|
REVISE ESOPHAGUS & STOMACH
|
Facility
|
IP
|
$2,825.00
|
|
|
Service Code
|
CPT 43325
|
| Hospital Charge Code |
6143325
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$771.23 |
| Max. Negotiated Rate |
$2,683.75 |
| Rate for Payer: Cash Price |
$1,695.00
|
| Rate for Payer: Cigna Commercial |
$2,401.25
|
| Rate for Payer: First Health Commercial |
$2,542.50
|
| Rate for Payer: First Health Workers Compensation |
$1,090.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,542.50
|
| Rate for Payer: GEHA Commercial |
$1,977.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,542.50
|
| Rate for Payer: Multiplan All |
$2,570.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,977.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,542.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,683.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,118.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,627.25
|
| Rate for Payer: Zelis Auto |
$1,130.00
|
| Rate for Payer: Zelis Worker's Compensation |
$771.23
|
|
|
REVISE EYE SOCKETS
|
Facility
|
OP
|
$3,164.00
|
|
|
Service Code
|
CPT 21267
|
| Hospital Charge Code |
6121267
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$863.77 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,898.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,898.40
|
| Rate for Payer: Cash Price |
$1,898.40
|
| Rate for Payer: Cigna Commercial |
$2,689.40
|
| Rate for Payer: First Health Commercial |
$2,847.60
|
| Rate for Payer: First Health Workers Compensation |
$1,221.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,847.60
|
| Rate for Payer: GEHA Commercial |
$2,531.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,847.60
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$2,879.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,214.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,847.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,005.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$2,373.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,942.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$1,265.60
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$863.77
|
|
|
REVISE EYE SOCKETS
|
Facility
|
IP
|
$3,164.00
|
|
|
Service Code
|
CPT 21267
|
| Hospital Charge Code |
6121267
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$863.77 |
| Max. Negotiated Rate |
$3,005.80 |
| Rate for Payer: Cash Price |
$1,898.40
|
| Rate for Payer: Cigna Commercial |
$2,689.40
|
| Rate for Payer: First Health Commercial |
$2,847.60
|
| Rate for Payer: First Health Workers Compensation |
$1,221.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,847.60
|
| Rate for Payer: GEHA Commercial |
$2,214.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,847.60
|
| Rate for Payer: Multiplan All |
$2,879.24
|
| Rate for Payer: OMNI Networks Commercial |
$2,214.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,847.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,005.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,373.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,942.52
|
| Rate for Payer: Zelis Auto |
$1,265.60
|
| Rate for Payer: Zelis Worker's Compensation |
$863.77
|
|
|
REVISE FINGER JOINT
|
Facility
|
IP
|
$852.00
|
|
|
Service Code
|
CPT 26535
|
| Hospital Charge Code |
6126535
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$232.60 |
| Max. Negotiated Rate |
$809.40 |
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cigna Commercial |
$724.20
|
| Rate for Payer: First Health Commercial |
$766.80
|
| Rate for Payer: First Health Workers Compensation |
$328.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$766.80
|
| Rate for Payer: GEHA Commercial |
$596.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$766.80
|
| Rate for Payer: Multiplan All |
$775.32
|
| Rate for Payer: OMNI Networks Commercial |
$596.40
|
| Rate for Payer: One Health Plan PPO/POS |
$766.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$809.40
|
| Rate for Payer: Three Rivers Provider Network All |
$639.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$792.36
|
| Rate for Payer: Zelis Auto |
$340.80
|
| Rate for Payer: Zelis Worker's Compensation |
$232.60
|
|
|
REVISE FINGER JOINT
|
Facility
|
OP
|
$852.00
|
|
|
Service Code
|
CPT 26535
|
| Hospital Charge Code |
6126535
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$232.60 |
| Max. Negotiated Rate |
$6,161.78 |
| 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 |
$511.20
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cigna Commercial |
$724.20
|
| Rate for Payer: First Health Commercial |
$766.80
|
| Rate for Payer: First Health Workers Compensation |
$328.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$766.80
|
| Rate for Payer: GEHA Commercial |
$681.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$766.80
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,260.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$775.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$596.40
|
| Rate for Payer: One Health Plan PPO/POS |
$766.80
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$809.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$639.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,260.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$792.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$340.80
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$232.60
|
|
|
REVISE FINGER JOINT EACH
|
Facility
|
OP
|
$1,021.00
|
|
|
Service Code
|
CPT 26140
|
| Hospital Charge Code |
6126140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$278.73 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$612.60
|
| 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 |
$1,519.65
|
| Rate for Payer: Cash Price |
$612.60
|
| Rate for Payer: Cash Price |
$612.60
|
