|
REMOVE/GRAFT FOREARM LESION
|
Facility
|
OP
|
$1,211.00
|
|
|
Service Code
|
CPT 25126
|
| Hospital Charge Code |
6125126
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$330.60 |
| 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 |
$726.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: Cash Price |
$726.60
|
| Rate for Payer: Cash Price |
$726.60
|
| Rate for Payer: Cigna Commercial |
$1,029.35
|
| Rate for Payer: First Health Commercial |
$1,089.90
|
| Rate for Payer: First Health Workers Compensation |
$467.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,089.90
|
| Rate for Payer: GEHA Commercial |
$968.80
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,089.90
|
| 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 |
$1,102.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$847.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,089.90
|
| 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 |
$1,150.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$908.25
|
| 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 |
$1,126.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$484.40
|
| 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 |
$330.60
|
|
|
REMOVE/GRAFT FOREARM LESION
|
Facility
|
OP
|
$1,185.00
|
|
|
Service Code
|
CPT 25125
|
| Hospital Charge Code |
6125125
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$323.50 |
| 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 |
$711.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,550.77
|
| Rate for Payer: Cash Price |
$711.00
|
| Rate for Payer: Cash Price |
$711.00
|
| Rate for Payer: Cigna Commercial |
$1,007.25
|
| Rate for Payer: First Health Commercial |
$1,066.50
|
| Rate for Payer: First Health Workers Compensation |
$457.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,066.50
|
| Rate for Payer: GEHA Commercial |
$948.00
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,066.50
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$1,078.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$829.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,066.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,125.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$888.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,102.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$474.00
|
| 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 |
$323.50
|
|
|
REMOVE/GRAFT FOREARM LESION
|
Facility
|
IP
|
$1,211.00
|
|
|
Service Code
|
CPT 25126
|
| Hospital Charge Code |
6125126
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$330.60 |
| Max. Negotiated Rate |
$1,150.45 |
| Rate for Payer: Cash Price |
$726.60
|
| Rate for Payer: Cigna Commercial |
$1,029.35
|
| Rate for Payer: First Health Commercial |
$1,089.90
|
| Rate for Payer: First Health Workers Compensation |
$467.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,089.90
|
| Rate for Payer: GEHA Commercial |
$847.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,089.90
|
| Rate for Payer: Multiplan All |
$1,102.01
|
| Rate for Payer: OMNI Networks Commercial |
$847.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,089.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,150.45
|
| Rate for Payer: Three Rivers Provider Network All |
$908.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,126.23
|
| Rate for Payer: Zelis Auto |
$484.40
|
| Rate for Payer: Zelis Worker's Compensation |
$330.60
|
|
|
REMOVE/GRAFT FOREARM LESION
|
Facility
|
IP
|
$1,185.00
|
|
|
Service Code
|
CPT 25125
|
| Hospital Charge Code |
6125125
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$323.50 |
| Max. Negotiated Rate |
$1,125.75 |
| Rate for Payer: Cash Price |
$711.00
|
| Rate for Payer: Cigna Commercial |
$1,007.25
|
| Rate for Payer: First Health Commercial |
$1,066.50
|
| Rate for Payer: First Health Workers Compensation |
$457.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,066.50
|
| Rate for Payer: GEHA Commercial |
$829.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,066.50
|
| Rate for Payer: Multiplan All |
$1,078.35
|
| Rate for Payer: OMNI Networks Commercial |
$829.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,066.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,125.75
|
| Rate for Payer: Three Rivers Provider Network All |
$888.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,102.05
|
| Rate for Payer: Zelis Auto |
$474.00
|
| Rate for Payer: Zelis Worker's Compensation |
$323.50
|
|
|
REMOVE/GRAFT HIP BONE LESION
|
Facility
|
OP
|
$2,105.00
|
|
|
Service Code
|
CPT 27067
|
| Hospital Charge Code |
6127067
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$574.66 |
| 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 |
$1,263.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,922.13
|
| Rate for Payer: Cash Price |
$1,263.00
|
| Rate for Payer: Cash Price |
$1,263.00
|
| Rate for Payer: Cigna Commercial |
$1,789.25
|
| Rate for Payer: First Health Commercial |
$1,894.50
|
| Rate for Payer: First Health Workers Compensation |
$812.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,894.50
|
| Rate for Payer: GEHA Commercial |
$1,684.00
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,894.50
