|
REVISE RADIUS OR ULNA
|
Facility
|
OP
|
$2,065.00
|
|
|
Service Code
|
CPT 25370
|
| Hospital Charge Code |
6125370
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$563.75 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,239.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,239.00
|
| Rate for Payer: Cash Price |
$1,239.00
|
| Rate for Payer: Cigna Commercial |
$1,755.25
|
| Rate for Payer: First Health Commercial |
$1,858.50
|
| Rate for Payer: First Health Workers Compensation |
$797.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,858.50
|
| Rate for Payer: GEHA Commercial |
$1,652.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,858.50
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,879.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,445.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,858.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,961.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,548.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,920.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$826.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$563.75
|
|
|
REVISE RADIUS OR ULNA
|
Facility
|
IP
|
$2,065.00
|
|
|
Service Code
|
CPT 25370
|
| Hospital Charge Code |
6125370
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$563.75 |
| Max. Negotiated Rate |
$1,961.75 |
| Rate for Payer: Cash Price |
$1,239.00
|
| Rate for Payer: Cigna Commercial |
$1,755.25
|
| Rate for Payer: First Health Commercial |
$1,858.50
|
| Rate for Payer: First Health Workers Compensation |
$797.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,858.50
|
| Rate for Payer: GEHA Commercial |
$1,445.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,858.50
|
| Rate for Payer: Multiplan All |
$1,879.15
|
| Rate for Payer: OMNI Networks Commercial |
$1,445.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,858.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,961.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,548.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,920.45
|
| Rate for Payer: Zelis Auto |
$826.00
|
| Rate for Payer: Zelis Worker's Compensation |
$563.75
|
|
|
REVISE RADIUS & ULNA
|
Facility
|
OP
|
$1,960.00
|
|
|
Service Code
|
CPT 25375
|
| Hospital Charge Code |
6125375
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$535.08 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,176.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,176.00
|
| Rate for Payer: Cash Price |
$1,176.00
|
| Rate for Payer: Cigna Commercial |
$1,666.00
|
| Rate for Payer: First Health Commercial |
$1,764.00
|
| Rate for Payer: First Health Workers Compensation |
$756.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,764.00
|
| Rate for Payer: GEHA Commercial |
$1,568.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,764.00
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,783.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,372.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,764.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,862.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,470.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,822.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$784.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$535.08
|
|
|
REVISE RADIUS & ULNA
|
Facility
|
IP
|
$1,872.00
|
|
|
Service Code
|
CPT 25365
|
| Hospital Charge Code |
6125365
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$511.06 |
| Max. Negotiated Rate |
$1,778.40 |
| Rate for Payer: Cash Price |
$1,123.20
|
| Rate for Payer: Cigna Commercial |
$1,591.20
|
| Rate for Payer: First Health Commercial |
$1,684.80
|
| Rate for Payer: First Health Workers Compensation |
$722.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,684.80
|
| Rate for Payer: GEHA Commercial |
$1,310.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,684.80
|
| Rate for Payer: Multiplan All |
$1,703.52
|
| Rate for Payer: OMNI Networks Commercial |
$1,310.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,684.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,778.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,404.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,740.96
|
| Rate for Payer: Zelis Auto |
$748.80
|
| Rate for Payer: Zelis Worker's Compensation |
$511.06
|
|
|
REVISE RADIUS & ULNA
|
Facility
|
IP
|
$1,960.00
|
|
|
Service Code
|
CPT 25375
|
| Hospital Charge Code |
6125375
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$535.08 |
| Max. Negotiated Rate |
$1,862.00 |
| Rate for Payer: Cash Price |
$1,176.00
|
| Rate for Payer: Cigna Commercial |
$1,666.00
|
| Rate for Payer: First Health Commercial |
$1,764.00
|
| Rate for Payer: First Health Workers Compensation |
$756.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,764.00
|
| Rate for Payer: GEHA Commercial |
$1,372.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,764.00
|
| Rate for Payer: Multiplan All |
$1,783.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,372.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,764.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,862.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,470.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,822.80
|
| Rate for Payer: Zelis Auto |
$784.00
|
| Rate for Payer: Zelis Worker's Compensation |
$535.08
|
|
|
REVISE RADIUS & ULNA
|
Facility
|
OP
|
$1,872.00
|
|
|
Service Code
|
CPT 25365
|
| Hospital Charge Code |
6125365
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$511.06 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,123.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: Cash Price |
$1,123.20
|
| Rate for Payer: Cash Price |
$1,123.20
|
| Rate for Payer: Cigna Commercial |
$1,591.20
|
| Rate for Payer: First Health Commercial |
$1,684.80
|
| Rate for Payer: First Health Workers Compensation |
$722.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,684.80
