|
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
|
|
|
ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 27331
|
| Hospital Charge Code |
6127331
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$263.99 |
| 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 |
$580.20
|
| 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 |
$580.20
|
| Rate for Payer: Cash Price |
$580.20
|
| Rate for Payer: Cigna Commercial |
$821.95
|
| Rate for Payer: First Health Commercial |
$870.30
|
| Rate for Payer: First Health Workers Compensation |
$373.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$870.30
|
| Rate for Payer: GEHA Commercial |
$773.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$870.30
|
| 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 |
$879.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$676.90
|
| Rate for Payer: One Health Plan PPO/POS |
$870.30
|
| 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 |
$918.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$725.25
|
| 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 |
$899.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$386.80
|
| 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 |
$263.99
|
|
|
ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB
|
Facility
|
IP
|
$1,476.00
|
|
|
Service Code
|
CPT 27331
|
| Hospital Charge Code |
21600488
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$402.95 |
| Max. Negotiated Rate |
$1,402.20 |
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Cigna Commercial |
$1,254.60
|
| Rate for Payer: First Health Commercial |
$1,328.40
|
| Rate for Payer: First Health Workers Compensation |
$569.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,328.40
|
| Rate for Payer: GEHA Commercial |
$1,033.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,328.40
|
| Rate for Payer: Multiplan All |
$1,343.16
|
| Rate for Payer: OMNI Networks Commercial |
$1,033.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,328.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,402.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,107.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,372.68
|
| Rate for Payer: Zelis Auto |
$590.40
|
| Rate for Payer: Zelis Worker's Compensation |
$402.95
|
|
|
ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 27331
|
| Hospital Charge Code |
6127331
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$263.99 |
| Max. Negotiated Rate |
$918.65 |
| Rate for Payer: Cash Price |
$580.20
|
| Rate for Payer: Cigna Commercial |
$821.95
|
| Rate for Payer: First Health Commercial |
$870.30
|
| Rate for Payer: First Health Workers Compensation |
$373.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$870.30
|
| Rate for Payer: GEHA Commercial |
$676.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$870.30
|
| Rate for Payer: Multiplan All |
$879.97
|
| Rate for Payer: OMNI Networks Commercial |
$676.90
|
| Rate for Payer: One Health Plan PPO/POS |
$870.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$918.65
|
| Rate for Payer: Three Rivers Provider Network All |
$725.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$899.31
|
| Rate for Payer: Zelis Auto |
$386.80
|
| Rate for Payer: Zelis Worker's Compensation |
$263.99
|
|
|
ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB
|
Facility
|
OP
|
$1,476.00
|
|
|
Service Code
|
CPT 27331
|
| Hospital Charge Code |
21600488
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$402.95 |
| 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 |
$885.60
|
| 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 |
$885.60
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Cigna Commercial |
$1,254.60
|
| Rate for Payer: First Health Commercial |
$1,328.40
|
| Rate for Payer: First Health Workers Compensation |
$569.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,328.40
|
| Rate for Payer: GEHA Commercial |
$1,180.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,328.40
|
| 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 |
$1,343.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,033.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,328.40
|
| 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 |
$1,402.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,107.00
|
| 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 |
$1,372.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$590.40
|
| 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 |
$402.95
|
|
|
ARTHRT RDCRPL/MIDCARPL JT W/EXPL DRG/RMV
|
Facility
|
IP
|
$1,145.00
|
|
|
Service Code
|
CPT 25040
|
| Hospital Charge Code |
6125040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$312.58 |
| Max. Negotiated Rate |
$1,087.75 |
| Rate for Payer: Cash Price |
$687.00
|
| Rate for Payer: Cigna Commercial |
$973.25
|
| Rate for Payer: First Health Commercial |
$1,030.50
|
| Rate for Payer: First Health Workers Compensation |
$442.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,030.50
|
| Rate for Payer: GEHA Commercial |
