|
INCISION OF ESOPHAGUS
|
Facility
|
IP
|
$2,758.00
|
|
|
Service Code
|
CPT 43045
|
| Hospital Charge Code |
6143045
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$752.93 |
| Max. Negotiated Rate |
$2,620.10 |
| Rate for Payer: Cash Price |
$1,654.80
|
| Rate for Payer: Cigna Commercial |
$2,344.30
|
| Rate for Payer: First Health Commercial |
$2,482.20
|
| Rate for Payer: First Health Workers Compensation |
$1,064.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,482.20
|
| Rate for Payer: GEHA Commercial |
$1,930.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,482.20
|
| Rate for Payer: Multiplan All |
$2,509.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,930.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,482.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,620.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,068.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,564.94
|
| Rate for Payer: Zelis Auto |
$1,103.20
|
| Rate for Payer: Zelis Worker's Compensation |
$752.93
|
|
|
INCISION OF ESOPHAGUS
|
Facility
|
IP
|
$1,105.00
|
|
|
Service Code
|
CPT 43020
|
| Hospital Charge Code |
6143020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$301.67 |
| Max. Negotiated Rate |
$1,049.75 |
| Rate for Payer: Cash Price |
$663.00
|
| Rate for Payer: Cigna Commercial |
$939.25
|
| Rate for Payer: First Health Commercial |
$994.50
|
| Rate for Payer: First Health Workers Compensation |
$426.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$994.50
|
| Rate for Payer: GEHA Commercial |
$773.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$994.50
|
| Rate for Payer: Multiplan All |
$1,005.55
|
| Rate for Payer: OMNI Networks Commercial |
$773.50
|
| Rate for Payer: One Health Plan PPO/POS |
$994.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,049.75
|
| Rate for Payer: Three Rivers Provider Network All |
$828.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,027.65
|
| Rate for Payer: Zelis Auto |
$442.00
|
| Rate for Payer: Zelis Worker's Compensation |
$301.67
|
|
|
INCISION OF ESOPHAGUS
|
Facility
|
OP
|
$1,105.00
|
|
|
Service Code
|
CPT 43020
|
| Hospital Charge Code |
6143020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$301.67 |
| Max. Negotiated Rate |
$2,813.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$663.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,406.53
|
| Rate for Payer: Cash Price |
$663.00
|
| Rate for Payer: Cash Price |
$663.00
|
| Rate for Payer: Cigna Commercial |
$939.25
|
| Rate for Payer: First Health Commercial |
$994.50
|
| Rate for Payer: First Health Workers Compensation |
$426.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$994.50
|
| Rate for Payer: GEHA Commercial |
$884.00
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$994.50
|
| Rate for Payer: Humana ChoiceCare |
$1,547.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,406.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,362.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,406.53
|
| Rate for Payer: Multiplan All |
$1,005.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$773.50
|
| Rate for Payer: One Health Plan PPO/POS |
$994.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,406.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,049.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$828.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,406.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,027.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$442.00
|
| Rate for Payer: Zelis Medicare |
$1,195.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,687.84
|
| Rate for Payer: Zelis Worker's Compensation |
$301.67
|
|
|
INCISION OF ESOPHAGUS
|
Facility
|
OP
|
$2,758.00
|
|
|
Service Code
|
CPT 43045
|
| Hospital Charge Code |
6143045
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$689.50 |
| Max. Negotiated Rate |
$2,620.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,654.80
|
| Rate for Payer: Cash Price |
$1,654.80
|
| Rate for Payer: Cigna Commercial |
$2,344.30
|
| Rate for Payer: First Health Commercial |
$2,482.20
|
| Rate for Payer: First Health Workers Compensation |
$1,064.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,482.20
|
| Rate for Payer: GEHA Commercial |
$2,206.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,482.20
|
| Rate for Payer: Humana ChoiceCare |
$717.08
|
| Rate for Payer: Multiplan All |
$2,509.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,654.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,930.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,482.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,620.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,068.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,427.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$689.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,564.94
|
| Rate for Payer: Zelis Auto |
$1,103.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,379.00
|
| Rate for Payer: Zelis Worker's Compensation |
$752.93
|
|
|
INCISION OF FACIAL NERVE
|
Facility
|
IP
|
$983.00
|
|
|
Service Code
|
CPT 64742
|
| Hospital Charge Code |
6164742
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$268.36 |
| Max. Negotiated Rate |
$933.85 |
| Rate for Payer: Cash Price |
$589.80
|
| Rate for Payer: Cigna Commercial |
$835.55
|
| Rate for Payer: First Health Commercial |
$884.70
|
| Rate for Payer: First Health Workers Compensation |
$379.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$884.70
|
| Rate for Payer: GEHA Commercial |
$688.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$884.70
|
| Rate for Payer: Multiplan All |
$894.53
|
| Rate for Payer: OMNI Networks Commercial |
