|
UNLISTED PROCEDURE, ARTHROSCOPY
|
Facility
|
OP
|
$3,025.16
|
|
|
Service Code
|
CPT 29999
|
| Hospital Charge Code |
6102999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$193.61 |
| Max. Negotiated Rate |
$3,025.16 |
| 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 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 |
$227.78
|
| Rate for Payer: First Health Workers Compensation |
$293.15
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| 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 |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$207.28
|
|
|
UNLISTED PROCEDURE FEMUR/KNEE
|
Facility
|
OP
|
$2,908.74
|
|
|
Service Code
|
CPT 27599
|
| Hospital Charge Code |
6127599
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$2,763.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,745.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$1,745.24
|
| Rate for Payer: Cash Price |
$1,745.24
|
| Rate for Payer: Cigna Commercial |
$2,472.43
|
| Rate for Payer: First Health Commercial |
$2,617.87
|
| Rate for Payer: First Health Workers Compensation |
$1,123.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,617.87
|
| Rate for Payer: GEHA Commercial |
$2,326.99
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,617.87
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$2,646.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$2,036.12
|
| Rate for Payer: One Health Plan PPO/POS |
$2,617.87
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,763.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$2,181.55
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,705.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$1,163.50
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$794.09
|
|
|
UNLISTED PROCEDURE FEMUR/KNEE
|
Facility
|
IP
|
$2,908.74
|
|
|
Service Code
|
CPT 27599
|
| Hospital Charge Code |
6127599
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$794.09 |
| Max. Negotiated Rate |
$2,763.30 |
| Rate for Payer: Cash Price |
$1,745.24
|
| Rate for Payer: Cigna Commercial |
$2,472.43
|
| Rate for Payer: First Health Commercial |
$2,617.87
|
| Rate for Payer: First Health Workers Compensation |
$1,123.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,617.87
|
| Rate for Payer: GEHA Commercial |
$2,036.12
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,617.87
|
| Rate for Payer: Multiplan All |
$2,646.95
|
| Rate for Payer: OMNI Networks Commercial |
$2,036.12
|
| Rate for Payer: One Health Plan PPO/POS |
$2,617.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,763.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,181.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,705.13
|
| Rate for Payer: Zelis Auto |
$1,163.50
|
| Rate for Payer: Zelis Worker's Compensation |
$794.09
|
|
|
UNLISTED PROCEDURE, FEMUR OR KNEE
|
Facility
|
OP
|
$455.56
|
|
|
Service Code
|
CPT 27599
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$455.56 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: First Health Workers Compensation |
$293.15
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$207.28
|
|
|
UNLISTED PROCEDURE, FOOT OR TOES
|
Facility
|
OP
|
$455.56
|
|
|
Service Code
|
CPT 28899
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$455.56 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: First Health Workers Compensation |
$293.15
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$207.28
|
|
|
UNLISTED PROCEDURE, FOOT OR TOES
|
Facility
|
OP
|
$455.56
|
|
|
Service Code
|
CPT 28899
|
| Hospital Charge Code |
6128294
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$455.56 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: First Health Workers Compensation |
$293.15
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$207.28
|
|
|
UNLISTED PROCEDURE, FOOT OR TOES
|
Facility
|
IP
|
$1,123.00
|
|
|
Service Code
|
CPT 28899
|
| Hospital Charge Code |
6128294
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$306.58 |
| Max. Negotiated Rate |
$1,066.85 |
| Rate for Payer: Cash Price |
$673.80
|
| Rate for Payer: Cigna Commercial |
$954.55
|
| Rate for Payer: First Health Commercial |
$1,010.70
|
| Rate for Payer: First Health Workers Compensation |
$433.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,010.70
|
| Rate for Payer: GEHA Commercial |
$786.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,010.70
|
| Rate for Payer: Multiplan All |
$1,021.93
|
| Rate for Payer: OMNI Networks Commercial |
$786.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,010.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,066.85
|
| Rate for Payer: Three Rivers Provider Network All |
$842.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,044.39
|
| Rate for Payer: Zelis Auto |
$449.20
|
| Rate for Payer: Zelis Worker's Compensation |
$306.58
|
|
|
UNLISTED PROCEDURE, FOOT OR TOES
|
Facility
|
OP
|
$1,123.00
|
|
|
Service Code
|
CPT 28899
|
| Hospital Charge Code |
6128294
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$1,066.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$673.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$673.80
|
| Rate for Payer: Cash Price |
$673.80
|
| Rate for Payer: Cigna Commercial |
$954.55
|
| Rate for Payer: First Health Commercial |
$1,010.70
|
| Rate for Payer: First Health Workers Compensation |
$433.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,010.70
|
| Rate for Payer: GEHA Commercial |
$898.40
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,010.70