$801.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,030.50
|
| Rate for Payer: Multiplan All |
$1,041.95
|
| Rate for Payer: OMNI Networks Commercial |
$801.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,030.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,087.75
|
| Rate for Payer: Three Rivers Provider Network All |
$858.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,064.85
|
| Rate for Payer: Zelis Auto |
$458.00
|
| Rate for Payer: Zelis Worker's Compensation |
$312.58
|
|
|
ARTHRT RDCRPL/MIDCARPL JT W/EXPL DRG/RMV
|
Facility
|
OP
|
$1,145.00
|
|
|
Service Code
|
CPT 25040
|
| Hospital Charge Code |
6125040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$312.58 |
| 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 |
$687.00
|
| 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 |
$687.00
|
| Rate for Payer: Cash Price |
$687.00
|
| Rate for Payer: Cigna Commercial |
$973.25
|
| Rate for Payer: First Health Commercial |
$1,030.50
|
| Rate for Payer: First Health Workers Compensation |
$442.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,030.50
|
| Rate for Payer: GEHA Commercial |
$916.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,030.50
|
| 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 |
$1,041.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$801.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,030.50
|
| 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 |
$1,087.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$858.75
|
| 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 |
$1,064.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$458.00
|
| 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 |
$312.58
|
|
|
ARTHRT RDCRPL/MIDCARPL JT W/EXPL DRG/RMV
|
Facility
|
IP
|
$1,745.00
|
|
|
Service Code
|
CPT 25040
|
| Hospital Charge Code |
21600505
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$476.38 |
| Max. Negotiated Rate |
$1,657.75 |
| Rate for Payer: Cash Price |
$1,047.00
|
| Rate for Payer: Cigna Commercial |
$1,483.25
|
| Rate for Payer: First Health Commercial |
$1,570.50
|
| Rate for Payer: First Health Workers Compensation |
$673.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,570.50
|
| Rate for Payer: GEHA Commercial |
$1,221.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,570.50
|
| Rate for Payer: Multiplan All |
$1,587.95
|
| Rate for Payer: OMNI Networks Commercial |
$1,221.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,570.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,657.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,308.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,622.85
|
| Rate for Payer: Zelis Auto |
$698.00
|
| Rate for Payer: Zelis Worker's Compensation |
$476.38
|
|
|
ARTHRT RDCRPL/MIDCARPL JT W/EXPL DRG/RMV
|
Facility
|
OP
|
$1,745.00
|
|
|
Service Code
|
CPT 25040
|
| Hospital Charge Code |
21600505
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$476.38 |
| 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 |
$1,047.00
|
| 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 |
$1,047.00
|
| Rate for Payer: Cash Price |
$1,047.00
|
| Rate for Payer: Cigna Commercial |
$1,483.25
|
| Rate for Payer: First Health Commercial |
$1,570.50
|
| Rate for Payer: First Health Workers Compensation |
$673.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,570.50
|
| Rate for Payer: GEHA Commercial |
$1,396.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,570.50
|
| 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 |
$1,587.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,221.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,570.50
|
| 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 |
$1,657.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,308.75
|
| 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 |
$1,622.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$698.00
|
| 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 |
$476.38
|
|
|
ARTHRT W/EXPL DRG/RMVL LOOSE/FB IPHAL JT
|
Facility
|
OP
|
$775.00
|
|
|
Service Code
|
CPT 28024
|
| Hospital Charge Code |
6128024
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$211.57 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$465.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cigna Commercial |
$658.75
|
| Rate for Payer: First Health Commercial |
$697.50
|
| Rate for Payer: First Health Workers Compensation |
$299.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$697.50
|
| Rate for Payer: GEHA Commercial |
$620.00
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$697.50
|
| 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 |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$705.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$542.50
|
| Rate for Payer: One Health Plan PPO/POS |
$697.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$736.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$581.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$720.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$310.00
