|
INCISION OF HIP TENDON
|
Facility
|
OP
|
$1,216.00
|
|
|
Service Code
|
CPT 27003
|
| Hospital Charge Code |
6127003
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$331.97 |
| 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 |
$729.60
|
| 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 |
$729.60
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cigna Commercial |
$1,033.60
|
| Rate for Payer: First Health Commercial |
$1,094.40
|
| Rate for Payer: First Health Workers Compensation |
$469.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,094.40
|
| Rate for Payer: GEHA Commercial |
$972.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,094.40
|
| 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 |
$1,106.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$851.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,094.40
|
| 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 |
$1,155.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$912.00
|
| 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 |
$1,130.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$486.40
|
| 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 |
$331.97
|
|
|
INCISION OF HIP TENDON
|
Facility
|
IP
|
$1,095.00
|
|
|
Service Code
|
CPT 27001
|
| Hospital Charge Code |
6127001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$298.94 |
| Max. Negotiated Rate |
$1,040.25 |
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$930.75
|
| Rate for Payer: First Health Commercial |
$985.50
|
| Rate for Payer: First Health Workers Compensation |
$422.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$985.50
|
| Rate for Payer: GEHA Commercial |
$766.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$985.50
|
| Rate for Payer: Multiplan All |
$996.45
|
| Rate for Payer: OMNI Networks Commercial |
$766.50
|
| Rate for Payer: One Health Plan PPO/POS |
$985.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,040.25
|
| Rate for Payer: Three Rivers Provider Network All |
$821.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,018.35
|
| Rate for Payer: Zelis Auto |
$438.00
|
| Rate for Payer: Zelis Worker's Compensation |
$298.94
|
|
|
INCISION OF HIP TENDON
|
Facility
|
OP
|
$849.00
|
|
|
Service Code
|
CPT 27000
|
| Hospital Charge Code |
6127000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$231.78 |
| Max. Negotiated Rate |
$3,039.30 |
| 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 |
$509.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$509.40
|
| Rate for Payer: Cash Price |
$509.40
|
| Rate for Payer: Cigna Commercial |
$721.65
|
| Rate for Payer: First Health Commercial |
$764.10
|
| Rate for Payer: First Health Workers Compensation |
$327.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$764.10
|
| Rate for Payer: GEHA Commercial |
$679.20
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$764.10
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$772.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$594.30
|
| Rate for Payer: One Health Plan PPO/POS |
$764.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$806.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$636.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$789.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$339.60
|
| 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 |
$231.78
|
|
|
INCISION OF HIP TENDON
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT 27001
|
| Hospital Charge Code |
6127001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$298.94 |
| 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 |
$657.00
|
| 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 |
$657.00
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$930.75
|
| Rate for Payer: First Health Commercial |
$985.50
|
| Rate for Payer: First Health Workers Compensation |
$422.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$985.50
|
| Rate for Payer: GEHA Commercial |
$876.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$985.50
|
| 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 |
$996.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$766.50
|
| Rate for Payer: One Health Plan PPO/POS |
$985.50
|
| 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 |
$1,040.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$821.25
|
| 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 |
$1,018.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$438.00
|
| 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 |
$298.94
|
|
|
INCISION OF HIP TENDON
|
Facility
|
IP
|
$1,216.00
|
|
|
Service Code
|
CPT 27003
|
| Hospital Charge Code |
6127003
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$331.97 |
| Max. Negotiated Rate |
$1,155.20 |
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cigna Commercial |
$1,033.60
|
| Rate for Payer: First Health Commercial |
$1,094.40
|
| Rate for Payer: First Health Workers Compensation |
$469.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,094.40
|
| Rate for Payer: GEHA Commercial |
$851.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,094.40
|
| Rate for Payer: Multiplan All |
$1,106.56
|
| Rate for Payer: OMNI Networks Commercial |
$851.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,094.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,155.20
|
| Rate for Payer: Three Rivers Provider Network All |
$912.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,130.88
|
| Rate for Payer: Zelis Auto |
$486.40
|
| Rate for Payer: Zelis Worker's Compensation |
$331.97
|
|
|
INCISION OF HIP TENDON
|
Facility
|
OP
|
$1,482.00
|
|
|
Service Code
|
CPT 27005
|
| Hospital Charge Code |
6127005
