|
REVISION OF KNEE JOINT
|
Facility
|
OP
|
$1,656.00
|
|
|
Service Code
|
CPT 27443
|
| Hospital Charge Code |
6127443
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$452.09 |
| Max. Negotiated Rate |
$24,435.12 |
| 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 |
$993.60
|
| 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 |
$12,217.56
|
| Rate for Payer: Cash Price |
$993.60
|
| Rate for Payer: Cash Price |
$993.60
|
| Rate for Payer: Cigna Commercial |
$1,407.60
|
| Rate for Payer: First Health Commercial |
$1,490.40
|
| Rate for Payer: First Health Workers Compensation |
$639.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,490.40
|
| Rate for Payer: GEHA Commercial |
$1,324.80
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,490.40
|
| 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 |
$3,260.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,506.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,159.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,490.40
|
| 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 |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,573.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,242.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,260.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,540.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$662.40
|
| 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 |
$452.09
|
|
|
REVISION OF KNEE JOINT
|
Facility
|
IP
|
$1,656.00
|
|
|
Service Code
|
CPT 27443
|
| Hospital Charge Code |
6127443
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$452.09 |
| Max. Negotiated Rate |
$1,573.20 |
| Rate for Payer: Cash Price |
$993.60
|
| Rate for Payer: Cigna Commercial |
$1,407.60
|
| Rate for Payer: First Health Commercial |
$1,490.40
|
| Rate for Payer: First Health Workers Compensation |
$639.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,490.40
|
| Rate for Payer: GEHA Commercial |
$1,159.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,490.40
|
| Rate for Payer: Multiplan All |
$1,506.96
|
| Rate for Payer: OMNI Networks Commercial |
$1,159.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,490.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,573.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,242.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,540.08
|
| Rate for Payer: Zelis Auto |
$662.40
|
| Rate for Payer: Zelis Worker's Compensation |
$452.09
|
|
|
REVISION OF KNEE JOINT
|
Facility
|
OP
|
$1,639.00
|
|
|
Service Code
|
CPT 27440
|
| Hospital Charge Code |
6127440
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$447.45 |
| Max. Negotiated Rate |
$24,435.12 |
| 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 |
$983.40
|
| 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 |
$12,217.56
|
| Rate for Payer: Cash Price |
$983.40
|
| Rate for Payer: Cash Price |
$983.40
|
| Rate for Payer: Cigna Commercial |
$1,393.15
|
| Rate for Payer: First Health Commercial |
$1,475.10
|
| Rate for Payer: First Health Workers Compensation |
$632.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,475.10
|
| Rate for Payer: GEHA Commercial |
$1,311.20
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,475.10
|
| 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 |
$3,260.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,491.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,147.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,475.10
|
| 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 |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,557.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,229.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,260.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,524.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$655.60
|
| 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 |
$447.45
|
|
|
REVISION OF KNEE JOINT
|
Facility
|
OP
|
$2,578.00
|
|
|
Service Code
|
CPT 27445
|
| Hospital Charge Code |
6127445
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$644.50 |
| Max. Negotiated Rate |
$2,449.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,546.80
|
| Rate for Payer: Cash Price |
$1,546.80
|
| Rate for Payer: Cigna Commercial |
$2,191.30
|
| Rate for Payer: First Health Commercial |
$2,320.20
|
| Rate for Payer: First Health Workers Compensation |
$995.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,320.20
|
| Rate for Payer: GEHA Commercial |
$2,062.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,320.20
|
| Rate for Payer: Humana ChoiceCare |
$670.28
|
| Rate for Payer: Multiplan All |
$2,345.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,546.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,804.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,320.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,449.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,933.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,268.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$644.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,397.54
