|
KIT DEVICE MILD VERTOS
|
Facility
|
IP
|
$10,350.00
|
|
|
Service Code
|
CPT C1889
|
| Hospital Charge Code |
7006690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,140.00 |
| Max. Negotiated Rate |
$9,832.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,280.00
|
| Rate for Payer: Cash Price |
$6,210.00
|
| Rate for Payer: Cash Price |
$6,210.00
|
| Rate for Payer: Cigna Commercial |
$8,797.50
|
| Rate for Payer: First Health Commercial |
$9,315.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,315.00
|
| Rate for Payer: GEHA Commercial |
$7,245.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,315.00
|
| Rate for Payer: Multiplan All |
$9,418.50
|
| Rate for Payer: OMNI Networks Commercial |
$7,245.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9,315.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9,832.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7,762.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9,625.50
|
| Rate for Payer: Zelis Auto |
$4,140.00
|
|
|
KIT PRP IMPLT
|
Facility
|
IP
|
$1,707.00
|
|
|
Service Code
|
CPT C9355
|
| Hospital Charge Code |
7002965
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$682.80 |
| Max. Negotiated Rate |
$1,621.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,365.60
|
| Rate for Payer: Cash Price |
$1,024.20
|
| Rate for Payer: Cash Price |
$1,024.20
|
| Rate for Payer: Cigna Commercial |
$1,450.95
|
| Rate for Payer: First Health Commercial |
$1,536.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,536.30
|
| Rate for Payer: GEHA Commercial |
$1,194.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,536.30
|
| Rate for Payer: Multiplan All |
$1,553.37
|
| Rate for Payer: OMNI Networks Commercial |
$1,194.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,536.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,621.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,280.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,587.51
|
| Rate for Payer: Zelis Auto |
$682.80
|
|
|
KIT PRP IMPLT
|
Facility
|
OP
|
$1,707.00
|
|
|
Service Code
|
CPT C9355
|
| Hospital Charge Code |
7002965
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.75 |
| Max. Negotiated Rate |
$1,621.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,024.20
|
| Rate for Payer: Cash Price |
$1,024.20
|
| Rate for Payer: Cash Price |
$1,024.20
|
| Rate for Payer: Cigna Commercial |
$1,450.95
|
| Rate for Payer: First Health Commercial |
$1,536.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,536.30
|
| Rate for Payer: GEHA Commercial |
$1,365.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,536.30
|
| Rate for Payer: Humana ChoiceCare |
$443.82
|
| Rate for Payer: Multiplan All |
$1,553.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,024.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,194.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,536.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,621.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,280.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,502.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$426.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,587.51
|
| Rate for Payer: Zelis Auto |
$682.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$853.50
|
|
|
KIT TRACHEOSTOMY PERCUTANEOUS DILATION
|
Facility
|
OP
|
$1,806.72
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7007053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.68 |
| Max. Negotiated Rate |
$1,716.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,084.03
|
| Rate for Payer: Cash Price |
$1,084.03
|
| Rate for Payer: Cash Price |
$1,084.03
|
| Rate for Payer: Cigna Commercial |
$1,535.71
|
| Rate for Payer: First Health Commercial |
$1,626.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,626.05
|
| Rate for Payer: GEHA Commercial |
$1,445.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,626.05
|
| Rate for Payer: Humana ChoiceCare |
$469.75
|
| Rate for Payer: Multiplan All |
$1,644.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,084.03
|
| Rate for Payer: OMNI Networks Commercial |
$1,264.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,626.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,716.38
|
| Rate for Payer: Three Rivers Provider Network All |
$1,355.04
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,589.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$451.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,680.25
|
| Rate for Payer: Zelis Auto |
$722.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$903.36
|
|
|
KIT TRACHEOSTOMY PERCUTANEOUS DILATION
|
Facility
|
IP
|
$1,806.72
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
7007053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$722.69 |
| Max. Negotiated Rate |
$1,716.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,445.38
|
| Rate for Payer: Cash Price |
$1,084.03
|
| Rate for Payer: Cash Price |
$1,084.03
|
| Rate for Payer: Cigna Commercial |
$1,535.71
|
| Rate for Payer: First Health Commercial |
$1,626.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,626.05
|
| Rate for Payer: GEHA Commercial |
$1,264.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,626.05
|
| Rate for Payer: Multiplan All |
$1,644.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,264.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,626.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,716.38
|
| Rate for Payer: Three Rivers Provider Network All |
$1,355.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,680.25
|
| Rate for Payer: Zelis Auto |
$722.69
|
|
|
kiwi fruit, IgE REF602781
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2200810
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
kiwi fruit, IgE REF602781
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2200810
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
KNEE ARTHOSCOPY/
|
Facility
|
IP
|
$1,358.00
|
|
|
Service Code
|
CPT 29879
|
| Hospital Charge Code |
6129879
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$370.73 |
| Max. Negotiated Rate |
$1,290.10 |
| Rate for Payer: Cash Price |
$814.80
|
| Rate for Payer: Cigna Commercial |
$1,154.30
|
| Rate for Payer: First Health Commercial |
$1,222.20
|
| Rate for Payer: First Health Workers Compensation |
$524.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,222.20