|
| 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 |
$1,915.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,473.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,894.50
|
| 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 |
$1,999.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,578.75
|
| 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 |
$1,957.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$842.00
|
| 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 |
$574.66
|
|
|
REMOVE/GRAFT HIP BONE LESION
|
Facility
|
IP
|
$2,105.00
|
|
|
Service Code
|
CPT 27067
|
| Hospital Charge Code |
6127067
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$574.66 |
| Max. Negotiated Rate |
$1,999.75 |
| Rate for Payer: Cash Price |
$1,263.00
|
| Rate for Payer: Cigna Commercial |
$1,789.25
|
| Rate for Payer: First Health Commercial |
$1,894.50
|
| Rate for Payer: First Health Workers Compensation |
$812.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,894.50
|
| Rate for Payer: GEHA Commercial |
$1,473.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,894.50
|
| Rate for Payer: Multiplan All |
$1,915.55
|
| Rate for Payer: OMNI Networks Commercial |
$1,473.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,894.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,999.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,578.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,957.65
|
| Rate for Payer: Zelis Auto |
$842.00
|
| Rate for Payer: Zelis Worker's Compensation |
$574.66
|
|
|
REMOVE/GRAFT LEG BONE LESION
|
Facility
|
OP
|
$1,567.00
|
|
|
Service Code
|
CPT 27638
|
| Hospital Charge Code |
6127638
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$427.79 |
| 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 |
$940.20
|
| 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: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,922.13
|
| Rate for Payer: Cash Price |
$940.20
|
| Rate for Payer: Cash Price |
$940.20
|
| Rate for Payer: Cigna Commercial |
$1,331.95
|
| Rate for Payer: First Health Commercial |
$1,410.30
|
| Rate for Payer: First Health Workers Compensation |
$605.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,410.30
|
| Rate for Payer: GEHA Commercial |
$1,253.60
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,410.30
|
| 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 |
$1,425.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,096.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,410.30
|
| 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 |
$1,488.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,175.25
|
| 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 |
$1,457.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$626.80
|
| 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 |
$427.79
|
|
|
REMOVE/GRAFT LEG BONE LESION
|
Facility
|
IP
|
$1,534.00
|
|
|
Service Code
|
CPT 27637
|
| Hospital Charge Code |
6127637
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$418.78 |
| Max. Negotiated Rate |
$1,457.30 |
| Rate for Payer: Cash Price |
$920.40
|
| Rate for Payer: Cigna Commercial |
$1,303.90
|
| Rate for Payer: First Health Commercial |
$1,380.60
|
| Rate for Payer: First Health Workers Compensation |
$592.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,380.60
|
| Rate for Payer: GEHA Commercial |
$1,073.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,380.60
|
| Rate for Payer: Multiplan All |
$1,395.94
|
| Rate for Payer: OMNI Networks Commercial |
$1,073.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,380.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,457.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,150.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,426.62
|
| Rate for Payer: Zelis Auto |
$613.60
|
| Rate for Payer: Zelis Worker's Compensation |
$418.78
|
|
|
REMOVE/GRAFT LEG BONE LESION
|
Facility
|
IP
|
$1,567.00
|
|
|
Service Code
|
CPT 27638
|
| Hospital Charge Code |
6127638
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$427.79 |
| Max. Negotiated Rate |
$1,488.65 |
| Rate for Payer: Cash Price |
$940.20
|
| Rate for Payer: Cigna Commercial |
$1,331.95
|
| Rate for Payer: First Health Commercial |
$1,410.30
|
| Rate for Payer: First Health Workers Compensation |
$605.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,410.30
|
| Rate for Payer: GEHA Commercial |
$1,096.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,410.30
|
| Rate for Payer: Multiplan All |
$1,425.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,096.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,410.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,488.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,175.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,457.31
|
| Rate for Payer: Zelis Auto |
$626.80
|
| Rate for Payer: Zelis Worker's Compensation |
$427.79
|
|
|
REMOVE/GRAFT LEG BONE LESION
|
Facility
|
OP
|
$1,534.00
|
|
|
Service Code
|
CPT 27637
|
| Hospital Charge Code |
6127637
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$418.78 |
| 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 |
$920.40
|
| 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 |