|
| Rate for Payer: Zelis Auto |
$1,031.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,289.00
|
| Rate for Payer: Zelis Worker's Compensation |
$703.79
|
|
|
REVISION OF KNEE JOINT
|
Facility
|
IP
|
$1,690.00
|
|
|
Service Code
|
CPT 27441
|
| Hospital Charge Code |
6127441
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$461.37 |
| Max. Negotiated Rate |
$1,605.50 |
| Rate for Payer: Cash Price |
$1,014.00
|
| Rate for Payer: Cigna Commercial |
$1,436.50
|
| Rate for Payer: First Health Commercial |
$1,521.00
|
| Rate for Payer: First Health Workers Compensation |
$652.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,521.00
|
| Rate for Payer: GEHA Commercial |
$1,183.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,521.00
|
| Rate for Payer: Multiplan All |
$1,537.90
|
| Rate for Payer: OMNI Networks Commercial |
$1,183.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,521.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,605.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,267.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,571.70
|
| Rate for Payer: Zelis Auto |
$676.00
|
| Rate for Payer: Zelis Worker's Compensation |
$461.37
|
|
|
REVISION OF KNEE JOINT
|
Facility
|
IP
|
$1,786.00
|
|
|
Service Code
|
CPT 27442
|
| Hospital Charge Code |
6127442
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$487.58 |
| Max. Negotiated Rate |
$1,696.70 |
| Rate for Payer: Cash Price |
$1,071.60
|
| Rate for Payer: Cigna Commercial |
$1,518.10
|
| Rate for Payer: First Health Commercial |
$1,607.40
|
| Rate for Payer: First Health Workers Compensation |
$689.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,607.40
|
| Rate for Payer: GEHA Commercial |
$1,250.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,607.40
|
| Rate for Payer: Multiplan All |
$1,625.26
|
| Rate for Payer: OMNI Networks Commercial |
$1,250.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,607.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,696.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,339.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,660.98
|
| Rate for Payer: Zelis Auto |
$714.40
|
| Rate for Payer: Zelis Worker's Compensation |
$487.58
|
|
|
REVISION OF KNEE JOINT
|
Facility
|
IP
|
$1,639.00
|
|
|
Service Code
|
CPT 27440
|
| Hospital Charge Code |
6127440
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$447.45 |
| Max. Negotiated Rate |
$1,557.05 |
| Rate for Payer: Cash Price |
$983.40
|
| Rate for Payer: Cigna Commercial |
$1,393.15
|
| Rate for Payer: First Health Commercial |
$1,475.10
|
| Rate for Payer: First Health Workers Compensation |
$632.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,475.10
|
| Rate for Payer: GEHA Commercial |
$1,147.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,475.10
|
| Rate for Payer: Multiplan All |
$1,491.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,147.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,475.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,557.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,229.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,524.27
|
| Rate for Payer: Zelis Auto |
$655.60
|
| Rate for Payer: Zelis Worker's Compensation |
$447.45
|
|
|
REVISION OF KNEE JOINT
|
Facility
|
OP
|
$1,690.00
|
|
|
Service Code
|
CPT 27441
|
| Hospital Charge Code |
6127441
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$461.37 |
| Max. Negotiated Rate |
$24,435.12 |
| 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 |
$1,014.00
|
| 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 |
$12,217.56
|
| Rate for Payer: Cash Price |
$1,014.00
|
| Rate for Payer: Cash Price |
$1,014.00
|
| Rate for Payer: Cigna Commercial |
$1,436.50
|
| Rate for Payer: First Health Commercial |
$1,521.00
|
| Rate for Payer: First Health Workers Compensation |
$652.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,521.00
|
| Rate for Payer: GEHA Commercial |
$1,352.00
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,521.00
|
| 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 |
$3,260.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,537.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,183.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,521.00
|
| 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 |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,605.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,267.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,260.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,571.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$676.00
|
| 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 |
$461.37
|
|
|
REVISION OF LARYNX
|
Facility
|
IP
|
$2,471.00
|
|
|
Service Code
|
CPT 31580
|
| Hospital Charge Code |
6131580
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$674.58 |
| Max. Negotiated Rate |
