|
ARTHRODSIS SI JT OPN W/OBTN B1 GRF INSTR
|
Facility
|
IP
|
$2,851.00
|
|
|
Service Code
|
CPT 27280
|
| Hospital Charge Code |
6127280
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$778.32 |
| Max. Negotiated Rate |
$2,708.45 |
| Rate for Payer: Cash Price |
$1,710.60
|
| Rate for Payer: Cigna Commercial |
$2,423.35
|
| Rate for Payer: First Health Commercial |
$2,565.90
|
| Rate for Payer: First Health Workers Compensation |
$1,100.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,565.90
|
| Rate for Payer: GEHA Commercial |
$1,995.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,565.90
|
| Rate for Payer: Multiplan All |
$2,594.41
|
| Rate for Payer: OMNI Networks Commercial |
$1,995.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,565.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,708.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,138.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,651.43
|
| Rate for Payer: Zelis Auto |
$1,140.40
|
| Rate for Payer: Zelis Worker's Compensation |
$778.32
|
|
|
ARTHRODSIS SI JT OPN W/OBTN B1 GRF INSTR
|
Facility
|
OP
|
$2,851.00
|
|
|
Service Code
|
CPT 27280
|
| Hospital Charge Code |
6127280
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$712.75 |
| Max. Negotiated Rate |
$2,708.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,710.60
|
| Rate for Payer: Cash Price |
$1,710.60
|
| Rate for Payer: Cigna Commercial |
$2,423.35
|
| Rate for Payer: First Health Commercial |
$2,565.90
|
| Rate for Payer: First Health Workers Compensation |
$1,100.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,565.90
|
| Rate for Payer: GEHA Commercial |
$2,280.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,565.90
|
| Rate for Payer: Humana ChoiceCare |
$741.26
|
| Rate for Payer: Multiplan All |
$2,594.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,710.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,995.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,565.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,708.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,138.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,508.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$712.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,651.43
|
| Rate for Payer: Zelis Auto |
$1,140.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,425.50
|
| Rate for Payer: Zelis Worker's Compensation |
$778.32
|
|
|
ARTHROPLASTY, ACETABULAR AND PROXIMAL FEMORAL PROSTHETIC REPLACEMENT (TOTAL HIP ARTHROPLASTY), WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT
|
Facility
|
OP
|
$24,935.38
|
|
|
Service Code
|
CPT 27130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,597.54 |
| Max. Negotiated Rate |
$24,935.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17,851.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17,851.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14,141.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,467.69
|
| Rate for Payer: First Health Workers Compensation |
$16,045.92
|
| Rate for Payer: GEHA Medicare |
$12,467.69
|
| Rate for Payer: Humana ChoiceCare |
$13,714.46
|
| Rate for Payer: Humana Medicare Advantage |
$12,467.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,945.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$14,429.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,467.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21,195.07
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$16,660.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$14,429.61
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,467.69
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,935.38
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,218.34
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14,429.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,467.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,467.69
|
| Rate for Payer: Zelis Medicare |
$10,597.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,961.23
|
| Rate for Payer: Zelis Worker's Compensation |
$11,345.60
|
|
|
ARTHROPLASTY, GLENOHUMERAL JOINT; TOTAL SHOULDER (GLENOID AND PROXIMAL HUMERAL REPLACEMENT (EG, TOTAL SHOULDER))
|
Facility
|
OP
|
$35,639.18
|
|
|
Service Code
|
CPT 23472
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$15,146.65 |
| Max. Negotiated Rate |
$35,639.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$26,634.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$26,634.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21,099.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17,819.59
|
| Rate for Payer: First Health Workers Compensation |
$22,933.81
|
| Rate for Payer: GEHA Medicare |
$17,819.59
|
| Rate for Payer: Humana ChoiceCare |
$19,601.55
|
| Rate for Payer: Humana Medicare Advantage |
$17,819.59
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29,936.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21,529.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,819.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30,293.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$24,858.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21,529.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17,819.59
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$35,639.18
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17,463.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21,529.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,819.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17,819.59
|
| Rate for Payer: Zelis Medicare |
$15,146.65
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21,383.51
|
| Rate for Payer: Zelis Worker's Compensation |