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$1,021.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$786.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,010.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,066.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$842.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,044.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$449.20
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$306.58
|
|
|
UNLISTED PROCEDURE, FOREARM OR WRIST
|
Facility
|
OP
|
$455.56
|
|
|
Service Code
|
CPT 25999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$455.56 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: First Health Workers Compensation |
$293.15
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$207.28
|
|
|
UNLISTED PROCEDURE FOREARM / WRIST
|
Facility
|
OP
|
$1,909.11
|
|
|
Service Code
|
CPT 25999
|
| Hospital Charge Code |
6125999
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$1,813.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,145.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$1,145.47
|
| Rate for Payer: Cash Price |
$1,145.47
|
| Rate for Payer: Cigna Commercial |
$1,622.74
|
| Rate for Payer: First Health Commercial |
$1,718.20
|
| Rate for Payer: First Health Workers Compensation |
$737.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,718.20
|
| Rate for Payer: GEHA Commercial |
$1,527.29
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,718.20
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$1,737.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,336.38
|
| Rate for Payer: One Health Plan PPO/POS |
$1,718.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,813.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$1,431.83
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,775.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$763.64
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$521.19
|
|
|
UNLISTED PROCEDURE FOREARM / WRIST
|
Facility
|
IP
|
$1,909.11
|
|
|
Service Code
|
CPT 25999
|
| Hospital Charge Code |
6125999
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$521.19 |
| Max. Negotiated Rate |
$1,813.65 |
| Rate for Payer: Cash Price |
$1,145.47
|
| Rate for Payer: Cigna Commercial |
$1,622.74
|
| Rate for Payer: First Health Commercial |
$1,718.20
|
| Rate for Payer: First Health Workers Compensation |
$737.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,718.20
|
| Rate for Payer: GEHA Commercial |
$1,336.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,718.20
|
| Rate for Payer: Multiplan All |
$1,737.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,336.38
|
| Rate for Payer: One Health Plan PPO/POS |
$1,718.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,813.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,431.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,775.47
|
| Rate for Payer: Zelis Auto |
$763.64
|
| Rate for Payer: Zelis Worker's Compensation |
$521.19
|
|
|
UNLISTED PROCEDURE HANDS/FINGERS
|
Facility
|
OP
|
$2,030.00
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
6126989
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$1,928.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,218.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cigna Commercial |
$1,725.50
|
| Rate for Payer: First Health Commercial |
$1,827.00
|
| Rate for Payer: First Health Workers Compensation |
$783.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,827.00
|
| Rate for Payer: GEHA Commercial |
$1,624.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,827.00
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$1,847.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,421.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,827.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,928.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$1,522.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,887.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$812.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$554.19
|
|
|
UNLISTED PROCEDURE HANDS/FINGERS
|
Facility
|
IP
|
$2,030.00
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
6126989
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$554.19 |
| Max. Negotiated Rate |
$1,928.50 |
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cigna Commercial |
$1,725.50
|
| Rate for Payer: First Health Commercial |
$1,827.00
|
| Rate for Payer: First Health Workers Compensation |
$783.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,827.00
|
| Rate for Payer: GEHA Commercial |
$1,421.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,827.00
|
| Rate for Payer: Multiplan All |
$1,847.30
|
| Rate for Payer: OMNI Networks Commercial |
$1,421.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,827.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,928.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,522.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,887.90
|
| Rate for Payer: Zelis Auto |
$812.00
|
| Rate for Payer: Zelis Worker's Compensation |
$554.19
|
|
|
UNLISTED PROCEDURE HUMERUS/ELBOW
|
Facility
|
OP
|
$1,962.96
|
|
|
Service Code
|
CPT 24999
|
| Hospital Charge Code |
6125002
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$1,864.81 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,177.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$1,177.78
|
| Rate for Payer: Cash Price |
$1,177.78
|
| Rate for Payer: Cigna Commercial |
