|
REMOVE VERTEBRAL BODY ADD-ON
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
CPT 63086
|
| Hospital Charge Code |
6163086
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$167.08 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cigna Commercial |
$520.20
|
| Rate for Payer: First Health Commercial |
$550.80
|
| Rate for Payer: First Health Workers Compensation |
$236.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$550.80
|
| Rate for Payer: GEHA Commercial |
$428.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$550.80
|
| Rate for Payer: Multiplan All |
$556.92
|
| Rate for Payer: OMNI Networks Commercial |
$428.40
|
| Rate for Payer: One Health Plan PPO/POS |
$550.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$581.40
|
| Rate for Payer: Three Rivers Provider Network All |
$459.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$569.16
|
| Rate for Payer: Zelis Auto |
$244.80
|
| Rate for Payer: Zelis Worker's Compensation |
$167.08
|
|
|
REMOVE VERT XDRL BODY CRVCL
|
Facility
|
OP
|
$3,921.00
|
|
|
Service Code
|
CPT 63300
|
| Hospital Charge Code |
6163300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$980.25 |
| Max. Negotiated Rate |
$3,724.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,352.60
|
| Rate for Payer: Cash Price |
$2,352.60
|
| Rate for Payer: Cigna Commercial |
$3,332.85
|
| Rate for Payer: First Health Commercial |
$3,528.90
|
| Rate for Payer: First Health Workers Compensation |
$1,513.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,528.90
|
| Rate for Payer: GEHA Commercial |
$3,136.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,528.90
|
| Rate for Payer: Humana ChoiceCare |
$1,019.46
|
| Rate for Payer: Multiplan All |
$3,568.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,352.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,744.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,528.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,724.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,940.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,450.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$980.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,646.53
|
| Rate for Payer: Zelis Auto |
$1,568.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,960.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,070.43
|
|
|
REMOVE VERT XDRL BODY CRVCL
|
Facility
|
IP
|
$3,921.00
|
|
|
Service Code
|
CPT 63300
|
| Hospital Charge Code |
6163300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,070.43 |
| Max. Negotiated Rate |
$3,724.95 |
| Rate for Payer: Cash Price |
$2,352.60
|
| Rate for Payer: Cigna Commercial |
$3,332.85
|
| Rate for Payer: First Health Commercial |
$3,528.90
|
| Rate for Payer: First Health Workers Compensation |
$1,513.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,528.90
|
| Rate for Payer: GEHA Commercial |
$2,744.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,528.90
|
| Rate for Payer: Multiplan All |
$3,568.11
|
| Rate for Payer: OMNI Networks Commercial |
$2,744.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,528.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,724.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,940.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,646.53
|
| Rate for Payer: Zelis Auto |
$1,568.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,070.43
|
|
|
REMOVE WRIST/FOREARM LESION
|
Facility
|
IP
|
$1,543.00
|
|
|
Service Code
|
CPT 25115
|
| Hospital Charge Code |
6125115
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$421.24 |
| Max. Negotiated Rate |
$1,465.85 |
| Rate for Payer: Cash Price |
$925.80
|
| Rate for Payer: Cigna Commercial |
$1,311.55
|
| Rate for Payer: First Health Commercial |
$1,388.70
|
| Rate for Payer: First Health Workers Compensation |
$595.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,388.70
|
| Rate for Payer: GEHA Commercial |
$1,080.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,388.70
|
| Rate for Payer: Multiplan All |
$1,404.13
|
| Rate for Payer: OMNI Networks Commercial |
$1,080.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,388.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,465.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,157.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,434.99
|
| Rate for Payer: Zelis Auto |
$617.20
|
| Rate for Payer: Zelis Worker's Compensation |
$421.24
|
|
|
REMOVE WRIST/FOREARM LESION
|
Facility
|
OP
|
$1,214.00
|
|
|
Service Code
|
CPT 25116
|
| Hospital Charge Code |
6125116
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$331.42 |
| 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 |
$728.40
|
| 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 |
$728.40
|
| Rate for Payer: Cash Price |
$728.40
|
| Rate for Payer: Cigna Commercial |
$1,031.90
|
| Rate for Payer: First Health Commercial |
$1,092.60
|
| Rate for Payer: First Health Workers Compensation |
$468.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,092.60
|
| Rate for Payer: GEHA Commercial |
$971.20
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,092.60
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$1,104.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$849.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,092.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$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 |
$1,153.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$910.50
|
| 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 |
$1,129.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$485.60
|
| 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 |
$331.42