|
| Rate for Payer: GEHA Commercial |
$950.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,222.20
|
| Rate for Payer: Multiplan All |
$1,235.78
|
| Rate for Payer: OMNI Networks Commercial |
$950.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,222.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,290.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,018.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,262.94
|
| Rate for Payer: Zelis Auto |
$543.20
|
| Rate for Payer: Zelis Worker's Compensation |
$370.73
|
|
|
KNEE ARTHOSCOPY/
|
Facility
|
OP
|
$1,358.00
|
|
|
Service Code
|
CPT 29879
|
| Hospital Charge Code |
6129879
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$370.73 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$814.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$814.80
|
| Rate for Payer: Cash Price |
$814.80
|
| Rate for Payer: Cigna Commercial |
$1,154.30
|
| Rate for Payer: First Health Commercial |
$1,222.20
|
| Rate for Payer: First Health Workers Compensation |
$524.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,222.20
|
| Rate for Payer: GEHA Commercial |
$1,086.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,222.20
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,235.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$950.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,222.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,290.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,018.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,262.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$543.20
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$370.73
|
|
|
KNEE ARTHROSCOPY DX
|
Facility
|
OP
|
$841.00
|
|
|
Service Code
|
CPT 29870
|
| Hospital Charge Code |
6129870
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$229.59 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$504.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$504.60
|
| Rate for Payer: Cash Price |
$504.60
|
| Rate for Payer: Cigna Commercial |
$714.85
|
| Rate for Payer: First Health Commercial |
$756.90
|
| Rate for Payer: First Health Workers Compensation |
$324.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$756.90
|
| Rate for Payer: GEHA Commercial |
$672.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$756.90
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$765.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$588.70
|
| Rate for Payer: One Health Plan PPO/POS |
$756.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$798.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$630.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$782.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$336.40
|
| 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 |
$229.59
|
|
|
KNEE ARTHROSCOPY DX
|
Facility
|
IP
|
$841.00
|
|
|
Service Code
|
CPT 29870
|
| Hospital Charge Code |
6129870
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$229.59 |
| Max. Negotiated Rate |
$798.95 |
| Rate for Payer: Cash Price |
$504.60
|
| Rate for Payer: Cigna Commercial |
$714.85
|
| Rate for Payer: First Health Commercial |
$756.90
|
| Rate for Payer: First Health Workers Compensation |
$324.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$756.90
|
| Rate for Payer: GEHA Commercial |
$588.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$756.90
|
| Rate for Payer: Multiplan All |
$765.31
|
| Rate for Payer: OMNI Networks Commercial |
$588.70
|
| Rate for Payer: One Health Plan PPO/POS |
$756.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$798.95
|
| Rate for Payer: Three Rivers Provider Network All |
$630.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$782.13
|
| Rate for Payer: Zelis Auto |
$336.40
|
| Rate for Payer: Zelis Worker's Compensation |
$229.59
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$2,033.00
|
|
|
Service Code
|
CPT 29888
|
| Hospital Charge Code |
6129888
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$555.01 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,219.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7,100.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,219.80
|
| Rate for Payer: Cash Price |
$1,219.80
|
| Rate for Payer: Cigna Commercial |
$1,728.05
|
| Rate for Payer: First Health Commercial |
$1,829.70
|
| Rate for Payer: First Health Workers Compensation |
$784.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,829.70
|
| Rate for Payer: GEHA Commercial |
$1,626.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,829.70
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,850.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,423.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,829.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8,365.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7,245.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,931.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,524.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,890.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$813.20
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$555.01
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,068.00
|
|
|
Service Code
|
CPT 29873
|
| Hospital Charge Code |
6129873
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$291.56 |
| Max. Negotiated Rate |
$1,014.60 |
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cigna Commercial |
$907.80
|
| Rate for Payer: First Health Commercial |
$961.20
|
| Rate for Payer: First Health Workers Compensation |
$412.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$961.20
|
| Rate for Payer: GEHA Commercial |
$747.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$961.20
|
| Rate for Payer: Multiplan All |
$971.88
|
| Rate for Payer: OMNI Networks Commercial |
$747.60
|
| Rate for Payer: One Health Plan PPO/POS |
$961.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,014.60
|
| Rate for Payer: Three Rivers Provider Network All |
$801.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$993.24
|
| Rate for Payer: Zelis Auto |
$427.20
|
| Rate for Payer: Zelis Worker's Compensation |
$291.56
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,533.00
|
|
|
Service Code
|
CPT 29887
|
| Hospital Charge Code |
6129887
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$418.51 |
