|
IR ARTHROCENT, MAJOR JOINT; W/US GUIDE
|
Facility
|
OP
|
$1,639.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
7720611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$238.25 |
| Max. Negotiated Rate |
$1,557.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$316.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$983.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$316.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$250.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$280.29
|
| Rate for Payer: Cash Price |
$983.40
|
| Rate for Payer: Cash Price |
$983.40
|
| Rate for Payer: Cigna Commercial |
$1,393.15
|
| Rate for Payer: First Health Commercial |
$1,475.10
|
| Rate for Payer: First Health Workers Compensation |
$360.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,475.10
|
| Rate for Payer: GEHA Commercial |
$1,311.20
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,475.10
|
| Rate for Payer: Humana ChoiceCare |
$308.32
|
| Rate for Payer: Humana Medicare Advantage |
$280.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$470.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$256.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$1,491.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,147.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,475.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$295.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$256.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,557.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$1,229.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$256.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,524.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$655.60
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$255.06
|
|
|
IR ARTHROCENT, SM JOINT; W/OUT US GUIDE
|
Facility
|
IP
|
$1,434.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
7720600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$391.48 |
| Max. Negotiated Rate |
$1,362.30 |
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$1,218.90
|
| Rate for Payer: First Health Commercial |
$1,290.60
|
| Rate for Payer: First Health Workers Compensation |
$553.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,290.60
|
| Rate for Payer: GEHA Commercial |
$1,003.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,290.60
|
| Rate for Payer: Multiplan All |
$1,304.94
|
| Rate for Payer: OMNI Networks Commercial |
$1,003.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,290.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,362.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,075.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,333.62
|
| Rate for Payer: Zelis Auto |
$573.60
|
| Rate for Payer: Zelis Worker's Compensation |
$391.48
|
|
|
IR ARTHROCENT, SM JOINT; W/OUT US GUIDE
|
Facility
|
OP
|
$1,434.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
7720600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$204.72 |
| Max. Negotiated Rate |
$1,362.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$860.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$258.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$204.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$280.29
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$1,218.90
|
| Rate for Payer: First Health Commercial |
$1,290.60
|
| Rate for Payer: First Health Workers Compensation |
$360.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,290.60
|
| Rate for Payer: GEHA Commercial |
$1,147.20
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,290.60
|
| Rate for Payer: Humana ChoiceCare |
$308.32
|
| Rate for Payer: Humana Medicare Advantage |
$280.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$470.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$1,304.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,003.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,290.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$241.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.89
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,362.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$1,075.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,333.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$573.60
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$255.06
|
|
|
IR ARTHROCENT, SM JOINT; W/US GUIDE
|
Facility
|
OP
|
$1,124.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
7720604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$238.25 |
| Max. Negotiated Rate |
$1,067.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$316.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$674.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$316.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$250.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$280.29
|
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cigna Commercial |
$955.40
|
| Rate for Payer: First Health Commercial |
$1,011.60
|
| Rate for Payer: First Health Workers Compensation |
$360.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,011.60
|
| Rate for Payer: GEHA Commercial |
$899.20
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,011.60
|
| Rate for Payer: Humana ChoiceCare |
$308.32
|
| Rate for Payer: Humana Medicare Advantage |
$280.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$470.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$256.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$1,022.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$786.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,011.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$295.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$256.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,067.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$843.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$256.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,045.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$449.60
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$255.06
|
|
|
IR ARTHROCENT, SM JOINT; W/US GUIDE
|
Facility
|
IP
|
$1,124.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
7720604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$306.85 |
| Max. Negotiated Rate |
$1,067.80 |