|
| Rate for Payer: GEHA Commercial |
$1,497.60
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,684.80
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,703.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,310.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,684.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,778.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,404.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,740.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$748.80
|
| Rate for Payer: Zelis Medicare |
$10,384.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,661.07
|
| Rate for Payer: Zelis Worker's Compensation |
$511.06
|
|
|
REVISE RECONST ELBOW JOINT
|
Facility
|
IP
|
$3,216.00
|
|
|
Service Code
|
CPT 24370
|
| Hospital Charge Code |
6124370
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$877.97 |
| Max. Negotiated Rate |
$3,055.20 |
| Rate for Payer: Cash Price |
$1,929.60
|
| Rate for Payer: Cigna Commercial |
$2,733.60
|
| Rate for Payer: First Health Commercial |
$2,894.40
|
| Rate for Payer: First Health Workers Compensation |
$1,241.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,894.40
|
| Rate for Payer: GEHA Commercial |
$2,251.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,894.40
|
| Rate for Payer: Multiplan All |
$2,926.56
|
| Rate for Payer: OMNI Networks Commercial |
$2,251.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,894.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,055.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,412.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,990.88
|
| Rate for Payer: Zelis Auto |
$1,286.40
|
| Rate for Payer: Zelis Worker's Compensation |
$877.97
|
|
|
REVISE RECONST ELBOW JOINT
|
Facility
|
OP
|
$3,686.00
|
|
|
Service Code
|
CPT 24371
|
| Hospital Charge Code |
6124371
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,006.28 |
| Max. Negotiated Rate |
$34,924.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$13,613.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,211.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$13,613.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$10,784.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17,462.09
|
| Rate for Payer: Cash Price |
$2,211.60
|
| Rate for Payer: Cash Price |
$2,211.60
|
| Rate for Payer: Cigna Commercial |
$3,133.10
|
| Rate for Payer: First Health Commercial |
$3,317.40
|
| Rate for Payer: First Health Workers Compensation |
$1,423.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,317.40
|
| Rate for Payer: GEHA Commercial |
$2,948.80
|
| Rate for Payer: GEHA Medicare |
$17,462.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,317.40
|
| Rate for Payer: Humana ChoiceCare |
$19,208.30
|
| Rate for Payer: Humana Medicare Advantage |
$17,462.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29,336.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11,004.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,462.09
|
| Rate for Payer: Multiplan All |
$3,354.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29,685.55
|
| Rate for Payer: OMNI Networks Commercial |
$2,580.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,317.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$12,706.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11,004.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17,462.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,501.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34,924.18
|
| Rate for Payer: Three Rivers Provider Network All |
$2,764.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17,112.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11,004.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,462.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,427.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17,462.09
|
| Rate for Payer: Zelis Auto |
$1,474.40
|
| Rate for Payer: Zelis Medicare |
$14,842.78
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20,954.51
|
| Rate for Payer: Zelis Worker's Compensation |
$1,006.28
|
|
|
REVISE RECONST ELBOW JOINT
|
Facility
|
OP
|
$3,216.00
|
|
|
Service Code
|
CPT 24370
|
| Hospital Charge Code |
6124370
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$877.97 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$13,613.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,929.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$13,613.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$10,784.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: Cash Price |
$1,929.60
|
| Rate for Payer: Cash Price |
$1,929.60
|
| Rate for Payer: Cigna Commercial |
$2,733.60
|
| Rate for Payer: First Health Commercial |
$2,894.40
|
| Rate for Payer: First Health Workers Compensation |
$1,241.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,894.40
|
| Rate for Payer: GEHA Commercial |
$2,572.80
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,894.40
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11,004.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$2,926.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$2,251.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,894.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$12,706.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11,004.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,055.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$2,412.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11,004.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,990.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$1,286.40
|
| Rate for Payer: Zelis Medicare |
$10,384.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,661.07
|
| Rate for Payer: Zelis Worker's Compensation |
$877.97
|
|
|
REVISE RECONST ELBOW JOINT
|
Facility
|
IP
|
$3,686.00
|
|
|
Service Code
|
CPT 24371
|
| Hospital Charge Code |
6124371
