|
SHOULDER ARTHROSCOPY DX
|
Facility
|
IP
|
$964.00
|
|
|
Service Code
|
CPT 29805
|
| Hospital Charge Code |
6129805
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$263.17 |
| Max. Negotiated Rate |
$915.80 |
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cigna Commercial |
$819.40
|
| Rate for Payer: First Health Commercial |
$867.60
|
| Rate for Payer: First Health Workers Compensation |
$372.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$867.60
|
| Rate for Payer: GEHA Commercial |
$674.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$867.60
|
| Rate for Payer: Multiplan All |
$877.24
|
| Rate for Payer: OMNI Networks Commercial |
$674.80
|
| Rate for Payer: One Health Plan PPO/POS |
$867.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$915.80
|
| Rate for Payer: Three Rivers Provider Network All |
$723.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$896.52
|
| Rate for Payer: Zelis Auto |
$385.60
|
| Rate for Payer: Zelis Worker's Compensation |
$263.17
|
|
|
SHOULDER ARTHROSCOPY DX
|
Facility
|
OP
|
$964.00
|
|
|
Service Code
|
CPT 29805
|
| Hospital Charge Code |
6129805
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$263.17 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$578.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cigna Commercial |
$819.40
|
| Rate for Payer: First Health Commercial |
$867.60
|
| Rate for Payer: First Health Workers Compensation |
$372.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$867.60
|
| Rate for Payer: GEHA Commercial |
$771.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$867.60
|
| 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 |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$877.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$674.80
|
| Rate for Payer: One Health Plan PPO/POS |
$867.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$915.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$723.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$896.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$385.60
|
| 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 |
$263.17
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,157.00
|
|
|
Service Code
|
CPT 29822
|
| Hospital Charge Code |
6129822
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$315.86 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$694.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$694.20
|
| Rate for Payer: Cash Price |
$694.20
|
| Rate for Payer: Cigna Commercial |
$983.45
|
| Rate for Payer: First Health Commercial |
$1,041.30
|
| Rate for Payer: First Health Workers Compensation |
$446.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,041.30
|
| Rate for Payer: GEHA Commercial |
$925.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,041.30
|
| 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 |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,052.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$809.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,041.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,099.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$867.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,076.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$462.80
|
| 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 |
$315.86
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$2,134.00
|
|
|
Service Code
|
CPT 29807
|
| Hospital Charge Code |
6129807
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$582.58 |
| Max. Negotiated Rate |
$2,027.30 |
| Rate for Payer: Cash Price |
$1,280.40
|
| Rate for Payer: Cigna Commercial |
$1,813.90
|
| Rate for Payer: First Health Commercial |
$1,920.60
|
| Rate for Payer: First Health Workers Compensation |
$823.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,920.60
|
| Rate for Payer: GEHA Commercial |
$1,493.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,920.60
|
| Rate for Payer: Multiplan All |
$1,941.94
|
| Rate for Payer: OMNI Networks Commercial |
$1,493.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,920.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,027.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,600.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,984.62
|
| Rate for Payer: Zelis Auto |
$853.60
|
| Rate for Payer: Zelis Worker's Compensation |
$582.58
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,361.00
|
|
|
Service Code
|
CPT 29824
|
| Hospital Charge Code |
6129824
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$371.55 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$816.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$816.60
|
| Rate for Payer: Cash Price |
$816.60
|
| Rate for Payer: Cigna Commercial |
$1,156.85
|
| Rate for Payer: First Health Commercial |
$1,224.90
|
| Rate for Payer: First Health Workers Compensation |
$525.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,224.90
|
| Rate for Payer: GEHA Commercial |
$1,088.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,224.90
|
| 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 |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,238.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$952.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,224.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,292.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,020.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,265.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$544.40
|
| 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 |
$371.55
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$2,187.00
|
|
|
Service Code
|
CPT 29806
|
| Hospital Charge Code |
6129806
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$597.05 |
| Max. Negotiated Rate |
$2,077.65 |
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: Cigna Commercial |
$1,858.95
|
| Rate for Payer: First Health Commercial |
$1,968.30
|
| Rate for Payer: First Health Workers Compensation |
$844.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,968.30
|
| Rate for Payer: GEHA Commercial |
$1,530.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,968.30
|
| Rate for Payer: Multiplan All |
$1,990.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,530.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,968.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,077.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,640.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,033.91
|
| Rate for Payer: Zelis Auto |
$874.80
|
| Rate for Payer: Zelis Worker's Compensation |
$597.05