|
|
|
REMOVE WRIST/FOREARM LESION
|
Facility
|
OP
|
$1,543.00
|
|
|
Service Code
|
CPT 25115
|
| Hospital Charge Code |
6125115
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$421.24 |
| Max. Negotiated Rate |
$3,101.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$925.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,550.77
|
| Rate for Payer: Cash Price |
$925.80
|
| Rate for Payer: Cash Price |
$925.80
|
| Rate for Payer: Cigna Commercial |
$1,311.55
|
| Rate for Payer: First Health Commercial |
$1,388.70
|
| Rate for Payer: First Health Workers Compensation |
$595.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,388.70
|
| Rate for Payer: GEHA Commercial |
$1,234.40
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,388.70
|
| Rate for Payer: Humana ChoiceCare |
$1,705.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,550.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,605.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$1,404.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$1,080.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,388.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,465.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$1,157.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,434.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$617.20
|
| 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 |
$421.24
|
|
|
REMOVE WRIST/FOREARM LESION
|
Facility
|
IP
|
$1,214.00
|
|
|
Service Code
|
CPT 25116
|
| Hospital Charge Code |
6125116
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$331.42 |
| Max. Negotiated Rate |
$1,153.30 |
| Rate for Payer: Cash Price |
$728.40
|
| Rate for Payer: Cigna Commercial |
$1,031.90
|
| Rate for Payer: First Health Commercial |
$1,092.60
|
| Rate for Payer: First Health Workers Compensation |
$468.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,092.60
|
| Rate for Payer: GEHA Commercial |
$849.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,092.60
|
| Rate for Payer: Multiplan All |
$1,104.74
|
| Rate for Payer: OMNI Networks Commercial |
$849.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,092.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,153.30
|
| Rate for Payer: Three Rivers Provider Network All |
$910.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,129.02
|
| Rate for Payer: Zelis Auto |
$485.60
|
| Rate for Payer: Zelis Worker's Compensation |
$331.42
|
|
|
REMOVE WRIST JOINT CARTILAGE
|
Facility
|
IP
|
$1,246.00
|
|
|
Service Code
|
CPT 25107
|
| Hospital Charge Code |
6125107
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$340.16 |
| Max. Negotiated Rate |
$1,183.70 |
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: Cigna Commercial |
$1,059.10
|
| Rate for Payer: First Health Commercial |
$1,121.40
|
| Rate for Payer: First Health Workers Compensation |
$481.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,121.40
|
| Rate for Payer: GEHA Commercial |
$872.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,121.40
|
| Rate for Payer: Multiplan All |
$1,133.86
|
| Rate for Payer: OMNI Networks Commercial |
$872.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,121.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,183.70
|
| Rate for Payer: Three Rivers Provider Network All |
$934.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,158.78
|
| Rate for Payer: Zelis Auto |
$498.40
|
| Rate for Payer: Zelis Worker's Compensation |
$340.16
|
|
|
REMOVE WRIST JOINT CARTILAGE
|
Facility
|
OP
|
$1,246.00
|
|
|
Service Code
|
CPT 25107
|
| Hospital Charge Code |
6125107
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$340.16 |
| 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 |
$747.60
|
| 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 |
$747.60
|
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: Cigna Commercial |
$1,059.10
|
| Rate for Payer: First Health Commercial |
$1,121.40
|
| Rate for Payer: First Health Workers Compensation |
$481.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,121.40
|
| Rate for Payer: GEHA Commercial |
$996.80
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,121.40
|
| 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 |
$1,133.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$872.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,121.40
|
| 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 |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,183.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$934.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,158.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$498.40
|
| 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 |
$340.16
|
|
|
REMOVE WRIST JOINT IMPLANT
|
Facility
|
IP
|
$2,116.00
|
|
|
Service Code
|
CPT 25449
|
| Hospital Charge Code |
6125449
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$577.67 |
| Max. Negotiated Rate |
$2,010.20 |
| Rate for Payer: Cash Price |
$1,269.60
|
| Rate for Payer: Cigna Commercial |
$1,798.60
|
| Rate for Payer: First Health Commercial |
$1,904.40
|
| Rate for Payer: First Health Workers Compensation |
$816.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,904.40
|
| Rate for Payer: GEHA Commercial |
$1,481.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,904.40
|
| Rate for Payer: Multiplan All |
$1,925.56
|
| Rate for Payer: OMNI Networks Commercial |
$1,481.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,904.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,010.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,587.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,967.88
|
| Rate for Payer: Zelis Auto |
