|
DECOMPRESSION OF FOREARM
|
Facility
|
IP
|
$1,333.00
|
|
|
Service Code
|
CPT 24495
|
| Hospital Charge Code |
6124495
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$363.91 |
| Max. Negotiated Rate |
$1,266.35 |
| Rate for Payer: Cash Price |
$799.80
|
| Rate for Payer: Cigna Commercial |
$1,133.05
|
| Rate for Payer: First Health Commercial |
$1,199.70
|
| Rate for Payer: First Health Workers Compensation |
$514.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,199.70
|
| Rate for Payer: GEHA Commercial |
$933.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,199.70
|
| Rate for Payer: Multiplan All |
$1,213.03
|
| Rate for Payer: OMNI Networks Commercial |
$933.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,199.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,266.35
|
| Rate for Payer: Three Rivers Provider Network All |
$999.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,239.69
|
| Rate for Payer: Zelis Auto |
$533.20
|
| Rate for Payer: Zelis Worker's Compensation |
$363.91
|
|
|
DECOMPRESSION OF FOREARM
|
Facility
|
OP
|
$1,333.00
|
|
|
Service Code
|
CPT 24495
|
| Hospital Charge Code |
6124495
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$363.91 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$799.80
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$799.80
|
| Rate for Payer: Cash Price |
$799.80
|
| Rate for Payer: Cigna Commercial |
$1,133.05
|
| Rate for Payer: First Health Commercial |
$1,199.70
|
| Rate for Payer: First Health Workers Compensation |
$514.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,199.70
|
| Rate for Payer: GEHA Commercial |
$1,066.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,199.70
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,213.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$933.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,199.70
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,266.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$999.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,239.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$533.20
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$363.91
|
|
|
DECOMPRESSION OF LEG
|
Facility
|
OP
|
$1,236.00
|
|
|
Service Code
|
CPT 27893
|
| Hospital Charge Code |
6127893
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$337.43 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$741.60
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cigna Commercial |
$1,050.60
|
| Rate for Payer: First Health Commercial |
$1,112.40
|
| Rate for Payer: First Health Workers Compensation |
$477.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,112.40
|
| Rate for Payer: GEHA Commercial |
$988.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,112.40
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,124.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$865.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,112.40
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,174.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$927.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,149.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$494.40
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$337.43
|
|
|
DECOMPRESSION OF LEG
|
Facility
|
IP
|
$1,768.00
|
|
|
Service Code
|
CPT 27894
|
| Hospital Charge Code |
6127894
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$482.66 |
| Max. Negotiated Rate |
$1,679.60 |
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cigna Commercial |
$1,502.80
|
| Rate for Payer: First Health Commercial |
$1,591.20
|
| Rate for Payer: First Health Workers Compensation |
$682.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,591.20
|
| Rate for Payer: GEHA Commercial |
$1,237.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,591.20
|
| Rate for Payer: Multiplan All |
$1,608.88
|
| Rate for Payer: OMNI Networks Commercial |
$1,237.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,591.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,679.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,326.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,644.24
|
| Rate for Payer: Zelis Auto |
$707.20
|
| Rate for Payer: Zelis Worker's Compensation |
$482.66
|
|
|
DECOMPRESSION OF LEG
|
Facility
|
IP
|
$1,139.00
|
|
|
Service Code
|
CPT 27892
|
| Hospital Charge Code |
6127892
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$310.95 |
| Max. Negotiated Rate |
$1,082.05 |
| Rate for Payer: Cash Price |
$683.40
|
| Rate for Payer: Cigna Commercial |
$968.15
|
| Rate for Payer: First Health Commercial |
$1,025.10
|
| Rate for Payer: First Health Workers Compensation |
$439.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,025.10
|
| Rate for Payer: GEHA Commercial |
$797.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,025.10
|
| Rate for Payer: Multiplan All |
$1,036.49
|
| Rate for Payer: OMNI Networks Commercial |
$797.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,025.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,082.05
|
| Rate for Payer: Three Rivers Provider Network All |
$854.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,059.27
|
| Rate for Payer: Zelis Auto |
$455.60
|
| Rate for Payer: Zelis Worker's Compensation |
$310.95
|
|
|
DECOMPRESSION OF LEG
|
Facility
|
OP
|
$1,139.00
|
|
|
Service Code
|
CPT 27892
|
| Hospital Charge Code |
6127892
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$310.95 |