$688.10
|
| Rate for Payer: One Health Plan PPO/POS |
$884.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$933.85
|
| Rate for Payer: Three Rivers Provider Network All |
$737.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$914.19
|
| Rate for Payer: Zelis Auto |
$393.20
|
| Rate for Payer: Zelis Worker's Compensation |
$268.36
|
|
|
INCISION OF FACIAL NERVE
|
Facility
|
OP
|
$983.00
|
|
|
Service Code
|
CPT 64742
|
| Hospital Charge Code |
6164742
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$268.36 |
| 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 |
$589.80
|
| 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 |
$589.80
|
| Rate for Payer: Cash Price |
$589.80
|
| Rate for Payer: Cigna Commercial |
$835.55
|
| Rate for Payer: First Health Commercial |
$884.70
|
| Rate for Payer: First Health Workers Compensation |
$379.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$884.70
|
| Rate for Payer: GEHA Commercial |
$786.40
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$884.70
|
| 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 |
$894.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$688.10
|
| Rate for Payer: One Health Plan PPO/POS |
$884.70
|
| 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 |
$933.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$737.25
|
| 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 |
$914.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$393.20
|
| 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 |
$268.36
|
|
|
INCISION OF FIBULA
|
Facility
|
OP
|
$1,191.48
|
|
|
Service Code
|
CPT 27707
|
| Hospital Charge Code |
6127707
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$325.27 |
| 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 |
$714.89
|
| 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 |
$714.89
|
| Rate for Payer: Cash Price |
$714.89
|
| Rate for Payer: Cigna Commercial |
$1,012.76
|
| Rate for Payer: First Health Commercial |
$1,072.33
|
| Rate for Payer: First Health Workers Compensation |
$460.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,072.33
|
| Rate for Payer: GEHA Commercial |
$953.18
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,072.33
|
| 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 |
$1,084.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$834.04
|
| Rate for Payer: One Health Plan PPO/POS |
$1,072.33
|
| 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 |
$1,131.91
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$893.61
|
| 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 |
$1,108.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$476.59
|
| 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 |
$325.27
|
|
|
INCISION OF FIBULA
|
Facility
|
IP
|
$1,191.48
|
|
|
Service Code
|
CPT 27707
|
| Hospital Charge Code |
6127707
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$325.27 |
| Max. Negotiated Rate |
$1,131.91 |
| Rate for Payer: Cash Price |
$714.89
|
| Rate for Payer: Cigna Commercial |
$1,012.76
|
| Rate for Payer: First Health Commercial |
$1,072.33
|
| Rate for Payer: First Health Workers Compensation |
$460.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,072.33
|
| Rate for Payer: GEHA Commercial |
$834.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,072.33
|
| Rate for Payer: Multiplan All |
$1,084.25
|
| Rate for Payer: OMNI Networks Commercial |
$834.04
|
| Rate for Payer: One Health Plan PPO/POS |
$1,072.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,131.91
|
| Rate for Payer: Three Rivers Provider Network All |
$893.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,108.08
|
| Rate for Payer: Zelis Auto |
$476.59
|
| Rate for Payer: Zelis Worker's Compensation |
$325.27
|
|
|
INCISION OF FINGER TENDON
|
Facility
|
IP
|
$987.00
|
|
|
Service Code
|
CPT 26455
|
| Hospital Charge Code |
6126455
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$269.45 |
| Max. Negotiated Rate |
$937.65 |
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cigna Commercial |
$838.95
|
| Rate for Payer: First Health Commercial |
$888.30
|
| Rate for Payer: First Health Workers Compensation |
$381.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$888.30
|
| Rate for Payer: GEHA Commercial |
$690.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$888.30
|
| Rate for Payer: Multiplan All |
$898.17
|
| Rate for Payer: OMNI Networks Commercial |
$690.90
|
| Rate for Payer: One Health Plan PPO/POS |
$888.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$937.65
|
| Rate for Payer: Three Rivers Provider Network All |
$740.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$917.91
|
| Rate for Payer: Zelis Auto |
$394.80
|
| Rate for Payer: Zelis Worker's Compensation |
$269.45
|
|
|
INCISION OF FINGER TENDON
|
Facility
|
OP
|
$987.00
|
|
|
Service Code
|
CPT 26455
|
| Hospital Charge Code |
6126455
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$269.45 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$592.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cigna Commercial |
$838.95
|
| Rate for Payer: First Health Commercial |
$888.30
|
| Rate for Payer: First Health Workers Compensation |
$381.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$888.30
|
| Rate for Payer: GEHA Commercial |
$789.60
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$888.30
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$898.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$690.90
|
| Rate for Payer: One Health Plan PPO/POS |
$888.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$937.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$740.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$917.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$394.80
