|
PARTIAL EXCISION OF LIP
|
Facility
|
IP
|
$923.00
|
|
|
Service Code
|
CPT 40520
|
| Hospital Charge Code |
6140520
|
|
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
|
|
|
PARTIAL EXCISION OF LIP
|
Facility
|
OP
|
$923.00
|
|
|
Service Code
|
CPT 40520
|
| Hospital Charge Code |
6140520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$251.98 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| 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 |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| 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 |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$830.70
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$839.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| 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 |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$876.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$692.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$858.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$369.20
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$251.98
|
|
|
PARTIAL EXCISION OF LIP
|
Facility
|
IP
|
$919.00
|
|
|
Service Code
|
CPT 40510
|
| Hospital Charge Code |
6140510
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$250.89 |
| Max. Negotiated Rate |
$873.05 |
| Rate for Payer: Cash Price |
$551.40
|
| Rate for Payer: Cigna Commercial |
$781.15
|
| Rate for Payer: First Health Commercial |
$827.10
|
| Rate for Payer: First Health Workers Compensation |
$354.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$827.10
|
| Rate for Payer: GEHA Commercial |
$643.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$827.10
|
| Rate for Payer: Multiplan All |
$836.29
|
| Rate for Payer: OMNI Networks Commercial |
$643.30
|
| Rate for Payer: One Health Plan PPO/POS |
$827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$873.05
|
| Rate for Payer: Three Rivers Provider Network All |
$689.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$854.67
|
| Rate for Payer: Zelis Auto |
$367.60
|
| Rate for Payer: Zelis Worker's Compensation |
$250.89
|
|
|
PARTIAL HIP REPLACEMENT
|
Facility
|
IP
|
$2,340.00
|
|
|
Service Code
|
CPT 27125
|
| Hospital Charge Code |
6127125
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$638.82 |
| Max. Negotiated Rate |
$2,223.00 |
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cigna Commercial |
$1,989.00
|
| Rate for Payer: First Health Commercial |
$2,106.00
|
| Rate for Payer: First Health Workers Compensation |
$903.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,106.00
|
| Rate for Payer: GEHA Commercial |
$1,638.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,106.00
|
| Rate for Payer: Multiplan All |
$2,129.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,638.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,106.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,223.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,755.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,176.20
|
| Rate for Payer: Zelis Auto |
$936.00
|
| Rate for Payer: Zelis Worker's Compensation |
$638.82
|
|
|
PARTIAL HIP REPLACEMENT
|
Facility
|
OP
|
$2,340.00
|
|
|
Service Code
|
CPT 27125
|
| Hospital Charge Code |
6127125
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$2,223.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,404.00
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cigna Commercial |
$1,989.00
|
| Rate for Payer: First Health Commercial |
$2,106.00
|
| Rate for Payer: First Health Workers Compensation |
$903.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,106.00
|
| Rate for Payer: GEHA Commercial |
$1,872.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,106.00
|
| Rate for Payer: Humana ChoiceCare |
$608.40
|
| Rate for Payer: Multiplan All |
$2,129.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,404.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,638.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,106.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,223.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,755.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,059.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$585.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,176.20
|
| Rate for Payer: Zelis Auto |
$936.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,170.00
|
| Rate for Payer: Zelis Worker's Compensation |
$638.82
|
|
|
PARTIAL HYSTERECTOMY
|
Facility
|
IP
|
$1,966.00
|
|
|
Service Code
|
CPT 58180
|
| Hospital Charge Code |
6158180
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$536.72 |
| Max. Negotiated Rate |
$1,867.70 |
| Rate for Payer: Cash Price |
$1,179.60
|
| Rate for Payer: Cigna Commercial |
$1,671.10
|
| Rate for Payer: First Health Commercial |
$1,769.40
|
| Rate for Payer: First Health Workers Compensation |
$759.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,769.40
|
| Rate for Payer: GEHA Commercial |
$1,376.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,769.40
|
| Rate for Payer: Multiplan All |
$1,789.06
|
| Rate for Payer: OMNI Networks Commercial |
$1,376.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,769.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,867.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,474.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,828.38
|
| Rate for Payer: Zelis Auto |
$786.40
|
| Rate for Payer: Zelis Worker's Compensation |
