|
ARTHROCENT ASPIR&/INJ SM JT/BURSA W/O US
|
Facility
|
OP
|
$150.69
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
8520600
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$41.14 |
| Max. Negotiated Rate |
$572.06 |
| Rate for Payer: Cigna Commercial |
$128.09
|
| Rate for Payer: First Health Commercial |
$135.62
|
| 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 |
$90.41
|
| 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 |
$286.03
|
| Rate for Payer: Cash Price |
$90.41
|
| Rate for Payer: Cash Price |
$90.41
|
| Rate for Payer: First Health Workers Compensation |
$58.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.62
|
| Rate for Payer: GEHA Commercial |
$120.55
|
| Rate for Payer: GEHA Medicare |
$286.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.62
|
| Rate for Payer: Humana ChoiceCare |
$314.63
|
| Rate for Payer: Humana Medicare Advantage |
$286.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$480.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$286.03
|
| Rate for Payer: Multiplan All |
$137.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$486.25
|
| Rate for Payer: OMNI Networks Commercial |
$105.48
|
| Rate for Payer: One Health Plan PPO/POS |
$135.62
|
| 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 |
$286.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.16
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$572.06
|
| Rate for Payer: Three Rivers Provider Network All |
$113.02
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$280.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$286.03
|
| Rate for Payer: Zelis Auto |
$60.28
|
| Rate for Payer: Zelis Medicare |
$243.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.24
|
| Rate for Payer: Zelis Worker's Compensation |
$41.14
|
|
|
ARTHROCENT ASPIR&/INJ SM JT/BURSA W/O US
|
Facility
|
OP
|
$1,435.27
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
9620600
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$204.72 |
| Max. Negotiated Rate |
$1,363.51 |
| 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 |
$861.16
|
| 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 |
$286.03
|
| Rate for Payer: Cash Price |
$861.16
|
| Rate for Payer: Cash Price |
$861.16
|
| Rate for Payer: Cigna Commercial |
$1,219.98
|
| Rate for Payer: First Health Commercial |
$1,291.74
|
| Rate for Payer: First Health Workers Compensation |
$554.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,291.74
|
| Rate for Payer: GEHA Commercial |
$1,148.22
|
| Rate for Payer: GEHA Medicare |
$286.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,291.74
|
| Rate for Payer: Humana ChoiceCare |
$314.63
|
| Rate for Payer: Humana Medicare Advantage |
$286.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$480.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$286.03
|
| Rate for Payer: Multiplan All |
$1,306.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$486.25
|
| Rate for Payer: OMNI Networks Commercial |
$1,004.69
|
| Rate for Payer: One Health Plan PPO/POS |
$1,291.74
|
| 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 |
$286.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,363.51
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$572.06
|
| Rate for Payer: Three Rivers Provider Network All |
$1,076.45
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$280.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,334.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$286.03
|
| Rate for Payer: Zelis Auto |
$574.11
|
| Rate for Payer: Zelis Medicare |
$243.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.24
|
| Rate for Payer: Zelis Worker's Compensation |
$391.83
|
|
|
ARTHROCENT ASPIR&/INJ SM JT/BURSA W/O US
|
Facility
|
OP
|
$150.69
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
7220600
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$41.14 |
| Max. Negotiated Rate |
$572.06 |
| 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 |
$90.41
|
| 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 |
$286.03
|
| Rate for Payer: Cash Price |
$90.41
|
| Rate for Payer: Cash Price |
$90.41
|
| Rate for Payer: Cigna Commercial |
$128.09
|
| Rate for Payer: First Health Commercial |
$135.62
|
| Rate for Payer: First Health Workers Compensation |
$58.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.62
|
| Rate for Payer: GEHA Commercial |
$120.55
|
| Rate for Payer: GEHA Medicare |
$286.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.62
|
| Rate for Payer: Humana ChoiceCare |
$314.63
|
| Rate for Payer: Humana Medicare Advantage |
$286.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$480.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$286.03
|
| Rate for Payer: Multiplan All |
$137.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$486.25
|
| Rate for Payer: OMNI Networks Commercial |
$105.48
|
| Rate for Payer: One Health Plan PPO/POS |
$135.62
|
| 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 |