| Rate for Payer: Cigna Commercial |
$867.85
|
| Rate for Payer: First Health Commercial |
$918.90
|
| Rate for Payer: First Health Workers Compensation |
$394.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$918.90
|
| Rate for Payer: GEHA Commercial |
$816.80
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$918.90
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$929.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$714.70
|
| Rate for Payer: One Health Plan PPO/POS |
$918.90
|
| 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 |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$969.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$765.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$949.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$408.40
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$278.73
|
|
|
REVISE FINGER JOINT EACH
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
CPT 26135
|
| Hospital Charge Code |
6126135
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$304.12 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$668.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$668.40
|
| Rate for Payer: Cash Price |
$668.40
|
| Rate for Payer: Cigna Commercial |
$946.90
|
| Rate for Payer: First Health Commercial |
$1,002.60
|
| Rate for Payer: First Health Workers Compensation |
$430.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,002.60
|
| Rate for Payer: GEHA Commercial |
$891.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,002.60
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,013.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$779.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,002.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,058.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$835.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,036.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$445.60
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$304.12
|
|
|
REVISE FINGER JOINT EACH
|
Facility
|
IP
|
$1,021.00
|
|
|
Service Code
|
CPT 26140
|
| Hospital Charge Code |
6126140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$278.73 |
| Max. Negotiated Rate |
$969.95 |
| Rate for Payer: Cash Price |
$612.60
|
| Rate for Payer: Cigna Commercial |
$867.85
|
| Rate for Payer: First Health Commercial |
$918.90
|
| Rate for Payer: First Health Workers Compensation |
$394.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$918.90
|
| Rate for Payer: GEHA Commercial |
$714.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$918.90
|
| Rate for Payer: Multiplan All |
$929.11
|
| Rate for Payer: OMNI Networks Commercial |
$714.70
|
| Rate for Payer: One Health Plan PPO/POS |
$918.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$969.95
|
| Rate for Payer: Three Rivers Provider Network All |
$765.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$949.53
|
| Rate for Payer: Zelis Auto |
$408.40
|
| Rate for Payer: Zelis Worker's Compensation |
$278.73
|
|
|
REVISE FINGER JOINT EACH
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
CPT 26135
|
| Hospital Charge Code |
6126135
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$304.12 |
| Max. Negotiated Rate |
$1,058.30 |
| Rate for Payer: Cash Price |
$668.40
|
| Rate for Payer: Cigna Commercial |
$946.90
|
| Rate for Payer: First Health Commercial |
$1,002.60
|
| Rate for Payer: First Health Workers Compensation |
$430.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,002.60
|
| Rate for Payer: GEHA Commercial |
$779.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,002.60
|
| Rate for Payer: Multiplan All |
$1,013.74
|
| Rate for Payer: OMNI Networks Commercial |
$779.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,002.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,058.30
|
| Rate for Payer: Three Rivers Provider Network All |
$835.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,036.02
|
| Rate for Payer: Zelis Auto |
$445.60
|
| Rate for Payer: Zelis Worker's Compensation |
$304.12
|
|
|
REVISE FINGER/TOE NERVE
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
CPT 64702
|
| Hospital Charge Code |
6164702
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$276.28 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$607.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$860.20
|
| Rate for Payer: First Health Commercial |
$910.80
|
| Rate for Payer: First Health Workers Compensation |
$390.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$910.80
|
| Rate for Payer: GEHA Commercial |
$809.60
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$910.80
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$920.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$708.40
|
| Rate for Payer: One Health Plan PPO/POS |
$910.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$961.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$759.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$941.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$404.80
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$276.28
|
|
|
REVISE FINGER/TOE NERVE
|
Facility
|
IP
|
$1,012.00
|
|
|
Service Code
|
CPT 64702
|
| Hospital Charge Code |
6164702
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$276.28 |
| Max. Negotiated Rate |
$961.40 |
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$860.20
|
| Rate for Payer: First Health Commercial |
$910.80
|
| Rate for Payer: First Health Workers Compensation |
$390.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$910.80
|
| Rate for Payer: GEHA Commercial |
$708.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$910.80
|
| Rate for Payer: Multiplan All |
$920.92
|
| Rate for Payer: OMNI Networks Commercial |
$708.40
|
| Rate for Payer: One Health Plan PPO/POS |
$910.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$961.40