$846.40
|
| Rate for Payer: Zelis Worker's Compensation |
$577.67
|
|
|
REMOVE WRIST JOINT IMPLANT
|
Facility
|
OP
|
$2,116.00
|
|
|
Service Code
|
CPT 25449
|
| Hospital Charge Code |
6125449
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$577.67 |
| Max. Negotiated Rate |
$13,844.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,033.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,269.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,033.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,194.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,922.13
|
| Rate for Payer: Cash Price |
$1,269.60
|
| Rate for Payer: Cash Price |
$1,269.60
|
| Rate for Payer: Cigna Commercial |
$1,798.60
|
| Rate for Payer: First Health Commercial |
$1,904.40
|
| Rate for Payer: First Health Workers Compensation |
$816.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,904.40
|
| Rate for Payer: GEHA Commercial |
$1,692.80
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,904.40
|
| 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 |
$3,260.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,925.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,481.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,904.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,764.14
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,260.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,010.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,587.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,260.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,967.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$846.40
|
| 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 |
$577.67
|
|
|
REMOVE WRIST JOINT LINING
|
Facility
|
IP
|
$976.00
|
|
|
Service Code
|
CPT 25105
|
| Hospital Charge Code |
6125105
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$266.45 |
| Max. Negotiated Rate |
$927.20 |
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Cigna Commercial |
$829.60
|
| Rate for Payer: First Health Commercial |
$878.40
|
| Rate for Payer: First Health Workers Compensation |
$376.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$878.40
|
| Rate for Payer: GEHA Commercial |
$683.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$878.40
|
| Rate for Payer: Multiplan All |
$888.16
|
| Rate for Payer: OMNI Networks Commercial |
$683.20
|
| Rate for Payer: One Health Plan PPO/POS |
$878.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$927.20
|
| Rate for Payer: Three Rivers Provider Network All |
$732.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$907.68
|
| Rate for Payer: Zelis Auto |
$390.40
|
| Rate for Payer: Zelis Worker's Compensation |
$266.45
|
|
|
REMOVE WRIST JOINT LINING
|
Facility
|
OP
|
$976.00
|
|
|
Service Code
|
CPT 25105
|
| Hospital Charge Code |
6125105
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$266.45 |
| 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 |
$585.60
|
| 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 |
$585.60
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Cigna Commercial |
$829.60
|
| Rate for Payer: First Health Commercial |
$878.40
|
| Rate for Payer: First Health Workers Compensation |
$376.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$878.40
|
| Rate for Payer: GEHA Commercial |
$780.80
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$878.40
|
| 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 |
$888.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$683.20
|
| Rate for Payer: One Health Plan PPO/POS |
$878.40
|
| 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 |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$927.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$732.00
|
| 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 |
$907.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$390.40
|
| 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 |
$266.45
|
|
|
REMOVE WRIST JOINT LINING
|
Facility
|
IP
|
$938.00
|
|
|
Service Code
|
CPT 26130
|
| Hospital Charge Code |
6126130
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$256.07 |
| Max. Negotiated Rate |
$891.10 |
| Rate for Payer: Cash Price |
$562.80
|
| Rate for Payer: Cigna Commercial |
$797.30
|
| Rate for Payer: First Health Commercial |
$844.20
|
| Rate for Payer: First Health Workers Compensation |
$362.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$844.20
|
| Rate for Payer: GEHA Commercial |
$656.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$844.20
|
| Rate for Payer: Multiplan All |
$853.58
|
| Rate for Payer: OMNI Networks Commercial |
$656.60
|
| Rate for Payer: One Health Plan PPO/POS |
$844.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$891.10
|
| Rate for Payer: Three Rivers Provider Network All |
$703.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$872.34
|
| Rate for Payer: Zelis Auto |
$375.20
|
| Rate for Payer: Zelis Worker's Compensation |
$256.07
|
|
|
REMOVE WRIST JOINT LINING
|
Facility
|
OP
|
$938.00
|
|
|
Service Code
|
CPT 26130
|
| Hospital Charge Code |
6126130
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$256.07 |
| Max. Negotiated Rate |
$6,287.92 |
| 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 |
$562.80
|
| 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 |
$3,143.96
|
| Rate for Payer: Cash Price |
$562.80
|
| Rate for Payer: Cash Price |
$562.80
|
| Rate for Payer: Cigna Commercial |
$797.30
|
| Rate for Payer: First Health Commercial |
$844.20
|
| Rate for Payer: First Health Workers Compensation |
$362.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$844.20
|
| Rate for Payer: GEHA Commercial |