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
CPT 29823
|
| Hospital Charge Code |
6129823
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$344.80 |
| Max. Negotiated Rate |
$1,199.85 |
| Rate for Payer: Cash Price |
$757.80
|
| Rate for Payer: Cigna Commercial |
$1,073.55
|
| Rate for Payer: First Health Commercial |
$1,136.70
|
| Rate for Payer: First Health Workers Compensation |
$487.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,136.70
|
| Rate for Payer: GEHA Commercial |
$884.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,136.70
|
| Rate for Payer: Multiplan All |
$1,149.33
|
| Rate for Payer: OMNI Networks Commercial |
$884.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,136.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,199.85
|
| Rate for Payer: Three Rivers Provider Network All |
$947.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,174.59
|
| Rate for Payer: Zelis Auto |
$505.20
|
| Rate for Payer: Zelis Worker's Compensation |
$344.80
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
CPT 29823
|
| Hospital Charge Code |
6129823
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$344.80 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$757.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,910.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$757.80
|
| Rate for Payer: Cash Price |
$757.80
|
| Rate for Payer: Cigna Commercial |
$1,073.55
|
| Rate for Payer: First Health Commercial |
$1,136.70
|
| Rate for Payer: First Health Workers Compensation |
$487.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,136.70
|
| Rate for Payer: GEHA Commercial |
$1,010.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,136.70
|
| 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 |
$3,989.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,149.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$884.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,136.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,606.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,989.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,199.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$947.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,989.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,174.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$505.20
|
| 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 |
$344.80
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,157.00
|
|
|
Service Code
|
CPT 29822
|
| Hospital Charge Code |
6129822
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$315.86 |
| Max. Negotiated Rate |
$1,099.15 |
| Rate for Payer: Cash Price |
$694.20
|
| Rate for Payer: Cigna Commercial |
$983.45
|
| Rate for Payer: First Health Commercial |
$1,041.30
|
| Rate for Payer: First Health Workers Compensation |
$446.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,041.30
|
| Rate for Payer: GEHA Commercial |
$809.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,041.30
|
| Rate for Payer: Multiplan All |
$1,052.87
|
| Rate for Payer: OMNI Networks Commercial |
$809.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,041.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,099.15
|
| Rate for Payer: Three Rivers Provider Network All |
$867.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,076.01
|
| Rate for Payer: Zelis Auto |
$462.80
|
| Rate for Payer: Zelis Worker's Compensation |
$315.86
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,201.00
|
|
|
Service Code
|
CPT 29819
|
| Hospital Charge Code |
6129819
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$327.87 |
| Max. Negotiated Rate |
$1,140.95 |
| Rate for Payer: Cash Price |
$720.60
|
| Rate for Payer: Cigna Commercial |
$1,020.85
|
| Rate for Payer: First Health Commercial |
$1,080.90
|
| Rate for Payer: First Health Workers Compensation |
$463.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,080.90
|
| Rate for Payer: GEHA Commercial |
$840.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,080.90
|
| Rate for Payer: Multiplan All |
$1,092.91
|
| Rate for Payer: OMNI Networks Commercial |
$840.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,080.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,140.95
|
| Rate for Payer: Three Rivers Provider Network All |
$900.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,116.93
|
| Rate for Payer: Zelis Auto |
$480.40
|
| Rate for Payer: Zelis Worker's Compensation |
$327.87
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$2,134.00
|
|
|
Service Code
|
CPT 29807
|
| Hospital Charge Code |
6129807
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$582.58 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,280.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,910.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,280.40
|
| Rate for Payer: Cash Price |
$1,280.40
|
| Rate for Payer: Cigna Commercial |
$1,813.90
|
| Rate for Payer: First Health Commercial |
$1,920.60
|
| Rate for Payer: First Health Workers Compensation |
$823.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,920.60
|
| Rate for Payer: GEHA Commercial |
$1,707.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,920.60
|
| 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 |
$3,989.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,941.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,493.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,920.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,606.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,989.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,027.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,600.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,989.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,984.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$853.60
|
| 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 |
$582.58
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,361.00
|
|
|
Service Code
|
CPT 29824
|
| Hospital Charge Code |
6129824
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$371.55 |
| Max. Negotiated Rate |
$1,292.95 |
| Rate for Payer: Cash Price |
$816.60
|
| Rate for Payer: Cigna Commercial |
$1,156.85
|
| Rate for Payer: First Health Commercial |
$1,224.90
|
| Rate for Payer: First Health Workers Compensation |
$525.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,224.90
|
| Rate for Payer: GEHA Commercial |
$952.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,224.90
|
| Rate for Payer: Multiplan All |
$1,238.51
|
| Rate for Payer: OMNI Networks Commercial |