|
| 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 |
$211.57
|
|
|
ARTHRT W/EXPL DRG/RMVL LOOSE/FB IPHAL JT
|
Facility
|
IP
|
$1,381.00
|
|
|
Service Code
|
CPT 28024
|
| Hospital Charge Code |
21600485
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$377.01 |
| Max. Negotiated Rate |
$1,311.95 |
| Rate for Payer: Cash Price |
$828.60
|
| Rate for Payer: Cigna Commercial |
$1,173.85
|
| Rate for Payer: First Health Commercial |
$1,242.90
|
| Rate for Payer: First Health Workers Compensation |
$533.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,242.90
|
| Rate for Payer: GEHA Commercial |
$966.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,242.90
|
| Rate for Payer: Multiplan All |
$1,256.71
|
| Rate for Payer: OMNI Networks Commercial |
$966.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,242.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,311.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,035.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,284.33
|
| Rate for Payer: Zelis Auto |
$552.40
|
| Rate for Payer: Zelis Worker's Compensation |
$377.01
|
|
|
ARTHRT W/EXPL DRG/RMVL LOOSE/FB IPHAL JT
|
Facility
|
OP
|
$1,381.00
|
|
|
Service Code
|
CPT 28024
|
| Hospital Charge Code |
21600485
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$377.01 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$828.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$828.60
|
| Rate for Payer: Cash Price |
$828.60
|
| Rate for Payer: Cigna Commercial |
$1,173.85
|
| Rate for Payer: First Health Commercial |
$1,242.90
|
| Rate for Payer: First Health Workers Compensation |
$533.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,242.90
|
| Rate for Payer: GEHA Commercial |
$1,104.80
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,242.90
|
| 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 |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$1,256.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$966.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,242.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,311.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,035.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,284.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$552.40
|
| 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 |
$377.01
|
|
|
ARTHRT W/EXPL DRG/RMVL LOOSE/FB IPHAL JT
|
Facility
|
IP
|
$775.00
|
|
|
Service Code
|
CPT 28024
|
| Hospital Charge Code |
6128024
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$211.57 |
| Max. Negotiated Rate |
$736.25 |
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cigna Commercial |
$658.75
|
| Rate for Payer: First Health Commercial |
$697.50
|
| Rate for Payer: First Health Workers Compensation |
$299.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$697.50
|
| Rate for Payer: GEHA Commercial |
$542.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$697.50
|
| Rate for Payer: Multiplan All |
$705.25
|
| Rate for Payer: OMNI Networks Commercial |
$542.50
|
| Rate for Payer: One Health Plan PPO/POS |
$697.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$736.25
|
| Rate for Payer: Three Rivers Provider Network All |
$581.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$720.75
|
| Rate for Payer: Zelis Auto |
$310.00
|
| Rate for Payer: Zelis Worker's Compensation |
$211.57
|
|
|
ARTHRT W/EXPL DRG/RMVL LOOSE/FB NTRTRSL/
|
Facility
|
OP
|
$1,644.00
|
|
|
Service Code
|
CPT 28020
|
| Hospital Charge Code |
21600503
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$448.81 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$986.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Cigna Commercial |
$1,397.40
|
| Rate for Payer: First Health Commercial |
$1,479.60
|
| Rate for Payer: First Health Workers Compensation |
$634.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,479.60
|
| Rate for Payer: GEHA Commercial |
$1,315.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,479.60
|
| 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 |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,496.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,150.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,479.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,561.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,233.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,528.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$657.60
|
| 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 |
$448.81
|
|
|
ARTHRT W/EXPL DRG/RMVL LOOSE/FB NTRTRSL/
|
Facility
|
OP
|
$1,644.00
|
|
|
Service Code
|
CPT 28020
|
| Hospital Charge Code |
21600486
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$448.81 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$986.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Cigna Commercial |
$1,397.40
|
| Rate for Payer: First Health Commercial |
$1,479.60
|
| Rate for Payer: First Health Workers Compensation |