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$370.50 |
| Max. Negotiated Rate |
$1,407.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$889.20
|
| 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 |
$1,185.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,333.80
|
| Rate for Payer: Humana ChoiceCare |
$385.32
|
| Rate for Payer: Multiplan All |
$1,348.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$889.20
|
| 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: TriWest Veterans Administration/VAPC3 |
$1,304.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$370.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,378.26
|
| Rate for Payer: Zelis Auto |
$592.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$741.00
|
| Rate for Payer: Zelis Worker's Compensation |
$404.59
|
|
|
INCISION OF HIP TENDON
|
Facility
|
IP
|
$849.00
|
|
|
Service Code
|
CPT 27000
|
| Hospital Charge Code |
6127000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$231.78 |
| Max. Negotiated Rate |
$806.55 |
| Rate for Payer: Cash Price |
$509.40
|
| Rate for Payer: Cigna Commercial |
$721.65
|
| Rate for Payer: First Health Commercial |
$764.10
|
| Rate for Payer: First Health Workers Compensation |
$327.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$764.10
|
| Rate for Payer: GEHA Commercial |
$594.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$764.10
|
| Rate for Payer: Multiplan All |
$772.59
|
| Rate for Payer: OMNI Networks Commercial |
$594.30
|
| Rate for Payer: One Health Plan PPO/POS |
$764.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$806.55
|
| Rate for Payer: Three Rivers Provider Network All |
$636.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$789.57
|
| Rate for Payer: Zelis Auto |
$339.60
|
| Rate for Payer: Zelis Worker's Compensation |
$231.78
|
|
|
INCISION OF HIP TENDONS
|
Facility
|
IP
|
$1,504.00
|
|
|
Service Code
|
CPT 27006
|
| Hospital Charge Code |
6127006
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$410.59 |
| Max. Negotiated Rate |
$1,428.80 |
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Cigna Commercial |
$1,278.40
|
| Rate for Payer: First Health Commercial |
$1,353.60
|
| Rate for Payer: First Health Workers Compensation |
$580.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,353.60
|
| Rate for Payer: GEHA Commercial |
$1,052.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,353.60
|
| Rate for Payer: Multiplan All |
$1,368.64
|
| Rate for Payer: OMNI Networks Commercial |
$1,052.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,353.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,428.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,128.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,398.72
|
| Rate for Payer: Zelis Auto |
$601.60
|
| Rate for Payer: Zelis Worker's Compensation |
$410.59
|
|
|
INCISION OF HIP TENDONS
|
Facility
|
OP
|
$1,504.00
|
|
|
Service Code
|
CPT 27006
|
| Hospital Charge Code |
6127006
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$410.59 |
| 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 |
$902.40
|
| 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 |
$902.40
|
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Cigna Commercial |
$1,278.40
|
| Rate for Payer: First Health Commercial |
$1,353.60
|
| Rate for Payer: First Health Workers Compensation |
$580.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,353.60
|
| Rate for Payer: GEHA Commercial |
$1,203.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,353.60
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,368.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,052.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,353.60
|
| 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 |
$1,428.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,128.00
|
| 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 |
$1,398.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$601.60
|
| 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 |
$410.59
|
|
|
INCISION OF HIP/THIGH FASCIA
|
Facility
|
OP
|
$1,877.00
|
|
|
Service Code
|
CPT 27025
|
| Hospital Charge Code |
6127025
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$469.25 |
| Max. Negotiated Rate |
$1,783.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,126.20
|
| Rate for Payer: Cash Price |
$1,126.20
|
| Rate for Payer: Cigna Commercial |
$1,595.45
|
| Rate for Payer: First Health Commercial |
$1,689.30
|
| Rate for Payer: First Health Workers Compensation |
$724.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,689.30
|
| Rate for Payer: GEHA Commercial |
$1,501.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,689.30
|
| Rate for Payer: Humana ChoiceCare |
$488.02
|
| Rate for Payer: Multiplan All |
$1,708.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,126.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,313.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,689.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,783.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,407.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,651.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$469.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,745.61
|
| Rate for Payer: Zelis Auto |
$750.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$938.50
|
| Rate for Payer: Zelis Worker's Compensation |
$512.42
|
|
|
INCISION OF HIP/THIGH FASCIA
|
Facility
|
IP
|
$1,877.00
|
|
|
Service Code
|
CPT 27025
|
| Hospital Charge Code |
6127025
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$512.42 |
| Max. Negotiated Rate |
$1,783.15 |
| Rate for Payer: Cash Price |
$1,126.20
|
| Rate for Payer: Cigna Commercial |
