|
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
|
|
|
ARTHRT ELBOW W/EXPLORATION DRAIN/REMV FB
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
CPT 24000
|
| Hospital Charge Code |
6124000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$264.54 |
| 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 |
$581.40
|
| 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 |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$823.65
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: First Health Workers Compensation |
$374.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$872.10
|
| Rate for Payer: GEHA Commercial |
$775.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$872.10
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$881.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$678.30
|
| Rate for Payer: One Health Plan PPO/POS |
$872.10
|
| 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 |
$920.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$726.75
|
| 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 |
$901.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$387.60
|
| 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 |
$264.54
|
|
|
ARTHRT ELBOW W/JNT EXPL W/WOBX W/WORMVL
|
Facility
|
OP
|
$1,017.00
|
|
|
Service Code
|
CPT 24101
|
| Hospital Charge Code |
6124101
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$277.64 |
| 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 |
$610.20
|
| 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 |
$610.20
|
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Cigna Commercial |
$864.45
|
| Rate for Payer: First Health Commercial |
$915.30
|
| Rate for Payer: First Health Workers Compensation |
$392.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$915.30
|
| Rate for Payer: GEHA Commercial |
$813.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$915.30
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$925.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$711.90
|
| Rate for Payer: One Health Plan PPO/POS |
$915.30
|
| 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 |
$966.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$762.75
|
| 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 |
$945.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$406.80
|
| 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 |
$277.64
|
|
|
ARTHRT ELBOW W/JNT EXPL W/WOBX W/WORMVL
|
Facility
|
IP
|
$1,017.00
|
|
|
Service Code
|
CPT 24101
|
| Hospital Charge Code |
6124101
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$277.64 |
| Max. Negotiated Rate |
$966.15 |
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Cigna Commercial |
$864.45
|
| Rate for Payer: First Health Commercial |
$915.30
|
| Rate for Payer: First Health Workers Compensation |
$392.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$915.30
|
| Rate for Payer: GEHA Commercial |
$711.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$915.30
|
| Rate for Payer: Multiplan All |
$925.47
|
| Rate for Payer: OMNI Networks Commercial |
$711.90
|
| Rate for Payer: One Health Plan PPO/POS |
$915.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$966.15
|
| Rate for Payer: Three Rivers Provider Network All |
$762.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$945.81
|
| Rate for Payer: Zelis Auto |
$406.80
|
| Rate for Payer: Zelis Worker's Compensation |
$277.64
|
|
|
ARTHRT ELBOW W/JNT EXPL W/WOBX W/WORMVL
|
Facility
|
IP
|
$1,551.00
|
|
|
Service Code
|
CPT 24101
|
| Hospital Charge Code |
21600475
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$423.42 |
| Max. Negotiated Rate |
$1,473.45 |
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Cigna Commercial |
$1,318.35
|
| Rate for Payer: First Health Commercial |
$1,395.90
|
| Rate for Payer: First Health Workers Compensation |
$598.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,395.90
|
| Rate for Payer: GEHA Commercial |
$1,085.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,395.90
|
| Rate for Payer: Multiplan All |
$1,411.41
|
| Rate for Payer: OMNI Networks Commercial |
$1,085.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,395.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,473.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,163.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,442.43
|
| Rate for Payer: Zelis Auto |
$620.40
|
| Rate for Payer: Zelis Worker's Compensation |
$423.42
|
|
|
ARTHRT ELBOW W/JNT EXPL W/WOBX W/WORMVL
|
Facility
|
OP
|
$1,551.00
|
|
|
Service Code
|
CPT 24101
|
| Hospital Charge Code |
21600475
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$423.42 |
| 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 |
$930.60
|
| 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 |
$930.60
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Cigna Commercial |
$1,318.35
|
| Rate for Payer: First Health Commercial |
$1,395.90
|
| Rate for Payer: First Health Workers Compensation |
$598.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,395.90
|
| Rate for Payer: GEHA Commercial |
$1,240.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,395.90
|
| 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 |