| 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 |
$683.40
|
| 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 |
$683.40
|
| Rate for Payer: Cash Price |
$683.40
|
| Rate for Payer: Cigna Commercial |
$968.15
|
| Rate for Payer: First Health Commercial |
$1,025.10
|
| Rate for Payer: First Health Workers Compensation |
$439.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,025.10
|
| Rate for Payer: GEHA Commercial |
$911.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,025.10
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,036.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$797.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,025.10
|
| 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 |
$1,082.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$854.25
|
| 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 |
$1,059.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$455.60
|
| 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 |
$310.95
|
|
|
DECOMPRESSION OF LEG
|
Facility
|
IP
|
$1,236.00
|
|
|
Service Code
|
CPT 27893
|
| Hospital Charge Code |
6127893
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$337.43 |
| Max. Negotiated Rate |
$1,174.20 |
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cigna Commercial |
$1,050.60
|
| Rate for Payer: First Health Commercial |
$1,112.40
|
| Rate for Payer: First Health Workers Compensation |
$477.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,112.40
|
| Rate for Payer: GEHA Commercial |
$865.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,112.40
|
| Rate for Payer: Multiplan All |
$1,124.76
|
| Rate for Payer: OMNI Networks Commercial |
$865.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,112.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,174.20
|
| Rate for Payer: Three Rivers Provider Network All |
$927.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,149.48
|
| Rate for Payer: Zelis Auto |
$494.40
|
| Rate for Payer: Zelis Worker's Compensation |
$337.43
|
|
|
DECOMPRESSION OF LEG
|
Facility
|
OP
|
$1,768.00
|
|
|
Service Code
|
CPT 27894
|
| Hospital Charge Code |
6127894
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$482.66 |
| 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 |
$1,060.80
|
| 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 |
$1,060.80
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cigna Commercial |
$1,502.80
|
| Rate for Payer: First Health Commercial |
$1,591.20
|
| Rate for Payer: First Health Workers Compensation |
$682.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,591.20
|
| Rate for Payer: GEHA Commercial |
$1,414.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,591.20
|
| 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 |
$1,608.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,237.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,591.20
|
| 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 |
$1,679.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,326.00
|
| 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 |
$1,644.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$707.20
|
| 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 |
$482.66
|
|
|
DECOMPRESSION OF LOWER LEG
|
Facility
|
IP
|
$853.00
|
|
|
Service Code
|
CPT 27600
|
| Hospital Charge Code |
6127600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$232.87 |
| Max. Negotiated Rate |
$810.35 |
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cigna Commercial |
$725.05
|
| Rate for Payer: First Health Commercial |
$767.70
|
| Rate for Payer: First Health Workers Compensation |
$329.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$767.70
|
| Rate for Payer: GEHA Commercial |
$597.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$767.70
|
| Rate for Payer: Multiplan All |
$776.23
|
| Rate for Payer: OMNI Networks Commercial |
$597.10
|
| Rate for Payer: One Health Plan PPO/POS |
$767.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$810.35
|
| Rate for Payer: Three Rivers Provider Network All |
$639.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$793.29
|
| Rate for Payer: Zelis Auto |
$341.20
|
| Rate for Payer: Zelis Worker's Compensation |
$232.87
|
|
|
DECOMPRESSION OF LOWER LEG
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT 27601
|
| Hospital Charge Code |
6127601
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$248.70 |
| Max. Negotiated Rate |
$865.45 |
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cigna Commercial |
$774.35
|
| Rate for Payer: First Health Commercial |
$819.90
|
| Rate for Payer: First Health Workers Compensation |
$351.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$819.90
|
| Rate for Payer: GEHA Commercial |
$637.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$819.90
|
| Rate for Payer: Multiplan All |
$829.01
|
| Rate for Payer: OMNI Networks Commercial |
$637.70
|
| Rate for Payer: One Health Plan PPO/POS |
$819.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$865.45
|
| Rate for Payer: Three Rivers Provider Network All |
$683.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$847.23
|
| Rate for Payer: Zelis Auto |
$364.40
|
| Rate for Payer: Zelis Worker's Compensation |
$248.70
|
|
|
DECOMPRESSION OF LOWER LEG
|
Facility
|
OP
|
$853.00
|
|
|
Service Code
|
CPT 27600
|
| Hospital Charge Code |
6127600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$232.87 |
| 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 |
$511.80
|
| 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 |