| Max. Negotiated Rate |
$1,456.35 |
| Rate for Payer: Cash Price |
$919.80
|
| Rate for Payer: Cigna Commercial |
$1,303.05
|
| Rate for Payer: First Health Commercial |
$1,379.70
|
| Rate for Payer: First Health Workers Compensation |
$591.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,379.70
|
| Rate for Payer: GEHA Commercial |
$1,073.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,379.70
|
| Rate for Payer: Multiplan All |
$1,395.03
|
| Rate for Payer: OMNI Networks Commercial |
$1,073.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,379.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,456.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,149.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,425.69
|
| Rate for Payer: Zelis Auto |
$613.20
|
| Rate for Payer: Zelis Worker's Compensation |
$418.51
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$2,033.00
|
|
|
Service Code
|
CPT 29888
|
| Hospital Charge Code |
6129888
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$555.01 |
| Max. Negotiated Rate |
$1,931.35 |
| Rate for Payer: Cash Price |
$1,219.80
|
| Rate for Payer: Cigna Commercial |
$1,728.05
|
| Rate for Payer: First Health Commercial |
$1,829.70
|
| Rate for Payer: First Health Workers Compensation |
$784.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,829.70
|
| Rate for Payer: GEHA Commercial |
$1,423.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,829.70
|
| Rate for Payer: Multiplan All |
$1,850.03
|
| Rate for Payer: OMNI Networks Commercial |
$1,423.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,829.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,931.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,524.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,890.69
|
| Rate for Payer: Zelis Auto |
$813.20
|
| Rate for Payer: Zelis Worker's Compensation |
$555.01
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,533.00
|
|
|
Service Code
|
CPT 29887
|
| Hospital Charge Code |
6129887
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$418.51 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$919.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$919.80
|
| Rate for Payer: Cash Price |
$919.80
|
| Rate for Payer: Cigna Commercial |
$1,303.05
|
| Rate for Payer: First Health Commercial |
$1,379.70
|
| Rate for Payer: First Health Workers Compensation |
$591.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,379.70
|
| Rate for Payer: GEHA Commercial |
$1,226.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,379.70
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,395.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,073.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,379.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,456.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,149.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,425.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$613.20
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$418.51
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
CPT 29877
|
| Hospital Charge Code |
6129877
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$348.07 |
| Max. Negotiated Rate |
$1,211.25 |
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,083.75
|
| Rate for Payer: First Health Commercial |
$1,147.50
|
| Rate for Payer: First Health Workers Compensation |
$492.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,147.50
|
| Rate for Payer: GEHA Commercial |
$892.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,147.50
|
| Rate for Payer: Multiplan All |
$1,160.25
|
| Rate for Payer: OMNI Networks Commercial |
$892.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,147.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,211.25
|
| Rate for Payer: Three Rivers Provider Network All |
$956.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,185.75
|
| Rate for Payer: Zelis Auto |
$510.00
|
| Rate for Payer: Zelis Worker's Compensation |
$348.07
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,731.00
|
|
|
Service Code
|
CPT 29883
|
| Hospital Charge Code |
6129883
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$472.56 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,038.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,038.60
|
| Rate for Payer: Cash Price |
$1,038.60
|
| Rate for Payer: Cigna Commercial |
$1,471.35
|
| Rate for Payer: First Health Commercial |
$1,557.90
|
| Rate for Payer: First Health Workers Compensation |
$668.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,557.90
|
| Rate for Payer: GEHA Commercial |
$1,384.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,557.90
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,575.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,211.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,557.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,644.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,298.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,609.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$692.40
|
| 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 |
$472.56
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,107.00
|
|
|
Service Code
|
CPT 29881
|
| Hospital Charge Code |
6129881
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$302.21 |
| Max. Negotiated Rate |
$1,051.65 |
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$940.95
|
| Rate for Payer: First Health Commercial |
$996.30
|
| Rate for Payer: First Health Workers Compensation |
$427.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$996.30
|
| Rate for Payer: GEHA Commercial |
$774.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$996.30
|
| Rate for Payer: Multiplan All |
$1,007.37
|
| Rate for Payer: OMNI Networks Commercial |
$774.90
|
| Rate for Payer: One Health Plan PPO/POS |
$996.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,051.65
|
| Rate for Payer: Three Rivers Provider Network All |
$830.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,029.51
|
| Rate for Payer: Zelis Auto |
$442.80
|
| Rate for Payer: Zelis Worker's Compensation |
$302.21
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,107.00
|
|
|
Service Code
|
CPT 29881
|
| Hospital Charge Code |
6129881