$16,215.83
|
|
|
ARTHROPLASTY, INTERCARPAL OR CARPOMETACARPAL JOINTS; INTERPOSITION (EG, TENDON)
|
Facility
|
OP
|
$6,287.92
|
|
|
Service Code
|
CPT 25447
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,672.37 |
| Max. Negotiated Rate |
$6,287.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,033.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,033.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,194.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: First Health Workers Compensation |
$4,046.28
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,260.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,764.14
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,260.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,260.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$2,861.00
|
|
|
ARTHROPLASTY, INTERCARPAL OR CARPOMETACARPAL JOINTS; SUSPENSION, INCLUDING TRANSFER OR TRANSPLANT OF TENDON, WITH INTERPOSITION, WHEN PERFORMED
|
Facility
|
OP
|
$6,287.92
|
|
|
Service Code
|
CPT 25448
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,672.37 |
| Max. Negotiated Rate |
$6,287.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,866.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,866.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,855.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: First Health Workers Compensation |
$4,046.28
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,934.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,542.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,934.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,934.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$2,861.00
|
|
|
ARTHROPLASTY, INTERCARPAL OR CMC JOINTS;
|
Facility
|
OP
|
$2,554.29
|
|
|
Service Code
|
CPT 25448
|
| Hospital Charge Code |
6125448
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$697.32 |
| Max. Negotiated Rate |
$6,287.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,866.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,532.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,866.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,855.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: Cash Price |
$1,532.57
|
| Rate for Payer: Cash Price |
$1,532.57
|
| Rate for Payer: Cigna Commercial |
$2,171.15
|
| Rate for Payer: First Health Commercial |
$2,298.86
|
| Rate for Payer: First Health Workers Compensation |
$986.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,298.86
|
| Rate for Payer: GEHA Commercial |
$2,043.43
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,298.86
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,934.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$2,324.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$1,788.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,298.86
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,542.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,934.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,426.58
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,915.72
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,934.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,375.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$1,021.72
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$697.32
|
|
|
ARTHROPLASTY, INTERCARPAL OR CMC JOINTS;
|
Facility
|
IP
|
$2,554.29
|
|
|
Service Code
|
CPT 25448
|
| Hospital Charge Code |
6125448
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$697.32 |
| Max. Negotiated Rate |
$2,426.58 |
| Rate for Payer: Cash Price |
$1,532.57
|
| Rate for Payer: Cigna Commercial |
$2,171.15
|
| Rate for Payer: First Health Commercial |
$2,298.86
|
| Rate for Payer: First Health Workers Compensation |
$986.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,298.86
|
| Rate for Payer: GEHA Commercial |
$1,788.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,298.86
|
| Rate for Payer: Multiplan All |
$2,324.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,788.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,298.86
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,426.58
|
| Rate for Payer: Three Rivers Provider Network All |
$1,915.72
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,375.49
|
| Rate for Payer: Zelis Auto |
$1,021.72
|
| Rate for Payer: Zelis Worker's Compensation |
$697.32
|
|
|
ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS WITH OR WITHOUT PATELLA RESURFACING (TOTAL KNEE ARTHROPLASTY)
|
Facility
|
OP
|
$24,935.38
|
|
|
Service Code
|
CPT 27447
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,597.54 |
| Max. Negotiated Rate |
$24,935.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$14,728.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$14,728.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$11,668.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,467.69
|
| Rate for Payer: First Health Workers Compensation |
$16,045.92
|
| Rate for Payer: GEHA Medicare |
$12,467.69
|
| Rate for Payer: Humana ChoiceCare |
$13,714.46
|
| Rate for Payer: Humana Medicare Advantage |
$12,467.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,945.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11,905.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,467.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21,195.07
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13,746.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11,905.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,467.69
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,935.38
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,218.34