$536.72
|
|
|
PARTIAL HYSTERECTOMY
|
Facility
|
OP
|
$1,966.00
|
|
|
Service Code
|
CPT 58180
|
| Hospital Charge Code |
6158180
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$491.50 |
| Max. Negotiated Rate |
$1,867.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,179.60
|
| Rate for Payer: Cash Price |
$1,179.60
|
| Rate for Payer: Cigna Commercial |
$1,671.10
|
| Rate for Payer: First Health Commercial |
$1,769.40
|
| Rate for Payer: First Health Workers Compensation |
$759.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,769.40
|
| Rate for Payer: GEHA Commercial |
$1,572.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,769.40
|
| Rate for Payer: Humana ChoiceCare |
$511.16
|
| Rate for Payer: Multiplan All |
$1,789.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,179.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,376.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,769.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,867.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,474.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,730.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$491.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,828.38
|
| Rate for Payer: Zelis Auto |
$786.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$983.00
|
| Rate for Payer: Zelis Worker's Compensation |
$536.72
|
|
|
PARTIAL PROCTECTOMY
|
Facility
|
OP
|
$2,338.00
|
|
|
Service Code
|
CPT 45123
|
| Hospital Charge Code |
6145123
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$584.50 |
| Max. Negotiated Rate |
$2,221.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,402.80
|
| Rate for Payer: Cash Price |
$1,402.80
|
| Rate for Payer: Cigna Commercial |
$1,987.30
|
| Rate for Payer: First Health Commercial |
$2,104.20
|
| Rate for Payer: First Health Workers Compensation |
$902.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,104.20
|
| Rate for Payer: GEHA Commercial |
$1,870.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,104.20
|
| Rate for Payer: Humana ChoiceCare |
$607.88
|
| Rate for Payer: Multiplan All |
$2,127.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,402.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,636.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,104.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,221.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,753.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,057.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$584.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,174.34
|
| Rate for Payer: Zelis Auto |
$935.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,169.00
|
| Rate for Payer: Zelis Worker's Compensation |
$638.27
|
|
|
PARTIAL PROCTECTOMY
|
Facility
|
IP
|
$2,338.00
|
|
|
Service Code
|
CPT 45123
|
| Hospital Charge Code |
6145123
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$638.27 |
| Max. Negotiated Rate |
$2,221.10 |
| Rate for Payer: Cash Price |
$1,402.80
|
| Rate for Payer: Cigna Commercial |
$1,987.30
|
| Rate for Payer: First Health Commercial |
$2,104.20
|
| Rate for Payer: First Health Workers Compensation |
$902.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,104.20
|
| Rate for Payer: GEHA Commercial |
$1,636.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,104.20
|
| Rate for Payer: Multiplan All |
$2,127.58
|
| Rate for Payer: OMNI Networks Commercial |
$1,636.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,104.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,221.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,753.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,174.34
|
| Rate for Payer: Zelis Auto |
$935.20
|
| Rate for Payer: Zelis Worker's Compensation |
$638.27
|
|
|
PARTIAL PROCTECTOMY
|
Facility
|
OP
|
$3,946.00
|
|
|
Service Code
|
CPT 45113
|
| Hospital Charge Code |
6145113
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$986.50 |
| Max. Negotiated Rate |
$3,748.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,367.60
|
| Rate for Payer: Cash Price |
$2,367.60
|
| Rate for Payer: Cigna Commercial |
$3,354.10
|
| Rate for Payer: First Health Commercial |
$3,551.40
|
| Rate for Payer: First Health Workers Compensation |
$1,523.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,551.40
|
| Rate for Payer: GEHA Commercial |
$3,156.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,551.40
|
| Rate for Payer: Humana ChoiceCare |
$1,025.96
|
| Rate for Payer: Multiplan All |
$3,590.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,367.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,762.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,551.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,748.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,959.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,472.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$986.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,669.78
|
| Rate for Payer: Zelis Auto |
$1,578.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,973.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,077.26
|
|
|
PARTIAL PROCTECTOMY
|
Facility
|
IP
|
$3,946.00
|
|
|
Service Code
|
CPT 45113
|
| Hospital Charge Code |
6145113
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,077.26 |
| Max. Negotiated Rate |
$3,748.70 |
| Rate for Payer: Cash Price |
$2,367.60
|
| Rate for Payer: Cigna Commercial |
$3,354.10
|