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$302.21 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$664.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$940.95
|
| Rate for Payer: First Health Commercial |
$996.30
|
| Rate for Payer: First Health Workers Compensation |
$427.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$996.30
|
| Rate for Payer: GEHA Commercial |
$885.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$996.30
|
| 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 |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,007.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$774.90
|
| Rate for Payer: One Health Plan PPO/POS |
$996.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,051.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$830.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,029.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$442.80
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$302.21
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,068.00
|
|
|
Service Code
|
CPT 29873
|
| Hospital Charge Code |
6129873
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$291.56 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$640.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cigna Commercial |
$907.80
|
| Rate for Payer: First Health Commercial |
$961.20
|
| Rate for Payer: First Health Workers Compensation |
$412.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$961.20
|
| Rate for Payer: GEHA Commercial |
$854.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$961.20
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$971.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$747.60
|
| Rate for Payer: One Health Plan PPO/POS |
$961.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,014.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$801.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$993.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$427.20
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$291.56
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,439.00
|
|
|
Service Code
|
CPT 29882
|
| Hospital Charge Code |
6129882
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$392.85 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$863.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$863.40
|
| Rate for Payer: Cash Price |
$863.40
|
| Rate for Payer: Cigna Commercial |
$1,223.15
|
| Rate for Payer: First Health Commercial |
$1,295.10
|
| Rate for Payer: First Health Workers Compensation |
$555.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,295.10
|
| Rate for Payer: GEHA Commercial |
$1,151.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,295.10
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,309.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,007.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,295.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,367.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,079.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,338.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$575.60
|
| 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 |
$392.85
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,731.00
|
|
|
Service Code
|
CPT 29883
|
| Hospital Charge Code |
6129883
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$472.56 |
| Max. Negotiated Rate |
$1,644.45 |
| Rate for Payer: Cash Price |
$1,038.60
|
| Rate for Payer: Cigna Commercial |
$1,471.35
|
| Rate for Payer: First Health Commercial |
$1,557.90
|
| Rate for Payer: First Health Workers Compensation |
$668.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,557.90
|
| Rate for Payer: GEHA Commercial |
$1,211.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,557.90
|
| Rate for Payer: Multiplan All |
$1,575.21
|
| Rate for Payer: OMNI Networks Commercial |
$1,211.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,557.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,644.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,298.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,609.83
|
| Rate for Payer: Zelis Auto |
$692.40
|
| Rate for Payer: Zelis Worker's Compensation |
$472.56
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,351.00
|
|
|
Service Code
|
CPT 29876
|
| Hospital Charge Code |
6129876
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$368.82 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$810.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cigna Commercial |
$1,148.35
|
| Rate for Payer: First Health Commercial |
$1,215.90
|
| Rate for Payer: First Health Workers Compensation |
$521.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,215.90
|
| Rate for Payer: GEHA Commercial |
$1,080.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,215.90
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,229.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$945.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,215.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,283.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,013.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,256.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$540.40
|
| 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 |
$368.82
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
CPT 29880
|
| Hospital Charge Code |
6129880
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$313.95 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$690.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$977.50
|
| Rate for Payer: First Health Commercial |
$1,035.00
|
| Rate for Payer: First Health Workers Compensation |
$444.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,035.00
|
| Rate for Payer: GEHA Commercial |
$920.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,035.00
|
| 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 |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,046.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$805.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,035.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,092.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$862.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,069.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$460.00
|
| 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 |
$313.95
|
|