$1,668.52
|
| Rate for Payer: First Health Commercial |
$1,766.66
|
| Rate for Payer: First Health Workers Compensation |
$757.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,766.66
|
| Rate for Payer: GEHA Commercial |
$1,570.37
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,766.66
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$1,786.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,374.07
|
| Rate for Payer: One Health Plan PPO/POS |
$1,766.66
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,864.81
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$1,472.22
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,825.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$785.18
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$535.89
|
|
|
UNLISTED PROCEDURE HUMERUS/ELBOW
|
Facility
|
IP
|
$1,962.96
|
|
|
Service Code
|
CPT 24999
|
| Hospital Charge Code |
6125002
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$535.89 |
| Max. Negotiated Rate |
$1,864.81 |
| Rate for Payer: Cash Price |
$1,177.78
|
| Rate for Payer: Cigna Commercial |
$1,668.52
|
| Rate for Payer: First Health Commercial |
$1,766.66
|
| Rate for Payer: First Health Workers Compensation |
$757.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,766.66
|
| Rate for Payer: GEHA Commercial |
$1,374.07
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,766.66
|
| Rate for Payer: Multiplan All |
$1,786.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,374.07
|
| Rate for Payer: One Health Plan PPO/POS |
$1,766.66
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,864.81
|
| Rate for Payer: Three Rivers Provider Network All |
$1,472.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,825.55
|
| Rate for Payer: Zelis Auto |
$785.18
|
| Rate for Payer: Zelis Worker's Compensation |
$535.89
|
|
|
UNLISTED PROCEDURE, HUMERUS OR ELBOW
|
Facility
|
OP
|
$1,076.00
|
|
|
Service Code
|
CPT 24999
|
| Hospital Charge Code |
6124999
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$1,022.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$645.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$645.60
|
| Rate for Payer: Cash Price |
$645.60
|
| Rate for Payer: Cigna Commercial |
$914.60
|
| Rate for Payer: First Health Commercial |
$968.40
|
| Rate for Payer: First Health Workers Compensation |
$415.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$968.40
|
| Rate for Payer: GEHA Commercial |
$860.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$968.40
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$979.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$753.20
|
| Rate for Payer: One Health Plan PPO/POS |
$968.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,022.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$807.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,000.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$430.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$293.75
|
|
|
UNLISTED PROCEDURE, HUMERUS OR ELBOW
|
Facility
|
IP
|
$1,076.00
|
|
|
Service Code
|
CPT 24999
|
| Hospital Charge Code |
6124999
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$293.75 |
| Max. Negotiated Rate |
$1,022.20 |
| Rate for Payer: Cash Price |
$645.60
|
| Rate for Payer: Cigna Commercial |
$914.60
|
| Rate for Payer: First Health Commercial |
$968.40
|
| Rate for Payer: First Health Workers Compensation |
$415.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$968.40
|
| Rate for Payer: GEHA Commercial |
$753.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$968.40
|
| Rate for Payer: Multiplan All |
$979.16
|
| Rate for Payer: OMNI Networks Commercial |
$753.20
|
| Rate for Payer: One Health Plan PPO/POS |
$968.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,022.20
|
| Rate for Payer: Three Rivers Provider Network All |
$807.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,000.68
|
| Rate for Payer: Zelis Auto |
$430.40
|
| Rate for Payer: Zelis Worker's Compensation |
$293.75
|
|
|
UNLISTED PROCEDURE, HUMERUS OR ELBOW
|
Facility
|
OP
|
$455.56
|
|
|
Service Code
|
CPT 24999
|
| Hospital Charge Code |
6124999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$455.56 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: First Health Workers Compensation |
$293.15
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$207.28
|
|
|
UNLISTED PROCEDURE, HUMERUS OR ELBOW
|
Facility
|
OP
|
$455.56
|
|
|
Service Code
|
CPT 24999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$455.56 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: First Health Workers Compensation |
$293.15
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$207.28
|
|
|
UNLISTED PROCEDURE, LEG OR ANKLE
|
Facility
|
IP
|
$1,977.81
|
|
|
Service Code
|
CPT 27899
|
| Hospital Charge Code |
6127900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$539.94 |
| Max. Negotiated Rate |
$1,878.92 |
| Rate for Payer: Cash Price |
$1,186.69
|
| Rate for Payer: Cigna Commercial |
$1,681.14
|
| Rate for Payer: First Health Commercial |
$1,780.03
|
| Rate for Payer: First Health Workers Compensation |
$763.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,780.03
|
| Rate for Payer: GEHA Commercial |
$1,384.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,780.03
|
| Rate for Payer: Multiplan All |
$1,799.81
|
| Rate for Payer: OMNI Networks Commercial |
$1,384.47
|
| Rate for Payer: One Health Plan PPO/POS |