$286.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.16
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$572.06
|
| Rate for Payer: Three Rivers Provider Network All |
$113.02
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$280.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$286.03
|
| Rate for Payer: Zelis Auto |
$60.28
|
| Rate for Payer: Zelis Medicare |
$243.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.24
|
| Rate for Payer: Zelis Worker's Compensation |
$41.14
|
|
|
ARTHROCENT ASPIR&/INJ SM JT/BURSA W/O US
|
Facility
|
OP
|
$150.69
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
6120600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$41.14 |
| Max. Negotiated Rate |
$572.06 |
| 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 |
$90.41
|
| 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 |
$286.03
|
| Rate for Payer: Cash Price |
$90.41
|
| Rate for Payer: Cash Price |
$90.41
|
| Rate for Payer: Cigna Commercial |
$128.09
|
| Rate for Payer: First Health Commercial |
$135.62
|
| Rate for Payer: First Health Workers Compensation |
$58.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.62
|
| Rate for Payer: GEHA Commercial |
$120.55
|
| Rate for Payer: GEHA Medicare |
$286.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.62
|
| Rate for Payer: Humana ChoiceCare |
$314.63
|
| Rate for Payer: Humana Medicare Advantage |
$286.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$480.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$286.03
|
| Rate for Payer: Multiplan All |
$137.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$486.25
|
| Rate for Payer: OMNI Networks Commercial |
$105.48
|
| Rate for Payer: One Health Plan PPO/POS |
$135.62
|
| 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 |
$286.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.16
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$572.06
|
| Rate for Payer: Three Rivers Provider Network All |
$113.02
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$280.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$286.03
|
| Rate for Payer: Zelis Auto |
$60.28
|
| Rate for Payer: Zelis Medicare |
$243.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.24
|
| Rate for Payer: Zelis Worker's Compensation |
$41.14
|
|
|
ARTHROCENT ASPIR&/INJ SM JT/BURSA W/O US
|
Facility
|
OP
|
$1,238.00
|
|
| Hospital Charge Code |
8150061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$309.50 |
| Max. Negotiated Rate |
$1,176.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$742.80
|
| Rate for Payer: Cash Price |
$742.80
|
| Rate for Payer: Cigna Commercial |
$1,052.30
|
| Rate for Payer: First Health Commercial |
$1,114.20
|
| Rate for Payer: First Health Workers Compensation |
$477.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,114.20
|
| Rate for Payer: GEHA Commercial |
$990.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,114.20
|
| Rate for Payer: Humana ChoiceCare |
$321.88
|
| Rate for Payer: Multiplan All |
$1,126.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$742.80
|
| Rate for Payer: OMNI Networks Commercial |
$866.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,114.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,176.10
|
| Rate for Payer: Three Rivers Provider Network All |
$928.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,089.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$309.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,151.34
|
| Rate for Payer: Zelis Auto |
$495.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$619.00
|
| Rate for Payer: Zelis Worker's Compensation |
$337.97
|
|
|
ARTHROCENT ASPIR&/INJ SM JT/BURSA W/O US
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
8720600
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$572.06 |
| 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 |
$88.80
|
| 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 |
$286.03
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cigna Commercial |
$125.80
|
| Rate for Payer: First Health Commercial |
$133.20
|
| Rate for Payer: First Health Workers Compensation |
$57.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$133.20
|
| Rate for Payer: GEHA Commercial |
$118.40
|
| Rate for Payer: GEHA Medicare |
$286.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$133.20
|
| Rate for Payer: Humana ChoiceCare |
$314.63
|
| Rate for Payer: Humana Medicare Advantage |
$286.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$480.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$286.03
|
| Rate for Payer: Multiplan All |
$134.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$486.25
|
| Rate for Payer: OMNI Networks Commercial |
$103.60
|
| Rate for Payer: One Health Plan PPO/POS |
$133.20
|
| 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 |
$286.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$140.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$572.06