$634.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,479.60
|
| Rate for Payer: GEHA Commercial |
$1,315.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,479.60
|
| 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 |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,496.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,150.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,479.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,561.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,233.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,528.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$657.60
|
| 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 |
$448.81
|
|
|
ARTHRT W/EXPL DRG/RMVL LOOSE/FB NTRTRSL/
|
Facility
|
IP
|
$1,644.00
|
|
|
Service Code
|
CPT 28020
|
| Hospital Charge Code |
21600503
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$448.81 |
| Max. Negotiated Rate |
$1,561.80 |
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Cigna Commercial |
$1,397.40
|
| Rate for Payer: First Health Commercial |
$1,479.60
|
| Rate for Payer: First Health Workers Compensation |
$634.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,479.60
|
| Rate for Payer: GEHA Commercial |
$1,150.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,479.60
|
| Rate for Payer: Multiplan All |
$1,496.04
|
| Rate for Payer: OMNI Networks Commercial |
$1,150.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,479.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,561.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,233.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,528.92
|
| Rate for Payer: Zelis Auto |
$657.60
|
| Rate for Payer: Zelis Worker's Compensation |
$448.81
|
|
|
ARTHRT W/EXPL DRG/RMVL LOOSE/FB NTRTRSL/
|
Facility
|
IP
|
$1,644.00
|
|
|
Service Code
|
CPT 28020
|
| Hospital Charge Code |
21600486
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$448.81 |
| Max. Negotiated Rate |
$1,561.80 |
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Cigna Commercial |
$1,397.40
|
| Rate for Payer: First Health Commercial |
$1,479.60
|
| Rate for Payer: First Health Workers Compensation |
$634.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,479.60
|
| Rate for Payer: GEHA Commercial |
$1,150.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,479.60
|
| Rate for Payer: Multiplan All |
$1,496.04
|
| Rate for Payer: OMNI Networks Commercial |
$1,150.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,479.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,561.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,233.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,528.92
|
| Rate for Payer: Zelis Auto |
$657.60
|
| Rate for Payer: Zelis Worker's Compensation |
$448.81
|
|
|
ARTHRT W/EXPL DRG/RMVL LOOSE/FB NTRTRSL/
|
Facility
|
IP
|
$923.00
|
|
|
Service Code
|
CPT 28020
|
| Hospital Charge Code |
6128020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$251.98 |
| Max. Negotiated Rate |
$876.85 |
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$784.55
|
| Rate for Payer: First Health Commercial |
$830.70
|
| Rate for Payer: First Health Workers Compensation |
$356.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$830.70
|
| Rate for Payer: GEHA Commercial |
$646.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$830.70
|
| Rate for Payer: Multiplan All |
$839.93
|
| Rate for Payer: OMNI Networks Commercial |
$646.10
|
| Rate for Payer: One Health Plan PPO/POS |
$830.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$876.85
|
| Rate for Payer: Three Rivers Provider Network All |
$692.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$858.39
|
| Rate for Payer: Zelis Auto |
$369.20
|
| Rate for Payer: Zelis Worker's Compensation |
$251.98
|
|
|
ARTHRT W/EXPL DRG/RMVL LOOSE/FB NTRTRSL/
|
Facility
|
OP
|
$923.00
|
|
|
Service Code
|
CPT 28020
|
| Hospital Charge Code |
6128020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$251.98 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$553.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$784.55
|
| Rate for Payer: First Health Commercial |
$830.70
|
| Rate for Payer: First Health Workers Compensation |
$356.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$830.70
|
| Rate for Payer: GEHA Commercial |
$738.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$830.70
|
| 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 |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$839.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$646.10
|
| Rate for Payer: One Health Plan PPO/POS |
$830.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$876.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$692.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$858.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$369.20
|
| 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 |
$251.98
|
|
|
ARTHRT WRST W/JT EXPL W/WO BX W/WO RMVL
|
Facility
|
IP
|
$1,017.00
|
|
|
Service Code