|
| 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 |
$269.45
|
|
|
INCISION OF FOOT FASCIA
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
6128008
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$203.66 |
| Max. Negotiated Rate |
$708.70 |
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cigna Commercial |
$634.10
|
| Rate for Payer: First Health Commercial |
$671.40
|
| Rate for Payer: First Health Workers Compensation |
$288.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$671.40
|
| Rate for Payer: GEHA Commercial |
$522.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$671.40
|
| Rate for Payer: Multiplan All |
$678.86
|
| Rate for Payer: OMNI Networks Commercial |
$522.20
|
| Rate for Payer: One Health Plan PPO/POS |
$671.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$708.70
|
| Rate for Payer: Three Rivers Provider Network All |
$559.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$693.78
|
| Rate for Payer: Zelis Auto |
$298.40
|
| Rate for Payer: Zelis Worker's Compensation |
$203.66
|
|
|
INCISION OF FOOT FASCIA
|
Facility
|
OP
|
$746.00
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
6128008
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$203.66 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$447.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cigna Commercial |
$634.10
|
| Rate for Payer: First Health Commercial |
$671.40
|
| Rate for Payer: First Health Workers Compensation |
$288.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$671.40
|
| Rate for Payer: GEHA Commercial |
$596.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$671.40
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$678.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$522.20
|
| Rate for Payer: One Health Plan PPO/POS |
$671.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$708.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$559.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$693.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$298.40
|
| 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 |
$203.66
|
|
|
INCISION OF FOOT TENDON
|
Facility
|
OP
|
$667.00
|
|
|
Service Code
|
CPT 28234
|
| Hospital Charge Code |
6128234
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$182.09 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$400.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cigna Commercial |
$566.95
|
| Rate for Payer: First Health Commercial |
$600.30
|
| Rate for Payer: First Health Workers Compensation |
$257.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$600.30
|
| Rate for Payer: GEHA Commercial |
$533.60
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$600.30
|
| 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 |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$606.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$466.90
|
| Rate for Payer: One Health Plan PPO/POS |
$600.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$633.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$500.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$620.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$266.80
|
| 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 |
$182.09
|
|
|
INCISION OF FOOT TENDON
|
Facility
|
IP
|
$667.00
|
|
|
Service Code
|
CPT 28234
|
| Hospital Charge Code |
6128234
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$182.09 |
| Max. Negotiated Rate |
$633.65 |
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cigna Commercial |
$566.95
|
| Rate for Payer: First Health Commercial |
$600.30
|
| Rate for Payer: First Health Workers Compensation |
$257.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$600.30
|
| Rate for Payer: GEHA Commercial |
$466.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$600.30
|
| Rate for Payer: Multiplan All |
$606.97
|
| Rate for Payer: OMNI Networks Commercial |
$466.90
|
| Rate for Payer: One Health Plan PPO/POS |
$600.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$633.65
|
| Rate for Payer: Three Rivers Provider Network All |
$500.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$620.31
|
| Rate for Payer: Zelis Auto |
$266.80
|
| Rate for Payer: Zelis Worker's Compensation |
$182.09
|
|
|
INCISION OF FOOT TENDON(S)
|
Facility
|
IP
|
$721.00
|
|
|
Service Code
|
CPT 28230
|
| Hospital Charge Code |
6128230
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$196.83 |
| Max. Negotiated Rate |
$684.95 |
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cigna Commercial |
$612.85
|
| Rate for Payer: First Health Commercial |
$648.90
|
| Rate for Payer: First Health Workers Compensation |
$278.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$648.90
|
| Rate for Payer: GEHA Commercial |
$504.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$648.90
|
| Rate for Payer: Multiplan All |
$656.11
|
| Rate for Payer: OMNI Networks Commercial |
$504.70
|
| Rate for Payer: One Health Plan PPO/POS |
$648.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$684.95
|
| Rate for Payer: Three Rivers Provider Network All |
$540.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$670.53
|
| Rate for Payer: Zelis Auto |
$288.40
|
| Rate for Payer: Zelis Worker's Compensation |
$196.83
|
|
|
INCISION OF FOOT TENDON(S)
|
Facility
|
OP
|
$721.00
|
|
|
Service Code
|
CPT 28230
|
| Hospital Charge Code |
6128230
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$196.83 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$432.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cigna Commercial |
$612.85
|
| Rate for Payer: First Health Commercial |
$648.90
|