$2,347.45 |
| Rate for Payer: Cash Price |
$1,482.60
|
| Rate for Payer: Cigna Commercial |
$2,100.35
|
| Rate for Payer: First Health Commercial |
$2,223.90
|
| Rate for Payer: First Health Workers Compensation |
$954.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,223.90
|
| Rate for Payer: GEHA Commercial |
$1,729.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,223.90
|
| Rate for Payer: Multiplan All |
$2,248.61
|
| Rate for Payer: OMNI Networks Commercial |
$1,729.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,223.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,347.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,853.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,298.03
|
| Rate for Payer: Zelis Auto |
$988.40
|
| Rate for Payer: Zelis Worker's Compensation |
$674.58
|
|
|
REVISION OF LARYNX
|
Facility
|
OP
|
$1,987.00
|
|
|
Service Code
|
CPT 31400
|
| Hospital Charge Code |
6131400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$542.45 |
| 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 |
$1,192.20
|
| 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 |
$1,192.20
|
| Rate for Payer: Cash Price |
$1,192.20
|
| Rate for Payer: Cigna Commercial |
$1,688.95
|
| Rate for Payer: First Health Commercial |
$1,788.30
|
| Rate for Payer: First Health Workers Compensation |
$767.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,788.30
|
| Rate for Payer: GEHA Commercial |
$1,589.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,788.30
|
| 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 |
$1,808.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,390.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,788.30
|
| 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 |
$1,887.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,490.25
|
| 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 |
$1,847.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$794.80
|
| 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 |
$542.45
|
|
|
REVISION OF LARYNX
|
Facility
|
IP
|
$2,316.00
|
|
|
Service Code
|
CPT 31599
|
| Hospital Charge Code |
6131588
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$632.27 |
| Max. Negotiated Rate |
$2,200.20 |
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cigna Commercial |
$1,968.60
|
| Rate for Payer: First Health Commercial |
$2,084.40
|
| Rate for Payer: First Health Workers Compensation |
$894.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,084.40
|
| Rate for Payer: GEHA Commercial |
$1,621.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,084.40
|
| Rate for Payer: Multiplan All |
$2,107.56
|
| Rate for Payer: OMNI Networks Commercial |
$1,621.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,084.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,200.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,737.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,153.88
|
| Rate for Payer: Zelis Auto |
$926.40
|
| Rate for Payer: Zelis Worker's Compensation |
$632.27
|
|
|
REVISION OF LARYNX
|
Facility
|
IP
|
$2,055.00
|
|
|
Service Code
|
CPT 31587
|
| Hospital Charge Code |
6131587
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$561.01 |
| Max. Negotiated Rate |
$1,952.25 |
| Rate for Payer: Cash Price |
$1,233.00
|
| Rate for Payer: Cigna Commercial |
$1,746.75
|
| Rate for Payer: First Health Commercial |
$1,849.50
|
| Rate for Payer: First Health Workers Compensation |
$793.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,849.50
|
| Rate for Payer: GEHA Commercial |
$1,438.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,849.50
|
| Rate for Payer: Multiplan All |
$1,870.05
|
| Rate for Payer: OMNI Networks Commercial |
$1,438.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,849.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,952.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,541.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,911.15
|
| Rate for Payer: Zelis Auto |
$822.00
|
| Rate for Payer: Zelis Worker's Compensation |
$561.01
|
|
|
REVISION OF LARYNX
|
Facility
|
IP
|
$1,987.00
|
|
|
Service Code
|
CPT 31400
|
| Hospital Charge Code |
6131400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$542.45 |
| Max. Negotiated Rate |
$1,887.65 |
| Rate for Payer: Cash Price |
$1,192.20
|
| Rate for Payer: Cigna Commercial |
$1,688.95
|
| Rate for Payer: First Health Commercial |
$1,788.30
|
| Rate for Payer: First Health Workers Compensation |
$767.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,788.30
|
| Rate for Payer: GEHA Commercial |
$1,390.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,788.30
|
| Rate for Payer: Multiplan All |
$1,808.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,390.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,788.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,887.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,490.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,847.91
|