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,006.28 |
| Max. Negotiated Rate |
$3,501.70 |
| Rate for Payer: Cash Price |
$2,211.60
|
| Rate for Payer: Cigna Commercial |
$3,133.10
|
| Rate for Payer: First Health Commercial |
$3,317.40
|
| Rate for Payer: First Health Workers Compensation |
$1,423.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,317.40
|
| Rate for Payer: GEHA Commercial |
$2,580.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,317.40
|
| Rate for Payer: Multiplan All |
$3,354.26
|
| Rate for Payer: OMNI Networks Commercial |
$2,580.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,317.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,501.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,764.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,427.98
|
| Rate for Payer: Zelis Auto |
$1,474.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,006.28
|
|
|
REVISE/REMOVE NEUROELECTRODE
|
Facility
|
OP
|
$1,207.00
|
|
|
Service Code
|
CPT 61880
|
| Hospital Charge Code |
6161880
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$329.51 |
| Max. Negotiated Rate |
$6,530.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,191.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,191.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,528.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,265.48
|
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cigna Commercial |
$1,025.95
|
| Rate for Payer: First Health Commercial |
$1,086.30
|
| Rate for Payer: First Health Workers Compensation |
$466.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,086.30
|
| Rate for Payer: GEHA Commercial |
$965.60
|
| Rate for Payer: GEHA Medicare |
$3,265.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,086.30
|
| Rate for Payer: Humana ChoiceCare |
$3,592.03
|
| Rate for Payer: Humana Medicare Advantage |
$3,265.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,486.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,580.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,265.48
|
| Rate for Payer: Multiplan All |
$1,098.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,551.32
|
| Rate for Payer: OMNI Networks Commercial |
$844.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,086.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,979.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,580.18
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,265.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,146.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,530.96
|
| Rate for Payer: Three Rivers Provider Network All |
$905.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,200.17
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,580.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,265.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,122.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,265.48
|
| Rate for Payer: Zelis Auto |
$482.80
|
| Rate for Payer: Zelis Medicare |
$2,775.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,918.58
|
| Rate for Payer: Zelis Worker's Compensation |
$329.51
|
|
|
REVISE/REMOVE NEUROELECTRODE
|
Facility
|
IP
|
$1,207.00
|
|
|
Service Code
|
CPT 61880
|
| Hospital Charge Code |
6161880
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$329.51 |
| Max. Negotiated Rate |
$1,146.65 |
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cigna Commercial |
$1,025.95
|
| Rate for Payer: First Health Commercial |
$1,086.30
|
| Rate for Payer: First Health Workers Compensation |
$466.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,086.30
|
| Rate for Payer: GEHA Commercial |
$844.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,086.30
|
| Rate for Payer: Multiplan All |
$1,098.37
|
| Rate for Payer: OMNI Networks Commercial |
$844.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,086.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,146.65
|
| Rate for Payer: Three Rivers Provider Network All |
$905.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,122.51
|
| Rate for Payer: Zelis Auto |
$482.80
|
| Rate for Payer: Zelis Worker's Compensation |
$329.51
|
|
|
REVISE/REMOVE NEUROELECTRODE
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
CPT 64585
|
| Hospital Charge Code |
6164585
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$119.30 |
| Max. Negotiated Rate |
$415.15 |
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cigna Commercial |
$371.45
|
| Rate for Payer: First Health Commercial |
$393.30
|
| Rate for Payer: First Health Workers Compensation |
$168.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$393.30
|
| Rate for Payer: GEHA Commercial |
$305.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$393.30
|
| Rate for Payer: Multiplan All |
$397.67
|
| Rate for Payer: OMNI Networks Commercial |
$305.90
|
| Rate for Payer: One Health Plan PPO/POS |
$393.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$415.15
|
| Rate for Payer: Three Rivers Provider Network All |
$327.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$406.41
|
| Rate for Payer: Zelis Auto |
$174.80
|
| Rate for Payer: Zelis Worker's Compensation |
$119.30
|
|
|
REVISE/REMOVE NEUROELECTRODE
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
CPT 64585
|
| Hospital Charge Code |
6164585
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$119.30 |
| Max. Negotiated Rate |
$6,530.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,191.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$262.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,191.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,528.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,265.48
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cigna Commercial |
$371.45
|
| Rate for Payer: First Health Commercial |
$393.30
|
| Rate for Payer: First Health Workers Compensation |
$168.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$393.30
