|
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 |
$6,284.94 |
| 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 |
$3,142.47
|
| 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 |
$3,142.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$678.60
|
| Rate for Payer: Humana ChoiceCare |
$3,456.72
|
| Rate for Payer: Humana Medicare Advantage |
$3,142.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,279.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,142.47
|
| Rate for Payer: Multiplan All |
$686.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,342.20
|
| 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 |
$3,142.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$716.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,284.94
|
| Rate for Payer: Three Rivers Provider Network All |
$565.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,079.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,142.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$701.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,142.47
|
| Rate for Payer: Zelis Auto |
$301.60
|
| Rate for Payer: Zelis Medicare |
$2,671.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,770.96
|
| Rate for Payer: Zelis Worker's Compensation |
$205.84
|
|
|
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 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 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 |
$6,284.94 |
| 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 |
$3,142.47
|
| 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 |
$3,142.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$673.20
|
| Rate for Payer: Humana ChoiceCare |
$3,456.72
|
| Rate for Payer: Humana Medicare Advantage |
$3,142.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,279.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,142.47
|
| Rate for Payer: Multiplan All |
$680.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,342.20
|
| 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 |
$3,142.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$710.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,284.94
|
| Rate for Payer: Three Rivers Provider Network All |
$561.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,079.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,142.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$695.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,142.47
|
| Rate for Payer: Zelis Auto |
$299.20
|
| Rate for Payer: Zelis Medicare |
$2,671.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,770.96
|
| 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 |
$5,546.54 |
| 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 |
$2,773.27
|
| 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 |
$2,773.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$736.20
|
| Rate for Payer: Humana ChoiceCare |
$3,050.60
|
| Rate for Payer: Humana Medicare Advantage |
$2,773.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,659.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,773.27
|
| Rate for Payer: Multiplan All |
$744.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,714.56
|
| 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 |
$2,773.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$777.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,546.54
|
| Rate for Payer: Three Rivers Provider Network All |
$613.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,717.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,773.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$760.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,773.27
|
| Rate for Payer: Zelis Auto |
$327.20
|
| Rate for Payer: Zelis Medicare |
$2,357.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,327.92
|
| 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: 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
|
| 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
|
|
|
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
|
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
|
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 |
$6,287.92 |
| 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 |
$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 |
$3,143.96
|
| 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 |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,106.10
|
| 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 |
$1,118.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| 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 |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,167.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$921.75
|
| 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 |
$1,142.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$491.60
|
| 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 |
$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 |
$6,287.92 |
| 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 |
$3,143.96
|
| 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 |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$837.00
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$846.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| 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 |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$883.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$697.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$864.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$372.00
|
| 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 |
$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
|
$1,669.00
|
|
|
Service Code
|
CPT 27357
|
| Hospital Charge Code |
6127357
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$455.64 |
| 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 |
$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 |
$6,922.13
|
| 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 |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,502.10
|
| 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 |
$1,518.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| 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 |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,585.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,251.75
|
| 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 |
$1,552.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$667.60
|
| 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 |
$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 |
$24,935.38 |
| 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 |
$12,467.69
|
| 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 |
$12,467.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,971.40
|
| Rate for Payer: Humana ChoiceCare |
$13,714.46
|
| Rate for Payer: Humana Medicare Advantage |
$12,467.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,945.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,467.69
|
| Rate for Payer: Multiplan All |
$1,993.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21,195.07
|
| 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 |
$12,467.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,080.93
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,935.38
|
| Rate for Payer: Three Rivers Provider Network All |
$1,642.84
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,218.34
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,467.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,037.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,467.69
|
| Rate for Payer: Zelis Auto |
$876.18
|
| Rate for Payer: Zelis Medicare |
$10,597.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,961.23
|
| 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 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 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 |
$3,101.54 |
| 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 |
$1,550.77
|
| 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 |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$984.60
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$995.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| 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 |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,039.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$820.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,017.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$437.60
|
| 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 |
$298.66
|
|
|
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 |
$6,287.92 |
| 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 |
$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 |
$3,143.96
|
| 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 |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$947.70
|
| 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 |
$958.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| 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 |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,000.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$789.75
|
| 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 |
$979.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$421.20
|
| 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 |
$287.47
|
|
|
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 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 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 |
$6,839.18 |
| 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 |
$3,419.59
|
| 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 |
$3,419.59
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,244.94
|
| Rate for Payer: Humana ChoiceCare |
$3,761.55
|
| Rate for Payer: Humana Medicare Advantage |
$3,419.59
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,744.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,221.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,419.59
|
| Rate for Payer: Multiplan All |
$2,269.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,813.30
|
| 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 |
$3,419.59
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,369.66
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,839.18
|
| Rate for Payer: Three Rivers Provider Network All |
$1,870.79
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,351.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,221.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,419.59
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,319.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,419.59
|
| Rate for Payer: Zelis Auto |
$997.75
|
| Rate for Payer: Zelis Medicare |
$2,906.65
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,103.51
|
| Rate for Payer: Zelis Worker's Compensation |
$680.97
|
|
|
REMOVE FOREIGN BODY LARYNX
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
CPT 31577
|
| Hospital Charge Code |
6131577
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$127.22 |
| Max. Negotiated Rate |
$752.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$446.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$279.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$446.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$353.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$376.26
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cigna Commercial |
$396.10
|
| Rate for Payer: First Health Commercial |
$419.40
|
| Rate for Payer: First Health Workers Compensation |
$179.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$419.40
|
| Rate for Payer: GEHA Commercial |
$372.80
|
| Rate for Payer: GEHA Medicare |
$376.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$419.40
|
| Rate for Payer: Humana ChoiceCare |
$413.89
|
| Rate for Payer: Humana Medicare Advantage |
$376.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$632.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$360.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$376.26
|
| Rate for Payer: Multiplan All |
$424.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$639.64
|
| Rate for Payer: OMNI Networks Commercial |
$326.20
|
| Rate for Payer: One Health Plan PPO/POS |
$419.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$416.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$360.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$376.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$442.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$752.52
|
| Rate for Payer: Three Rivers Provider Network All |
$349.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$368.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$360.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$376.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$433.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$376.26
|
| Rate for Payer: Zelis Auto |
$186.40
|
| Rate for Payer: Zelis Medicare |
$319.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$451.51
|
| Rate for Payer: Zelis Worker's Compensation |
$127.22
|
|