| Rate for Payer: First Health Commercial |
$3,551.40
|
| Rate for Payer: First Health Workers Compensation |
$1,523.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,551.40
|
| Rate for Payer: GEHA Commercial |
$2,762.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,551.40
|
| Rate for Payer: Multiplan All |
$3,590.86
|
| Rate for Payer: OMNI Networks Commercial |
$2,762.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,551.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,748.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,959.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,669.78
|
| Rate for Payer: Zelis Auto |
$1,578.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,077.26
|
|
|
PARTIAL RELEASE OF LUNG
|
Facility
|
OP
|
$2,095.00
|
|
|
Service Code
|
CPT 32225
|
| Hospital Charge Code |
6132225
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$523.75 |
| Max. Negotiated Rate |
$1,990.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,257.00
|
| Rate for Payer: Cash Price |
$1,257.00
|
| Rate for Payer: Cigna Commercial |
$1,780.75
|
| Rate for Payer: First Health Commercial |
$1,885.50
|
| Rate for Payer: First Health Workers Compensation |
$808.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,885.50
|
| Rate for Payer: GEHA Commercial |
$1,676.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,885.50
|
| Rate for Payer: Humana ChoiceCare |
$544.70
|
| Rate for Payer: Multiplan All |
$1,906.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,257.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,466.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,885.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,990.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,571.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,843.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$523.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,948.35
|
| Rate for Payer: Zelis Auto |
$838.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,047.50
|
| Rate for Payer: Zelis Worker's Compensation |
$571.93
|
|
|
PARTIAL RELEASE OF LUNG
|
Facility
|
IP
|
$2,095.00
|
|
|
Service Code
|
CPT 32225
|
| Hospital Charge Code |
6132225
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$571.93 |
| Max. Negotiated Rate |
$1,990.25 |
| Rate for Payer: Cash Price |
$1,257.00
|
| Rate for Payer: Cigna Commercial |
$1,780.75
|
| Rate for Payer: First Health Commercial |
$1,885.50
|
| Rate for Payer: First Health Workers Compensation |
$808.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,885.50
|
| Rate for Payer: GEHA Commercial |
$1,466.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,885.50
|
| Rate for Payer: Multiplan All |
$1,906.45
|
| Rate for Payer: OMNI Networks Commercial |
$1,466.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,885.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,990.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,571.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,948.35
|
| Rate for Payer: Zelis Auto |
$838.00
|
| Rate for Payer: Zelis Worker's Compensation |
$571.93
|
|
|
PARTIAL REMOVAL COLLAR BONE
|
Facility
|
IP
|
$1,190.00
|
|
|
Service Code
|
CPT 23120
|
| Hospital Charge Code |
6123120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$324.87 |
| Max. Negotiated Rate |
$1,130.50 |
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cigna Commercial |
$1,011.50
|
| Rate for Payer: First Health Commercial |
$1,071.00
|
| Rate for Payer: First Health Workers Compensation |
$459.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,071.00
|
| Rate for Payer: GEHA Commercial |
$833.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,071.00
|
| Rate for Payer: Multiplan All |
$1,082.90
|
| Rate for Payer: OMNI Networks Commercial |
$833.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,071.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,130.50
|
| Rate for Payer: Three Rivers Provider Network All |
$892.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,106.70
|
| Rate for Payer: Zelis Auto |
$476.00
|
| Rate for Payer: Zelis Worker's Compensation |
$324.87
|
|
|
PARTIAL REMOVAL COLLAR BONE
|
Facility
|
OP
|
$1,190.00
|
|
|
Service Code
|
CPT 23120
|
| Hospital Charge Code |
6123120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$324.87 |
| 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 |
$714.00
|
| 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 |
$714.00
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cigna Commercial |
$1,011.50
|
| Rate for Payer: First Health Commercial |
$1,071.00
|
| Rate for Payer: First Health Workers Compensation |
$459.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,071.00
|
| Rate for Payer: GEHA Commercial |
$952.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,071.00
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,082.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$833.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,071.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,130.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$892.50
|
| 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 |
$1,106.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$476.00
|
| 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 |
$324.87
|
|
|
PARTIAL REMOVAL FINGER BONE
|
Facility
|
IP
|
$1,364.00
|
|
|
Service Code
|
CPT 26236
|
| Hospital Charge Code |
6126236
