|
ARTHROTOMY ANKLE W/EXPL DRAIN/REMOVAL FB
|
Facility
|
OP
|
$1,335.00
|
|
|
Service Code
|
CPT 27610
|
| Hospital Charge Code |
6127610
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$364.45 |
| 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 |
$801.00
|
| 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 |
$801.00
|
| 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 |
$1,068.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,201.50
|
| 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 |
$1,214.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$934.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,201.50
|
| 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 |
$1,268.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,001.25
|
| 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 |
$1,241.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$534.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$364.45
|
|
|
ARTHROTOMY GLENOHUMERAL JT EXPL/DRG/RMVL
|
Facility
|
OP
|
$2,238.00
|
|
|
Service Code
|
CPT 23040
|
| Hospital Charge Code |
21600497
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$610.97 |
| 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 |
$1,342.80
|
| 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 |
$1,342.80
|
| Rate for Payer: Cash Price |
$1,342.80
|
| Rate for Payer: Cigna Commercial |
$1,902.30
|
| Rate for Payer: First Health Commercial |
$2,014.20
|
| Rate for Payer: First Health Workers Compensation |
$864.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,014.20
|
| Rate for Payer: GEHA Commercial |
$1,790.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,014.20
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$2,036.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,566.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,014.20
|
| 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 |
$2,126.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,678.50
|
| 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 |
$2,081.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$895.20
|
| 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 |
$610.97
|
|
|
ARTHROTOMY GLENOHUMERAL JT EXPL/DRG/RMVL
|
Facility
|
IP
|
$1,473.00
|
|
|
Service Code
|
CPT 23040
|
| Hospital Charge Code |
6123040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$402.13 |
| Max. Negotiated Rate |
$1,399.35 |
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Cigna Commercial |
$1,252.05
|
| Rate for Payer: First Health Commercial |
$1,325.70
|
| Rate for Payer: First Health Workers Compensation |
$568.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,325.70
|
| Rate for Payer: GEHA Commercial |
$1,031.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,325.70
|
| Rate for Payer: Multiplan All |
$1,340.43
|
| Rate for Payer: OMNI Networks Commercial |
$1,031.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,325.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,399.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,104.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,369.89
|
| Rate for Payer: Zelis Auto |
$589.20
|
| Rate for Payer: Zelis Worker's Compensation |
$402.13
|
|
|
ARTHROTOMY GLENOHUMERAL JT EXPL/DRG/RMVL
|
Facility
|
OP
|
$1,473.00
|
|
|
Service Code
|
CPT 23040
|
| Hospital Charge Code |
6123040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$402.13 |
| 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 |
$883.80
|
| 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 |
$883.80
|
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Cigna Commercial |
$1,252.05
|
| Rate for Payer: First Health Commercial |
$1,325.70
|
| Rate for Payer: First Health Workers Compensation |
$568.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,325.70
|
| Rate for Payer: GEHA Commercial |
$1,178.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,325.70
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,340.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,031.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,325.70
|
| 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 |
$1,399.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,104.75
|
| 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 |
$1,369.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$589.20
|
| 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 |
$402.13
|
|
|
ARTHROTOMY GLENOHUMERAL JT EXPL/DRG/RMVL
|
Facility
|
IP
|
$2,238.00
|
|
|
Service Code
|
CPT 23040
|
| Hospital Charge Code |
21600497
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$610.97 |
| Max. Negotiated Rate |
$2,126.10 |
| Rate for Payer: Cash Price |
$1,342.80
|
| Rate for Payer: Cigna Commercial |
$1,902.30
|
| Rate for Payer: First Health Commercial |
$2,014.20
|
| Rate for Payer: First Health Workers Compensation |
$864.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,014.20
|
| Rate for Payer: GEHA Commercial |
$1,566.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,014.20
|
| Rate for Payer: Multiplan All |
$2,036.58
|
| Rate for Payer: OMNI Networks Commercial |
$1,566.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,014.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,126.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,678.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,081.34
|
| Rate for Payer: Zelis Auto |
$895.20
|
| Rate for Payer: Zelis Worker's Compensation |
$610.97
|
|
|
ARTHROTOMY HIP EXPLORATION/REMOVAL FB
|
Facility
|
IP
|
$3,055.00
|
|
|
Service Code
|
CPT 27033
|
| Hospital Charge Code |