$1,411.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,085.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,395.90
|
| 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 |
$1,473.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,163.25
|
| 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 |
$1,442.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$620.40
|
| 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 |
$423.42
|
|
|
ARTHRT EXPL DRG/RMVL LOOSE/FB CARP/MTCRP
|
Facility
|
IP
|
$986.00
|
|
|
Service Code
|
CPT 26070
|
| Hospital Charge Code |
21600481
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$269.18 |
| Max. Negotiated Rate |
$936.70 |
| Rate for Payer: Cash Price |
$591.60
|
| Rate for Payer: Cigna Commercial |
$838.10
|
| Rate for Payer: First Health Commercial |
$887.40
|
| Rate for Payer: First Health Workers Compensation |
$380.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$887.40
|
| Rate for Payer: GEHA Commercial |
$690.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$887.40
|
| Rate for Payer: Multiplan All |
$897.26
|
| Rate for Payer: OMNI Networks Commercial |
$690.20
|
| Rate for Payer: One Health Plan PPO/POS |
$887.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$936.70
|
| Rate for Payer: Three Rivers Provider Network All |
$739.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$916.98
|
| Rate for Payer: Zelis Auto |
$394.40
|
| Rate for Payer: Zelis Worker's Compensation |
$269.18
|
|
|
ARTHRT EXPL DRG/RMVL LOOSE/FB CARP/MTCRP
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
CPT 26070
|
| Hospital Charge Code |
6126070
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$215.94 |
| Max. Negotiated Rate |
$751.45 |
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Cigna Commercial |
$672.35
|
| Rate for Payer: First Health Commercial |
$711.90
|
| Rate for Payer: First Health Workers Compensation |
$305.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$711.90
|
| Rate for Payer: GEHA Commercial |
$553.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$711.90
|
| Rate for Payer: Multiplan All |
$719.81
|
| Rate for Payer: OMNI Networks Commercial |
$553.70
|
| Rate for Payer: One Health Plan PPO/POS |
$711.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$751.45
|
| Rate for Payer: Three Rivers Provider Network All |
$593.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$735.63
|
| Rate for Payer: Zelis Auto |
$316.40
|
| Rate for Payer: Zelis Worker's Compensation |
$215.94
|
|
|
ARTHRT EXPL DRG/RMVL LOOSE/FB CARP/MTCRP
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
CPT 26070
|
| Hospital Charge Code |
6126070
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$215.94 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$474.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Cigna Commercial |
$672.35
|
| Rate for Payer: First Health Commercial |
$711.90
|
| Rate for Payer: First Health Workers Compensation |
$305.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$711.90
|
| Rate for Payer: GEHA Commercial |
$632.80
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$711.90
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$719.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$553.70
|
| Rate for Payer: One Health Plan PPO/POS |
$711.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$751.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$593.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$735.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$316.40
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$215.94
|
|
|
ARTHRT EXPL DRG/RMVL LOOSE/FB CARP/MTCRP
|
Facility
|
OP
|
$986.00
|
|
|
Service Code
|
CPT 26070
|
| Hospital Charge Code |
21600481
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$269.18 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$591.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$591.60
|
| Rate for Payer: Cash Price |
$591.60
|
| Rate for Payer: Cigna Commercial |
$838.10
|
| Rate for Payer: First Health Commercial |
$887.40
|
| Rate for Payer: First Health Workers Compensation |
$380.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$887.40
|
| Rate for Payer: GEHA Commercial |
$788.80
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$887.40
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$897.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$690.20
|
| Rate for Payer: One Health Plan PPO/POS |
$887.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$936.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$739.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$916.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$394.40
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$269.18
|
|
|
ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT E
|
Facility
|
OP
|
$1,205.00
|
|
|
Service Code
|
CPT 26080
|
| Hospital Charge Code |
21600478
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$328.96 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$723.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$723.00
|
| Rate for Payer: Cash Price |
$723.00
|
| Rate for Payer: Cigna Commercial |
$1,024.25
|
| Rate for Payer: First Health Commercial |
$1,084.50
|
| Rate for Payer: First Health Workers Compensation |