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$372.37 |
| Max. Negotiated Rate |
$1,295.80 |
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cigna Commercial |
$1,159.40
|
| Rate for Payer: First Health Commercial |
$1,227.60
|
| Rate for Payer: First Health Workers Compensation |
$526.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,227.60
|
| Rate for Payer: GEHA Commercial |
$954.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,227.60
|
| Rate for Payer: Multiplan All |
$1,241.24
|
| Rate for Payer: OMNI Networks Commercial |
$954.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,227.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,295.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,023.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,268.52
|
| Rate for Payer: Zelis Auto |
$545.60
|
| Rate for Payer: Zelis Worker's Compensation |
$372.37
|
|
|
PARTIAL REMOVAL FINGER BONE
|
Facility
|
OP
|
$1,364.00
|
|
|
Service Code
|
CPT 26236
|
| Hospital Charge Code |
6126236
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$372.37 |
| 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 |
$818.40
|
| 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 |
$818.40
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cigna Commercial |
$1,159.40
|
| Rate for Payer: First Health Commercial |
$1,227.60
|
| Rate for Payer: First Health Workers Compensation |
$526.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,227.60
|
| Rate for Payer: GEHA Commercial |
$1,091.20
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,227.60
|
| 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 |
$1,241.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$954.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,227.60
|
| 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 |
$1,295.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,023.00
|
| 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 |
$1,268.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$545.60
|
| 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 |
$372.37
|
|
|
PARTIAL REMOVAL FINGER BONE
|
Facility
|
OP
|
$1,001.00
|
|
|
Service Code
|
CPT 26235
|
| Hospital Charge Code |
6126235
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$273.27 |
| 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 |
$600.60
|
| 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 |
$600.60
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cigna Commercial |
$850.85
|
| Rate for Payer: First Health Commercial |
$900.90
|
| Rate for Payer: First Health Workers Compensation |
$386.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$900.90
|
| Rate for Payer: GEHA Commercial |
$800.80
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$900.90
|
| 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 |
$910.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$700.70
|
| Rate for Payer: One Health Plan PPO/POS |
$900.90
|
| 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 |
$950.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$750.75
|
| 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 |
$930.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$400.40
|
| 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 |
$273.27
|
|
|
PARTIAL REMOVAL FINGER BONE
|
Facility
|
IP
|
$1,001.00
|
|
|
Service Code
|
CPT 26235
|
| Hospital Charge Code |
6126235
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$273.27 |
| Max. Negotiated Rate |
$950.95 |
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cigna Commercial |
$850.85
|
| Rate for Payer: First Health Commercial |
$900.90
|
| Rate for Payer: First Health Workers Compensation |
$386.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$900.90
|
| Rate for Payer: GEHA Commercial |
$700.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$900.90
|
| Rate for Payer: Multiplan All |
$910.91
|
| Rate for Payer: OMNI Networks Commercial |
$700.70
|
| Rate for Payer: One Health Plan PPO/POS |
$900.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$950.95
|
| Rate for Payer: Three Rivers Provider Network All |
$750.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$930.93
|
| Rate for Payer: Zelis Auto |
$400.40
|
| Rate for Payer: Zelis Worker's Compensation |
$273.27
|
|
|
PARTIAL REMOVAL FOOT FASCIA
|
Facility
|
IP
|
$909.00
|
|
|
Service Code
|
CPT 28060
|
| Hospital Charge Code |
6128060
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$248.16 |
| Max. Negotiated Rate |
$863.55 |
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$772.65
|
| Rate for Payer: First Health Commercial |
$818.10
|
| Rate for Payer: First Health Workers Compensation |
$350.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$818.10
|
| Rate for Payer: GEHA Commercial |
$636.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$818.10
|
| Rate for Payer: Multiplan All |
$827.19
|
| Rate for Payer: OMNI Networks Commercial |
$636.30
|
| Rate for Payer: One Health Plan PPO/POS |
$818.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$863.55
|
| Rate for Payer: Three Rivers Provider Network All |
$681.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$845.37
|
| Rate for Payer: Zelis Auto |
$363.60
|
| Rate for Payer: Zelis Worker's Compensation |
$248.16
|
|
|
PARTIAL REMOVAL FOOT FASCIA
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
CPT 28060
|
| Hospital Charge Code |
6128060
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$248.16 |