$1,780.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,878.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,483.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,839.36
|
| Rate for Payer: Zelis Auto |
$791.12
|
| Rate for Payer: Zelis Worker's Compensation |
$539.94
|
|
|
UNLISTED PROCEDURE, LEG OR ANKLE
|
Facility
|
OP
|
$1,977.81
|
|
|
Service Code
|
CPT 27899
|
| Hospital Charge Code |
6127900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$1,878.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,186.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$1,186.69
|
| Rate for Payer: Cash Price |
$1,186.69
|
| Rate for Payer: Cigna Commercial |
$1,681.14
|
| Rate for Payer: First Health Commercial |
$1,780.03
|
| Rate for Payer: First Health Workers Compensation |
$763.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,780.03
|
| Rate for Payer: GEHA Commercial |
$1,582.25
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,780.03
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$1,799.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,384.47
|
| Rate for Payer: One Health Plan PPO/POS |
$1,780.03
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,878.92
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$1,483.36
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,839.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$791.12
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$539.94
|
|
|
UNLISTED PROCEDURE MUSCSKELETAL SYSTEM G
|
Facility
|
OP
|
$8,162.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
6120999
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$193.61 |
| Max. Negotiated Rate |
$7,753.90 |
| 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 |
$4,897.20
|
| 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 |
$227.78
|
| Rate for Payer: Cash Price |
$4,897.20
|
| Rate for Payer: Cash Price |
$4,897.20
|
| Rate for Payer: Cigna Commercial |
$6,937.70
|
| Rate for Payer: First Health Commercial |
$7,345.80
|
| Rate for Payer: First Health Workers Compensation |
$3,151.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,345.80
|
| Rate for Payer: GEHA Commercial |
$6,529.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,345.80
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$7,427.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$5,713.40
|
| Rate for Payer: One Health Plan PPO/POS |
$7,345.80
|
| 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 |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,753.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$6,121.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,590.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$3,264.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$2,228.23
|
|
|
UNLISTED PROCEDURE MUSCSKELETAL SYSTEM G
|
Facility
|
IP
|
$8,162.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
6120999
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,228.23 |
| Max. Negotiated Rate |
$7,753.90 |
| Rate for Payer: Cash Price |
$4,897.20
|
| Rate for Payer: Cigna Commercial |
$6,937.70
|
| Rate for Payer: First Health Commercial |
$7,345.80
|
| Rate for Payer: First Health Workers Compensation |
$3,151.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,345.80
|
| Rate for Payer: GEHA Commercial |
$5,713.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,345.80
|
| Rate for Payer: Multiplan All |
$7,427.42
|
| Rate for Payer: OMNI Networks Commercial |
$5,713.40
|
| Rate for Payer: One Health Plan PPO/POS |
$7,345.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,753.90
|
| Rate for Payer: Three Rivers Provider Network All |
$6,121.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,590.66
|
| Rate for Payer: Zelis Auto |
$3,264.80
|
| Rate for Payer: Zelis Worker's Compensation |
$2,228.23
|
|
|
UNLISTED PROCEDURE NERVOUS SYSTEM
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
7664999
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$124.76 |
| Max. Negotiated Rate |
$560.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$274.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$204.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$280.29
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cigna Commercial |
$388.45
|
| Rate for Payer: First Health Commercial |
$411.30
|
| Rate for Payer: First Health Workers Compensation |
$176.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$411.30
|
| Rate for Payer: GEHA Commercial |
$365.60
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$411.30
|
| Rate for Payer: Humana ChoiceCare |
$308.32
|
| Rate for Payer: Humana Medicare Advantage |
$280.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$470.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$415.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$319.90
|
| Rate for Payer: One Health Plan PPO/POS |
$411.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$434.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$342.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$425.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$182.80
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$124.76
|
|
|
UNLISTED PROCEDURE NERVOUS SYSTEM
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
20364999
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.42 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$78.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$142.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Worker's Compensation |
$55.42
|
|