|
| Rate for Payer: Three Rivers Provider Network All |
$759.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$941.16
|
| Rate for Payer: Zelis Auto |
$404.80
|
| Rate for Payer: Zelis Worker's Compensation |
$276.28
|
|
|
REVISE GASTRIC PORT, OPEN
|
Facility
|
OP
|
$932.00
|
|
|
Service Code
|
CPT 43886
|
| Hospital Charge Code |
6143886
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$254.44 |
| Max. Negotiated Rate |
$6,952.48 |
| 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 |
$559.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,476.24
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cigna Commercial |
$792.20
|
| Rate for Payer: First Health Commercial |
$838.80
|
| Rate for Payer: First Health Workers Compensation |
$359.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$838.80
|
| Rate for Payer: GEHA Commercial |
$745.60
|
| Rate for Payer: GEHA Medicare |
$3,476.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$838.80
|
| Rate for Payer: Humana ChoiceCare |
$3,823.86
|
| Rate for Payer: Humana Medicare Advantage |
$3,476.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,840.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,476.24
|
| Rate for Payer: Multiplan All |
$848.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,909.61
|
| Rate for Payer: OMNI Networks Commercial |
$652.40
|
| Rate for Payer: One Health Plan PPO/POS |
$838.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,476.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$885.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,952.48
|
| Rate for Payer: Three Rivers Provider Network All |
$699.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,406.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,476.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$866.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,476.24
|
| Rate for Payer: Zelis Auto |
$372.80
|
| Rate for Payer: Zelis Medicare |
$2,954.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,171.49
|
| Rate for Payer: Zelis Worker's Compensation |
$254.44
|
|
|
REVISE GASTRIC PORT, OPEN
|
Facility
|
IP
|
$932.00
|
|
|
Service Code
|
CPT 43886
|
| Hospital Charge Code |
6143886
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$254.44 |
| Max. Negotiated Rate |
$885.40 |
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cigna Commercial |
$792.20
|
| Rate for Payer: First Health Commercial |
$838.80
|
| Rate for Payer: First Health Workers Compensation |
$359.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$838.80
|
| Rate for Payer: GEHA Commercial |
$652.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$838.80
|
| Rate for Payer: Multiplan All |
$848.12
|
| Rate for Payer: OMNI Networks Commercial |
$652.40
|
| Rate for Payer: One Health Plan PPO/POS |
$838.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$885.40
|
| Rate for Payer: Three Rivers Provider Network All |
$699.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$866.76
|
| Rate for Payer: Zelis Auto |
$372.80
|
| Rate for Payer: Zelis Worker's Compensation |
$254.44
|
|
|
REVISE HAND/FINGER TENDON
|
Facility
|
OP
|
$1,673.00
|
|
|
Service Code
|
CPT 26390
|
| Hospital Charge Code |
6126390
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$456.73 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,003.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,003.80
|
| Rate for Payer: Cash Price |
$1,003.80
|
| Rate for Payer: Cigna Commercial |
$1,422.05
|
| Rate for Payer: First Health Commercial |
$1,505.70
|
| Rate for Payer: First Health Workers Compensation |
$645.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,505.70
|
| Rate for Payer: GEHA Commercial |
$1,338.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,505.70
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,522.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,171.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,505.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,589.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,254.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,555.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$669.20
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$456.73
|
|
|
REVISE HAND/FINGER TENDON
|
Facility
|
IP
|
$1,673.00
|
|
|
Service Code
|
CPT 26390
|
| Hospital Charge Code |
6126390
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$456.73 |
| Max. Negotiated Rate |
$1,589.35 |
| Rate for Payer: Cash Price |
$1,003.80
|
| Rate for Payer: Cigna Commercial |
$1,422.05
|
| Rate for Payer: First Health Commercial |
$1,505.70
|
| Rate for Payer: First Health Workers Compensation |
$645.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,505.70
|
| Rate for Payer: GEHA Commercial |
$1,171.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,505.70
|
| Rate for Payer: Multiplan All |
$1,522.43
|
| Rate for Payer: OMNI Networks Commercial |
$1,171.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,505.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,589.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,254.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,555.89
|
| Rate for Payer: Zelis Auto |
$669.20
|
| Rate for Payer: Zelis Worker's Compensation |
$456.73
|
|
|
REVISE HAND/FOOT NERVE
|
Facility
|
IP
|
$808.00
|
|
|
Service Code
|
CPT 64704
|
| Hospital Charge Code |
6164704
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$220.58 |
| Max. Negotiated Rate |
$767.60 |
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cigna Commercial |
$686.80
|
| Rate for Payer: First Health Commercial |
$727.20
|
| Rate for Payer: First Health Workers Compensation |
$311.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$727.20
|
| Rate for Payer: GEHA Commercial |