| Rate for Payer: First Health Workers Compensation |
$278.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$648.90
|
| Rate for Payer: GEHA Commercial |
$576.80
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$648.90
|
| 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 |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$656.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$504.70
|
| Rate for Payer: One Health Plan PPO/POS |
$648.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$684.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$540.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$670.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$288.40
|
| 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 |
$196.83
|
|
|
INCISION OF GALLBLADDER
|
Facility
|
IP
|
$1,826.00
|
|
|
Service Code
|
CPT 47480
|
| Hospital Charge Code |
6147480
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$498.50 |
| Max. Negotiated Rate |
$1,734.70 |
| Rate for Payer: Cash Price |
$1,095.60
|
| Rate for Payer: Cigna Commercial |
$1,552.10
|
| Rate for Payer: First Health Commercial |
$1,643.40
|
| Rate for Payer: First Health Workers Compensation |
$705.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,643.40
|
| Rate for Payer: GEHA Commercial |
$1,278.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,643.40
|
| Rate for Payer: Multiplan All |
$1,661.66
|
| Rate for Payer: OMNI Networks Commercial |
$1,278.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,643.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,734.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,369.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,698.18
|
| Rate for Payer: Zelis Auto |
$730.40
|
| Rate for Payer: Zelis Worker's Compensation |
$498.50
|
|
|
INCISION OF GALLBLADDER
|
Facility
|
OP
|
$1,826.00
|
|
|
Service Code
|
CPT 47480
|
| Hospital Charge Code |
6147480
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$456.50 |
| Max. Negotiated Rate |
$1,734.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,095.60
|
| Rate for Payer: Cash Price |
$1,095.60
|
| Rate for Payer: Cigna Commercial |
$1,552.10
|
| Rate for Payer: First Health Commercial |
$1,643.40
|
| Rate for Payer: First Health Workers Compensation |
$705.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,643.40
|
| Rate for Payer: GEHA Commercial |
$1,460.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,643.40
|
| Rate for Payer: Humana ChoiceCare |
$474.76
|
| Rate for Payer: Multiplan All |
$1,661.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,095.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,278.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,643.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,734.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,369.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,606.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$456.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,698.18
|
| Rate for Payer: Zelis Auto |
$730.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$913.00
|
| Rate for Payer: Zelis Worker's Compensation |
$498.50
|
|
|
INCISION OF HEEL BONE
|
Facility
|
IP
|
$1,339.00
|
|
|
Service Code
|
CPT 28300
|
| Hospital Charge Code |
6128300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$365.55 |
| Max. Negotiated Rate |
$1,272.05 |
| Rate for Payer: Cash Price |
$803.40
|
| Rate for Payer: Cigna Commercial |
$1,138.15
|
| Rate for Payer: First Health Commercial |
$1,205.10
|
| Rate for Payer: First Health Workers Compensation |
$516.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,205.10
|
| Rate for Payer: GEHA Commercial |
$937.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,205.10
|
| Rate for Payer: Multiplan All |
$1,218.49
|
| Rate for Payer: OMNI Networks Commercial |
$937.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,205.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,272.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,004.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,245.27
|
| Rate for Payer: Zelis Auto |
$535.60
|
| Rate for Payer: Zelis Worker's Compensation |
$365.55
|
|
|
INCISION OF HEEL BONE
|
Facility
|
OP
|
$1,339.00
|
|
|
Service Code
|
CPT 28300
|
| Hospital Charge Code |
6128300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$365.55 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$803.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,207.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$803.40
|
| Rate for Payer: Cash Price |
$803.40
|
| Rate for Payer: Cigna Commercial |
$1,138.15
|
| Rate for Payer: First Health Commercial |
$1,205.10
|
| Rate for Payer: First Health Workers Compensation |
$516.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,205.10
|
| Rate for Payer: GEHA Commercial |
$1,071.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,205.10
|
| 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 |
$4,292.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,218.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$937.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,205.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,956.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,292.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,272.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,004.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,292.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,245.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$535.60
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$365.55
|
|
|
INCISION OF HIP BONE
|
Facility
|
IP
|
$2,659.00
|
|
|
Service Code
|
CPT 27146
|
| Hospital Charge Code |