$511.80
|
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cigna Commercial |
$725.05
|
| Rate for Payer: First Health Commercial |
$767.70
|
| Rate for Payer: First Health Workers Compensation |
$329.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$767.70
|
| Rate for Payer: GEHA Commercial |
$682.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$767.70
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$776.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$597.10
|
| Rate for Payer: One Health Plan PPO/POS |
$767.70
|
| 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 |
$810.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$639.75
|
| 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 |
$793.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$341.20
|
| 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 |
$232.87
|
|
|
DECOMPRESSION OF LOWER LEG
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT 27601
|
| Hospital Charge Code |
6127601
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$248.70 |
| 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 |
$546.60
|
| 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 |
$546.60
|
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cigna Commercial |
$774.35
|
| Rate for Payer: First Health Commercial |
$819.90
|
| Rate for Payer: First Health Workers Compensation |
$351.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$819.90
|
| Rate for Payer: GEHA Commercial |
$728.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$819.90
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$829.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$637.70
|
| Rate for Payer: One Health Plan PPO/POS |
$819.90
|
| 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 |
$865.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$683.25
|
| 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 |
$847.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$364.40
|
| 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 |
$248.70
|
|
|
DECOMPRESSION OF LOWER LEG
|
Facility
|
OP
|
$1,032.00
|
|
|
Service Code
|
CPT 27602
|
| Hospital Charge Code |
6127602
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$281.74 |
| 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 |
$619.20
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cigna Commercial |
$877.20
|
| Rate for Payer: First Health Commercial |
$928.80
|
| Rate for Payer: First Health Workers Compensation |
$398.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$928.80
|
| Rate for Payer: GEHA Commercial |
$825.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$928.80
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$939.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$722.40
|
| Rate for Payer: One Health Plan PPO/POS |
$928.80
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$980.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$774.00
|
| 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 |
$959.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$412.80
|
| 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 |
$281.74
|
|
|
DECOMPRESSION OF LOWER LEG
|
Facility
|
IP
|
$1,032.00
|
|
|
Service Code
|
CPT 27602
|
| Hospital Charge Code |
6127602
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$281.74 |
| Max. Negotiated Rate |
$980.40 |
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cigna Commercial |
$877.20
|
| Rate for Payer: First Health Commercial |
$928.80
|
| Rate for Payer: First Health Workers Compensation |
$398.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$928.80
|
| Rate for Payer: GEHA Commercial |
$722.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$928.80
|
| Rate for Payer: Multiplan All |
$939.12
|
| Rate for Payer: OMNI Networks Commercial |
$722.40
|
| Rate for Payer: One Health Plan PPO/POS |
$928.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$980.40
|
| Rate for Payer: Three Rivers Provider Network All |
$774.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$959.76
|
| Rate for Payer: Zelis Auto |
$412.80
|
| Rate for Payer: Zelis Worker's Compensation |
$281.74
|
|
|
DECOMPRESSION OF THIGH/KNEE
|
Facility
|
IP
|
$1,103.00
|
|
|
Service Code
|
CPT 27496
|
| Hospital Charge Code |
6127496
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$301.12 |
| Max. Negotiated Rate |
$1,047.85 |
| Rate for Payer: Cash Price |
$661.80
|
| Rate for Payer: Cigna Commercial |
$937.55
|
| Rate for Payer: First Health Commercial |
$992.70
|
| Rate for Payer: First Health Workers Compensation |
$425.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$992.70
|
| Rate for Payer: GEHA Commercial |
$772.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$992.70
|
| Rate for Payer: Multiplan All |
$1,003.73
|
| Rate for Payer: OMNI Networks Commercial |
$772.10
|
| Rate for Payer: One Health Plan PPO/POS |
$992.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,047.85
|
| Rate for Payer: Three Rivers Provider Network All |
$827.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,025.79
|
| Rate for Payer: Zelis Auto |
$441.20
|
| Rate for Payer: Zelis Worker's Compensation |
$301.12
|
|
|
DECOMPRESSION OF THIGH/KNEE
|
Facility
|
IP
|
$1,427.00
|
|
|
Service Code
|
CPT 27499
|
| Hospital Charge Code |
6127499
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$389.57 |
| Max. Negotiated Rate |
$1,355.65 |
| Rate for Payer: Cash Price |
$856.20
|
| Rate for Payer: Cigna Commercial |