21600482
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$834.01 |
| Max. Negotiated Rate |
$2,902.25 |
| Rate for Payer: Cash Price |
$1,833.00
|
| Rate for Payer: Cigna Commercial |
$2,596.75
|
| Rate for Payer: First Health Commercial |
$2,749.50
|
| Rate for Payer: First Health Workers Compensation |
$1,179.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,749.50
|
| Rate for Payer: GEHA Commercial |
$2,138.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,749.50
|
| Rate for Payer: Multiplan All |
$2,780.05
|
| Rate for Payer: OMNI Networks Commercial |
$2,138.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,749.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,902.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,291.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,841.15
|
| Rate for Payer: Zelis Auto |
$1,222.00
|
| Rate for Payer: Zelis Worker's Compensation |
$834.01
|
|
|
ARTHROTOMY HIP EXPLORATION/REMOVAL FB
|
Facility
|
OP
|
$3,055.00
|
|
|
Service Code
|
CPT 27033
|
| Hospital Charge Code |
21600482
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$834.01 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,833.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,833.00
|
| Rate for Payer: Cash Price |
$1,833.00
|
| Rate for Payer: Cigna Commercial |
$2,596.75
|
| Rate for Payer: First Health Commercial |
$2,749.50
|
| Rate for Payer: First Health Workers Compensation |
$1,179.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,749.50
|
| Rate for Payer: GEHA Commercial |
$2,444.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,749.50
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$2,780.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$2,138.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,749.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,902.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$2,291.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,841.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$1,222.00
|
| 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 |
$834.01
|
|
|
ARTHROTOMY HIP EXPLORATION/REMOVAL FB
|
Facility
|
IP
|
$2,002.00
|
|
|
Service Code
|
CPT 27033
|
| Hospital Charge Code |
6127033
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$546.55 |
| Max. Negotiated Rate |
$1,901.90 |
| Rate for Payer: Cash Price |
$1,201.20
|
| Rate for Payer: Cigna Commercial |
$1,701.70
|
| Rate for Payer: First Health Commercial |
$1,801.80
|
| Rate for Payer: First Health Workers Compensation |
$772.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,801.80
|
| Rate for Payer: GEHA Commercial |
$1,401.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,801.80
|
| Rate for Payer: Multiplan All |
$1,821.82
|
| Rate for Payer: OMNI Networks Commercial |
$1,401.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,801.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,901.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,501.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,861.86
|
| Rate for Payer: Zelis Auto |
$800.80
|
| Rate for Payer: Zelis Worker's Compensation |
$546.55
|
|
|
ARTHROTOMY HIP EXPLORATION/REMOVAL FB
|
Facility
|
OP
|
$2,002.00
|
|
|
Service Code
|
CPT 27033
|
| Hospital Charge Code |
6127033
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$546.55 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,201.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,201.20
|
| Rate for Payer: Cash Price |
$1,201.20
|
| Rate for Payer: Cigna Commercial |
$1,701.70
|
| Rate for Payer: First Health Commercial |
$1,801.80
|
| Rate for Payer: First Health Workers Compensation |
$772.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,801.80
|
| Rate for Payer: GEHA Commercial |
$1,601.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,801.80
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,821.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,401.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,801.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,901.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,501.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,861.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$800.80
|
| 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 |
$546.55
|
|
|
ARTHRS AID TIBIAL FRAC PROXIMAL UNICONDY
|
Facility
|
OP
|
$2,375.00
|
|
|
Service Code
|
CPT 29855
|
| Hospital Charge Code |
6129855
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$648.38 |
| 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 Community HMO |
$1,425.00
|
| 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: Cash Price |
$1,425.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$2,018.75
|
| Rate for Payer: First Health Commercial |
$2,137.50
|
| Rate for Payer: First Health Workers Compensation |
$916.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,137.50
|
| Rate for Payer: GEHA Commercial |
$1,900.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,137.50
|
| 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: Multiplan All |
$2,161.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,662.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,137.50
|
| 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 Commercial |
$2,256.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,781.25
|
| 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: United Payors & United Providers UP&UP |
$2,208.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$950.00
|
| 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 |