$750.40
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$844.20
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$853.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$656.60
|
| Rate for Payer: One Health Plan PPO/POS |
$844.20
|
| 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 |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$891.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$703.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$872.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$375.20
|
| 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 |
$256.07
|
|
|
REMOVE WRIST TENDON LESION
|
Facility
|
IP
|
$865.00
|
|
|
Service Code
|
CPT 25110
|
| Hospital Charge Code |
6125110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.15 |
| Max. Negotiated Rate |
$821.75 |
| Rate for Payer: Cash Price |
$519.00
|
| Rate for Payer: Cigna Commercial |
$735.25
|
| Rate for Payer: First Health Commercial |
$778.50
|
| Rate for Payer: First Health Workers Compensation |
$333.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$778.50
|
| Rate for Payer: GEHA Commercial |
$605.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$778.50
|
| Rate for Payer: Multiplan All |
$787.15
|
| Rate for Payer: OMNI Networks Commercial |
$605.50
|
| Rate for Payer: One Health Plan PPO/POS |
$778.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$821.75
|
| Rate for Payer: Three Rivers Provider Network All |
$648.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$804.45
|
| Rate for Payer: Zelis Auto |
$346.00
|
| Rate for Payer: Zelis Worker's Compensation |
$236.15
|
|
|
REMOVE WRIST TENDON LESION
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
CPT 25110
|
| Hospital Charge Code |
6125110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.15 |
| Max. Negotiated Rate |
$3,101.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$519.00
|
| 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 |
$1,550.77
|
| Rate for Payer: Cash Price |
$519.00
|
| Rate for Payer: Cash Price |
$519.00
|
| Rate for Payer: Cigna Commercial |
$735.25
|
| Rate for Payer: First Health Commercial |
$778.50
|
| Rate for Payer: First Health Workers Compensation |
$333.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$778.50
|
| Rate for Payer: GEHA Commercial |
$692.00
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$778.50
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$787.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$605.50
|
| Rate for Payer: One Health Plan PPO/POS |
$778.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$821.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$648.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$804.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$346.00
|
| 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 |
$236.15
|
|
|
REMOVL FOREIGN BODY UPPER ARM/ELBOW DEEP
|
Facility
|
IP
|
$923.00
|
|
|
Service Code
|
CPT 24201
|
| Hospital Charge Code |
6124201
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$251.98 |
| Max. Negotiated Rate |
$876.85 |
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$784.55
|
| Rate for Payer: First Health Commercial |
$830.70
|
| Rate for Payer: First Health Workers Compensation |
$356.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$830.70
|
| Rate for Payer: GEHA Commercial |
$646.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$830.70
|
| Rate for Payer: Multiplan All |
$839.93
|
| Rate for Payer: OMNI Networks Commercial |
$646.10
|
| Rate for Payer: One Health Plan PPO/POS |
$830.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$876.85
|
| Rate for Payer: Three Rivers Provider Network All |
$692.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$858.39
|
| Rate for Payer: Zelis Auto |
$369.20
|
| Rate for Payer: Zelis Worker's Compensation |
$251.98
|
|
|
REMOVL FOREIGN BODY UPPER ARM/ELBOW DEEP
|
Facility
|
IP
|
$1,117.00
|
|
|
Service Code
|
CPT 24201
|
| Hospital Charge Code |
21600476
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$304.94 |
| Max. Negotiated Rate |
$1,061.15 |
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$949.45
|
| Rate for Payer: First Health Commercial |
$1,005.30
|
| Rate for Payer: First Health Workers Compensation |
$431.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,005.30
|
| Rate for Payer: GEHA Commercial |
$781.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,005.30
|
| Rate for Payer: Multiplan All |
$1,016.47
|
| Rate for Payer: OMNI Networks Commercial |
$781.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,005.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,061.15
|
| Rate for Payer: Three Rivers Provider Network All |
$837.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,038.81
|
| Rate for Payer: Zelis Auto |
$446.80
|
| Rate for Payer: Zelis Worker's Compensation |
$304.94
|
|
|
REMOVL FOREIGN BODY UPPER ARM/ELBOW DEEP
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
CPT 24201
|
| Hospital Charge Code |
21600471
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$457.27 |
| 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 |
$1,005.00
|
| 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 |
$1,005.00
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$1,423.75
|
| Rate for Payer: First Health Commercial |
$1,507.50
|
| Rate for Payer: First Health Workers Compensation |
$646.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,507.50
|
| Rate for Payer: GEHA Commercial |
$1,340.00
|
| Rate for Payer: GEHA Medicare |
$2,773.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,507.50
|
| 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 |