$465.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,084.50
|
| Rate for Payer: GEHA Commercial |
$964.00
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,084.50
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$1,096.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$843.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,084.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,144.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$903.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,120.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$482.00
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$328.96
|
|
|
ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT E
|
Facility
|
OP
|
$983.00
|
|
|
Service Code
|
CPT 26080
|
| Hospital Charge Code |
6126080
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$268.36 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$589.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$589.80
|
| Rate for Payer: Cash Price |
$589.80
|
| Rate for Payer: Cigna Commercial |
$835.55
|
| Rate for Payer: First Health Commercial |
$884.70
|
| Rate for Payer: First Health Workers Compensation |
$379.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$884.70
|
| Rate for Payer: GEHA Commercial |
$786.40
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$884.70
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$894.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$688.10
|
| Rate for Payer: One Health Plan PPO/POS |
$884.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$933.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$737.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$914.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$393.20
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$268.36
|
|
|
ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT E
|
Facility
|
IP
|
$1,205.00
|
|
|
Service Code
|
CPT 26080
|
| Hospital Charge Code |
21600478
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$328.96 |
| Max. Negotiated Rate |
$1,144.75 |
| Rate for Payer: Cash Price |
$723.00
|
| Rate for Payer: Cigna Commercial |
$1,024.25
|
| Rate for Payer: First Health Commercial |
$1,084.50
|
| Rate for Payer: First Health Workers Compensation |
$465.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,084.50
|
| Rate for Payer: GEHA Commercial |
$843.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,084.50
|
| Rate for Payer: Multiplan All |
$1,096.55
|
| Rate for Payer: OMNI Networks Commercial |
$843.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,084.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,144.75
|
| Rate for Payer: Three Rivers Provider Network All |
$903.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,120.65
|
| Rate for Payer: Zelis Auto |
$482.00
|
| Rate for Payer: Zelis Worker's Compensation |
$328.96
|
|
|
ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT E
|
Facility
|
IP
|
$983.00
|
|
|
Service Code
|
CPT 26080
|
| Hospital Charge Code |
6126080
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$268.36 |
| Max. Negotiated Rate |
$933.85 |
| Rate for Payer: Cash Price |
$589.80
|
| Rate for Payer: Cigna Commercial |
$835.55
|
| Rate for Payer: First Health Commercial |
$884.70
|
| Rate for Payer: First Health Workers Compensation |
$379.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$884.70
|
| Rate for Payer: GEHA Commercial |
$688.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$884.70
|
| Rate for Payer: Multiplan All |
$894.53
|
| Rate for Payer: OMNI Networks Commercial |
$688.10
|
| Rate for Payer: One Health Plan PPO/POS |
$884.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$933.85
|
| Rate for Payer: Three Rivers Provider Network All |
$737.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$914.19
|
| Rate for Payer: Zelis Auto |
$393.20
|
| Rate for Payer: Zelis Worker's Compensation |
$268.36
|
|
|
ARTHRT EXPL DRG/RMVL LOOSE/FB MTCARPHLNG
|
Facility
|
OP
|
$1,028.00
|
|
|
Service Code
|
CPT 26075
|
| Hospital Charge Code |
21600477
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$280.64 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$616.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$873.80
|
| Rate for Payer: First Health Commercial |
$925.20
|
| Rate for Payer: First Health Workers Compensation |
$396.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$925.20
|
| Rate for Payer: GEHA Commercial |
$822.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$925.20
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$935.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$719.60
|
| Rate for Payer: One Health Plan PPO/POS |
$925.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$976.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$771.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$956.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$411.20
|
| 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 |
$280.64
|
|
|
ARTHRT EXPL DRG/RMVL LOOSE/FB MTCARPHLNG
|
Facility
|
IP
|
$1,028.00
|
|
|
Service Code
|
CPT 26075
|
| Hospital Charge Code |
6126075
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$280.64 |
| Max. Negotiated Rate |