$1,595.45
|
| Rate for Payer: First Health Commercial |
$1,689.30
|
| Rate for Payer: First Health Workers Compensation |
$724.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,689.30
|
| Rate for Payer: GEHA Commercial |
$1,313.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,689.30
|
| Rate for Payer: Multiplan All |
$1,708.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,313.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,689.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,783.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,407.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,745.61
|
| Rate for Payer: Zelis Auto |
$750.80
|
| Rate for Payer: Zelis Worker's Compensation |
$512.42
|
|
|
INCISION OF JAW JOINT
|
Facility
|
OP
|
$1,524.00
|
|
|
Service Code
|
CPT 21010
|
| Hospital Charge Code |
6121010
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$416.05 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$914.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cigna Commercial |
$1,295.40
|
| Rate for Payer: First Health Commercial |
$1,371.60
|
| Rate for Payer: First Health Workers Compensation |
$588.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,371.60
|
| Rate for Payer: GEHA Commercial |
$1,219.20
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,371.60
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$1,386.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$1,066.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,371.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,447.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$1,143.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,417.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$609.60
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$416.05
|
|
|
INCISION OF JAW JOINT
|
Facility
|
IP
|
$1,524.00
|
|
|
Service Code
|
CPT 21010
|
| Hospital Charge Code |
6121010
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$416.05 |
| Max. Negotiated Rate |
$1,447.80 |
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cigna Commercial |
$1,295.40
|
| Rate for Payer: First Health Commercial |
$1,371.60
|
| Rate for Payer: First Health Workers Compensation |
$588.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,371.60
|
| Rate for Payer: GEHA Commercial |
$1,066.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,371.60
|
| Rate for Payer: Multiplan All |
$1,386.84
|
| Rate for Payer: OMNI Networks Commercial |
$1,066.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,371.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,447.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,143.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,417.32
|
| Rate for Payer: Zelis Auto |
$609.60
|
| Rate for Payer: Zelis Worker's Compensation |
$416.05
|
|
|
INCISION OF JAW NERVE
|
Facility
|
OP
|
$868.00
|
|
|
Service Code
|
CPT 64738
|
| Hospital Charge Code |
6164738
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.96 |
| 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 |
$520.80
|
| 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 |
$520.80
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cigna Commercial |
$737.80
|
| Rate for Payer: First Health Commercial |
$781.20
|
| Rate for Payer: First Health Workers Compensation |
$335.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$781.20
|
| Rate for Payer: GEHA Commercial |
$694.40
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$781.20
|
| 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 |
$789.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$607.60
|
| Rate for Payer: One Health Plan PPO/POS |
$781.20
|
| 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 |
$824.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$651.00
|
| 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 |
$807.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$347.20
|
| 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 |
$236.96
|
|
|
INCISION OF JAW NERVE
|
Facility
|
IP
|
$868.00
|
|
|
Service Code
|
CPT 64738
|
| Hospital Charge Code |
6164738
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.96 |
| Max. Negotiated Rate |
$824.60 |
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cigna Commercial |
$737.80
|
| Rate for Payer: First Health Commercial |
$781.20
|
| Rate for Payer: First Health Workers Compensation |
$335.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$781.20
|
| Rate for Payer: GEHA Commercial |
$607.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$781.20
|
| Rate for Payer: Multiplan All |
$789.88
|
| Rate for Payer: OMNI Networks Commercial |
$607.60
|
| Rate for Payer: One Health Plan PPO/POS |
$781.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$824.60
|
| Rate for Payer: Three Rivers Provider Network All |
$651.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$807.24
|
| Rate for Payer: Zelis Auto |
$347.20
|
| Rate for Payer: Zelis Worker's Compensation |
$236.96
|
|
|
INCISION OF KNEE JOINT
|
Facility
|
OP
|
$1,649.00
|
|
|
Service Code
|
CPT 27435
|
| Hospital Charge Code |
6127435
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$450.18 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$989.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$989.40
|
| Rate for Payer: Cash Price |
$989.40
|
| Rate for Payer: Cigna Commercial |
$1,401.65
|
| Rate for Payer: First Health Commercial |
$1,484.10
|
| Rate for Payer: First Health Workers Compensation |
$636.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,484.10
|
| Rate for Payer: GEHA Commercial |
$1,319.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,484.10