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11,905.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,467.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,467.69
|
| Rate for Payer: Zelis Medicare |
$10,597.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,961.23
|
| Rate for Payer: Zelis Worker's Compensation |
$11,345.60
|
|
|
ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL OR LATERAL COMPARTMENT
|
Facility
|
OP
|
$24,935.38
|
|
|
Service Code
|
CPT 27446
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,513.07 |
| Max. Negotiated Rate |
$24,935.38 |
| Rate for Payer: Humana Medicare Advantage |
$12,467.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$12,008.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$12,008.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9,513.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,467.69
|
| Rate for Payer: First Health Workers Compensation |
$16,045.92
|
| Rate for Payer: GEHA Medicare |
$12,467.69
|
| Rate for Payer: Humana ChoiceCare |
$13,714.46
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,945.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9,706.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,467.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21,195.07
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11,207.85
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9,706.80
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,467.69
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,935.38
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,218.34
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9,706.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,467.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,467.69
|
| Rate for Payer: Zelis Medicare |
$10,597.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,961.23
|
| Rate for Payer: Zelis Worker's Compensation |
$11,345.60
|
|
|
ARTHROPLASTY, RADIAL HEAD; WITH IMPLANT
|
Facility
|
OP
|
$24,935.38
|
|
|
Service Code
|
CPT 24366
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,513.07 |
| Max. Negotiated Rate |
$24,935.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$12,008.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$12,008.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9,513.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,467.69
|
| Rate for Payer: First Health Workers Compensation |
$16,045.92
|
| Rate for Payer: GEHA Medicare |
$12,467.69
|
| Rate for Payer: Humana ChoiceCare |
$13,714.46
|
| Rate for Payer: Humana Medicare Advantage |
$12,467.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,945.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9,706.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,467.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21,195.07
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11,207.85
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9,706.80
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,467.69
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,935.38
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,218.34
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9,706.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,467.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,467.69
|
| Rate for Payer: Zelis Medicare |
$10,597.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,961.23
|
| Rate for Payer: Zelis Worker's Compensation |
$11,345.60
|
|
|
ARTHROSCOPICALLY AIDED ANTERIOR CRUCIATE LIGAMENT REPAIR/AUGMENTATION OR RECONSTRUCTION
|
Facility
|
OP
|
$13,844.26
|
|
|
Service Code
|
CPT 29888
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,883.81 |
| Max. Negotiated Rate |
$13,844.26 |
| 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 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 |
$6,922.13
|
| Rate for Payer: First Health Workers Compensation |
$8,908.78
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| 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 |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$6,299.14
|
|
|
ARTHROSCOPICALLY AIDED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); BICONDYLAR, INCLUDES INTERNAL FIXATION, WHEN PERFORMED (INCLUDES ARTHROSCOPY)
|
Facility
|
OP
|
$24,935.38
|
|
|
Service Code
|
CPT 29856
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,910.22 |
| Max. Negotiated Rate |
$24,935.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,910.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,467.69
|
| Rate for Payer: First Health Workers Compensation |
$16,045.92
|
| Rate for Payer: GEHA Medicare |
$12,467.69
|
| Rate for Payer: Humana ChoiceCare |
$13,714.46
|
| Rate for Payer: Humana Medicare Advantage |
$12,467.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,945.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,989.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,467.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21,195.07
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,606.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,989.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,467.69
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,935.38
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,218.34
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,989.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,467.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,467.69
|
| Rate for Payer: Zelis Medicare |
$10,597.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,961.23
|
| Rate for Payer: Zelis Worker's Compensation |
$11,345.60
|
|
|
ARTHROSCOP ROTATOR CUFF REPR
|
Facility
|
OP
|
$2,169.00
|
|
|
Service Code