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cigna Commercial |
$955.40
|
| Rate for Payer: First Health Commercial |
$1,011.60
|
| Rate for Payer: First Health Workers Compensation |
$433.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,011.60
|
| Rate for Payer: GEHA Commercial |
$786.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,011.60
|
| Rate for Payer: Multiplan All |
$1,022.84
|
| Rate for Payer: OMNI Networks Commercial |
$786.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,011.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,067.80
|
| Rate for Payer: Three Rivers Provider Network All |
$843.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,045.32
|
| Rate for Payer: Zelis Auto |
$449.60
|
| Rate for Payer: Zelis Worker's Compensation |
$306.85
|
|
|
IR ARTHROGRAM ANKLE
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
7727648
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$135.75 |
| Max. Negotiated Rate |
$604.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$461.55
|
| Rate for Payer: First Health Commercial |
$488.70
|
| Rate for Payer: First Health Workers Compensation |
$604.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$488.70
|
| Rate for Payer: GEHA Commercial |
$434.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$488.70
|
| Rate for Payer: Humana ChoiceCare |
$141.18
|
| Rate for Payer: Multiplan All |
$494.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$325.80
|
| Rate for Payer: OMNI Networks Commercial |
$380.10
|
| Rate for Payer: One Health Plan PPO/POS |
$488.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$515.85
|
| Rate for Payer: Three Rivers Provider Network All |
$407.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$477.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.99
|
| Rate for Payer: Zelis Auto |
$217.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$271.50
|
| Rate for Payer: Zelis Worker's Compensation |
$427.07
|
|
|
IR ARTHROGRAM ANKLE
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
CPT 27648
|
| Hospital Charge Code |
7727648
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$148.24 |
| Max. Negotiated Rate |
$515.85 |
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$461.55
|
| Rate for Payer: First Health Commercial |
$488.70
|
| Rate for Payer: First Health Workers Compensation |
$209.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$488.70
|
| Rate for Payer: GEHA Commercial |
$380.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$488.70
|
| Rate for Payer: Multiplan All |
$494.13
|
| Rate for Payer: OMNI Networks Commercial |
$380.10
|
| Rate for Payer: One Health Plan PPO/POS |
$488.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$515.85
|
| Rate for Payer: Three Rivers Provider Network All |
$407.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.99
|
| Rate for Payer: Zelis Auto |
$217.20
|
| Rate for Payer: Zelis Worker's Compensation |
$148.24
|
|
|
IR ARTHROGRAM ELBOW
|
Facility
|
IP
|
$977.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
7724220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$266.72 |
| Max. Negotiated Rate |
$928.15 |
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Cigna Commercial |
$830.45
|
| Rate for Payer: First Health Commercial |
$879.30
|
| Rate for Payer: First Health Workers Compensation |
$377.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$879.30
|
| Rate for Payer: GEHA Commercial |
$683.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$879.30
|
| Rate for Payer: Multiplan All |
$889.07
|
| Rate for Payer: OMNI Networks Commercial |
$683.90
|
| Rate for Payer: One Health Plan PPO/POS |
$879.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$928.15
|
| Rate for Payer: Three Rivers Provider Network All |
$732.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$908.61
|
| Rate for Payer: Zelis Auto |
$390.80
|
| Rate for Payer: Zelis Worker's Compensation |
$266.72
|
|
|
IR ARTHROGRAM ELBOW
|
Facility
|
OP
|
$977.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
7724220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$244.25 |
| Max. Negotiated Rate |
$928.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$586.20
|
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Cigna Commercial |
$830.45
|
| Rate for Payer: First Health Commercial |
$879.30
|
| Rate for Payer: First Health Workers Compensation |
$545.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$879.30
|
| Rate for Payer: GEHA Commercial |
$781.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$879.30
|
| Rate for Payer: Humana ChoiceCare |
$254.02
|
| Rate for Payer: Multiplan All |
$889.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$586.20
|
| Rate for Payer: OMNI Networks Commercial |
$683.90
|
| Rate for Payer: One Health Plan PPO/POS |
$879.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$928.15
|
| Rate for Payer: Three Rivers Provider Network All |
$732.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$859.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$244.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$908.61
|
| Rate for Payer: Zelis Auto |
$390.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$488.50
|
| Rate for Payer: Zelis Worker's Compensation |
$385.60
|
|
|
IR ARTHROGRAM HIP
|
Facility
|
OP
|
$1,509.00
|
|
|
Service Code
|
CPT 73525
|
| Hospital Charge Code |
2400241
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$113.83 |
| Max. Negotiated Rate |
$1,433.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$397.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$905.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$397.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$315.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Cigna Commercial |
$1,282.65
|
| Rate for Payer: First Health Commercial |
$1,358.10
|
| Rate for Payer: First Health Workers Compensation |
$160.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,358.10
|
| Rate for Payer: GEHA Commercial |
$1,207.20
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,358.10