$1,524.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,714.56
|
| Rate for Payer: OMNI Networks Commercial |
$1,172.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,507.50
|
| 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 |
$1,591.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,546.54
|
| Rate for Payer: Three Rivers Provider Network All |
$1,256.25
|
| 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 |
$1,557.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,773.27
|
| Rate for Payer: Zelis Auto |
$670.00
|
| 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 |
$457.27
|
|
|
REMOVL FOREIGN BODY UPPER ARM/ELBOW DEEP
|
Facility
|
OP
|
$923.00
|
|
|
Service Code
|
CPT 24201
|
| Hospital Charge Code |
6124201
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$251.98 |
| 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 |
$553.80
|
| 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 |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$784.55
|
| Rate for Payer: First Health Commercial |
$830.70
|
| Rate for Payer: First Health Workers Compensation |
$356.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$830.70
|
| Rate for Payer: GEHA Commercial |
$738.40
|
| Rate for Payer: GEHA Medicare |
$2,773.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$830.70
|
| 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 |
$839.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,714.56
|
| Rate for Payer: OMNI Networks Commercial |
$646.10
|
| Rate for Payer: One Health Plan PPO/POS |
$830.70
|
| 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 |
$876.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,546.54
|
| Rate for Payer: Three Rivers Provider Network All |
$692.25
|
| 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 |
$858.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,773.27
|
| Rate for Payer: Zelis Auto |
$369.20
|
| 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 |
$251.98
|
|
|
REMOVL FOREIGN BODY UPPER ARM/ELBOW DEEP
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
CPT 24201
|
| Hospital Charge Code |
21600471
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$457.27 |
| Max. Negotiated Rate |
$1,591.25 |
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$1,423.75
|
| Rate for Payer: First Health Commercial |
$1,507.50
|
| Rate for Payer: First Health Workers Compensation |
$646.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,507.50
|
| Rate for Payer: GEHA Commercial |
$1,172.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,507.50
|
| Rate for Payer: Multiplan All |
$1,524.25
|
| Rate for Payer: OMNI Networks Commercial |
$1,172.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,507.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,591.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,256.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,557.75
|
| Rate for Payer: Zelis Auto |
$670.00
|
| Rate for Payer: Zelis Worker's Compensation |
$457.27
|
|
|
REMOVL FOREIGN BODY UPPER ARM/ELBOW DEEP
|
Facility
|
OP
|
$1,117.00
|
|
|
Service Code
|
CPT 24201
|
| Hospital Charge Code |
21600476
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$304.94 |
| 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 |
$670.20
|
| 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 |
$670.20
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$949.45
|
| Rate for Payer: First Health Commercial |
$1,005.30
|
| Rate for Payer: First Health Workers Compensation |
$431.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,005.30
|
| Rate for Payer: GEHA Commercial |
$893.60
|
| Rate for Payer: GEHA Medicare |
$2,773.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,005.30
|
| 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 |
$1,430.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,773.27
|
| Rate for Payer: Multiplan All |
$1,016.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,714.56
|
| Rate for Payer: OMNI Networks Commercial |
$781.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,005.30
|
| 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 |
$1,061.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,546.54
|
| Rate for Payer: Three Rivers Provider Network All |
$837.75
|
| 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 |
$1,038.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,773.27
|
| Rate for Payer: Zelis Auto |
$446.80
|
| 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 |
$304.94
|
|
|
REMOVL SUTURES UNDER ANESTH SAME SURGEON
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 15850
|
| Hospital Charge Code |
23500014
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$68.85
|
| Rate for Payer: First Health Commercial |
$72.90
|
| Rate for Payer: First Health Workers Compensation |
$31.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$64.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Humana ChoiceCare |
$21.06
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.60
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$71.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$40.50
|
| Rate for Payer: Zelis Worker's Compensation |
$22.11
|
|
|
REMOVL SUTURES UNDER ANESTH SAME SURGEON
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 15850
|
| Hospital Charge Code |
21600307
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$68.85
|
| Rate for Payer: First Health Commercial |
$72.90
|
| Rate for Payer: First Health Workers Compensation |
$31.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$56.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Worker's Compensation |
$22.11
|
|