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,500.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,154.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,484.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,566.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,236.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,533.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$659.60
|
| 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 |
$450.18
|
|
|
INCISION OF KNEE JOINT
|
Facility
|
IP
|
$1,649.00
|
|
|
Service Code
|
CPT 27435
|
| Hospital Charge Code |
6127435
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$450.18 |
| Max. Negotiated Rate |
$1,566.55 |
| Rate for Payer: Cash Price |
$989.40
|
| Rate for Payer: Cigna Commercial |
$1,401.65
|
| Rate for Payer: First Health Commercial |
$1,484.10
|
| Rate for Payer: First Health Workers Compensation |
$636.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,484.10
|
| Rate for Payer: GEHA Commercial |
$1,154.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,484.10
|
| Rate for Payer: Multiplan All |
$1,500.59
|
| Rate for Payer: OMNI Networks Commercial |
$1,154.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,484.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,566.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,236.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,533.57
|
| Rate for Payer: Zelis Auto |
$659.60
|
| Rate for Payer: Zelis Worker's Compensation |
$450.18
|
|
|
INCISION OF LARGE BOWEL
|
Facility
|
OP
|
$2,074.00
|
|
|
Service Code
|
CPT 44025
|
| Hospital Charge Code |
6144025
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$518.50 |
| Max. Negotiated Rate |
$1,970.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,244.40
|
| Rate for Payer: Cash Price |
$1,244.40
|
| Rate for Payer: Cigna Commercial |
$1,762.90
|
| Rate for Payer: First Health Commercial |
$1,866.60
|
| Rate for Payer: First Health Workers Compensation |
$800.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,866.60
|
| Rate for Payer: GEHA Commercial |
$1,659.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,866.60
|
| Rate for Payer: Humana ChoiceCare |
$539.24
|
| Rate for Payer: Multiplan All |
$1,887.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,244.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,451.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,866.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,970.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,555.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,825.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$518.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,928.82
|
| Rate for Payer: Zelis Auto |
$829.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,037.00
|
| Rate for Payer: Zelis Worker's Compensation |
$566.20
|
|
|
INCISION OF LARGE BOWEL
|
Facility
|
IP
|
$2,074.00
|
|
|
Service Code
|
CPT 44025
|
| Hospital Charge Code |
6144025
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$566.20 |
| Max. Negotiated Rate |
$1,970.30 |
| Rate for Payer: Cash Price |
$1,244.40
|
| Rate for Payer: Cigna Commercial |
$1,762.90
|
| Rate for Payer: First Health Commercial |
$1,866.60
|
| Rate for Payer: First Health Workers Compensation |
$800.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,866.60
|
| Rate for Payer: GEHA Commercial |
$1,451.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,866.60
|
| Rate for Payer: Multiplan All |
$1,887.34
|
| Rate for Payer: OMNI Networks Commercial |
$1,451.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,866.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,970.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,555.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,928.82
|
| Rate for Payer: Zelis Auto |
$829.60
|
| Rate for Payer: Zelis Worker's Compensation |
$566.20
|
|
|
INCISION OF LIP FOLD
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT 40806
|
| Hospital Charge Code |
6140806
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$27.03 |
| Max. Negotiated Rate |
$967.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$59.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$274.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$483.55
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna Commercial |
$84.15
|
| Rate for Payer: First Health Commercial |
$89.10
|
| Rate for Payer: First Health Workers Compensation |
$38.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$89.10
|
| Rate for Payer: GEHA Commercial |
$79.20
|
| Rate for Payer: GEHA Medicare |
$483.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$89.10
|
| Rate for Payer: Humana ChoiceCare |
$531.90
|
| Rate for Payer: Humana Medicare Advantage |
$483.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$812.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$279.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$483.55
|
| Rate for Payer: Multiplan All |
$90.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$822.03
|
| Rate for Payer: OMNI Networks Commercial |
$69.30
|
| Rate for Payer: One Health Plan PPO/POS |
$89.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$323.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$279.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$483.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$94.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$967.10
|
| Rate for Payer: Three Rivers Provider Network All |
$74.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$473.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$483.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$92.07