| Rate for Payer: Zelis Auto |
$794.80
|
| Rate for Payer: Zelis Worker's Compensation |
$542.45
|
|
|
REVISION OF LARYNX
|
Facility
|
OP
|
$2,316.00
|
|
|
Service Code
|
CPT 31599
|
| Hospital Charge Code |
6131588
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$187.43 |
| Max. Negotiated Rate |
$2,200.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$349.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,389.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$349.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$276.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$220.50
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cigna Commercial |
$1,968.60
|
| Rate for Payer: First Health Commercial |
$2,084.40
|
| Rate for Payer: First Health Workers Compensation |
$894.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,084.40
|
| Rate for Payer: GEHA Commercial |
$1,852.80
|
| Rate for Payer: GEHA Medicare |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,084.40
|
| Rate for Payer: Humana ChoiceCare |
$242.55
|
| Rate for Payer: Humana Medicare Advantage |
$220.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$370.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$282.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$220.50
|
| Rate for Payer: Multiplan All |
$2,107.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$374.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,621.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,084.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$325.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$282.19
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,200.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$441.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,737.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$216.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$282.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,153.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$220.50
|
| Rate for Payer: Zelis Auto |
$926.40
|
| Rate for Payer: Zelis Medicare |
$187.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.60
|
| Rate for Payer: Zelis Worker's Compensation |
$632.27
|
|
|
REVISION OF LARYNX
|
Facility
|
OP
|
$2,055.00
|
|
|
Service Code
|
CPT 31587
|
| Hospital Charge Code |
6131587
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$561.01 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,369.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,233.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,369.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6,630.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,233.00
|
| Rate for Payer: Cash Price |
$1,233.00
|
| Rate for Payer: Cigna Commercial |
$1,746.75
|
| Rate for Payer: First Health Commercial |
$1,849.50
|
| Rate for Payer: First Health Workers Compensation |
$793.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,849.50
|
| Rate for Payer: GEHA Commercial |
$1,644.00
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,849.50
|
| 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 |
$6,765.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,870.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,438.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,849.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7,811.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6,765.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,952.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,541.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6,765.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,911.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$822.00
|
| 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 |
$561.01
|
|
|
REVISION OF LARYNX
|
Facility
|
OP
|
$2,471.00
|
|
|
Service Code
|
CPT 31580
|
| Hospital Charge Code |
6131580
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$674.58 |
| 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 |
$1,482.60
|
| 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 |
$1,482.60
|
| Rate for Payer: Cash Price |
$1,482.60
|
| Rate for Payer: Cigna Commercial |
$2,100.35
|
| Rate for Payer: First Health Commercial |
$2,223.90
|
| Rate for Payer: First Health Workers Compensation |
$954.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,223.90
|
| Rate for Payer: GEHA Commercial |
$1,976.80
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,223.90
|
| 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 |
$2,248.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,729.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,223.90
|
| 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 |
$2,347.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,853.25
|
| 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 |
$2,298.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$988.40
|
| 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 |
$674.58
|
|
|