| 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 |
$545.40
|
| 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 |
$545.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$772.65
|
| Rate for Payer: First Health Commercial |
$818.10
|
| Rate for Payer: First Health Workers Compensation |
$350.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$818.10
|
| Rate for Payer: GEHA Commercial |
$727.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$818.10
|
| 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 |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$827.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$636.30
|
| Rate for Payer: One Health Plan PPO/POS |
$818.10
|
| 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 |
$863.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$681.75
|
| 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 |
$845.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$363.60
|
| 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 |
$248.16
|
|
|
PARTIAL REMOVAL LEG BONE(S)
|
Facility
|
OP
|
$1,741.00
|
|
|
Service Code
|
CPT 27360
|
| Hospital Charge Code |
6127360
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$475.29 |
| 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 |
$1,044.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,044.60
|
| Rate for Payer: Cash Price |
$1,044.60
|
| Rate for Payer: Cigna Commercial |
$1,479.85
|
| Rate for Payer: First Health Commercial |
$1,566.90
|
| Rate for Payer: First Health Workers Compensation |
$672.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,566.90
|
| Rate for Payer: GEHA Commercial |
$1,392.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,566.90
|
| 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 |
$1,584.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,218.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,566.90
|
| 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 |
$1,653.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,305.75
|
| 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 |
$1,619.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$696.40
|
| 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 |
$475.29
|
|
|
PARTIAL REMOVAL LEG BONE(S)
|
Facility
|
IP
|
$1,741.00
|
|
|
Service Code
|
CPT 27360
|
| Hospital Charge Code |
6127360
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$475.29 |
| Max. Negotiated Rate |
$1,653.95 |
| Rate for Payer: Cash Price |
$1,044.60
|
| Rate for Payer: Cigna Commercial |
$1,479.85
|
| Rate for Payer: First Health Commercial |
$1,566.90
|
| Rate for Payer: First Health Workers Compensation |
$672.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,566.90
|
| Rate for Payer: GEHA Commercial |
$1,218.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,566.90
|
| Rate for Payer: Multiplan All |
$1,584.31
|
| Rate for Payer: OMNI Networks Commercial |
$1,218.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,566.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,653.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,305.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,619.13
|
| Rate for Payer: Zelis Auto |
$696.40
|
| Rate for Payer: Zelis Worker's Compensation |
$475.29
|
|
|
PARTIAL REMOVAL OF ARM BONE
|
Facility
|
IP
|
$1,432.00
|
|
|
Service Code
|
CPT 24140
|
| Hospital Charge Code |
6124140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$390.94 |
| Max. Negotiated Rate |
$1,360.40 |
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Cigna Commercial |
$1,217.20
|
| Rate for Payer: First Health Commercial |
$1,288.80
|
| Rate for Payer: First Health Workers Compensation |
$552.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,288.80
|
| Rate for Payer: GEHA Commercial |
$1,002.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,288.80
|
| Rate for Payer: Multiplan All |
$1,303.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,002.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,288.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,360.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,074.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,331.76
|
| Rate for Payer: Zelis Auto |
$572.80
|
| Rate for Payer: Zelis Worker's Compensation |
$390.94
|
|
|
PARTIAL REMOVAL OF ARM BONE
|
Facility
|
OP
|
$1,432.00
|
|
|
Service Code
|
CPT 24140
|
| Hospital Charge Code |
6124140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$390.94 |
| 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 |
$859.20
|
| 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 |
$859.20
|
| Rate for Payer: Cash Price |
$859.20
|
| Rate for Payer: Cigna Commercial |
$1,217.20
|
| Rate for Payer: First Health Commercial |
$1,288.80
|
| Rate for Payer: First Health Workers Compensation |
$552.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,288.80
|
| Rate for Payer: GEHA Commercial |
$1,145.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,288.80
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,303.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,002.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,288.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,360.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,074.00
|
| 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 |
$1,331.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$572.80
|
| 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 |
$390.94
|
|