|
CPT 29827
|
| Hospital Charge Code |
6129827
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$592.14 |
| Max. Negotiated Rate |
$13,844.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,301.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,910.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,922.13
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Cigna Commercial |
$1,843.65
|
| Rate for Payer: First Health Commercial |
$1,952.10
|
| Rate for Payer: First Health Workers Compensation |
$837.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,952.10
|
| Rate for Payer: GEHA Commercial |
$1,735.20
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,952.10
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,989.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,973.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,518.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,952.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,606.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,989.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,060.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,626.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,989.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,017.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$867.60
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$592.14
|
|
|
ARTHROSCOP ROTATOR CUFF REPR
|
Facility
|
IP
|
$2,169.00
|
|
|
Service Code
|
CPT 29827
|
| Hospital Charge Code |
6129827
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$592.14 |
| Max. Negotiated Rate |
$2,060.55 |
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Cigna Commercial |
$1,843.65
|
| Rate for Payer: First Health Commercial |
$1,952.10
|
| Rate for Payer: First Health Workers Compensation |
$837.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,952.10
|
| Rate for Payer: GEHA Commercial |
$1,518.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,952.10
|
| Rate for Payer: Multiplan All |
$1,973.79
|
| Rate for Payer: OMNI Networks Commercial |
$1,518.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,952.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,060.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,626.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,017.17
|
| Rate for Payer: Zelis Auto |
$867.60
|
| Rate for Payer: Zelis Worker's Compensation |
$592.14
|
|
|
ARTHROSCOPY AID TX SPINE&/FX KNEE W/FIXJ
|
Facility
|
OP
|
$2,933.00
|
|
|
Service Code
|
CPT 29851
|
| Hospital Charge Code |
6129851
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$800.71 |
| Max. Negotiated Rate |
$4,935.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,759.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,910.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,550.77
|
| Rate for Payer: Cash Price |
$1,759.80
|
| Rate for Payer: Cash Price |
$1,759.80
|
| Rate for Payer: Cigna Commercial |
$2,493.05
|
| Rate for Payer: First Health Commercial |
$2,639.70
|
| Rate for Payer: First Health Workers Compensation |
$1,132.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,639.70
|
| Rate for Payer: GEHA Commercial |
$2,346.40
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,639.70
|
| Rate for Payer: Humana ChoiceCare |
$1,705.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,550.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,605.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,989.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$2,669.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$2,053.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,639.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,606.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,989.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,786.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$2,199.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,989.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,727.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$1,173.20
|
| Rate for Payer: Zelis Medicare |
$1,318.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,860.92
|
| Rate for Payer: Zelis Worker's Compensation |
$800.71
|
|
|
ARTHROSCOPY AID TX SPINE&/FX KNEE W/FIXJ
|
Facility
|
IP
|
$2,933.00
|
|
|
Service Code
|
CPT 29851
|
| Hospital Charge Code |
6129851
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$800.71 |
| Max. Negotiated Rate |
$2,786.35 |
| Rate for Payer: Cash Price |
$1,759.80
|
| Rate for Payer: Cigna Commercial |
$2,493.05
|
| Rate for Payer: First Health Commercial |
$2,639.70
|
| Rate for Payer: First Health Workers Compensation |
$1,132.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,639.70
|
| Rate for Payer: GEHA Commercial |
$2,053.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,639.70
|
| Rate for Payer: Multiplan All |
$2,669.03
|
| Rate for Payer: OMNI Networks Commercial |
$2,053.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,639.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,786.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,199.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,727.69
|
| Rate for Payer: Zelis Auto |
$1,173.20
|
| Rate for Payer: Zelis Worker's Compensation |
$800.71
|
|
|
ARTHROSCOPY, ANKLE, SURGICAL, EXCISION OF OSTEOCHONDRAL DEFECT OF TALUS AND/OR TIBIA, INCLUDING DRILLING OF THE DEFECT
|
Facility
|
OP
|
$6,287.92
|
|
|
Service Code
|
CPT 29891
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,672.37 |
| Max. Negotiated Rate |
$6,287.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,910.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: First Health Workers Compensation |
$4,046.28
