|
ARTHROSCOPY, KNEE, SURGICAL; ABRASION ARTHROPLASTY (INCLUDES CHONDROPLASTY WHERE NECESSARY) OR MULTIPLE DRILLING OR MICROFRACTURE
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 29879
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,396.53 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$2,803.61
|
|
|
ARTHROSCOPY, KNEE, SURGICAL; DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY)
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 29877
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,396.53 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$2,803.61
|
|
|
ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR INTACT OSTEOCHONDRITIS DISSECANS LESION WITH INTERNAL FIXATION
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 29887
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,396.53 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$6,172.77
|
|
|
ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, LIMITED (EG, PLICA OR SHELF RESECTION) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 29875
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,396.53 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$2,803.61
|
|
|
ARTHROSCOPY, KNEE, SURGICAL; WITH LATERAL RELEASE
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 29873
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,396.53 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$2,803.61
|
|
|
ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL AND LATERAL, INCLUDING ANY MENISCAL SHAVING) INCLUDING DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY), SAME OR SEPARATE COMPARTMENT(S), WHEN PERFORMED
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 29880
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,396.53 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$2,803.61
|
|
|
ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL OR LATERAL, INCLUDING ANY MENISCAL SHAVING) INCLUDING DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY), SAME OR SEPARATE COMPARTMENT(S), WHEN PERFORMED
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 29881
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,396.53 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$2,803.61
|
|
|
ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCUS REPAIR (MEDIAL AND LATERAL)
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 29883
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,396.53 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$2,803.61
|
|
|
ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCUS REPAIR (MEDIAL OR LATERAL)
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 29882
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,396.53 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$2,803.61
|
|
|
ARTHROSCOPY KNEE W/LYSIS ADHESIONS W/WO
|
Facility
|
OP
|
$1,893.00
|
|
|
Service Code
|
CPT 29884
|
| Hospital Charge Code |
6129884
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$516.79 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,135.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,135.80
|
| Rate for Payer: Cash Price |
$1,135.80
|
| Rate for Payer: Cigna Commercial |
$1,609.05
|
| Rate for Payer: First Health Commercial |
$1,703.70
|
| Rate for Payer: First Health Workers Compensation |
$730.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,703.70
|
| Rate for Payer: GEHA Commercial |
$1,514.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,703.70
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,722.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,325.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,703.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,798.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,419.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,760.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$757.20
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$516.79
|
|
|
ARTHROSCOPY KNEE W/LYSIS ADHESIONS W/WO
|
Facility
|
IP
|
$1,893.00
|
|
|
Service Code
|
CPT 29884
|
| Hospital Charge Code |
6129884
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$516.79 |
| Max. Negotiated Rate |
$1,798.35 |
| Rate for Payer: Cash Price |
$1,135.80
|
| Rate for Payer: Cigna Commercial |
$1,609.05
|
| Rate for Payer: First Health Commercial |
$1,703.70
|
| Rate for Payer: First Health Workers Compensation |
$730.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,703.70
|
| Rate for Payer: GEHA Commercial |
$1,325.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,703.70
|
| Rate for Payer: Multiplan All |
$1,722.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,325.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,703.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,798.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,419.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,760.49
|
| Rate for Payer: Zelis Auto |
$757.20
|
| Rate for Payer: Zelis Worker's Compensation |
$516.79
|
|
|
ARTHROSCOPY SHOULDER AHESIOLYSIS W/WO MA
|
Facility
|
IP
|
$1,789.00
|
|
|
Service Code
|
CPT 29825
|
| Hospital Charge Code |
6129825
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$488.40 |
| Max. Negotiated Rate |
$1,699.55 |
| Rate for Payer: Cash Price |
$1,073.40
|
| Rate for Payer: Cigna Commercial |
$1,520.65
|
| Rate for Payer: First Health Commercial |
$1,610.10
|
| Rate for Payer: First Health Workers Compensation |
$690.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,610.10
|
| Rate for Payer: GEHA Commercial |
$1,252.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,610.10
|
| Rate for Payer: Multiplan All |
$1,627.99
|
| Rate for Payer: OMNI Networks Commercial |
$1,252.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,610.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,699.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,341.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,663.77
|
| Rate for Payer: Zelis Auto |
$715.60
|
| Rate for Payer: Zelis Worker's Compensation |
$488.40
|
|
|
ARTHROSCOPY SHOULDER AHESIOLYSIS W/WO MA
|
Facility
|
OP
|
$1,789.00
|
|
|
Service Code
|
CPT 29825
|
| Hospital Charge Code |
6129825
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$488.40 |
| Max. Negotiated Rate |
$6,161.78 |
| 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 |
$1,073.40
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,073.40
|
| Rate for Payer: Cash Price |
$1,073.40
|
| Rate for Payer: Cigna Commercial |
$1,520.65
|
| Rate for Payer: First Health Commercial |
$1,610.10
|
| Rate for Payer: First Health Workers Compensation |
$690.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,610.10
|
| Rate for Payer: GEHA Commercial |
$1,431.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,610.10
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,989.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,627.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,252.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,610.10
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,699.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,341.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,989.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,663.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$715.60
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$488.40
|
|
|
ARTHROSCOPY, SHOULDER, SURGICAL; BICEPS TENODESIS
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 29828
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,910.22 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,989.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,989.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$6,172.77
|
|
|
ARTHROSCOPY, SHOULDER, SURGICAL; CAPSULORRHAPHY