|
| Rate for Payer: Three Rivers Provider Network All |
$111.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$280.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$137.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$286.03
|
| Rate for Payer: Zelis Auto |
$59.20
|
| Rate for Payer: Zelis Medicare |
$243.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.24
|
| Rate for Payer: Zelis Worker's Compensation |
$40.40
|
|
|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, INTERMEDIATE JOINT OR BURSA (EG, TEMPOROMANDIBULAR, ACROMIOCLAVICULAR, WRIST, ELBOW OR ANKLE, OLECRANON BURSA); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$572.06
|
|
|
Service Code
|
CPT 20605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$204.72 |
| Max. Negotiated Rate |
$572.06 |
| 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 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 |
$286.03
|
| Rate for Payer: First Health Workers Compensation |
$368.12
|
| Rate for Payer: GEHA Medicare |
$286.03
|
| Rate for Payer: Humana ChoiceCare |
$314.63
|
| Rate for Payer: Humana Medicare Advantage |
$286.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$480.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$286.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$486.25
|
| 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 |
$286.03
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$572.06
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$280.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$286.03
|
| Rate for Payer: Zelis Medicare |
$243.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.24
|
| Rate for Payer: Zelis Worker's Compensation |
$260.29
|
|
|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$572.06
|
|
|
Service Code
|
CPT 20610
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$204.72 |
| Max. Negotiated Rate |
$572.06 |
| 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 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 |
$286.03
|
| Rate for Payer: First Health Workers Compensation |
$368.12
|
| Rate for Payer: GEHA Medicare |
$286.03
|
| Rate for Payer: Humana ChoiceCare |
$314.63
|
| Rate for Payer: Humana Medicare Advantage |
$286.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$480.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$286.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$486.25
|
| 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 |
$286.03
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$572.06
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$280.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$286.03
|
| Rate for Payer: Zelis Medicare |
$243.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.24
|
| Rate for Payer: Zelis Worker's Compensation |
$260.29
|
|
|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, SMALL JOINT OR BURSA (EG, FINGERS, TOES); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$572.06
|
|
|
Service Code
|
CPT 20600
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$204.72 |
| Max. Negotiated Rate |
$572.06 |
| 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 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 |
$286.03
|
| Rate for Payer: First Health Workers Compensation |
$368.12
|
| Rate for Payer: GEHA Medicare |
$286.03
|
| Rate for Payer: Humana ChoiceCare |
$314.63
|
| Rate for Payer: Humana Medicare Advantage |
$286.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$480.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$286.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$486.25
|
| 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 |
$286.03
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$572.06
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$280.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$286.03
|
| Rate for Payer: Zelis Medicare |
$243.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.24
|
| Rate for Payer: Zelis Worker's Compensation |
$260.29
|
|
|
ARTHROCNT ASPIR&/INJ INTERM JT/BURS W/O
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
8820605
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$572.06 |
| Rate for Payer: Cigna Commercial |
$130.90
|
| Rate for Payer: First Health Commercial |
$138.60
|
| Rate for Payer: First Health Workers Compensation |
$59.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$138.60
|
| Rate for Payer: GEHA Commercial |
$123.20
|
| Rate for Payer: GEHA Medicare |
$286.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$138.60
|
| Rate for Payer: Humana ChoiceCare |
$314.63
|
| Rate for Payer: Humana Medicare Advantage |
$286.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$480.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$286.03
|
| Rate for Payer: Multiplan All |
$140.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$486.25
|
| Rate for Payer: OMNI Networks Commercial |
$107.80
|
| Rate for Payer: One Health Plan PPO/POS |