$920.40
|
| Rate for Payer: Cash Price |
$920.40
|
| Rate for Payer: Cigna Commercial |
$1,303.90
|
| Rate for Payer: First Health Commercial |
$1,380.60
|
| Rate for Payer: First Health Workers Compensation |
$592.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,380.60
|
| Rate for Payer: GEHA Commercial |
$1,227.20
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,380.60
|
| 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 |
$1,395.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,073.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,380.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,457.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,150.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,426.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$613.60
|
| 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 |
$418.78
|
|
|
REMOVE & GRAFT WRIST LESION
|
Facility
|
IP
|
$1,126.00
|
|
|
Service Code
|
CPT 25135
|
| Hospital Charge Code |
6125135
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$307.40 |
| Max. Negotiated Rate |
$1,069.70 |
| Rate for Payer: Cash Price |
$675.60
|
| Rate for Payer: Cigna Commercial |
$957.10
|
| Rate for Payer: First Health Commercial |
$1,013.40
|
| Rate for Payer: First Health Workers Compensation |
$434.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,013.40
|
| Rate for Payer: GEHA Commercial |
$788.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,013.40
|
| Rate for Payer: Multiplan All |
$1,024.66
|
| Rate for Payer: OMNI Networks Commercial |
$788.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,013.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,069.70
|
| Rate for Payer: Three Rivers Provider Network All |
$844.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,047.18
|
| Rate for Payer: Zelis Auto |
$450.40
|
| Rate for Payer: Zelis Worker's Compensation |
$307.40
|
|
|
REMOVE & GRAFT WRIST LESION
|
Facility
|
OP
|
$1,126.00
|
|
|
Service Code
|
CPT 25135
|
| Hospital Charge Code |
6125135
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$307.40 |
| 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 |
$675.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,922.13
|
| Rate for Payer: Cash Price |
$675.60
|
| Rate for Payer: Cash Price |
$675.60
|
| Rate for Payer: Cigna Commercial |
$957.10
|
| Rate for Payer: First Health Commercial |
$1,013.40
|
| Rate for Payer: First Health Workers Compensation |
$434.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,013.40
|
| Rate for Payer: GEHA Commercial |
$900.80
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,013.40
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,024.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$788.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,013.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,069.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$844.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,047.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$450.40
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$307.40
|
|
|
REMOVE & GRAFT WRIST LESION
|
Facility
|
IP
|
$996.00
|
|
|
Service Code
|
CPT 25136
|
| Hospital Charge Code |
6125136
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$271.91 |
| Max. Negotiated Rate |
$946.20 |
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cigna Commercial |
$846.60
|
| Rate for Payer: First Health Commercial |
$896.40
|
| Rate for Payer: First Health Workers Compensation |
$384.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$896.40
|
| Rate for Payer: GEHA Commercial |
$697.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$896.40
|
| Rate for Payer: Multiplan All |
$906.36
|
| Rate for Payer: OMNI Networks Commercial |
$697.20
|
| Rate for Payer: One Health Plan PPO/POS |
$896.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$946.20
|
| Rate for Payer: Three Rivers Provider Network All |
$747.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$926.28
|
| Rate for Payer: Zelis Auto |
$398.40
|
| Rate for Payer: Zelis Worker's Compensation |
$271.91
|
|
|
REMOVE & GRAFT WRIST LESION
|
Facility
|
OP
|
$996.00
|
|
|
Service Code
|
CPT 25136
|
| Hospital Charge Code |
6125136
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$271.91 |
| 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 |
$597.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,922.13
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cigna Commercial |
$846.60
|
| Rate for Payer: First Health Commercial |
$896.40
|
| Rate for Payer: First Health Workers Compensation |
$384.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$896.40
|
| Rate for Payer: GEHA Commercial |
$796.80
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$896.40
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$906.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$697.20
|
| Rate for Payer: One Health Plan PPO/POS |
$896.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$946.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$747.00
|
| 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 |
$926.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$398.40