$648.38
|
|
|
ARTHRS AID TIBIAL FRAC PROXIMAL UNICONDY
|
Facility
|
IP
|
$2,375.00
|
|
|
Service Code
|
CPT 29855
|
| Hospital Charge Code |
6129855
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$648.38 |
| Max. Negotiated Rate |
$2,256.25 |
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$2,018.75
|
| Rate for Payer: First Health Commercial |
$2,137.50
|
| Rate for Payer: First Health Workers Compensation |
$916.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,137.50
|
| Rate for Payer: GEHA Commercial |
$1,662.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,137.50
|
| Rate for Payer: Multiplan All |
$2,161.25
|
| Rate for Payer: OMNI Networks Commercial |
$1,662.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,137.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,256.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,781.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,208.75
|
| Rate for Payer: Zelis Auto |
$950.00
|
| Rate for Payer: Zelis Worker's Compensation |
$648.38
|
|
|
ARTHRSCPY, ELBOW, SURG SYNOVECTOMY PARTI
|
Facility
|
OP
|
$504.34
|
|
|
Service Code
|
CPT 29835
|
| Hospital Charge Code |
6129835
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$137.68 |
| 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 |
$302.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$302.60
|
| Rate for Payer: Cash Price |
$302.60
|
| Rate for Payer: Cigna Commercial |
$428.69
|
| Rate for Payer: First Health Commercial |
$453.91
|
| Rate for Payer: First Health Workers Compensation |
$194.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$453.91
|
| Rate for Payer: GEHA Commercial |
$403.47
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$453.91
|
| 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 |
$458.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$353.04
|
| Rate for Payer: One Health Plan PPO/POS |
$453.91
|
| 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 |
$479.12
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$378.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$469.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$201.74
|
| 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 |
$137.68
|
|
|
ARTHRSCPY, ELBOW, SURG SYNOVECTOMY PARTI
|
Facility
|
IP
|
$504.34
|
|
|
Service Code
|
CPT 29835
|
| Hospital Charge Code |
6129835
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$137.68 |
| Max. Negotiated Rate |
$479.12 |
| Rate for Payer: Cash Price |
$302.60
|
| Rate for Payer: Cigna Commercial |
$428.69
|
| Rate for Payer: First Health Commercial |
$453.91
|
| Rate for Payer: First Health Workers Compensation |
$194.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$453.91
|
| Rate for Payer: GEHA Commercial |
$353.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$453.91
|
| Rate for Payer: Multiplan All |
$458.95
|
| Rate for Payer: OMNI Networks Commercial |
$353.04
|
| Rate for Payer: One Health Plan PPO/POS |
$453.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$479.12
|
| Rate for Payer: Three Rivers Provider Network All |
$378.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$469.04
|
| Rate for Payer: Zelis Auto |
$201.74
|
| Rate for Payer: Zelis Worker's Compensation |
$137.68
|
|
|
ARTHRSCPY, SHLDR, SRG; W/SUBACROMIAL SPA
|
Facility
|
IP
|
$6,397.05
|
|
|
Service Code
|
CPT C9781
|
| Hospital Charge Code |
619781
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,746.39 |
| Max. Negotiated Rate |
$6,077.20 |
| Rate for Payer: Cash Price |
$3,838.23
|
| Rate for Payer: Cigna Commercial |
$5,437.49
|
| Rate for Payer: First Health Commercial |
$5,757.35
|
| Rate for Payer: First Health Workers Compensation |
$2,469.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,757.35
|
| Rate for Payer: GEHA Commercial |
$4,477.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,757.35
|
| Rate for Payer: Multiplan All |
$5,821.32
|
| Rate for Payer: OMNI Networks Commercial |
$4,477.94
|
| Rate for Payer: One Health Plan PPO/POS |
$5,757.35
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,077.20
|
| Rate for Payer: Three Rivers Provider Network All |
$4,797.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,949.26
|
| Rate for Payer: Zelis Auto |
$2,558.82
|
| Rate for Payer: Zelis Worker's Compensation |
$1,746.39
|
|
|
ARTHRSCPY, SHLDR, SRG; W/SUBACROMIAL SPA
|
Facility
|
OP
|
$6,397.05
|
|
|
Service Code
|
CPT C9781
|
| Hospital Charge Code |
619781
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,746.39 |
| 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 Community HMO |
$3,838.23
|
| 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: Cash Price |
$3,838.23
|
| Rate for Payer: Cash Price |
$3,838.23
|
| Rate for Payer: Cigna Commercial |
$5,437.49
|
| Rate for Payer: First Health Commercial |
$5,757.35
|
| Rate for Payer: First Health Workers Compensation |
$2,469.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,757.35
|
| Rate for Payer: GEHA Commercial |
$5,117.64
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,757.35
|
| 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: Multiplan All |
$5,821.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$4,477.94
|
| Rate for Payer: One Health Plan PPO/POS |
$5,757.35
|
| 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 Commercial |
$6,077.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$4,797.79
|
| 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: United Payors & United Providers UP&UP |
$5,949.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$2,558.82
|