$138.60
|
| 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 |
$286.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$146.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$572.06
|
| Rate for Payer: Three Rivers Provider Network All |
$115.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$280.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$143.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$286.03
|
| Rate for Payer: Zelis Auto |
$61.60
|
| Rate for Payer: Zelis Medicare |
$243.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.24
|
| Rate for Payer: Zelis Worker's Compensation |
$42.04
|
| 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 |
$92.40
|
| 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 |
$286.03
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
|
|
ARTHROCNT ASPIR&/INJ INTERM JT/BURS W/O
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
8720605
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$572.06 |
| 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 |
$92.40
|
| 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 |
$286.03
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$130.90
|
| Rate for Payer: First Health Commercial |
$138.60
|
| Rate for Payer: First Health Workers Compensation |
$59.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$138.60
|
| Rate for Payer: GEHA Commercial |
$123.20
|
| Rate for Payer: GEHA Medicare |
$286.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$138.60
|
| Rate for Payer: Humana ChoiceCare |
$314.63
|
| Rate for Payer: Humana Medicare Advantage |
$286.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$480.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$286.03
|
| Rate for Payer: Multiplan All |
$140.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$486.25
|
| Rate for Payer: OMNI Networks Commercial |
$107.80
|
| Rate for Payer: One Health Plan PPO/POS |
$138.60
|
| 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 |
$286.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$146.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$572.06
|
| Rate for Payer: Three Rivers Provider Network All |
$115.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$280.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$143.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$286.03
|
| Rate for Payer: Zelis Auto |
$61.60
|
| Rate for Payer: Zelis Medicare |
$243.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.24
|
| Rate for Payer: Zelis Worker's Compensation |
$42.04
|
|
|
ARTHROCNT ASPIR&/INJ INTERM JT/BURS W/O
|
Facility
|
OP
|
$153.51
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
8520605
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$41.91 |
| Max. Negotiated Rate |
$572.06 |
| 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 |
$92.11
|
| 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 |
$286.03
|
| Rate for Payer: Cash Price |
$92.11
|
| Rate for Payer: Cash Price |
$92.11
|
| Rate for Payer: Cigna Commercial |
$130.48
|
| Rate for Payer: First Health Commercial |
$138.16
|
| Rate for Payer: First Health Workers Compensation |
$59.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$138.16
|
| Rate for Payer: GEHA Commercial |
$122.81
|
| Rate for Payer: GEHA Medicare |
$286.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$138.16
|
| Rate for Payer: Humana ChoiceCare |
$314.63
|
| Rate for Payer: Humana Medicare Advantage |
$286.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$480.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$286.03
|
| Rate for Payer: Multiplan All |
$139.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$486.25
|
| Rate for Payer: OMNI Networks Commercial |
$107.46
|
| Rate for Payer: One Health Plan PPO/POS |
$138.16
|
| 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 |
$286.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$145.83
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$572.06
|
| Rate for Payer: Three Rivers Provider Network All |
$115.13
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$280.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$142.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$286.03
|
| Rate for Payer: Zelis Auto |
$61.40
|
| Rate for Payer: Zelis Medicare |
$243.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.24
|
| Rate for Payer: Zelis Worker's Compensation |
$41.91
|
|
|
ARTHROCNT ASPIR&/INJ INTERM JT/BURS W/O
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
8720605
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$130.90
|
| Rate for Payer: First Health Commercial |
$138.60
|
| Rate for Payer: First Health Workers Compensation |
$59.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$138.60
|
| Rate for Payer: GEHA Commercial |
$107.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$138.60
|
| Rate for Payer: Multiplan All |
$140.14
|
| Rate for Payer: OMNI Networks Commercial |
$107.80