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$321.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$1,373.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,056.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,358.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$371.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$321.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,433.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$1,131.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$1,282.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$321.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,403.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$603.60
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$113.83
|
|
|
IR ARTHROGRAM HIP
|
Facility
|
IP
|
$1,509.00
|
|
|
Service Code
|
CPT 73525
|
| Hospital Charge Code |
2400241
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$113.83 |
| Max. Negotiated Rate |
$1,433.55 |
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Cigna Commercial |
$1,282.65
|
| Rate for Payer: First Health Commercial |
$1,358.10
|
| Rate for Payer: First Health Workers Compensation |
$160.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,358.10
|
| Rate for Payer: GEHA Commercial |
$1,056.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,358.10
|
| Rate for Payer: Multiplan All |
$1,373.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,056.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,358.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,433.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,131.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,403.37
|
| Rate for Payer: Zelis Auto |
$603.60
|
| Rate for Payer: Zelis Worker's Compensation |
$113.83
|
|
|
IR ARTHROGRAM HIP RT
|
Facility
|
OP
|
$1,509.00
|
|
|
Service Code
|
CPT 73525
|
| Hospital Charge Code |
2400240
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$113.83 |
| Max. Negotiated Rate |
$1,433.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$397.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$905.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$397.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$315.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Cigna Commercial |
$1,282.65
|
| Rate for Payer: First Health Commercial |
$1,358.10
|
| Rate for Payer: First Health Workers Compensation |
$160.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,358.10
|
| Rate for Payer: GEHA Commercial |
$1,207.20
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,358.10
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$321.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$1,373.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,056.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,358.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$371.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$321.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,433.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$1,131.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$1,282.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$321.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,403.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$603.60
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$113.83
|
|
|
IR ARTHROGRAM HIP RT
|
Facility
|
IP
|
$1,509.00
|
|
|
Service Code
|
CPT 73525
|
| Hospital Charge Code |
2400240
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$113.83 |
| Max. Negotiated Rate |
$1,433.55 |
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Cigna Commercial |
$1,282.65
|
| Rate for Payer: First Health Commercial |
$1,358.10
|
| Rate for Payer: First Health Workers Compensation |
$160.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,358.10
|
| Rate for Payer: GEHA Commercial |
$1,056.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,358.10
|
| Rate for Payer: Multiplan All |
$1,373.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,056.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,358.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,433.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,131.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,403.37
|
| Rate for Payer: Zelis Auto |
$603.60
|
| Rate for Payer: Zelis Worker's Compensation |
$113.83
|
|
|
IR ARTHROGRAM HIP; W/ANESTHESIA
|
Facility
|
OP
|
$3,652.00
|
|
|
Service Code
|
CPT 27095
|
| Hospital Charge Code |
7727095
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$619.14 |
| Max. Negotiated Rate |
$3,469.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,191.20
|
| Rate for Payer: Cash Price |
$2,191.20
|
| Rate for Payer: Cash Price |
$2,191.20
|
| Rate for Payer: Cigna Commercial |
$3,104.20
|
| Rate for Payer: First Health Commercial |
$3,286.80
|
| Rate for Payer: First Health Workers Compensation |
$875.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,286.80
|
| Rate for Payer: GEHA Commercial |
$2,921.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,286.80
|
| Rate for Payer: Humana ChoiceCare |
$949.52
|
| Rate for Payer: Multiplan All |
$3,323.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,191.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,556.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,286.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,469.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,739.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,213.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$913.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,396.36
|
| Rate for Payer: Zelis Auto |
$1,460.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,826.00
|
| Rate for Payer: Zelis Worker's Compensation |
$619.14
|
|
|
IR ARTHROGRAM HIP; W/ANESTHESIA
|
Facility
|
IP
|
$3,652.00
|
|
|
Service Code
|
CPT 27095
|
| Hospital Charge Code |
7727095
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$997.00 |
| Max. Negotiated Rate |
$3,469.40 |
| Rate for Payer: Cash Price |
$2,191.20
|
| Rate for Payer: Cigna Commercial |
$3,104.20
|
| Rate for Payer: First Health Commercial |
$3,286.80
|
| Rate for Payer: First Health Workers Compensation |
$1,410.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,286.80
|
| Rate for Payer: GEHA Commercial |
$2,556.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,286.80
|
| Rate for Payer: Multiplan All |
$3,323.32
|
| Rate for Payer: OMNI Networks Commercial |
$2,556.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,286.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,469.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,739.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,396.36