$952.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,224.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,292.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,020.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,265.73
|
| Rate for Payer: Zelis Auto |
$544.40
|
| Rate for Payer: Zelis Worker's Compensation |
$371.55
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
CPT 29826
|
| Hospital Charge Code |
6129826
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$143.52 |
| Max. Negotiated Rate |
$4,935.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$331.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,910.22
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: First Health Commercial |
$496.80
|
| Rate for Payer: First Health Workers Compensation |
$213.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$496.80
|
| Rate for Payer: GEHA Commercial |
$441.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$496.80
|
| Rate for Payer: Humana ChoiceCare |
$143.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,989.85
|
| Rate for Payer: Multiplan All |
$502.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$331.20
|
| Rate for Payer: OMNI Networks Commercial |
$386.40
|
| Rate for Payer: One Health Plan PPO/POS |
$496.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,606.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,989.85
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$524.40
|
| Rate for Payer: Three Rivers Provider Network All |
$414.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$485.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,989.85
|
| Rate for Payer: United Payors & United Providers UP&UP |
$513.36
|
| Rate for Payer: Zelis Auto |
$220.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$276.00
|
| Rate for Payer: Zelis Worker's Compensation |
$150.70
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
CPT 29826
|
| Hospital Charge Code |
6129826
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$150.70 |
| Max. Negotiated Rate |
$524.40 |
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: First Health Commercial |
$496.80
|
| Rate for Payer: First Health Workers Compensation |
$213.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$496.80
|
| Rate for Payer: GEHA Commercial |
$386.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$496.80
|
| Rate for Payer: Multiplan All |
$502.32
|
| Rate for Payer: OMNI Networks Commercial |
$386.40
|
| Rate for Payer: One Health Plan PPO/POS |
$496.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$524.40
|
| Rate for Payer: Three Rivers Provider Network All |
$414.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$513.36
|
| Rate for Payer: Zelis Auto |
$220.80
|
| Rate for Payer: Zelis Worker's Compensation |
$150.70
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,201.00
|
|
|
Service Code
|
CPT 29819
|
| Hospital Charge Code |
6129819
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$327.87 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$720.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,910.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$720.60
|
| Rate for Payer: Cash Price |
$720.60
|
| Rate for Payer: Cigna Commercial |
$1,020.85
|
| Rate for Payer: First Health Commercial |
$1,080.90
|
| Rate for Payer: First Health Workers Compensation |
$463.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,080.90
|
| Rate for Payer: GEHA Commercial |
$960.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,080.90
|
| 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 |
$3,989.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,092.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$840.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,080.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,606.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,989.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,140.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$900.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,989.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,116.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$480.40
|
| 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 |
$327.87
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$2,187.00
|
|
|
Service Code
|
CPT 29806
|
| Hospital Charge Code |
6129806
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$597.05 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,312.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,910.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: Cigna Commercial |
$1,858.95
|
| Rate for Payer: First Health Commercial |
$1,968.30
|
| Rate for Payer: First Health Workers Compensation |
$844.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,968.30
|
| Rate for Payer: GEHA Commercial |
$1,749.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,968.30
|
| 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 |
$3,989.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,990.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,530.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,968.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,606.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,989.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,077.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,640.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,989.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,033.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$874.80
|
| 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 |
$597.05
|
|
|
SHOULDER IMMOBILIZER
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
8233964
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.42 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$107.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$107.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$85.14
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$99.45
|
| Rate for Payer: First Health Commercial |
$105.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$105.30
|
| Rate for Payer: GEHA Commercial |
$93.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$105.30
|
| Rate for Payer: Humana ChoiceCare |
$30.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$86.88
|
| Rate for Payer: Multiplan All |
$106.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$70.20
|
| Rate for Payer: OMNI Networks Commercial |
$81.90
|
| Rate for Payer: One Health Plan PPO/POS |
$105.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$100.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$86.88