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,989.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,606.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,989.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,989.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$2,861.00
|
|
|
ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT, LIMITED
|
Facility
|
OP
|
$6,287.92
|
|
|
Service Code
|
CPT 29897
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,396.53 |
| Max. Negotiated Rate |
$6,287.92 |
| 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 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 |
$3,143.96
|
| Rate for Payer: First Health Workers Compensation |
$4,046.28
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| 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 |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$2,861.00
|
|
|
ARTHROSCOPY BICEPS TENODESIS
|
Facility
|
OP
|
$1,871.00
|
|
|
Service Code
|
CPT 29828
|
| Hospital Charge Code |
6129828
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$510.78 |
| Max. Negotiated Rate |
$13,844.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,122.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,910.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,922.13
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cigna Commercial |
$1,590.35
|
| Rate for Payer: First Health Commercial |
$1,683.90
|
| Rate for Payer: First Health Workers Compensation |
$722.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,683.90
|
| Rate for Payer: GEHA Commercial |
$1,496.80
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,683.90
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,989.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,702.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,309.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,683.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,606.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,989.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,777.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,403.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,989.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,740.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$748.40
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$510.78
|
|
|
ARTHROSCOPY BICEPS TENODESIS
|
Facility
|
IP
|
$1,871.00
|
|
|
Service Code
|
CPT 29828
|
| Hospital Charge Code |
6129828
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$510.78 |
| Max. Negotiated Rate |
$1,777.45 |
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cigna Commercial |
$1,590.35
|
| Rate for Payer: First Health Commercial |
$1,683.90
|
| Rate for Payer: First Health Workers Compensation |
$722.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,683.90
|
| Rate for Payer: GEHA Commercial |
$1,309.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,683.90
|
| Rate for Payer: Multiplan All |
$1,702.61
|
| Rate for Payer: OMNI Networks Commercial |
$1,309.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,683.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,777.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,403.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,740.03
|
| Rate for Payer: Zelis Auto |
$748.40
|
| Rate for Payer: Zelis Worker's Compensation |
$510.78
|
|
|
ARTHROSCOPY, ELBOW, SURGICAL; DEBRIDEMENT, LIMITED
|
Facility
|
OP
|
$6,287.92
|
|
|
Service Code
|
CPT 29837
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,396.53 |
| Max. Negotiated Rate |
$6,287.92 |
| 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 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 |
$3,143.96
|
| Rate for Payer: First Health Workers Compensation |
$4,046.28
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| 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 |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$2,861.00
|
|
|
ARTHROSCOPY, ELBOW, SURGICAL; SYNOVECTOMY, PARTIAL
|
Facility
|
OP
|
$6,287.92
|
|
|
Service Code
|
CPT 29835
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,396.53 |
| Max. Negotiated Rate |
$6,287.92 |
| 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 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 |
$3,143.96
|
| Rate for Payer: First Health Workers Compensation |
$4,046.28
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| 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 |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$2,861.00
|
|
|
ARTHROSCOPY, ELBOW, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY
|
Facility
|
OP
|
$6,287.92
|
|
|
Service Code
|
CPT 29834
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,396.53 |
| Max. Negotiated Rate |
$6,287.92 |
| 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 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 |
$3,143.96
|
| Rate for Payer: First Health Workers Compensation |
$4,046.28
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| 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 |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$2,861.00
|
|
|
ARTHROSCOPY, KNEE, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$6,287.92
|
|
|
Service Code
|
CPT 29870
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,396.53 |
| Max. Negotiated Rate |
$6,287.92 |
| 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 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 |
$3,143.96
|
| Rate for Payer: First Health Workers Compensation |
$4,046.28
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| 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 |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$2,861.00
|
|