|
| Rate for Payer: GEHA Commercial |
$349.60
|
| Rate for Payer: GEHA Medicare |
$3,265.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$393.30
|
| Rate for Payer: Humana ChoiceCare |
$3,592.03
|
| Rate for Payer: Humana Medicare Advantage |
$3,265.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,486.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,580.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,265.48
|
| Rate for Payer: Multiplan All |
$397.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,551.32
|
| Rate for Payer: OMNI Networks Commercial |
$305.90
|
| Rate for Payer: One Health Plan PPO/POS |
$393.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,979.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,580.18
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,265.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$415.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,530.96
|
| Rate for Payer: Three Rivers Provider Network All |
$327.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,200.17
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,580.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,265.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$406.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,265.48
|
| Rate for Payer: Zelis Auto |
$174.80
|
| Rate for Payer: Zelis Medicare |
$2,775.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,918.58
|
| Rate for Payer: Zelis Worker's Compensation |
$119.30
|
|
|
REVISE/REMOVE NEURORECEIVER
|
Facility
|
OP
|
$843.00
|
|
|
Service Code
|
CPT 61888
|
| Hospital Charge Code |
6161888
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$230.14 |
| Max. Negotiated Rate |
$23,682.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,898.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$505.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,898.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,295.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11,841.06
|
| Rate for Payer: Cash Price |
$505.80
|
| Rate for Payer: Cash Price |
$505.80
|
| Rate for Payer: Cigna Commercial |
$716.55
|
| Rate for Payer: First Health Commercial |
$758.70
|
| Rate for Payer: First Health Workers Compensation |
$325.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$758.70
|
| Rate for Payer: GEHA Commercial |
$674.40
|
| Rate for Payer: GEHA Medicare |
$11,841.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$758.70
|
| Rate for Payer: Humana ChoiceCare |
$13,025.17
|
| Rate for Payer: Humana Medicare Advantage |
$11,841.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19,892.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,342.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11,841.06
|
| Rate for Payer: Multiplan All |
$767.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,129.80
|
| Rate for Payer: OMNI Networks Commercial |
$590.10
|
| Rate for Payer: One Health Plan PPO/POS |
$758.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,704.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,342.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11,841.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$800.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23,682.12
|
| Rate for Payer: Three Rivers Provider Network All |
$632.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,604.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,342.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,841.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11,841.06
|
| Rate for Payer: Zelis Auto |
$337.20
|
| Rate for Payer: Zelis Medicare |
$10,064.90
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,209.27
|
| Rate for Payer: Zelis Worker's Compensation |
$230.14
|
|
|
REVISE/REMOVE NEURORECEIVER
|
Facility
|
IP
|
$843.00
|
|
|
Service Code
|
CPT 61888
|
| Hospital Charge Code |
6161888
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$230.14 |
| Max. Negotiated Rate |
$800.85 |
| Rate for Payer: Cash Price |
$505.80
|
| Rate for Payer: Cigna Commercial |
$716.55
|
| Rate for Payer: First Health Commercial |
$758.70
|
| Rate for Payer: First Health Workers Compensation |
$325.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$758.70
|
| Rate for Payer: GEHA Commercial |
$590.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$758.70
|
| Rate for Payer: Multiplan All |
$767.13
|
| Rate for Payer: OMNI Networks Commercial |
$590.10
|
| Rate for Payer: One Health Plan PPO/POS |
$758.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$800.85
|
| Rate for Payer: Three Rivers Provider Network All |
$632.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.99
|
| Rate for Payer: Zelis Auto |
$337.20
|
| Rate for Payer: Zelis Worker's Compensation |
$230.14
|
|
|
REVISE/REMOVE NEURORECEIVER
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
CPT 63688
|
| Hospital Charge Code |
6163688
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$261.81 |
| Max. Negotiated Rate |
$6,530.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,191.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$575.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,191.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,528.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,265.48
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cigna Commercial |
$815.15
|
| Rate for Payer: First Health Commercial |
$863.10
|
| Rate for Payer: First Health Workers Compensation |
$370.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$863.10
|
| Rate for Payer: GEHA Commercial |
$767.20
|
| Rate for Payer: GEHA Medicare |
$3,265.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$863.10
|
| Rate for Payer: Humana ChoiceCare |
$3,592.03
|
| Rate for Payer: Humana Medicare Advantage |
$3,265.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,486.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,580.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,265.48