| 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 |
$1,746.39
|
|
|
ARTHRT ACROMCLAV STRNCLAV JT EXPL/DRG/RM
|
Facility
|
IP
|
$1,164.00
|
|
|
Service Code
|
CPT 23044
|
| Hospital Charge Code |
6123044
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$317.77 |
| Max. Negotiated Rate |
$1,105.80 |
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna Commercial |
$989.40
|
| Rate for Payer: First Health Commercial |
$1,047.60
|
| Rate for Payer: First Health Workers Compensation |
$449.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,047.60
|
| Rate for Payer: GEHA Commercial |
$814.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,047.60
|
| Rate for Payer: Multiplan All |
$1,059.24
|
| Rate for Payer: OMNI Networks Commercial |
$814.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,047.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,105.80
|
| Rate for Payer: Three Rivers Provider Network All |
$873.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,082.52
|
| Rate for Payer: Zelis Auto |
$465.60
|
| Rate for Payer: Zelis Worker's Compensation |
$317.77
|
|
|
ARTHRT ACROMCLAV STRNCLAV JT EXPL/DRG/RM
|
Facility
|
IP
|
$1,770.00
|
|
|
Service Code
|
CPT 23044
|
| Hospital Charge Code |
21600498
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$483.21 |
| Max. Negotiated Rate |
$1,681.50 |
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cigna Commercial |
$1,504.50
|
| Rate for Payer: First Health Commercial |
$1,593.00
|
| Rate for Payer: First Health Workers Compensation |
$683.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,593.00
|
| Rate for Payer: GEHA Commercial |
$1,239.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,593.00
|
| Rate for Payer: Multiplan All |
$1,610.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,239.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,593.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,681.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,327.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,646.10
|
| Rate for Payer: Zelis Auto |
$708.00
|
| Rate for Payer: Zelis Worker's Compensation |
$483.21
|
|
|
ARTHRT ACROMCLAV STRNCLAV JT EXPL/DRG/RM
|
Facility
|
OP
|
$1,770.00
|
|
|
Service Code
|
CPT 23044
|
| Hospital Charge Code |
21600498
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$483.21 |
| 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 |
$1,062.00
|
| 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 |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cigna Commercial |
$1,504.50
|
| Rate for Payer: First Health Commercial |
$1,593.00
|
| Rate for Payer: First Health Workers Compensation |
$683.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,593.00
|
| Rate for Payer: GEHA Commercial |
$1,416.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,593.00
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,610.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,239.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,593.00
|
| 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 |
$1,681.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,327.50
|
| 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 |
$1,646.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$708.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$483.21
|
|
|
ARTHRT ACROMCLAV STRNCLAV JT EXPL/DRG/RM
|
Facility
|
OP
|
$1,164.00
|
|
|
Service Code
|
CPT 23044
|
| Hospital Charge Code |
6123044
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$317.77 |
| 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 |
$698.40
|
| 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 |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna Commercial |
$989.40
|
| Rate for Payer: First Health Commercial |
$1,047.60
|
| Rate for Payer: First Health Workers Compensation |
$449.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,047.60
|
| Rate for Payer: GEHA Commercial |
$931.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,047.60
|
| 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 |
$1,059.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$814.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,047.60
|
| 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 |
$1,105.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$873.00
|
| 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 |
$1,082.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$465.60
|
| 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 |
$317.77
|
|
|
ARTHRT ANKLE W/EXPL W/WO BX W/WO RMVL LO
|
Facility
|
OP
|
$926.00
|
|
|
Service Code
|
CPT 27620
|
| Hospital Charge Code |
6127620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$252.80 |
| 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 |
$555.60
|
| 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 |
$555.60
|
| Rate for Payer: Cash Price |
$555.60
|
| Rate for Payer: Cigna Commercial |
$787.10
|
| Rate for Payer: First Health Commercial |
$833.40
|
| Rate for Payer: First Health Workers Compensation |
$357.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$833.40
|
| Rate for Payer: GEHA Commercial |
$740.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$833.40
|
| 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 |
$842.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$648.20
|
| Rate for Payer: One Health Plan PPO/POS |
$833.40
|
| 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 |
$879.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$694.50
|
| 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 |