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$271.91
|
|
|
REMOVE GROIN LYMPH NODES
|
Facility
|
OP
|
$1,760.00
|
|
|
Service Code
|
CPT 38760
|
| Hospital Charge Code |
6138760
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$480.48 |
| Max. Negotiated Rate |
$12,638.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,488.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,056.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,488.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,971.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,319.16
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cigna Commercial |
$1,496.00
|
| Rate for Payer: First Health Commercial |
$1,584.00
|
| Rate for Payer: First Health Workers Compensation |
$679.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,584.00
|
| Rate for Payer: GEHA Commercial |
$1,408.00
|
| Rate for Payer: GEHA Medicare |
$6,319.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,584.00
|
| Rate for Payer: Humana ChoiceCare |
$6,951.08
|
| Rate for Payer: Humana Medicare Advantage |
$6,319.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10,616.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,011.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,319.16
|
| Rate for Payer: Multiplan All |
$1,601.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,742.57
|
| Rate for Payer: OMNI Networks Commercial |
$1,232.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,584.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,322.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,011.74
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,319.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,672.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12,638.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,320.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,192.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,011.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,319.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,636.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,319.16
|
| Rate for Payer: Zelis Auto |
$704.00
|
| Rate for Payer: Zelis Medicare |
$5,371.29
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,582.99
|
| Rate for Payer: Zelis Worker's Compensation |
$480.48
|
|
|
REMOVE GROIN LYMPH NODES
|
Facility
|
IP
|
$1,760.00
|
|
|
Service Code
|
CPT 38760
|
| Hospital Charge Code |
6138760
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$480.48 |
| Max. Negotiated Rate |
$1,672.00 |
| Rate for Payer: Cash Price |
$1,056.00
|
| Rate for Payer: Cigna Commercial |
$1,496.00
|
| Rate for Payer: First Health Commercial |
$1,584.00
|
| Rate for Payer: First Health Workers Compensation |
$679.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,584.00
|
| Rate for Payer: GEHA Commercial |
$1,232.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,584.00
|
| Rate for Payer: Multiplan All |
$1,601.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,232.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,584.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,672.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,320.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,636.80
|
| Rate for Payer: Zelis Auto |
$704.00
|
| Rate for Payer: Zelis Worker's Compensation |
$480.48
|
|
|
REMOVE HAND BONE LESION
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT 26200
|
| Hospital Charge Code |
6126200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$248.70 |
| 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 |
$546.60
|
| 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 |
$546.60
|
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cigna Commercial |
$774.35
|
| Rate for Payer: First Health Commercial |
$819.90
|
| Rate for Payer: First Health Workers Compensation |
$351.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$819.90
|
| Rate for Payer: GEHA Commercial |
$728.80
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$819.90
|
| Rate for Payer: Humana ChoiceCare |
$1,705.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,550.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,605.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$829.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$637.70
|
| Rate for Payer: One Health Plan PPO/POS |
$819.90
|
| 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 |
$865.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$683.25
|
| 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 |
$847.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$364.40
|
| Rate for Payer: Zelis Medicare |
$1,318.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,860.92
|
| Rate for Payer: Zelis Worker's Compensation |
$248.70
|
|
|
REMOVE HAND BONE LESION
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT 26200
|
| Hospital Charge Code |
6126200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$248.70 |
| Max. Negotiated Rate |
$865.45 |
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cigna Commercial |
$774.35
|
| Rate for Payer: First Health Commercial |
$819.90
|
| Rate for Payer: First Health Workers Compensation |