|
| Rate for Payer: One Health Plan PPO/POS |
$138.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$146.30
|
| Rate for Payer: Three Rivers Provider Network All |
$115.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$143.22
|
| Rate for Payer: Zelis Auto |
$61.60
|
| Rate for Payer: Zelis Worker's Compensation |
$42.04
|
|
|
ARTHROCNT ASPIR&/INJ INTERM JT/BURS W/O
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
21600032
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$572.06 |
| 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 |
$92.40
|
| 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 |
$286.03
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$130.90
|
| Rate for Payer: First Health Commercial |
$138.60
|
| Rate for Payer: First Health Workers Compensation |
$59.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$138.60
|
| Rate for Payer: GEHA Commercial |
$123.20
|
| Rate for Payer: GEHA Medicare |
$286.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$138.60
|
| Rate for Payer: Humana ChoiceCare |
$314.63
|
| Rate for Payer: Humana Medicare Advantage |
$286.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$480.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$286.03
|
| Rate for Payer: Multiplan All |
$140.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$486.25
|
| Rate for Payer: OMNI Networks Commercial |
$107.80
|
| Rate for Payer: One Health Plan PPO/POS |
$138.60
|
| 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 |
$286.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$146.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$572.06
|
| Rate for Payer: Three Rivers Provider Network All |
$115.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$280.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$143.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$286.03
|
| Rate for Payer: Zelis Auto |
$61.60
|
| Rate for Payer: Zelis Medicare |
$243.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.24
|
| Rate for Payer: Zelis Worker's Compensation |
$42.04
|
|
|
ARTHROCNT ASPIR&/INJ INTERM JT/BURS W/O
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
25500032
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$130.90
|
| Rate for Payer: First Health Commercial |
$138.60
|
| Rate for Payer: First Health Workers Compensation |
$59.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$138.60
|
| Rate for Payer: GEHA Commercial |
$107.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$138.60
|
| Rate for Payer: Multiplan All |
$140.14
|
| Rate for Payer: OMNI Networks Commercial |
$107.80
|
| Rate for Payer: One Health Plan PPO/POS |
$138.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$146.30
|
| Rate for Payer: Three Rivers Provider Network All |
$115.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$143.22
|
| Rate for Payer: Zelis Auto |
$61.60
|
| Rate for Payer: Zelis Worker's Compensation |
$42.04
|
|
|
ARTHROCNT ASPIR&/INJ INTERM JT/BURS W/O
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
7620605
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$130.90
|
| Rate for Payer: First Health Commercial |
$138.60
|
| Rate for Payer: First Health Workers Compensation |
$59.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$138.60
|
| Rate for Payer: GEHA Commercial |
$107.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$138.60
|
| Rate for Payer: Multiplan All |
$140.14
|
| Rate for Payer: OMNI Networks Commercial |
$107.80
|
| Rate for Payer: One Health Plan PPO/POS |
$138.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$146.30
|
| Rate for Payer: Three Rivers Provider Network All |
$115.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$143.22
|
| Rate for Payer: Zelis Auto |
$61.60
|
| Rate for Payer: Zelis Worker's Compensation |
$42.04
|
|
|
ARTHROCNT ASPIR&/INJ INTERM JT/BURS W/O
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
25500032
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$572.06 |
| 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 |
$92.40
|
| 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 |
$286.03
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$130.90
|
| Rate for Payer: First Health Commercial |
$138.60
|
| Rate for Payer: First Health Workers Compensation |
$59.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$138.60
|
| Rate for Payer: GEHA Commercial |
$123.20
|
| Rate for Payer: GEHA Medicare |
$286.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$138.60
|
| Rate for Payer: Humana ChoiceCare |
$314.63
|
| Rate for Payer: Humana Medicare Advantage |
$286.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$480.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$286.03
|
| Rate for Payer: Multiplan All |
$140.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$486.25
|
| Rate for Payer: OMNI Networks Commercial |
$107.80
|
| Rate for Payer: One Health Plan PPO/POS |
$138.60
|