|
| Rate for Payer: Zelis Auto |
$1,460.80
|
| Rate for Payer: Zelis Worker's Compensation |
$997.00
|
|
|
IR ARTHROGRAM HIP; W/OUT ANESTHESIA
|
Facility
|
IP
|
$1,093.00
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
7727093
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$298.39 |
| Max. Negotiated Rate |
$1,038.35 |
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cigna Commercial |
$929.05
|
| Rate for Payer: First Health Commercial |
$983.70
|
| Rate for Payer: First Health Workers Compensation |
$422.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$983.70
|
| Rate for Payer: GEHA Commercial |
$765.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$983.70
|
| Rate for Payer: Multiplan All |
$994.63
|
| Rate for Payer: OMNI Networks Commercial |
$765.10
|
| Rate for Payer: One Health Plan PPO/POS |
$983.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,038.35
|
| Rate for Payer: Three Rivers Provider Network All |
$819.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,016.49
|
| Rate for Payer: Zelis Auto |
$437.20
|
| Rate for Payer: Zelis Worker's Compensation |
$298.39
|
|
|
IR ARTHROGRAM HIP; W/OUT ANESTHESIA
|
Facility
|
OP
|
$1,093.00
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
7727093
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$273.25 |
| Max. Negotiated Rate |
$1,038.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$655.80
|
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cigna Commercial |
$929.05
|
| Rate for Payer: First Health Commercial |
$983.70
|
| Rate for Payer: First Health Workers Compensation |
$660.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$983.70
|
| Rate for Payer: GEHA Commercial |
$874.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$983.70
|
| Rate for Payer: Humana ChoiceCare |
$284.18
|
| Rate for Payer: Multiplan All |
$994.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$655.80
|
| Rate for Payer: OMNI Networks Commercial |
$765.10
|
| Rate for Payer: One Health Plan PPO/POS |
$983.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,038.35
|
| Rate for Payer: Three Rivers Provider Network All |
$819.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$961.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$273.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,016.49
|
| Rate for Payer: Zelis Auto |
$437.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$546.50
|
| Rate for Payer: Zelis Worker's Compensation |
$467.08
|
|
|
IR ARTHROGRAM KNEE
|
Facility
|
IP
|
$1,560.00
|
|
|
Service Code
|
CPT 73580
|
| Hospital Charge Code |
2410099
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$124.14 |
| Max. Negotiated Rate |
$1,482.00 |
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cigna Commercial |
$1,326.00
|
| Rate for Payer: First Health Commercial |
$1,404.00
|
| Rate for Payer: First Health Workers Compensation |
$175.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,404.00
|
| Rate for Payer: GEHA Commercial |
$1,092.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,404.00
|
| Rate for Payer: Multiplan All |
$1,419.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,092.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,404.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,482.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,170.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,450.80
|
| Rate for Payer: Zelis Auto |
$624.00
|
| Rate for Payer: Zelis Worker's Compensation |
$124.14
|
|
|
IR ARTHROGRAM KNEE
|
Facility
|
OP
|
$1,560.00
|
|
|
Service Code
|
CPT 73580
|
| Hospital Charge Code |
2410099
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$124.14 |
| Max. Negotiated Rate |
$1,482.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$397.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$397.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$315.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cigna Commercial |
$1,326.00
|
| Rate for Payer: First Health Commercial |
$1,404.00
|
| Rate for Payer: First Health Workers Compensation |
$175.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,404.00
|
| Rate for Payer: GEHA Commercial |
$1,248.00
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,404.00
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$321.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$1,419.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,092.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,404.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$371.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$321.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,482.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$1,170.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$1,326.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$321.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,450.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$624.00
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$124.14
|
|
|
IR ARTHROGRAM KNEE RT
|
Facility
|
OP
|
$1,560.00
|
|
|
Service Code
|
CPT 73580
|
| Hospital Charge Code |
2400217
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$124.14 |
| Max. Negotiated Rate |
$1,482.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$397.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$397.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$315.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cigna Commercial |
$1,326.00
|
| Rate for Payer: First Health Commercial |
$1,404.00
|
| Rate for Payer: First Health Workers Compensation |
$175.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,404.00
|
| Rate for Payer: GEHA Commercial |
$1,248.00
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,404.00
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$321.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$1,419.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,092.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,404.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$371.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$321.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,482.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$1,170.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$1,326.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$321.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,450.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$624.00