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 29806
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,910.22 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,989.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,989.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$6,172.77
|
|
|
ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, EXTENSIVE, 3 OR MORE DISCRETE STRUCTURES (EG, HUMERAL BONE, HUMERAL ARTICULAR CARTILAGE, GLENOID BONE, GLENOID ARTICULAR CARTILAGE, BICEPS TENDON, BICEPS ANCHOR COMPLEX, LABRUM, ARTICULAR CAPSULE, ARTICULAR SIDE OF THE ROTATOR CUFF, BURSAL SIDE OF THE ROTATOR CUFF, SUBACROMIAL BURSA, FOREIGN BODY[IES])
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 29823
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,618.76 |
| Max. Negotiated Rate |
$6,161.78 |
| 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 |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,989.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,989.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$2,803.61
|
|
|
ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, LIMITED, 1 OR 2 DISCRETE STRUCTURES (EG, HUMERAL BONE, HUMERAL ARTICULAR CARTILAGE, GLENOID BONE, GLENOID ARTICULAR CARTILAGE, BICEPS TENDON, BICEPS ANCHOR COMPLEX, LABRUM, ARTICULAR CAPSULE, ARTICULAR SIDE OF THE ROTATOR CUFF, BURSAL SIDE OF THE ROTATOR CUFF, SUBACROMIAL BURSA, FOREIGN BODY[IES])
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 29822
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,396.53 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$2,803.61
|
|
|
ARTHROSCOPY, SHOULDER, SURGICAL; DECOMPRESSION OF SUBACROMIAL SPACE WITH PARTIAL ACROMIOPLASTY, WITH CORACOACROMIAL LIGAMENT (IE, ARCH) RELEASE, WHEN PERFORMED (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$4,935.90
|
|
|
Service Code
|
CPT 29826
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$368.14 |
| 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 Preferred |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,910.22
|
| Rate for Payer: First Health Workers Compensation |
$520.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,989.85
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,606.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,989.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,989.85
|
| Rate for Payer: Zelis Worker's Compensation |
$368.14
|
|
|
ARTHROSCOPY, SHOULDER, SURGICAL; DISTAL CLAVICULECTOMY INCLUDING DISTAL ARTICULAR SURFACE (MUMFORD PROCEDURE)
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 29824
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,396.53 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$2,803.61
|
|
|
ARTHROSCOPY, SHOULDER, SURGICAL; REPAIR OF SLAP LESION
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 29807
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,910.22 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,989.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,989.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$6,172.77
|
|
|
ARTHROSCOPY, SHOULDER, SURGICAL; WITH IMPLANTATION OF SUBACROMIAL SPACER (E.G., BALLOON), INCLUDES DEBRIDEMENT (E.G., LIMITED OR EXTENSIVE), SUBACROMIAL DECOMPRESSION, ACROMIOPLASTY, AND BICEPS TENODESIS WHEN PERFORMED
|
Facility
|
OP
|
$24,435.12
|
|
|
Service Code
|
CPT C9781
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,601.61 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9,595.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9,595.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7,601.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: First Health Workers Compensation |
$15,724.00
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7,756.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8,955.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7,756.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,756.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Medicare |
$10,384.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,661.07
|
| Rate for Payer: Zelis Worker's Compensation |
$11,117.98
|
|
|
ARTHROSCOPY, SHOULDER, SURGICAL; WITH ROTATOR CUFF REPAIR
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 29827
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,910.22 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,989.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,989.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$6,172.77
|
|
|
ARTHROTOMY ANKLE W/EXPL DRAIN/REMOVAL FB
|
Facility
|
OP
|
$2,031.00
|
|
|
Service Code
|
CPT 27610
|
| Hospital Charge Code |
21600468
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$554.46 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,218.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,218.60
|
| Rate for Payer: Cash Price |
$1,218.60
|
| Rate for Payer: Cigna Commercial |
$1,726.35
|
| Rate for Payer: First Health Commercial |
$1,827.90
|
| Rate for Payer: First Health Workers Compensation |
$784.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,827.90
|
| Rate for Payer: GEHA Commercial |
$1,624.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,827.90
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,848.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,421.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,827.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,929.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,523.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,888.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$812.40
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$554.46
|
|
|
ARTHROTOMY ANKLE W/EXPL DRAIN/REMOVAL FB
|
Facility
|
IP
|
$1,335.00
|
|
|
Service Code
|
CPT 27610
|
| Hospital Charge Code |
6127610
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$364.45 |
| Max. Negotiated Rate |
$1,268.25 |
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Cigna Commercial |
$1,134.75
|
| Rate for Payer: First Health Commercial |
$1,201.50
|
| Rate for Payer: First Health Workers Compensation |
$515.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,201.50
|
| Rate for Payer: GEHA Commercial |
$934.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,201.50
|
| Rate for Payer: Multiplan All |
$1,214.85
|
| Rate for Payer: OMNI Networks Commercial |
$934.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,201.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,268.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,001.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,241.55
|
| Rate for Payer: Zelis Auto |
$534.00
|
| Rate for Payer: Zelis Worker's Compensation |
$364.45
|
|
|
ARTHROTOMY ANKLE W/EXPL DRAIN/REMOVAL FB
|
Facility
|
IP
|
$2,031.00
|
|
|
Service Code
|
CPT 27610
|
| Hospital Charge Code |
21600468
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$554.46 |
| Max. Negotiated Rate |
$1,929.45 |
| Rate for Payer: Cash Price |
$1,218.60
|
| Rate for Payer: Cigna Commercial |
$1,726.35
|
| Rate for Payer: First Health Commercial |
$1,827.90
|
| Rate for Payer: First Health Workers Compensation |
$784.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,827.90
|
| Rate for Payer: GEHA Commercial |
$1,421.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,827.90
|
| Rate for Payer: Multiplan All |
$1,848.21
|
| Rate for Payer: OMNI Networks Commercial |
$1,421.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,827.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,929.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,523.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,888.83
|
| Rate for Payer: Zelis Auto |
$812.40
|
| Rate for Payer: Zelis Worker's Compensation |
$554.46
|
|