$351.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$819.90
|
| Rate for Payer: GEHA Commercial |
$637.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$819.90
|
| Rate for Payer: Multiplan All |
$829.01
|
| Rate for Payer: OMNI Networks Commercial |
$637.70
|
| Rate for Payer: One Health Plan PPO/POS |
$819.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$865.45
|
| Rate for Payer: Three Rivers Provider Network All |
$683.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$847.23
|
| Rate for Payer: Zelis Auto |
$364.40
|
| Rate for Payer: Zelis Worker's Compensation |
$248.70
|
|
|
REMOVE HIP BONE LES DEEP
|
Facility
|
OP
|
$1,661.00
|
|
|
Service Code
|
CPT 27066
|
| Hospital Charge Code |
6127066
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$453.45 |
| 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 |
$996.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: Cash Price |
$996.60
|
| Rate for Payer: Cash Price |
$996.60
|
| Rate for Payer: Cigna Commercial |
$1,411.85
|
| Rate for Payer: First Health Commercial |
$1,494.90
|
| Rate for Payer: First Health Workers Compensation |
$641.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,494.90
|
| Rate for Payer: GEHA Commercial |
$1,328.80
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,494.90
|
| 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 |
$1,511.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$1,162.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,494.90
|
| 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 |
$1,577.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,245.75
|
| 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 |
$1,544.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$664.40
|
| 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 |
$453.45
|
|
|
REMOVE HIP BONE LES DEEP
|
Facility
|
IP
|
$1,661.00
|
|
|
Service Code
|
CPT 27066
|
| Hospital Charge Code |
6127066
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$453.45 |
| Max. Negotiated Rate |
$1,577.95 |
| Rate for Payer: Cash Price |
$996.60
|
| Rate for Payer: Cigna Commercial |
$1,411.85
|
| Rate for Payer: First Health Commercial |
$1,494.90
|
| Rate for Payer: First Health Workers Compensation |
$641.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,494.90
|
| Rate for Payer: GEHA Commercial |
$1,162.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,494.90
|
| Rate for Payer: Multiplan All |
$1,511.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,162.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,494.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,577.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,245.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,544.73
|
| Rate for Payer: Zelis Auto |
$664.40
|
| Rate for Payer: Zelis Worker's Compensation |
$453.45
|
|
|
REMOVE HIP BONE LES SUPER
|
Facility
|
IP
|
$1,041.00
|
|
|
Service Code
|
CPT 27065
|
| Hospital Charge Code |
6127065
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$284.19 |
| Max. Negotiated Rate |
$988.95 |
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cigna Commercial |
$884.85
|
| Rate for Payer: First Health Commercial |
$936.90
|
| Rate for Payer: First Health Workers Compensation |
$401.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$936.90
|
| Rate for Payer: GEHA Commercial |
$728.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$936.90
|
| Rate for Payer: Multiplan All |
$947.31
|
| Rate for Payer: OMNI Networks Commercial |
$728.70
|
| Rate for Payer: One Health Plan PPO/POS |
$936.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$988.95
|
| Rate for Payer: Three Rivers Provider Network All |
$780.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$968.13
|
| Rate for Payer: Zelis Auto |
$416.40
|
| Rate for Payer: Zelis Worker's Compensation |
$284.19
|
|
|
REMOVE HIP BONE LES SUPER
|
Facility
|
OP
|
$1,041.00
|
|
|
Service Code
|
CPT 27065
|
| Hospital Charge Code |
6127065
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$284.19 |
| Max. Negotiated Rate |
$13,844.26 |
| 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 |
$624.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,922.13
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cigna Commercial |
$884.85
|
| Rate for Payer: First Health Commercial |
$936.90
|
| Rate for Payer: First Health Workers Compensation |
$401.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$936.90
|
| Rate for Payer: GEHA Commercial |
$832.80
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$936.90
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$947.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$728.70
|
| Rate for Payer: One Health Plan PPO/POS |
$936.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$988.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$780.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$968.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$416.40
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$284.19
|
|
|
REMOVE HIP PRESSURE SORE
|
Facility
|
OP
|
$1,837.00
|
|
|
Service Code
|
CPT 15941
|
| Hospital Charge Code |
6115941
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$501.50 |