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$483.55
|
| Rate for Payer: Zelis Auto |
$39.60
|
| Rate for Payer: Zelis Medicare |
$411.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$580.26
|
| Rate for Payer: Zelis Worker's Compensation |
$27.03
|
|
|
INCISION OF LIP FOLD
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
CPT 40806
|
| Hospital Charge Code |
6140806
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$27.03 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna Commercial |
$84.15
|
| Rate for Payer: First Health Commercial |
$89.10
|
| Rate for Payer: First Health Workers Compensation |
$38.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$89.10
|
| Rate for Payer: GEHA Commercial |
$69.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$89.10
|
| Rate for Payer: Multiplan All |
$90.09
|
| Rate for Payer: OMNI Networks Commercial |
$69.30
|
| Rate for Payer: One Health Plan PPO/POS |
$89.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$94.05
|
| Rate for Payer: Three Rivers Provider Network All |
$74.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$92.07
|
| Rate for Payer: Zelis Auto |
$39.60
|
| Rate for Payer: Zelis Worker's Compensation |
$27.03
|
|
|
INCISION OF LIVER DUCT
|
Facility
|
IP
|
$4,535.00
|
|
|
Service Code
|
CPT 47400
|
| Hospital Charge Code |
6147400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,238.06 |
| Max. Negotiated Rate |
$4,308.25 |
| Rate for Payer: Cash Price |
$2,721.00
|
| Rate for Payer: Cigna Commercial |
$3,854.75
|
| Rate for Payer: First Health Commercial |
$4,081.50
|
| Rate for Payer: First Health Workers Compensation |
$1,750.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,081.50
|
| Rate for Payer: GEHA Commercial |
$3,174.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,081.50
|
| Rate for Payer: Multiplan All |
$4,126.85
|
| Rate for Payer: OMNI Networks Commercial |
$3,174.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,081.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,308.25
|
| Rate for Payer: Three Rivers Provider Network All |
$3,401.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,217.55
|
| Rate for Payer: Zelis Auto |
$1,814.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,238.06
|
|
|
INCISION OF LIVER DUCT
|
Facility
|
OP
|
$4,535.00
|
|
|
Service Code
|
CPT 47400
|
| Hospital Charge Code |
6147400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,133.75 |
| Max. Negotiated Rate |
$4,308.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,721.00
|
| Rate for Payer: Cash Price |
$2,721.00
|
| Rate for Payer: Cigna Commercial |
$3,854.75
|
| Rate for Payer: First Health Commercial |
$4,081.50
|
| Rate for Payer: First Health Workers Compensation |
$1,750.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,081.50
|
| Rate for Payer: GEHA Commercial |
$3,628.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,081.50
|
| Rate for Payer: Humana ChoiceCare |
$1,179.10
|
| Rate for Payer: Multiplan All |
$4,126.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,721.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,174.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,081.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,308.25
|
| Rate for Payer: Three Rivers Provider Network All |
$3,401.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,990.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,133.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,217.55
|
| Rate for Payer: Zelis Auto |
$1,814.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,267.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,238.06
|
|
|
INCISION OF METATARSAL
|
Facility
|
IP
|
$1,850.43
|
|
|
Service Code
|
CPT 28308
|
| Hospital Charge Code |
6128308
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$505.17 |
| Max. Negotiated Rate |
$1,757.91 |
| Rate for Payer: Cash Price |
$1,110.26
|
| Rate for Payer: Cigna Commercial |
$1,572.87
|
| Rate for Payer: First Health Commercial |
$1,665.39
|
| Rate for Payer: First Health Workers Compensation |
$714.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,665.39
|
| Rate for Payer: GEHA Commercial |
$1,295.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,665.39
|
| Rate for Payer: Multiplan All |
$1,683.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,295.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,665.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,757.91
|
| Rate for Payer: Three Rivers Provider Network All |
$1,387.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,720.90
|
| Rate for Payer: Zelis Auto |
$740.17
|
| Rate for Payer: Zelis Worker's Compensation |
$505.17
|
|
|
INCISION OF METATARSAL
|
Facility
|
IP
|
$826.00
|
|
|
Service Code
|
CPT 28306
|
| Hospital Charge Code |
6128306
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$225.50 |
| Max. Negotiated Rate |
$784.70 |
| Rate for Payer: Cash Price |
$495.60
|
| Rate for Payer: Cigna Commercial |
$702.10
|
| Rate for Payer: First Health Commercial |
$743.40
|
| Rate for Payer: First Health Workers Compensation |
$318.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$743.40
|
| Rate for Payer: GEHA Commercial |
$578.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$743.40
|
| Rate for Payer: Multiplan All |
$751.66
|
| Rate for Payer: OMNI Networks Commercial |
$578.20
|
| Rate for Payer: One Health Plan PPO/POS |
$743.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$784.70
|
| Rate for Payer: Three Rivers Provider Network All |
$619.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$768.18
|
| Rate for Payer: Zelis Auto |
$330.40
|
| Rate for Payer: Zelis Worker's Compensation |
$225.50
|
|