$565.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$727.20
|
| Rate for Payer: Multiplan All |
$735.28
|
| Rate for Payer: OMNI Networks Commercial |
$565.60
|
| Rate for Payer: One Health Plan PPO/POS |
$727.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$767.60
|
| Rate for Payer: Three Rivers Provider Network All |
$606.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$751.44
|
| Rate for Payer: Zelis Auto |
$323.20
|
| Rate for Payer: Zelis Worker's Compensation |
$220.58
|
|
|
REVISE HAND/FOOT NERVE
|
Facility
|
OP
|
$808.00
|
|
|
Service Code
|
CPT 64704
|
| Hospital Charge Code |
6164704
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$220.58 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$484.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cigna Commercial |
$686.80
|
| Rate for Payer: First Health Commercial |
$727.20
|
| Rate for Payer: First Health Workers Compensation |
$311.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$727.20
|
| Rate for Payer: GEHA Commercial |
$646.40
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$727.20
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$735.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$565.60
|
| Rate for Payer: One Health Plan PPO/POS |
$727.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$767.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$606.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$751.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$323.20
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$220.58
|
|
|
REVISE HEAD/NECK OF FEMUR
|
Facility
|
IP
|
$2,011.00
|
|
|
Service Code
|
CPT 27179
|
| Hospital Charge Code |
6127179
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$549.00 |
| Max. Negotiated Rate |
$1,910.45 |
| Rate for Payer: Cash Price |
$1,206.60
|
| Rate for Payer: Cigna Commercial |
$1,709.35
|
| Rate for Payer: First Health Commercial |
$1,809.90
|
| Rate for Payer: First Health Workers Compensation |
$776.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,809.90
|
| Rate for Payer: GEHA Commercial |
$1,407.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,809.90
|
| Rate for Payer: Multiplan All |
$1,830.01
|
| Rate for Payer: OMNI Networks Commercial |
$1,407.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,809.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,910.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,508.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,870.23
|
| Rate for Payer: Zelis Auto |
$804.40
|
| Rate for Payer: Zelis Worker's Compensation |
$549.00
|
|
|
REVISE HEAD/NECK OF FEMUR
|
Facility
|
OP
|
$2,011.00
|
|
|
Service Code
|
CPT 27179
|
| Hospital Charge Code |
6127179
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$549.00 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,206.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7,100.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,206.60
|
| Rate for Payer: Cash Price |
$1,206.60
|
| Rate for Payer: Cigna Commercial |
$1,709.35
|
| Rate for Payer: First Health Commercial |
$1,809.90
|
| Rate for Payer: First Health Workers Compensation |
$776.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,809.90
|
| Rate for Payer: GEHA Commercial |
$1,608.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,809.90
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,830.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,407.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,809.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8,365.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7,245.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,910.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,508.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,870.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$804.40
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$549.00
|
|
|
REVISE HERNIA & SPERM VEINS
|
Facility
|
IP
|
$1,127.00
|
|
|
Service Code
|
CPT 55540
|
| Hospital Charge Code |
6155540
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$307.67 |
| Max. Negotiated Rate |
$1,070.65 |
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: Cigna Commercial |
$957.95
|
| Rate for Payer: First Health Commercial |
$1,014.30
|
| Rate for Payer: First Health Workers Compensation |
$435.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,014.30
|
| Rate for Payer: GEHA Commercial |
$788.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,014.30
|
| Rate for Payer: Multiplan All |
$1,025.57
|
| Rate for Payer: OMNI Networks Commercial |
$788.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,014.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,070.65
|
| Rate for Payer: Three Rivers Provider Network All |
$845.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,048.11
|
| Rate for Payer: Zelis Auto |
$450.80
|
| Rate for Payer: Zelis Worker's Compensation |
$307.67
|
|
|
REVISE HERNIA & SPERM VEINS
|
Facility
|
OP
|
$1,127.00
|
|
|
Service Code
|
CPT 55540
|
| Hospital Charge Code |
6155540
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$307.67 |
| Max. Negotiated Rate |
$6,701.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$676.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,560.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,350.98
|
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: Cigna Commercial |
$957.95
|
| Rate for Payer: First Health Commercial |
$1,014.30
|
| Rate for Payer: First Health Workers Compensation |
$435.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,014.30
|
| Rate for Payer: GEHA Commercial |
$901.60
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,014.30
|
| Rate for Payer: Humana ChoiceCare |
$3,686.08
|
| Rate for Payer: Humana Medicare Advantage |