|
| Rate for Payer: Multiplan All |
$872.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,551.32
|
| Rate for Payer: OMNI Networks Commercial |
$671.30
|
| Rate for Payer: One Health Plan PPO/POS |
$863.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,979.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,580.18
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,265.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$911.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,530.96
|
| Rate for Payer: Three Rivers Provider Network All |
$719.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,200.17
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,580.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,265.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$891.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,265.48
|
| Rate for Payer: Zelis Auto |
$383.60
|
| Rate for Payer: Zelis Medicare |
$2,775.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,918.58
|
| Rate for Payer: Zelis Worker's Compensation |
$261.81
|
|
|
REVISE/REMOVE NEURORECEIVER
|
Facility
|
IP
|
$959.00
|
|
|
Service Code
|
CPT 63688
|
| Hospital Charge Code |
6163688
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$261.81 |
| Max. Negotiated Rate |
$911.05 |
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cigna Commercial |
$815.15
|
| Rate for Payer: First Health Commercial |
$863.10
|
| Rate for Payer: First Health Workers Compensation |
$370.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$863.10
|
| Rate for Payer: GEHA Commercial |
$671.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$863.10
|
| Rate for Payer: Multiplan All |
$872.69
|
| Rate for Payer: OMNI Networks Commercial |
$671.30
|
| Rate for Payer: One Health Plan PPO/POS |
$863.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$911.05
|
| Rate for Payer: Three Rivers Provider Network All |
$719.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$891.87
|
| Rate for Payer: Zelis Auto |
$383.60
|
| Rate for Payer: Zelis Worker's Compensation |
$261.81
|
|
|
REVISE/REMOVE SLING REPAIR
|
Facility
|
IP
|
$2,083.71
|
|
|
Service Code
|
CPT 57287
|
| Hospital Charge Code |
6157287
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$568.85 |
| Max. Negotiated Rate |
$1,979.52 |
| Rate for Payer: Cash Price |
$1,250.23
|
| Rate for Payer: Cigna Commercial |
$1,771.15
|
| Rate for Payer: First Health Commercial |
$1,875.34
|
| Rate for Payer: First Health Workers Compensation |
$804.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,875.34
|
| Rate for Payer: GEHA Commercial |
$1,458.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,875.34
|
| Rate for Payer: Multiplan All |
$1,896.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,458.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,875.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,979.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,562.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,937.85
|
| Rate for Payer: Zelis Auto |
$833.48
|
| Rate for Payer: Zelis Worker's Compensation |
$568.85
|
|
|
REVISE/REMOVE SLING REPAIR
|
Facility
|
OP
|
$2,083.71
|
|
|
Service Code
|
CPT 57287
|
| Hospital Charge Code |
6157287
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$568.85 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,768.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,250.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,768.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,192.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$1,250.23
|
| Rate for Payer: Cash Price |
$1,250.23
|
| Rate for Payer: Cigna Commercial |
$1,771.15
|
| Rate for Payer: First Health Commercial |
$1,875.34
|
| Rate for Payer: First Health Workers Compensation |
$804.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,875.34
|
| Rate for Payer: GEHA Commercial |
$1,666.97
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,875.34
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,237.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$1,896.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$1,458.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,875.34
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,583.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,237.63
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,979.52
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$1,562.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,237.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,937.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$833.48
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$568.85
|
|
|
REVISE/REPLACE KNEE JOINT
|
Facility
|
OP
|
$2,908.00
|
|
|
Service Code
|
CPT 27486
|
| Hospital Charge Code |
6127486
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$727.00 |
| Max. Negotiated Rate |
$2,762.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,744.80
|
| Rate for Payer: Cash Price |
$1,744.80
|
| Rate for Payer: Cigna Commercial |
$2,471.80
|
| Rate for Payer: First Health Commercial |
$2,617.20
|
| Rate for Payer: First Health Workers Compensation |
$1,122.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,617.20
|
| Rate for Payer: GEHA Commercial |
$2,326.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,617.20
|
| Rate for Payer: Humana ChoiceCare |
$756.08
|
| Rate for Payer: Multiplan All |
$2,646.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,744.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,035.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,617.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,762.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,181.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,559.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$727.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,704.44
|