REVISION OF LOWER LEG
|
Facility
|
OP
|
$2,209.00
|
|
|
Service Code
|
CPT 27715
|
| Hospital Charge Code |
6127715
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$552.25 |
| Max. Negotiated Rate |
$2,098.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,325.40
|
| Rate for Payer: Cash Price |
$1,325.40
|
| Rate for Payer: Cigna Commercial |
$1,877.65
|
| Rate for Payer: First Health Commercial |
$1,988.10
|
| Rate for Payer: First Health Workers Compensation |
$852.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,988.10
|
| Rate for Payer: GEHA Commercial |
$1,767.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,988.10
|
| Rate for Payer: Humana ChoiceCare |
$574.34
|
| Rate for Payer: Multiplan All |
$2,010.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,325.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,546.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,988.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,098.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,656.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,943.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$552.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,054.37
|
| Rate for Payer: Zelis Auto |
$883.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,104.50
|
| Rate for Payer: Zelis Worker's Compensation |
$603.06
|
|
|
REVISION OF LOWER LEG
|
Facility
|
IP
|
$2,209.00
|
|
|
Service Code
|
CPT 27715
|
| Hospital Charge Code |
6127715
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$603.06 |
| Max. Negotiated Rate |
$2,098.55 |
| Rate for Payer: Cash Price |
$1,325.40
|
| Rate for Payer: Cigna Commercial |
$1,877.65
|
| Rate for Payer: First Health Commercial |
$1,988.10
|
| Rate for Payer: First Health Workers Compensation |
$852.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,988.10
|
| Rate for Payer: GEHA Commercial |
$1,546.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,988.10
|
| Rate for Payer: Multiplan All |
$2,010.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,546.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,988.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,098.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,656.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,054.37
|
| Rate for Payer: Zelis Auto |
$883.60
|
| Rate for Payer: Zelis Worker's Compensation |
$603.06
|
|
|
REVISION OF LOWER LEG TENDON
|
Facility
|
IP
|
$947.00
|
|
|
Service Code
|
CPT 27685
|
| Hospital Charge Code |
6127685
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$258.53 |
| Max. Negotiated Rate |
$899.65 |
| Rate for Payer: Cash Price |
$568.20
|
| Rate for Payer: Cigna Commercial |
$804.95
|
| Rate for Payer: First Health Commercial |
$852.30
|
| Rate for Payer: First Health Workers Compensation |
$365.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$852.30
|
| Rate for Payer: GEHA Commercial |
$662.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$852.30
|
| Rate for Payer: Multiplan All |
$861.77
|
| Rate for Payer: OMNI Networks Commercial |
$662.90
|
| Rate for Payer: One Health Plan PPO/POS |
$852.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$899.65
|
| Rate for Payer: Three Rivers Provider Network All |
$710.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$880.71
|
| Rate for Payer: Zelis Auto |
$378.80
|
| Rate for Payer: Zelis Worker's Compensation |
$258.53
|
|
|
REVISION OF LOWER LEG TENDON
|
Facility
|
OP
|
$947.00
|
|
|
Service Code
|
CPT 27685
|
| Hospital Charge Code |
6127685
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$258.53 |
| Max. Negotiated Rate |
$6,161.78 |
| 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 |
$568.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$568.20
|
| Rate for Payer: Cash Price |
$568.20
|
| Rate for Payer: Cigna Commercial |
$804.95
|
| Rate for Payer: First Health Commercial |
$852.30
|
| Rate for Payer: First Health Workers Compensation |
$365.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$852.30
|
| Rate for Payer: GEHA Commercial |
$757.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$852.30
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$861.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$662.90
|
| Rate for Payer: One Health Plan PPO/POS |
$852.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$899.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$710.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$880.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$378.80
|
| 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 |
$258.53
|
|
|
REVISION OF NECK MUSCLE
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
CPT 21700
|
| Hospital Charge Code |
6121700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$265.90 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$584.40
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$584.40
|
| Rate for Payer: Cash Price |
$584.40
|
| Rate for Payer: Cigna Commercial |
$827.90
|