|
CPT 25101
|
| Hospital Charge Code |
6125101
|
|
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 WRST W/JT EXPL W/WO BX W/WO RMVL
|
Facility
|
IP
|
$1,247.00
|
|
|
Service Code
|
CPT 25101
|
| Hospital Charge Code |
21600506
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$340.43 |
| Max. Negotiated Rate |
$1,184.65 |
| Rate for Payer: Cash Price |
$748.20
|
| Rate for Payer: Cigna Commercial |
$1,059.95
|
| Rate for Payer: First Health Commercial |
$1,122.30
|
| Rate for Payer: First Health Workers Compensation |
$481.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,122.30
|
| Rate for Payer: GEHA Commercial |
$872.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,122.30
|
| Rate for Payer: Multiplan All |
$1,134.77
|
| Rate for Payer: OMNI Networks Commercial |
$872.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,122.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,184.65
|
| Rate for Payer: Three Rivers Provider Network All |
$935.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,159.71
|
| Rate for Payer: Zelis Auto |
$498.80
|
| Rate for Payer: Zelis Worker's Compensation |
$340.43
|
|
|
ARTHRT WRST W/JT EXPL W/WO BX W/WO RMVL
|
Facility
|
OP
|
$1,017.00
|
|
|
Service Code
|
CPT 25101
|
| Hospital Charge Code |
6125101
|
|
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 WRST W/JT EXPL W/WO BX W/WO RMVL
|
Facility
|
OP
|
$1,247.00
|
|
|
Service Code
|
CPT 25101
|
| Hospital Charge Code |
21600506
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$340.43 |
| 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 |
$748.20
|
| 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 |
$748.20
|
| Rate for Payer: Cash Price |
$748.20
|
| Rate for Payer: Cigna Commercial |
$1,059.95
|
| Rate for Payer: First Health Commercial |
$1,122.30
|
| Rate for Payer: First Health Workers Compensation |
$481.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,122.30
|
| Rate for Payer: GEHA Commercial |
$997.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,122.30
|
| 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 |
$1,134.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$872.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,122.30
|
| 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 |
$1,184.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$935.25
|
| 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 |
$1,159.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$498.80
|
| 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 |
$340.43
|
|
|
ARTL CATHJ/CANNULJ MNTR/TRANSFUS SPX PRQ
|
Facility
|
OP
|
$1,208.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
6100002
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$94.59 |
| Max. Negotiated Rate |
$1,147.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.80
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cigna Commercial |
$1,026.80
|
| Rate for Payer: First Health Commercial |
$1,087.20
|
| Rate for Payer: First Health Workers Compensation |
$133.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,087.20
|
| Rate for Payer: GEHA Commercial |
$966.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,087.20
|
| Rate for Payer: Humana ChoiceCare |
$314.08
|
| Rate for Payer: Multiplan All |
$1,099.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$724.80
|
| Rate for Payer: OMNI Networks Commercial |
$845.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,087.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,147.60
|
| Rate for Payer: Three Rivers Provider Network All |
$906.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,063.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$302.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,123.44
|
| Rate for Payer: Zelis Auto |
$483.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$604.00
|
| Rate for Payer: Zelis Worker's Compensation |
$94.59
|
|
|
ARTL CATHJ/CANNULJ MNTR/TRANSFUS SPX PRQ
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
8150110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: First Health Commercial |
$144.00
|
| Rate for Payer: First Health Workers Compensation |
$61.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.00
|
| Rate for Payer: GEHA Commercial |
$128.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.00
|
| Rate for Payer: Humana ChoiceCare |
$41.60
|
| Rate for Payer: Multiplan All |
$145.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$96.00
|
| Rate for Payer: OMNI Networks Commercial |
$112.00
|
| Rate for Payer: One Health Plan PPO/POS |
$144.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.00
|
| Rate for Payer: Three Rivers Provider Network All |
$120.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$140.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$40.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$148.80
|
| Rate for Payer: Zelis Auto |
$64.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$80.00
|
| Rate for Payer: Zelis Worker's Compensation |
$43.68
|
|