| Rate for Payer: Zelis Auto |
$1,163.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,454.00
|
| Rate for Payer: Zelis Worker's Compensation |
$793.88
|
|
|
REVISE/REPLACE KNEE JOINT
|
Facility
|
IP
|
$3,643.00
|
|
|
Service Code
|
CPT 27487
|
| Hospital Charge Code |
6127487
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$994.54 |
| Max. Negotiated Rate |
$3,460.85 |
| Rate for Payer: Cash Price |
$2,185.80
|
| Rate for Payer: Cigna Commercial |
$3,096.55
|
| Rate for Payer: First Health Commercial |
$3,278.70
|
| Rate for Payer: First Health Workers Compensation |
$1,406.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,278.70
|
| Rate for Payer: GEHA Commercial |
$2,550.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,278.70
|
| Rate for Payer: Multiplan All |
$3,315.13
|
| Rate for Payer: OMNI Networks Commercial |
$2,550.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,278.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,460.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,732.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,387.99
|
| Rate for Payer: Zelis Auto |
$1,457.20
|
| Rate for Payer: Zelis Worker's Compensation |
$994.54
|
|
|
REVISE/REPLACE KNEE JOINT
|
Facility
|
IP
|
$2,908.00
|
|
|
Service Code
|
CPT 27486
|
| Hospital Charge Code |
6127486
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$793.88 |
| Max. Negotiated Rate |
$2,762.60 |
| Rate for Payer: Cash Price |
$1,744.80
|
| Rate for Payer: Cigna Commercial |
$2,471.80
|
| Rate for Payer: First Health Commercial |
$2,617.20
|
| Rate for Payer: First Health Workers Compensation |
$1,122.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,617.20
|
| Rate for Payer: GEHA Commercial |
$2,035.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,617.20
|
| Rate for Payer: Multiplan All |
$2,646.28
|
| Rate for Payer: OMNI Networks Commercial |
$2,035.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,617.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,762.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,181.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,704.44
|
| Rate for Payer: Zelis Auto |
$1,163.20
|
| Rate for Payer: Zelis Worker's Compensation |
$793.88
|
|
|
REVISE/REPLACE KNEE JOINT
|
Facility
|
OP
|
$3,643.00
|
|
|
Service Code
|
CPT 27487
|
| Hospital Charge Code |
6127487
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$910.75 |
| Max. Negotiated Rate |
$3,460.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,185.80
|
| Rate for Payer: Cash Price |
$2,185.80
|
| Rate for Payer: Cigna Commercial |
$3,096.55
|
| Rate for Payer: First Health Commercial |
$3,278.70
|
| Rate for Payer: First Health Workers Compensation |
$1,406.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,278.70
|
| Rate for Payer: GEHA Commercial |
$2,914.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,278.70
|
| Rate for Payer: Humana ChoiceCare |
$947.18
|
| Rate for Payer: Multiplan All |
$3,315.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,185.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,550.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,278.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,460.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,732.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,205.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$910.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,387.99
|
| Rate for Payer: Zelis Auto |
$1,457.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,821.50
|
| Rate for Payer: Zelis Worker's Compensation |
$994.54
|
|
|
REVISE/REPL VAGUS N ELTRD
|
Facility
|
OP
|
$1,651.00
|
|
|
Service Code
|
CPT 64569
|
| Hospital Charge Code |
6164569
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$450.72 |
| Max. Negotiated Rate |
$23,682.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,238.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$990.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,238.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,941.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11,841.06
|
| Rate for Payer: Cash Price |
$990.60
|
| Rate for Payer: Cash Price |
$990.60
|
| Rate for Payer: Cigna Commercial |
$1,403.35
|
| Rate for Payer: First Health Commercial |
$1,485.90
|
| Rate for Payer: First Health Workers Compensation |
$637.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,485.90
|
| Rate for Payer: GEHA Commercial |
$1,320.80
|
| Rate for Payer: GEHA Medicare |
$11,841.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,485.90
|
| Rate for Payer: Humana ChoiceCare |
$13,025.17
|
| Rate for Payer: Humana Medicare Advantage |
$11,841.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19,892.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,042.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11,841.06
|
| Rate for Payer: Multiplan All |
$1,502.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,129.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,155.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,485.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5,822.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,042.45
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11,841.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,568.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23,682.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,238.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,604.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,042.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,841.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,535.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11,841.06
|
| Rate for Payer: Zelis Auto |
$660.40
|
| Rate for Payer: Zelis Medicare |
$10,064.90
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,209.27
|
| Rate for Payer: Zelis Worker's Compensation |
$450.72
|
|