| Rate for Payer: First Health Commercial |
$876.60
|
| Rate for Payer: First Health Workers Compensation |
$376.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$876.60
|
| Rate for Payer: GEHA Commercial |
$779.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$876.60
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$886.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$681.80
|
| Rate for Payer: One Health Plan PPO/POS |
$876.60
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$925.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$730.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$905.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$389.60
|
| 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 |
$265.90
|
|
|
REVISION OF NECK MUSCLE
|
Facility
|
IP
|
$1,098.00
|
|
|
Service Code
|
CPT 21725
|
| Hospital Charge Code |
6121725
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$299.75 |
| Max. Negotiated Rate |
$1,043.10 |
| Rate for Payer: Cash Price |
$658.80
|
| Rate for Payer: Cigna Commercial |
$933.30
|
| Rate for Payer: First Health Commercial |
$988.20
|
| Rate for Payer: First Health Workers Compensation |
$423.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$988.20
|
| Rate for Payer: GEHA Commercial |
$768.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$988.20
|
| Rate for Payer: Multiplan All |
$999.18
|
| Rate for Payer: OMNI Networks Commercial |
$768.60
|
| Rate for Payer: One Health Plan PPO/POS |
$988.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,043.10
|
| Rate for Payer: Three Rivers Provider Network All |
$823.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,021.14
|
| Rate for Payer: Zelis Auto |
$439.20
|
| Rate for Payer: Zelis Worker's Compensation |
$299.75
|
|
|
REVISION OF NECK MUSCLE
|
Facility
|
IP
|
$929.00
|
|
|
Service Code
|
CPT 21720
|
| Hospital Charge Code |
6121720
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$253.62 |
| Max. Negotiated Rate |
$882.55 |
| Rate for Payer: Cash Price |
$557.40
|
| Rate for Payer: Cigna Commercial |
$789.65
|
| Rate for Payer: First Health Commercial |
$836.10
|
| Rate for Payer: First Health Workers Compensation |
$358.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$836.10
|
| Rate for Payer: GEHA Commercial |
$650.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$836.10
|
| Rate for Payer: Multiplan All |
$845.39
|
| Rate for Payer: OMNI Networks Commercial |
$650.30
|
| Rate for Payer: One Health Plan PPO/POS |
$836.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$882.55
|
| Rate for Payer: Three Rivers Provider Network All |
$696.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$863.97
|
| Rate for Payer: Zelis Auto |
$371.60
|
| Rate for Payer: Zelis Worker's Compensation |
$253.62
|
|
|
REVISION OF NECK MUSCLE
|
Facility
|
OP
|
$929.00
|
|
|
Service Code
|
CPT 21720
|
| Hospital Charge Code |
6121720
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$253.62 |
| Max. Negotiated Rate |
$6,161.78 |
| 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 |
$557.40
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$557.40
|
| Rate for Payer: Cash Price |
$557.40
|
| Rate for Payer: Cigna Commercial |
$789.65
|
| Rate for Payer: First Health Commercial |
$836.10
|
| Rate for Payer: First Health Workers Compensation |
$358.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$836.10
|
| Rate for Payer: GEHA Commercial |
$743.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$836.10
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$845.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$650.30
|
| Rate for Payer: One Health Plan PPO/POS |
$836.10
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$882.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$696.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$863.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$371.60
|
| 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 |
$253.62
|
|
|
REVISION OF NECK MUSCLE
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
CPT 21700
|
| Hospital Charge Code |
6121700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$265.90 |
| Max. Negotiated Rate |
$925.30 |
| Rate for Payer: Cash Price |
$584.40
|
| Rate for Payer: Cigna Commercial |
$827.90
|
| Rate for Payer: First Health Commercial |
$876.60
|
| Rate for Payer: First Health Workers Compensation |
$376.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$876.60
|
| Rate for Payer: GEHA Commercial |
$681.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$876.60
|
| Rate for Payer: Multiplan All |
$886.34
|
| Rate for Payer: OMNI Networks Commercial |
$681.80
|
| Rate for Payer: One Health Plan PPO/POS |
$876.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$925.30
|
| Rate for Payer: Three Rivers Provider Network All |
$730.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$905.82
|
| Rate for Payer: Zelis Auto |
$389.60
|
| Rate for Payer: Zelis Worker's Compensation |
$265.90
|
|