| 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 |
$286.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$146.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$572.06
|
| Rate for Payer: Three Rivers Provider Network All |
$115.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$280.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$143.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$286.03
|
| Rate for Payer: Zelis Auto |
$61.60
|
| Rate for Payer: Zelis Medicare |
$243.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.24
|
| Rate for Payer: Zelis Worker's Compensation |
$42.04
|
|
|
ARTHROCNT ASPIR&/INJ INTERM JT/BURS W/O
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
21600032
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$130.90
|
| Rate for Payer: First Health Commercial |
$138.60
|
| Rate for Payer: First Health Workers Compensation |
$59.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$138.60
|
| Rate for Payer: GEHA Commercial |
$107.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$138.60
|
| Rate for Payer: Multiplan All |
$140.14
|
| Rate for Payer: OMNI Networks Commercial |
$107.80
|
| Rate for Payer: One Health Plan PPO/POS |
$138.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$146.30
|
| Rate for Payer: Three Rivers Provider Network All |
$115.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$143.22
|
| Rate for Payer: Zelis Auto |
$61.60
|
| Rate for Payer: Zelis Worker's Compensation |
$42.04
|
|
|
ARTHROCNT ASPIR&/INJ INTERM JT/BURS W/O
|
Facility
|
IP
|
$1,124.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
9620605
|
|
Hospital Revenue Code
|
510
|
| 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
|
|
|
ARTHROCNT ASPIR&/INJ INTERM JT/BURS W/O
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
20300060
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$572.06 |
| 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 |
$92.40
|
| 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 |
$286.03
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$130.90
|
| Rate for Payer: First Health Commercial |
$138.60
|
| Rate for Payer: First Health Workers Compensation |
$59.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$138.60
|
| Rate for Payer: GEHA Commercial |
$123.20
|
| Rate for Payer: GEHA Medicare |
$286.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$138.60
|
| Rate for Payer: Humana ChoiceCare |
$314.63
|
| Rate for Payer: Humana Medicare Advantage |
$286.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$480.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$286.03
|
| Rate for Payer: Multiplan All |
$140.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$486.25
|
| Rate for Payer: OMNI Networks Commercial |
$107.80
|
| Rate for Payer: One Health Plan PPO/POS |
$138.60
|
| 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 |
$286.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$146.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$572.06
|
| Rate for Payer: Three Rivers Provider Network All |
$115.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$280.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$143.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$286.03
|
| Rate for Payer: Zelis Auto |
$61.60
|
| Rate for Payer: Zelis Medicare |
$243.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.24
|
| Rate for Payer: Zelis Worker's Compensation |
$42.04
|
|
|
ARTHROCNT ASPIR&/INJ INTERM JT/BURS W/O
|
Facility
|
IP
|
$1,015.00
|
|
| Hospital Charge Code |
8150062
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$277.10 |
| Max. Negotiated Rate |
$964.25 |
| Rate for Payer: Cash Price |
$609.00
|
| Rate for Payer: Cigna Commercial |
$862.75
|
| Rate for Payer: First Health Commercial |
$913.50
|
| Rate for Payer: First Health Workers Compensation |
$391.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$913.50
|
| Rate for Payer: GEHA Commercial |
$710.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$913.50
|
| Rate for Payer: Multiplan All |
$923.65
|
| Rate for Payer: OMNI Networks Commercial |
$710.50
|
| Rate for Payer: One Health Plan PPO/POS |
$913.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$964.25
|
| Rate for Payer: Three Rivers Provider Network All |
$761.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$943.95
|
| Rate for Payer: Zelis Auto |
$406.00
|
| Rate for Payer: Zelis Worker's Compensation |
$277.10
|
|
|
ARTHROCNT ASPIR&/INJ INTERM JT/BURS W/O
|
Facility
|
OP
|
$153.51
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
7220605
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$41.91 |
| Max. Negotiated Rate |
$572.06 |
| Rate for Payer: Cigna Commercial |
$130.48
|
| Rate for Payer: First Health Commercial |
$138.16
|
| 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 |
$92.11
|
| 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 |
$286.03
|
| Rate for Payer: Cash Price |
$92.11
|
| Rate for Payer: Cash Price |