$1,212.95
|
| Rate for Payer: First Health Commercial |
$1,284.30
|
| Rate for Payer: First Health Workers Compensation |
$550.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,284.30
|
| Rate for Payer: GEHA Commercial |
$998.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,284.30
|
| Rate for Payer: Multiplan All |
$1,298.57
|
| Rate for Payer: OMNI Networks Commercial |
$998.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,284.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,355.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,070.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,327.11
|
| Rate for Payer: Zelis Auto |
$570.80
|
| Rate for Payer: Zelis Worker's Compensation |
$389.57
|
|
|
DECOMPRESSION OF THIGH/KNEE
|
Facility
|
IP
|
$1,322.00
|
|
|
Service Code
|
CPT 27498
|
| Hospital Charge Code |
6127498
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$360.91 |
| Max. Negotiated Rate |
$1,255.90 |
| Rate for Payer: Cash Price |
$793.20
|
| Rate for Payer: Cigna Commercial |
$1,123.70
|
| Rate for Payer: First Health Commercial |
$1,189.80
|
| Rate for Payer: First Health Workers Compensation |
$510.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,189.80
|
| Rate for Payer: GEHA Commercial |
$925.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,189.80
|
| Rate for Payer: Multiplan All |
$1,203.02
|
| Rate for Payer: OMNI Networks Commercial |
$925.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,189.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,255.90
|
| Rate for Payer: Three Rivers Provider Network All |
$991.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,229.46
|
| Rate for Payer: Zelis Auto |
$528.80
|
| Rate for Payer: Zelis Worker's Compensation |
$360.91
|
|
|
DECOMPRESSION OF THIGH/KNEE
|
Facility
|
OP
|
$1,103.00
|
|
|
Service Code
|
CPT 27496
|
| Hospital Charge Code |
6127496
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$301.12 |
| 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 |
$661.80
|
| 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 |
$661.80
|
| Rate for Payer: Cash Price |
$661.80
|
| Rate for Payer: Cigna Commercial |
$937.55
|
| Rate for Payer: First Health Commercial |
$992.70
|
| Rate for Payer: First Health Workers Compensation |
$425.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$992.70
|
| Rate for Payer: GEHA Commercial |
$882.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$992.70
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,003.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$772.10
|
| Rate for Payer: One Health Plan PPO/POS |
$992.70
|
| 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 |
$1,047.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$827.25
|
| 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 |
$1,025.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$441.20
|
| 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 |
$301.12
|
|
|
DECOMPRESSION OF THIGH/KNEE
|
Facility
|
OP
|
$1,322.00
|
|
|
Service Code
|
CPT 27498
|
| Hospital Charge Code |
6127498
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$360.91 |
| Max. Negotiated Rate |
$3,212.40 |
| 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 |
$793.20
|
| 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 |
$1,519.65
|
| Rate for Payer: Cash Price |
$793.20
|
| Rate for Payer: Cash Price |
$793.20
|
| Rate for Payer: Cigna Commercial |
$1,123.70
|
| Rate for Payer: First Health Commercial |
$1,189.80
|
| Rate for Payer: First Health Workers Compensation |
$510.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,189.80
|
| Rate for Payer: GEHA Commercial |
$1,057.60
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,189.80
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$1,203.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$925.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,189.80
|
| 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 |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,255.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$991.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,229.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$528.80
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$360.91
|
|
|
DECOMPRESSION OF THIGH/KNEE
|
Facility
|
OP
|
$1,182.00
|
|
|
Service Code
|
CPT 27497
|
| Hospital Charge Code |
6127497
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$322.69 |
| 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 |
$709.20
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Cigna Commercial |
$1,004.70
|
| Rate for Payer: First Health Commercial |
$1,063.80
|
| Rate for Payer: First Health Workers Compensation |
$456.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,063.80
|
| Rate for Payer: GEHA Commercial |
$945.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,063.80
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,075.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$827.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,063.80
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,122.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$886.50
|
| 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 |
$1,099.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$472.80
|
| 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 |
$322.69
|
|
|
DECOMPRESSION OF THIGH/KNEE
|
Facility
|
IP
|
$1,182.00
|
|
|
Service Code
|
CPT 27497
|
| Hospital Charge Code |
6127497
