate for Payer: Zelis Auto |
$876.18
|
| Rate for Payer: Zelis Worker's Compensation |
$597.99
|
|
|
REMOVE FEMUR LESION/GRAFT
|
Facility
|
OP
|
$1,669.00
|
|
|
Service Code
|
CPT 27357
|
| Hospital Charge Code |
6127357
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$455.64 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,001.40
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cigna Commercial |
$1,418.65
|
| Rate for Payer: First Health Commercial |
$1,502.10
|
| Rate for Payer: First Health Workers Compensation |
$644.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,502.10
|
| Rate for Payer: GEHA Commercial |
$1,335.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,502.10
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,518.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,168.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,502.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,585.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,251.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,552.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$667.60
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$455.64
|
|
|
REMOVE FINGER BONE
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT 26185
|
| Hospital Charge Code |
6126185
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$298.66 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$656.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cigna Commercial |
$929.90
|
| Rate for Payer: First Health Commercial |
$984.60
|
| Rate for Payer: First Health Workers Compensation |
$422.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$984.60
|
| Rate for Payer: GEHA Commercial |
$875.20
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$984.60
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$995.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$765.80
|
| Rate for Payer: One Health Plan PPO/POS |
$984.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,039.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$820.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,017.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$437.60
|
| 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 |
$298.66
|
|
|
REMOVE FINGER BONE
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
CPT 26185
|
| Hospital Charge Code |
6126185
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$298.66 |
| Max. Negotiated Rate |
$1,039.30 |
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cigna Commercial |
$929.90
|
| Rate for Payer: First Health Commercial |
$984.60
|
| Rate for Payer: First Health Workers Compensation |
$422.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$984.60
|
| Rate for Payer: GEHA Commercial |
$765.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$984.60
|
| Rate for Payer: Multiplan All |
$995.54
|
| Rate for Payer: OMNI Networks Commercial |
$765.80
|
| Rate for Payer: One Health Plan PPO/POS |
$984.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$820.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,017.42
|
| Rate for Payer: Zelis Auto |
$437.60
|
| Rate for Payer: Zelis Worker's Compensation |
$298.66
|
|
|
REMOVE FOREARM BONE LESION
|
Facility
|
IP
|
$1,053.00
|
|
|
Service Code
|
CPT 25145
|
| Hospital Charge Code |
6125145
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$287.47 |
| Max. Negotiated Rate |
$1,000.35 |
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna Commercial |
$895.05
|
| Rate for Payer: First Health Commercial |
$947.70
|
| Rate for Payer: First Health Workers Compensation |
$406.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$947.70
|
| Rate for Payer: GEHA Commercial |
$737.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$947.70
|
| Rate for Payer: Multiplan All |
$958.23
|
| Rate for Payer: OMNI Networks Commercial |
$737.10
|
| Rate for Payer: One Health Plan PPO/POS |
$947.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,000.35
|
| Rate for Payer: Three Rivers Provider Network All |
$789.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$979.29
|
| Rate for Payer: Zelis Auto |
$421.20
|
| Rate for Payer: Zelis Worker's Compensation |
$287.47
|
|
|
REMOVE FOREARM BONE LESION
|
Facility
|
OP
|
$1,053.00
|
|
|
Service Code
|
CPT 25145
|
| Hospital Charge Code |
6125145
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$287.47 |
| 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 |
$631.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna Commercial |
$895.05
|
| Rate for Payer: First Health Commercial |
$947.70
|
| Rate for Payer: First Health Workers Compensation |
$406.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$947.70
|
| Rate for Payer: GEHA Commercial |
$842.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$947.70
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$958.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$737.10
|
| Rate for Payer: One Health Plan PPO/POS |
$947.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,000.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$789.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$979.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$421.20
|
| 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 |
$287.47
|
|
|
REMOVE FOREIGN BODY ADBOMEN
|
Facility
|
OP
|
$2,494.38
|
|
|
Service Code
|
CPT 49402
|
| Hospital Charge Code |
6149402
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$680.97 |
| Max. Negotiated Rate |
$6,701.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,748.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,496.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,748.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,177.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,350.98
|
| Rate for Payer: Cash Price |
$1,496.63
|
| Rate for Payer: Cash Price |
$1,496.63
|
| Rate for Payer: Cigna Commercial |
$2,120.22
|
| Rate for Payer: First Health Commercial |
$2,244.94
|
| Rate for Payer: First Health Workers Compensation |
$963.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,244.94
|
| Rate for Payer: GEHA Commercial |
$1,995.50
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,244.94
|
| Rate for Payer: Humana ChoiceCare |
$3,686.08
|
| Rate for Payer: Humana Medicare Advantage |
$3,350.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,629.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,221.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,350.98
|
| Rate for Payer: Multiplan All |
$2,269.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,746.07
|
| Rate for Payer: One Health Plan PPO/POS |
$2,244.94
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,565.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,221.87
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,350.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,369.66
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: Three Rivers Provider Network All |
$1,870.79
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,283.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,221.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,319.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Auto |
$997.75
|
| Rate for Payer: Zelis Medicare |
$2,848.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,021.18
|
| Rate for Payer: Zelis Worker's Compensation |
$680.97
|
|
|
REMOVE FOREIGN BODY ADBOMEN
|
Facility
|
IP
|
$2,494.38
|
|
|
Service Code
|
CPT 49402
|
| Hospital Charge Code |
6149402
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$680.97 |
| Max. Negotiated Rate |
$2,369.66 |
| Rate for Payer: Cash Price |
$1,496.63
|
| Rate for Payer: Cigna Commercial |
$2,120.22
|
| Rate for Payer: First Health Commercial |
$2,244.94
|
| Rate for Payer: First Health Workers Compensation |
$963.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,244.94
|
| Rate for Payer: GEHA Commercial |
$1,746.07
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,244.94
|
| Rate for Payer: Multiplan All |
$2,269.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,746.07
|
| Rate for Payer: One Health Plan PPO/POS |
$2,244.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,369.66
|
| Rate for Payer: Three Rivers Provider Network All |
$1,870.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,319.77
|
| Rate for Payer: Zelis Auto |
$997.75
|
| Rate for Payer: Zelis Worker's Compensation |
$680.97
|
|
|
REMOVE FOREIGN BODY LARYNX
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 31511
|
| Hospital Charge Code |
6131511
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$110.56 |
| Max. Negotiated Rate |
$384.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$186.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$243.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$186.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$147.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$184.34
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$344.25
|
| Rate for Payer: First Health Commercial |
$364.50
|
| Rate for Payer: First Health Workers Compensation |
$156.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$364.50
|
| Rate for Payer: GEHA Commercial |
$324.00
|
| Rate for Payer: GEHA Medicare |
$184.34
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$364.50
|
| Rate for Payer: Humana ChoiceCare |
$202.77
|
| Rate for Payer: Humana Medicare Advantage |
$184.34
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$309.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$150.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$184.34
|
| Rate for Payer: Multiplan All |
$368.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$313.38
|
| Rate for Payer: OMNI Networks Commercial |
$283.50
|
| Rate for Payer: One Health Plan PPO/POS |
$364.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$173.88
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$150.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$184.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$384.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$368.68
|
| Rate for Payer: Three Rivers Provider Network All |
$303.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$180.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$150.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.34
|
| Rate for Payer: United Payors & United Providers UP&UP |
$376.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$184.34
|
| Rate for Payer: Zelis Auto |
$162.00
|
| Rate for Payer: Zelis Medicare |
$156.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$221.21
|
| Rate for Payer: Zelis Worker's Compensation |
$110.56
|
|