$976.60 |
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$873.80
|
| Rate for Payer: First Health Commercial |
$925.20
|
| Rate for Payer: First Health Workers Compensation |
$396.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$925.20
|
| Rate for Payer: GEHA Commercial |
$719.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$925.20
|
| Rate for Payer: Multiplan All |
$935.48
|
| Rate for Payer: OMNI Networks Commercial |
$719.60
|
| Rate for Payer: One Health Plan PPO/POS |
$925.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$976.60
|
| Rate for Payer: Three Rivers Provider Network All |
$771.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$956.04
|
| Rate for Payer: Zelis Auto |
$411.20
|
| Rate for Payer: Zelis Worker's Compensation |
$280.64
|
|
|
ARTHRT EXPL DRG/RMVL LOOSE/FB MTCARPHLNG
|
Facility
|
OP
|
$1,028.00
|
|
|
Service Code
|
CPT 26075
|
| Hospital Charge Code |
8226075
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$280.64 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$616.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$873.80
|
| Rate for Payer: First Health Commercial |
$925.20
|
| Rate for Payer: First Health Workers Compensation |
$396.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$925.20
|
| Rate for Payer: GEHA Commercial |
$822.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$925.20
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$935.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$719.60
|
| Rate for Payer: One Health Plan PPO/POS |
$925.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$976.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$771.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$956.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$411.20
|
| 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 |
$280.64
|
|
|
ARTHRT EXPL DRG/RMVL LOOSE/FB MTCARPHLNG
|
Facility
|
OP
|
$1,028.00
|
|
|
Service Code
|
CPT 26075
|
| Hospital Charge Code |
8826075
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$280.64 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$616.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$873.80
|
| Rate for Payer: First Health Commercial |
$925.20
|
| Rate for Payer: First Health Workers Compensation |
$396.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$925.20
|
| Rate for Payer: GEHA Commercial |
$822.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$925.20
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$935.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$719.60
|
| Rate for Payer: One Health Plan PPO/POS |
$925.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$976.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$771.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$956.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$411.20
|
| 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 |
$280.64
|
|
|
ARTHRT EXPL DRG/RMVL LOOSE/FB MTCARPHLNG
|
Facility
|
OP
|
$1,028.00
|
|
|
Service Code
|
CPT 26075
|
| Hospital Charge Code |
6126075
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$280.64 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$616.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$873.80
|
| Rate for Payer: First Health Commercial |
$925.20
|
| Rate for Payer: First Health Workers Compensation |
$396.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$925.20
|
| Rate for Payer: GEHA Commercial |
$822.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$925.20
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$935.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$719.60
|
| Rate for Payer: One Health Plan PPO/POS |
$925.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$976.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$771.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$956.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$411.20
|
| 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 |
$280.64
|
|
|
ARTHRT EXPL DRG/RMVL LOOSE/FB MTCARPHLNG
|
Facility
|
IP
|
$1,028.00
|
|
|
Service Code
|
CPT 26075
|
| Hospital Charge Code |
8826075
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$280.64 |
| Max. Negotiated Rate |
$976.60 |
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$873.80
|
| Rate for Payer: First Health Commercial |
$925.20
|
| Rate for Payer: First Health Workers Compensation |
$396.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$925.20
|
| Rate for Payer: GEHA Commercial |
$719.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$925.20
|
| Rate for Payer: Multiplan All |
$935.48
|
| Rate for Payer: OMNI Networks Commercial |
$719.60
|
| Rate for Payer: One Health Plan PPO/POS |
$925.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$976.60
|
| Rate for Payer: Three Rivers Provider Network All |
$771.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$956.04
|
| Rate for Payer: Zelis Auto |
$411.20
|
| Rate for Payer: Zelis Worker's Compensation |
$280.64
|
|
|
ARTHRT EXPL DRG/RMVL LOOSE/FB MTCARPHLNG
|
Facility
|
IP
|
$1,028.00
|
|
|
Service Code
|
CPT 26075
|
| Hospital Charge Code |
8226075
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$280.64 |
| Max. Negotiated Rate |
$976.60 |