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$111.15
|
| Rate for Payer: Three Rivers Provider Network All |
$87.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$102.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.88
|
| Rate for Payer: United Payors & United Providers UP&UP |
$108.81
|
| Rate for Payer: Zelis Auto |
$46.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$58.50
|
|
|
SHOULDER IMMOBILIZER
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
8233964
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$99.45
|
| Rate for Payer: First Health Commercial |
$105.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$105.30
|
| Rate for Payer: GEHA Commercial |
$81.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$105.30
|
| Rate for Payer: Multiplan All |
$106.47
|
| Rate for Payer: OMNI Networks Commercial |
$81.90
|
| Rate for Payer: One Health Plan PPO/POS |
$105.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$111.15
|
| Rate for Payer: Three Rivers Provider Network All |
$87.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$108.81
|
| Rate for Payer: Zelis Auto |
$46.80
|
|
|
SHOULDER IMMOBILIZER
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
8800013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$99.45
|
| Rate for Payer: First Health Commercial |
$105.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$105.30
|
| Rate for Payer: GEHA Commercial |
$81.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$105.30
|
| Rate for Payer: Multiplan All |
$106.47
|
| Rate for Payer: OMNI Networks Commercial |
$81.90
|
| Rate for Payer: One Health Plan PPO/POS |
$105.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$111.15
|
| Rate for Payer: Three Rivers Provider Network All |
$87.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$108.81
|
| Rate for Payer: Zelis Auto |
$46.80
|
|
|
SHOULDER IMMOBILIZER
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
8800013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.42 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$107.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$107.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$85.14
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$99.45
|
| Rate for Payer: First Health Commercial |
$105.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$105.30
|
| Rate for Payer: GEHA Commercial |
$93.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$105.30
|
| Rate for Payer: Humana ChoiceCare |
$30.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$86.88
|
| Rate for Payer: Multiplan All |
$106.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$70.20
|
| Rate for Payer: OMNI Networks Commercial |
$81.90
|
| Rate for Payer: One Health Plan PPO/POS |
$105.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$100.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$86.88
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$111.15
|
| Rate for Payer: Three Rivers Provider Network All |
$87.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$102.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.88
|
| Rate for Payer: United Payors & United Providers UP&UP |
$108.81
|
| Rate for Payer: Zelis Auto |
$46.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$58.50
|
|
|
SHOULDER JOINT SURGERY
|
Facility
|
OP
|
$926.00
|
|
|
Service Code
|
CPT 23101
|
| Hospital Charge Code |
6123101
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$252.80 |
| 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 |
$555.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$555.60
|
| Rate for Payer: Cash Price |
$555.60
|
| Rate for Payer: Cigna Commercial |
$787.10
|
| Rate for Payer: First Health Commercial |
$833.40
|
| Rate for Payer: First Health Workers Compensation |
$357.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$833.40
|
| Rate for Payer: GEHA Commercial |
$740.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$833.40
|
| 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 |
$842.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$648.20
|
| Rate for Payer: One Health Plan PPO/POS |
$833.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$879.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$694.50
|
| 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 |
$861.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$370.40
|
| 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 |
$252.80
|
|
|
SHOULDER JOINT SURGERY
|
Facility
|
IP
|
$926.00
|
|
|
Service Code
|
CPT 23101
|
| Hospital Charge Code |
6123101
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$252.80 |
| Max. Negotiated Rate |
$879.70 |
| Rate for Payer: Cash Price |
$555.60
|
| Rate for Payer: Cigna Commercial |
$787.10
|
| Rate for Payer: First Health Commercial |
$833.40
|
| Rate for Payer: First Health Workers Compensation |
$357.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$833.40
|
| Rate for Payer: GEHA Commercial |
$648.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$833.40
|
| Rate for Payer: Multiplan All |
$842.66
|
| Rate for Payer: OMNI Networks Commercial |
$648.20
|
| Rate for Payer: One Health Plan PPO/POS |
$833.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$879.70
|
| Rate for Payer: Three Rivers Provider Network All |
$694.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$861.18
|
| Rate for Payer: Zelis Auto |
$370.40
|
| Rate for Payer: Zelis Worker's Compensation |
$252.80
|
|
|
shrimp IgE REF602473
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299200
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
shrimp IgE REF602473
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299200
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
SHVG SKIN LESION 1 T/A/L DIAM 0.6-1.0 CM
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 11301
|
| Hospital Charge Code |
6111301
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$297.50
|
| Rate for Payer: First Health Commercial |
$315.00
|
| Rate for Payer: First Health Workers Compensation |
$135.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$315.00
|
| Rate for Payer: GEHA Commercial |
$245.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$315.00
|
| Rate for Payer: Multiplan All |
$318.50
|
| Rate for Payer: OMNI Networks Commercial |
$245.00
|
| Rate for Payer: One Health Plan PPO/POS |
$315.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$332.50
|
| Rate for Payer: Three Rivers Provider Network All |
$262.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$325.50
|
| Rate for Payer: Zelis Auto |
$140.00
|
| Rate for Payer: Zelis Worker's Compensation |
$95.55
|
|