$3,350.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,629.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,612.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,350.98
|
| Rate for Payer: Multiplan All |
$1,025.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: OMNI Networks Commercial |
$788.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,014.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,016.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,612.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,350.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,070.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: Three Rivers Provider Network All |
$845.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,283.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,612.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,048.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Auto |
$450.80
|
| Rate for Payer: Zelis Medicare |
$2,848.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,021.18
|
| Rate for Payer: Zelis Worker's Compensation |
$307.67
|
|
|
REVISE HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$3,980.00
|
|
|
Service Code
|
CPT 27134
|
| Hospital Charge Code |
6127134
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,086.54 |
| Max. Negotiated Rate |
$3,781.00 |
| Rate for Payer: Cash Price |
$2,388.00
|
| Rate for Payer: Cigna Commercial |
$3,383.00
|
| Rate for Payer: First Health Commercial |
$3,582.00
|
| Rate for Payer: First Health Workers Compensation |
$1,536.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,582.00
|
| Rate for Payer: GEHA Commercial |
$2,786.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,582.00
|
| Rate for Payer: Multiplan All |
$3,621.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,786.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,582.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,781.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,985.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,701.40
|
| Rate for Payer: Zelis Auto |
$1,592.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,086.54
|
|
|
REVISE HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$3,172.00
|
|
|
Service Code
|
CPT 27138
|
| Hospital Charge Code |
6127138
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$865.96 |
| Max. Negotiated Rate |
$3,013.40 |
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$2,696.20
|
| Rate for Payer: First Health Commercial |
$2,854.80
|
| Rate for Payer: First Health Workers Compensation |
$1,224.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,854.80
|
| Rate for Payer: GEHA Commercial |
$2,220.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,854.80
|
| Rate for Payer: Multiplan All |
$2,886.52
|
| Rate for Payer: OMNI Networks Commercial |
$2,220.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,854.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,013.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,379.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,949.96
|
| Rate for Payer: Zelis Auto |
$1,268.80
|
| Rate for Payer: Zelis Worker's Compensation |
$865.96
|
|
|
REVISE HIP JOINT REPLACEMENT
|
Facility
|
OP
|
$3,172.00
|
|
|
Service Code
|
CPT 27138
|
| Hospital Charge Code |
6127138
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$793.00 |
| Max. Negotiated Rate |
$3,013.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,903.20
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$2,696.20
|
| Rate for Payer: First Health Commercial |
$2,854.80
|
| Rate for Payer: First Health Workers Compensation |
$1,224.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,854.80
|
| Rate for Payer: GEHA Commercial |
$2,537.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,854.80
|
| Rate for Payer: Humana ChoiceCare |
$824.72
|
| Rate for Payer: Multiplan All |
$2,886.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,903.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,220.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,854.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,013.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,379.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,791.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$793.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,949.96
|
| Rate for Payer: Zelis Auto |
$1,268.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,586.00
|
| Rate for Payer: Zelis Worker's Compensation |
$865.96
|
|
|
REVISE HIP JOINT REPLACEMENT
|
Facility
|
OP
|
$3,052.00
|
|
|
Service Code
|
CPT 27137
|
| Hospital Charge Code |
6127137
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$763.00 |
| Max. Negotiated Rate |
$2,899.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,831.20
|
| Rate for Payer: Cash Price |
$1,831.20
|
| Rate for Payer: Cigna Commercial |
$2,594.20
|
| Rate for Payer: First Health Commercial |
$2,746.80
|
| Rate for Payer: First Health Workers Compensation |
$1,178.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,746.80
|
| Rate for Payer: GEHA Commercial |
$2,441.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,746.80
|
| Rate for Payer: Humana ChoiceCare |
$793.52
|
| Rate for Payer: Multiplan All |
$2,777.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,831.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,136.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,746.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,899.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,289.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,685.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$763.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,838.36
|
| Rate for Payer: Zelis Auto |
$1,220.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,526.00
|
| Rate for Payer: Zelis Worker's Compensation |
$833.20
|
|