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$873.80
|
| Rate for Payer: First Health Commercial |
$925.20
|
| Rate for Payer: First Health Workers Compensation |
$396.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$925.20
|
| Rate for Payer: GEHA Commercial |
$719.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$925.20
|
| Rate for Payer: Multiplan All |
$935.48
|
| Rate for Payer: OMNI Networks Commercial |
$719.60
|
| Rate for Payer: One Health Plan PPO/POS |
$925.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$976.60
|
| Rate for Payer: Three Rivers Provider Network All |
$771.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$956.04
|
| Rate for Payer: Zelis Auto |
$411.20
|
| Rate for Payer: Zelis Worker's Compensation |
$280.64
|
|
|
ARTHRT EXPL DRG/RMVL LOOSE/FB MTCARPHLNG
|
Facility
|
IP
|
$1,028.00
|
|
|
Service Code
|
CPT 26075
|
| Hospital Charge Code |
21600477
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$280.64 |
| Max. Negotiated Rate |
$976.60 |
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$873.80
|
| Rate for Payer: First Health Commercial |
$925.20
|
| Rate for Payer: First Health Workers Compensation |
$396.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$925.20
|
| Rate for Payer: GEHA Commercial |
$719.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$925.20
|
| Rate for Payer: Multiplan All |
$935.48
|
| Rate for Payer: OMNI Networks Commercial |
$719.60
|
| Rate for Payer: One Health Plan PPO/POS |
$925.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$976.60
|
| Rate for Payer: Three Rivers Provider Network All |
$771.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$956.04
|
| Rate for Payer: Zelis Auto |
$411.20
|
| Rate for Payer: Zelis Worker's Compensation |
$280.64
|
|
|
ARTHRT KNE W/EXPL DRG/RMVL FB
|
Facility
|
IP
|
$1,498.00
|
|
|
Service Code
|
CPT 27310
|
| Hospital Charge Code |
6127310
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$408.95 |
| Max. Negotiated Rate |
$1,423.10 |
| Rate for Payer: Cash Price |
$898.80
|
| Rate for Payer: Cigna Commercial |
$1,273.30
|
| Rate for Payer: First Health Commercial |
$1,348.20
|
| Rate for Payer: First Health Workers Compensation |
$578.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,348.20
|
| Rate for Payer: GEHA Commercial |
$1,048.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,348.20
|
| Rate for Payer: Multiplan All |
$1,363.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,048.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,348.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,423.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,123.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,393.14
|
| Rate for Payer: Zelis Auto |
$599.20
|
| Rate for Payer: Zelis Worker's Compensation |
$408.95
|
|
|
ARTHRT KNE W/EXPL DRG/RMVL FB
|
Facility
|
OP
|
$2,285.00
|
|
|
Service Code
|
CPT 27310
|
| Hospital Charge Code |
21600487
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$623.80 |
| 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 |
$1,371.00
|
| 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 |
$1,371.00
|
| Rate for Payer: Cash Price |
$1,371.00
|
| Rate for Payer: Cigna Commercial |
$1,942.25
|
| Rate for Payer: First Health Commercial |
$2,056.50
|
| Rate for Payer: First Health Workers Compensation |
$882.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,056.50
|
| Rate for Payer: GEHA Commercial |
$1,828.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,056.50
|
| 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 |
$2,079.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,599.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,056.50
|
| 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 |
$2,170.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,713.75
|
| 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 |
$2,125.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$914.00
|
| 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 |
$623.80
|
|
|
ARTHRT KNE W/EXPL DRG/RMVL FB
|
Facility
|
OP
|
$1,498.00
|
|
|
Service Code
|
CPT 27310
|
| Hospital Charge Code |
6127310
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$408.95 |
| 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 |
$898.80
|
| 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 |
$898.80
|
| Rate for Payer: Cash Price |
$898.80
|
| Rate for Payer: Cigna Commercial |
$1,273.30
|
| Rate for Payer: First Health Commercial |
$1,348.20
|
| Rate for Payer: First Health Workers Compensation |
$578.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,348.20
|
| Rate for Payer: GEHA Commercial |
$1,198.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,348.20
|
| 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 |
$1,363.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,048.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,348.20
|
| 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 |
$1,423.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,123.50
|
| 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 |
$1,393.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$599.20
|
| 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 |
$408.95
|
|