$861.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$370.40
|
| 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 |
$252.80
|
|
|
ARTHRT ANKLE W/EXPL W/WO BX W/WO RMVL LO
|
Facility
|
OP
|
$1,402.00
|
|
|
Service Code
|
CPT 27620
|
| Hospital Charge Code |
21600469
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$382.75 |
| 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 |
$841.20
|
| 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 |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$1,191.70
|
| Rate for Payer: First Health Commercial |
$1,261.80
|
| Rate for Payer: First Health Workers Compensation |
$541.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,261.80
|
| Rate for Payer: GEHA Commercial |
$1,121.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,261.80
|
| 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 |
$1,275.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$981.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,261.80
|
| 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 |
$1,331.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,051.50
|
| 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 |
$1,303.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$560.80
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$382.75
|
|
|
ARTHRT ANKLE W/EXPL W/WO BX W/WO RMVL LO
|
Facility
|
IP
|
$926.00
|
|
|
Service Code
|
CPT 27620
|
| Hospital Charge Code |
6127620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$252.80 |
| Max. Negotiated Rate |
$879.70 |
| Rate for Payer: Cash Price |
$555.60
|
| Rate for Payer: Cigna Commercial |
$787.10
|
| Rate for Payer: First Health Commercial |
$833.40
|
| Rate for Payer: First Health Workers Compensation |
$357.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$833.40
|
| Rate for Payer: GEHA Commercial |
$648.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$833.40
|
| Rate for Payer: Multiplan All |
$842.66
|
| Rate for Payer: OMNI Networks Commercial |
$648.20
|
| Rate for Payer: One Health Plan PPO/POS |
$833.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$879.70
|
| Rate for Payer: Three Rivers Provider Network All |
$694.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$861.18
|
| Rate for Payer: Zelis Auto |
$370.40
|
| Rate for Payer: Zelis Worker's Compensation |
$252.80
|
|
|
ARTHRT ANKLE W/EXPL W/WO BX W/WO RMVL LO
|
Facility
|
IP
|
$1,402.00
|
|
|
Service Code
|
CPT 27620
|
| Hospital Charge Code |
21600469
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$382.75 |
| Max. Negotiated Rate |
$1,331.90 |
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$1,191.70
|
| Rate for Payer: First Health Commercial |
$1,261.80
|
| Rate for Payer: First Health Workers Compensation |
$541.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,261.80
|
| Rate for Payer: GEHA Commercial |
$981.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,261.80
|
| Rate for Payer: Multiplan All |
$1,275.82
|
| Rate for Payer: OMNI Networks Commercial |
$981.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,261.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,331.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,051.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,303.86
|
| Rate for Payer: Zelis Auto |
$560.80
|
| Rate for Payer: Zelis Worker's Compensation |
$382.75
|
|
|
ARTHRT ELBOW W/EXPLORATION DRAIN/REMV FB
|
Facility
|
OP
|
$1,480.00
|
|
|
Service Code
|
CPT 24000
|
| Hospital Charge Code |
21600474
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$404.04 |
| 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 |
$888.00
|
| 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 |
$888.00
|
| Rate for Payer: Cash Price |
$888.00
|
| Rate for Payer: Cigna Commercial |
$1,258.00
|
| Rate for Payer: First Health Commercial |
$1,332.00
|
| Rate for Payer: First Health Workers Compensation |
$571.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,332.00
|
| Rate for Payer: GEHA Commercial |
$1,184.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,332.00
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,346.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,036.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,332.00
|
| 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 |
$1,406.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,110.00
|
| 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 |
$1,376.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$592.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$404.04
|
|
|
ARTHRT ELBOW W/EXPLORATION DRAIN/REMV FB
|
Facility
|
IP
|
$1,480.00
|
|
|
Service Code
|
CPT 24000
|
| Hospital Charge Code |
21600474
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$404.04 |
| Max. Negotiated Rate |
$1,406.00 |
| Rate for Payer: Cash Price |
$888.00
|
| Rate for Payer: Cigna Commercial |
$1,258.00
|
| Rate for Payer: First Health Commercial |
$1,332.00
|
| Rate for Payer: First Health Workers Compensation |
$571.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,332.00
|
| Rate for Payer: GEHA Commercial |
$1,036.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,332.00
|
| Rate for Payer: Multiplan All |
$1,346.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,036.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,332.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,406.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,110.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,376.40
|
| Rate for Payer: Zelis Auto |
$592.00
|
| Rate for Payer: Zelis Worker's Compensation |
$404.04
|
|