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$124.14
|
|
|
IR ARTHROGRAM KNEE RT
|
Facility
|
IP
|
$1,560.00
|
|
|
Service Code
|
CPT 73580
|
| Hospital Charge Code |
2400217
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$124.14 |
| Max. Negotiated Rate |
$1,482.00 |
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cigna Commercial |
$1,326.00
|
| Rate for Payer: First Health Commercial |
$1,404.00
|
| Rate for Payer: First Health Workers Compensation |
$175.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,404.00
|
| Rate for Payer: GEHA Commercial |
$1,092.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,404.00
|
| Rate for Payer: Multiplan All |
$1,419.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,092.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,404.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,482.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,170.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,450.80
|
| Rate for Payer: Zelis Auto |
$624.00
|
| Rate for Payer: Zelis Worker's Compensation |
$124.14
|
|
|
IR ARTHROGRAM SHOULDER
|
Facility
|
IP
|
$891.00
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
7723350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$243.24 |
| Max. Negotiated Rate |
$846.45 |
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cigna Commercial |
$757.35
|
| Rate for Payer: First Health Commercial |
$801.90
|
| Rate for Payer: First Health Workers Compensation |
$344.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$801.90
|
| Rate for Payer: GEHA Commercial |
$623.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$801.90
|
| Rate for Payer: Multiplan All |
$810.81
|
| Rate for Payer: OMNI Networks Commercial |
$623.70
|
| Rate for Payer: One Health Plan PPO/POS |
$801.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$846.45
|
| Rate for Payer: Three Rivers Provider Network All |
$668.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$828.63
|
| Rate for Payer: Zelis Auto |
$356.40
|
| Rate for Payer: Zelis Worker's Compensation |
$243.24
|
|
|
IR ARTHROGRAM SHOULDER
|
Facility
|
IP
|
$1,562.00
|
|
|
Service Code
|
CPT 73040
|
| Hospital Charge Code |
2410088
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$111.98 |
| Max. Negotiated Rate |
$1,483.90 |
| Rate for Payer: Cash Price |
$937.20
|
| Rate for Payer: Cash Price |
$937.20
|
| Rate for Payer: Cigna Commercial |
$1,327.70
|
| Rate for Payer: First Health Commercial |
$1,405.80
|
| Rate for Payer: First Health Workers Compensation |
$158.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,405.80
|
| Rate for Payer: GEHA Commercial |
$1,093.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,405.80
|
| Rate for Payer: Multiplan All |
$1,421.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,093.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,405.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,483.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,171.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,452.66
|
| Rate for Payer: Zelis Auto |
$624.80
|
| Rate for Payer: Zelis Worker's Compensation |
$111.98
|
|
|
IR ARTHROGRAM SHOULDER
|
Facility
|
OP
|
$1,562.00
|
|
|
Service Code
|
CPT 73040
|
| Hospital Charge Code |
2410088
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$111.98 |
| Max. Negotiated Rate |
$1,483.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$397.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$937.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$397.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$315.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$937.20
|
| Rate for Payer: Cash Price |
$937.20
|
| Rate for Payer: Cigna Commercial |
$1,327.70
|
| Rate for Payer: First Health Commercial |
$1,405.80
|
| Rate for Payer: First Health Workers Compensation |
$158.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,405.80
|
| Rate for Payer: GEHA Commercial |
$1,249.60
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,405.80
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$321.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$1,421.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,093.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,405.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$371.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$321.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,483.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$1,171.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$1,327.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$321.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,452.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$624.80
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$111.98
|
|
|
IR ARTHROGRAM SHOULDER
|
Facility
|
OP
|
$891.00
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
7723350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$222.75 |
| Max. Negotiated Rate |
$846.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$534.60
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cigna Commercial |
$757.35
|
| Rate for Payer: First Health Commercial |
$801.90
|
| Rate for Payer: First Health Workers Compensation |
$465.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$801.90
|
| Rate for Payer: GEHA Commercial |
$712.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$801.90
|
| Rate for Payer: Humana ChoiceCare |
$231.66
|
| Rate for Payer: Multiplan All |
$810.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$534.60
|
| Rate for Payer: OMNI Networks Commercial |
$623.70
|
| Rate for Payer: One Health Plan PPO/POS |
$801.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$846.45
|
| Rate for Payer: Three Rivers Provider Network All |
$668.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$784.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$222.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$828.63
|
| Rate for Payer: Zelis Auto |
$356.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$445.50
|
| Rate for Payer: Zelis Worker's Compensation |
$328.85
|
|