| Max. Negotiated Rate |
$5,546.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,102.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,773.27
|
| Rate for Payer: Cash Price |
$1,102.20
|
| Rate for Payer: Cash Price |
$1,102.20
|
| Rate for Payer: Cigna Commercial |
$1,561.45
|
| Rate for Payer: First Health Commercial |
$1,653.30
|
| Rate for Payer: First Health Workers Compensation |
$709.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,653.30
|
| Rate for Payer: GEHA Commercial |
$1,469.60
|
| Rate for Payer: GEHA Medicare |
$2,773.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,653.30
|
| 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 |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,773.27
|
| Rate for Payer: Multiplan All |
$1,671.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,714.56
|
| Rate for Payer: OMNI Networks Commercial |
$1,285.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,653.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,773.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,745.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,546.54
|
| Rate for Payer: Three Rivers Provider Network All |
$1,377.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,717.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,773.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,708.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,773.27
|
| Rate for Payer: Zelis Auto |
$734.80
|
| 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 |
$501.50
|
|
|
REMOVE HIP PRESSURE SORE
|
Facility
|
OP
|
$3,358.00
|
|
|
Service Code
|
CPT 15946
|
| Hospital Charge Code |
6115946
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$916.73 |
| Max. Negotiated Rate |
$3,544.98 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,014.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,772.49
|
| Rate for Payer: Cash Price |
$2,014.80
|
| Rate for Payer: Cash Price |
$2,014.80
|
| Rate for Payer: Cigna Commercial |
$2,854.30
|
| Rate for Payer: First Health Commercial |
$3,022.20
|
| Rate for Payer: First Health Workers Compensation |
$1,296.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,022.20
|
| Rate for Payer: GEHA Commercial |
$2,686.40
|
| Rate for Payer: GEHA Medicare |
$1,772.49
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,022.20
|
| Rate for Payer: Humana ChoiceCare |
$1,949.74
|
| Rate for Payer: Humana Medicare Advantage |
$1,772.49
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,977.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,772.49
|
| Rate for Payer: Multiplan All |
$3,055.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,013.23
|
| Rate for Payer: OMNI Networks Commercial |
$2,350.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,022.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,772.49
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,190.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,544.98
|
| Rate for Payer: Three Rivers Provider Network All |
$2,518.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,737.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,772.49
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,122.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,772.49
|
| Rate for Payer: Zelis Auto |
$1,343.20
|
| Rate for Payer: Zelis Medicare |
$1,506.62
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,126.99
|
| Rate for Payer: Zelis Worker's Compensation |
$916.73
|
|
|
REMOVE HIP PRESSURE SORE
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
CPT 15940
|
| Hospital Charge Code |
6115940
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$393.39 |
| Max. Negotiated Rate |
$5,546.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$864.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,773.27
|
| Rate for Payer: Cash Price |
$864.60
|
| Rate for Payer: Cash Price |
$864.60
|
| Rate for Payer: Cigna Commercial |
$1,224.85
|
| Rate for Payer: First Health Commercial |
$1,296.90
|
| Rate for Payer: First Health Workers Compensation |
$556.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,296.90
|
| Rate for Payer: GEHA Commercial |
$1,152.80
|
| Rate for Payer: GEHA Medicare |
$2,773.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,296.90
|
| 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 |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,773.27
|
| Rate for Payer: Multiplan All |
$1,311.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,714.56
|
| Rate for Payer: OMNI Networks Commercial |
$1,008.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,296.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,773.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,368.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,546.54
|
| Rate for Payer: Three Rivers Provider Network All |
$1,080.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,717.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,773.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,340.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,773.27
|
| Rate for Payer: Zelis Auto |
$576.40
|
| 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 |
$393.39
|
|