$92.11
|
| Rate for Payer: First Health Workers Compensation |
$59.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$138.16
|
| Rate for Payer: GEHA Commercial |
$122.81
|
| Rate for Payer: GEHA Medicare |
$286.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$138.16
|
| Rate for Payer: Humana ChoiceCare |
$314.63
|
| Rate for Payer: Humana Medicare Advantage |
$286.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$480.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$286.03
|
| Rate for Payer: Multiplan All |
$139.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$486.25
|
| Rate for Payer: OMNI Networks Commercial |
$107.46
|
| Rate for Payer: One Health Plan PPO/POS |
$138.16
|
| 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 |
$286.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$145.83
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$572.06
|
| Rate for Payer: Three Rivers Provider Network All |
$115.13
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$280.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$142.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$286.03
|
| Rate for Payer: Zelis Auto |
$61.40
|
| Rate for Payer: Zelis Medicare |
$243.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.24
|
| Rate for Payer: Zelis Worker's Compensation |
$41.91
|
|
|
ARTHROCNT ASPIR&/INJ INTERM JT/BURS W/O
|
Facility
|
IP
|
$1,015.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
1000042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.10 |
| Max. Negotiated Rate |
$964.25 |
| Rate for Payer: Cash Price |
$609.00
|
| Rate for Payer: Cigna Commercial |
$862.75
|
| Rate for Payer: First Health Commercial |
$913.50
|
| Rate for Payer: First Health Workers Compensation |
$391.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$913.50
|
| Rate for Payer: GEHA Commercial |
$710.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$913.50
|
| Rate for Payer: Multiplan All |
$923.65
|
| Rate for Payer: OMNI Networks Commercial |
$710.50
|
| Rate for Payer: One Health Plan PPO/POS |
$913.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$964.25
|
| Rate for Payer: Three Rivers Provider Network All |
$761.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$943.95
|
| Rate for Payer: Zelis Auto |
$406.00
|
| Rate for Payer: Zelis Worker's Compensation |
$277.10
|
|
|
ARTHROCNT ASPIR&/INJ INTERM JT/BURS W/O
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
8220605
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$572.06 |
| 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 |
$92.40
|
| 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 |
$286.03
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$130.90
|
| Rate for Payer: First Health Commercial |
$138.60
|
| Rate for Payer: First Health Workers Compensation |
$59.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$138.60
|
| Rate for Payer: GEHA Commercial |
$123.20
|
| Rate for Payer: GEHA Medicare |
$286.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$138.60
|
| Rate for Payer: Humana ChoiceCare |
$314.63
|
| Rate for Payer: Humana Medicare Advantage |
$286.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$480.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$286.03
|
| Rate for Payer: Multiplan All |
$140.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$486.25
|
| Rate for Payer: OMNI Networks Commercial |
$107.80
|
| Rate for Payer: One Health Plan PPO/POS |
$138.60
|
| 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 |
$286.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$146.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$572.06
|
| Rate for Payer: Three Rivers Provider Network All |
$115.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$280.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$143.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$286.03
|
| Rate for Payer: Zelis Auto |
$61.60
|
| Rate for Payer: Zelis Medicare |
$243.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$343.24
|
| Rate for Payer: Zelis Worker's Compensation |
$42.04
|
|
|
ARTHROCNT ASPIR&/INJ INTERM JT/BURS W/O
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
8820605
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$130.90
|
| Rate for Payer: First Health Commercial |
$138.60
|
| Rate for Payer: First Health Workers Compensation |
$59.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$138.60
|
| Rate for Payer: GEHA Commercial |
$107.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$138.60
|
| Rate for Payer: Multiplan All |
$140.14
|
| Rate for Payer: OMNI Networks Commercial |
$107.80
|
| Rate for Payer: One Health Plan PPO/POS |
$138.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$146.30
|
| Rate for Payer: Three Rivers Provider Network All |
$115.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$143.22
|
| Rate for Payer: Zelis Auto |
$61.60
|
| Rate for Payer: Zelis Worker's Compensation |
$42.04
|
|