6127146
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$725.91 |
| Max. Negotiated Rate |
$2,526.05 |
| Rate for Payer: Cash Price |
$1,595.40
|
| Rate for Payer: Cigna Commercial |
$2,260.15
|
| Rate for Payer: First Health Commercial |
$2,393.10
|
| Rate for Payer: First Health Workers Compensation |
$1,026.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,393.10
|
| Rate for Payer: GEHA Commercial |
$1,861.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,393.10
|
| Rate for Payer: Multiplan All |
$2,419.69
|
| Rate for Payer: OMNI Networks Commercial |
$1,861.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,393.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,526.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,994.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,472.87
|
| Rate for Payer: Zelis Auto |
$1,063.60
|
| Rate for Payer: Zelis Worker's Compensation |
$725.91
|
|
|
INCISION OF HIP BONE
|
Facility
|
OP
|
$2,659.00
|
|
|
Service Code
|
CPT 27146
|
| Hospital Charge Code |
6127146
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$664.75 |
| Max. Negotiated Rate |
$2,526.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,595.40
|
| Rate for Payer: Cash Price |
$1,595.40
|
| Rate for Payer: Cigna Commercial |
$2,260.15
|
| Rate for Payer: First Health Commercial |
$2,393.10
|
| Rate for Payer: First Health Workers Compensation |
$1,026.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,393.10
|
| Rate for Payer: GEHA Commercial |
$2,127.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,393.10
|
| Rate for Payer: Humana ChoiceCare |
$691.34
|
| Rate for Payer: Multiplan All |
$2,419.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,595.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,861.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,393.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,526.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,994.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,339.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$664.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,472.87
|
| Rate for Payer: Zelis Auto |
$1,063.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,329.50
|
| Rate for Payer: Zelis Worker's Compensation |
$725.91
|
|
|
INCISION OF HIP BONES
|
Facility
|
OP
|
$3,289.00
|
|
|
Service Code
|
CPT 27151
|
| Hospital Charge Code |
6127151
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$822.25 |
| Max. Negotiated Rate |
$3,124.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,973.40
|
| Rate for Payer: Cash Price |
$1,973.40
|
| Rate for Payer: Cigna Commercial |
$2,795.65
|
| Rate for Payer: First Health Commercial |
$2,960.10
|
| Rate for Payer: First Health Workers Compensation |
$1,269.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,960.10
|
| Rate for Payer: GEHA Commercial |
$2,631.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,960.10
|
| Rate for Payer: Humana ChoiceCare |
$855.14
|
| Rate for Payer: Multiplan All |
$2,992.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,973.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,302.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,960.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,124.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,466.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,894.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$822.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,058.77
|
| Rate for Payer: Zelis Auto |
$1,315.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,644.50
|
| Rate for Payer: Zelis Worker's Compensation |
$897.90
|
|
|
INCISION OF HIP BONES
|
Facility
|
IP
|
$3,289.00
|
|
|
Service Code
|
CPT 27151
|
| Hospital Charge Code |
6127151
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$897.90 |
| Max. Negotiated Rate |
$3,124.55 |
| Rate for Payer: Cash Price |
$1,973.40
|
| Rate for Payer: Cigna Commercial |
$2,795.65
|
| Rate for Payer: First Health Commercial |
$2,960.10
|
| Rate for Payer: First Health Workers Compensation |
$1,269.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,960.10
|
| Rate for Payer: GEHA Commercial |
$2,302.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,960.10
|
| Rate for Payer: Multiplan All |
$2,992.99
|
| Rate for Payer: OMNI Networks Commercial |
$2,302.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,960.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,124.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,466.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,058.77
|
| Rate for Payer: Zelis Auto |
$1,315.60
|
| Rate for Payer: Zelis Worker's Compensation |
$897.90
|
|
|
INCISION OF HIP TENDON
|
Facility
|
IP
|
$1,482.00
|
|
|
Service Code
|
CPT 27005
|
| Hospital Charge Code |
6127005
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$404.59 |
| Max. Negotiated Rate |
$1,407.90 |
| Rate for Payer: Cash Price |
$889.20
|
| Rate for Payer: Cigna Commercial |
$1,259.70
|
| Rate for Payer: First Health Commercial |
$1,333.80
|
| Rate for Payer: First Health Workers Compensation |
$572.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,333.80
|
| Rate for Payer: GEHA Commercial |
$1,037.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,333.80
|
| Rate for Payer: Multiplan All |
$1,348.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,037.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,333.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,407.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,111.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,378.26
|
| Rate for Payer: Zelis Auto |
$592.80
|
| Rate for Payer: Zelis Worker's Compensation |
$404.59
|
|