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$322.69 |
| Max. Negotiated Rate |
$1,122.90 |
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Cigna Commercial |
$1,004.70
|
| Rate for Payer: First Health Commercial |
$1,063.80
|
| Rate for Payer: First Health Workers Compensation |
$456.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,063.80
|
| Rate for Payer: GEHA Commercial |
$827.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,063.80
|
| Rate for Payer: Multiplan All |
$1,075.62
|
| Rate for Payer: OMNI Networks Commercial |
$827.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,063.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,122.90
|
| Rate for Payer: Three Rivers Provider Network All |
$886.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,099.26
|
| Rate for Payer: Zelis Auto |
$472.80
|
| Rate for Payer: Zelis Worker's Compensation |
$322.69
|
|
|
DECOMPRESSION OF THIGH/KNEE
|
Facility
|
OP
|
$1,427.00
|
|
|
Service Code
|
CPT 27499
|
| Hospital Charge Code |
6127499
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$389.57 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$856.20
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$856.20
|
| Rate for Payer: Cash Price |
$856.20
|
| Rate for Payer: Cigna Commercial |
$1,212.95
|
| Rate for Payer: First Health Commercial |
$1,284.30
|
| Rate for Payer: First Health Workers Compensation |
$550.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,284.30
|
| Rate for Payer: GEHA Commercial |
$1,141.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,284.30
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,298.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$998.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,284.30
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,355.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,070.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,327.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$570.80
|
| 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 |
$389.57
|
|
|
DECOMPRESSION OF TIBIA NERVE
|
Facility
|
IP
|
$903.00
|
|
|
Service Code
|
CPT 28035
|
| Hospital Charge Code |
6128035
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$246.52 |
| Max. Negotiated Rate |
$857.85 |
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cigna Commercial |
$767.55
|
| Rate for Payer: First Health Commercial |
$812.70
|
| Rate for Payer: First Health Workers Compensation |
$348.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$812.70
|
| Rate for Payer: GEHA Commercial |
$632.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$812.70
|
| Rate for Payer: Multiplan All |
$821.73
|
| Rate for Payer: OMNI Networks Commercial |
$632.10
|
| Rate for Payer: One Health Plan PPO/POS |
$812.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$857.85
|
| Rate for Payer: Three Rivers Provider Network All |
$677.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$839.79
|
| Rate for Payer: Zelis Auto |
$361.20
|
| Rate for Payer: Zelis Worker's Compensation |
$246.52
|
|
|
DECOMPRESSION OF TIBIA NERVE
|
Facility
|
OP
|
$903.00
|
|
|
Service Code
|
CPT 28035
|
| Hospital Charge Code |
6128035
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$246.52 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$541.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cigna Commercial |
$767.55
|
| Rate for Payer: First Health Commercial |
$812.70
|
| Rate for Payer: First Health Workers Compensation |
$348.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$812.70
|
| Rate for Payer: GEHA Commercial |
$722.40
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$812.70
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$821.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$632.10
|
| Rate for Payer: One Health Plan PPO/POS |
$812.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$857.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$677.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$839.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$361.20
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$246.52
|
|
|
DECOMPRESSIVE CRANIOTOMY
|
Facility
|
OP
|
$5,121.00
|
|
|
Service Code
|
CPT 61322
|
| Hospital Charge Code |
6161322
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,280.25 |
| Max. Negotiated Rate |
$4,864.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,072.60
|
| Rate for Payer: Cash Price |
$3,072.60
|
| Rate for Payer: Cigna Commercial |
$4,352.85
|
| Rate for Payer: First Health Commercial |
$4,608.90
|
| Rate for Payer: First Health Workers Compensation |
$1,977.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,608.90
|
| Rate for Payer: GEHA Commercial |
$4,096.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,608.90
|
| Rate for Payer: Humana ChoiceCare |
$1,331.46
|
| Rate for Payer: Multiplan All |
$4,660.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,072.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,584.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,608.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,864.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,840.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,506.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,280.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,762.53
|
| Rate for Payer: Zelis Auto |
$2,048.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,560.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,398.03
|
|
