|
REBUILD EARDRUM STRUCTURES
|
Facility
|
IP
|
$2,187.00
|
|
|
Service Code
|
CPT 69632
|
| Hospital Charge Code |
6169632
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$597.05 |
| Max. Negotiated Rate |
$2,077.65 |
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: Cigna Commercial |
$1,858.95
|
| Rate for Payer: First Health Commercial |
$1,968.30
|
| Rate for Payer: First Health Workers Compensation |
$844.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,968.30
|
| Rate for Payer: GEHA Commercial |
$1,530.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,968.30
|
| Rate for Payer: Multiplan All |
$1,990.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,530.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,968.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,077.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,640.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,033.91
|
| Rate for Payer: Zelis Auto |
$874.80
|
| Rate for Payer: Zelis Worker's Compensation |
$597.05
|
|
|
REBUILD EARDRUM STRUCTURES
|
Facility
|
IP
|
$2,799.00
|
|
|
Service Code
|
CPT 69636
|
| Hospital Charge Code |
6169636
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$764.13 |
| Max. Negotiated Rate |
$2,659.05 |
| Rate for Payer: Cash Price |
$1,679.40
|
| Rate for Payer: Cigna Commercial |
$2,379.15
|
| Rate for Payer: First Health Commercial |
$2,519.10
|
| Rate for Payer: First Health Workers Compensation |
$1,080.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,519.10
|
| Rate for Payer: GEHA Commercial |
$1,959.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,519.10
|
| Rate for Payer: Multiplan All |
$2,547.09
|
| Rate for Payer: OMNI Networks Commercial |
$1,959.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,519.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,659.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,099.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,603.07
|
| Rate for Payer: Zelis Auto |
$1,119.60
|
| Rate for Payer: Zelis Worker's Compensation |
$764.13
|
|
|
REBUILD EARDRUM STRUCTURES
|
Facility
|
OP
|
$2,187.00
|
|
|
Service Code
|
CPT 69632
|
| Hospital Charge Code |
6169632
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$597.05 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,312.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: Cash Price |
$1,312.20
|
| Rate for Payer: Cigna Commercial |
$1,858.95
|
| Rate for Payer: First Health Commercial |
$1,968.30
|
| Rate for Payer: First Health Workers Compensation |
$844.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,968.30
|
| Rate for Payer: GEHA Commercial |
$1,749.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,968.30
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,990.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,530.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,968.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,077.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,640.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,033.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$874.80
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$597.05
|
|
|
REBUILD EARDRUM STRUCTURES
|
Facility
|
IP
|
$2,122.00
|
|
|
Service Code
|
CPT 69633
|
| Hospital Charge Code |
6169633
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$579.31 |
| Max. Negotiated Rate |
$2,015.90 |
| Rate for Payer: Cash Price |
$1,273.20
|
| Rate for Payer: Cigna Commercial |
$1,803.70
|
| Rate for Payer: First Health Commercial |
$1,909.80
|
| Rate for Payer: First Health Workers Compensation |
$819.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,909.80
|
| Rate for Payer: GEHA Commercial |
$1,485.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,909.80
|
| Rate for Payer: Multiplan All |
$1,931.02
|
| Rate for Payer: OMNI Networks Commercial |
$1,485.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,909.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,015.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,591.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,973.46
|
| Rate for Payer: Zelis Auto |
$848.80
|
| Rate for Payer: Zelis Worker's Compensation |
$579.31
|
|
|
REBUILD EARDRUM STRUCTURES
|
Facility
|
OP
|
$2,122.00
|
|
|
Service Code
|
CPT 69633
|
| Hospital Charge Code |
6169633
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$579.31 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,273.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,273.20
|
| Rate for Payer: Cash Price |
$1,273.20
|
| Rate for Payer: Cigna Commercial |
$1,803.70
|
| Rate for Payer: First Health Commercial |
$1,909.80
|
| Rate for Payer: First Health Workers Compensation |
$819.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,909.80
|
| Rate for Payer: GEHA Commercial |
$1,697.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,909.80
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,931.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,485.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,909.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,015.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,591.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,973.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$848.80
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$579.31
|
|
|
REBUILD EARDRUM STRUCTURES
|
Facility
|
OP
|
$2,799.00
|
|
|
Service Code
|
CPT 69636
|
| Hospital Charge Code |
6169636
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$764.13 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,679.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,679.40
|
| Rate for Payer: Cash Price |
$1,679.40
|
| Rate for Payer: Cigna Commercial |
$2,379.15
|
| Rate for Payer: First Health Commercial |
$2,519.10
|
| Rate for Payer: First Health Workers Compensation |
$1,080.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,519.10
|
| Rate for Payer: GEHA Commercial |
$2,239.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,519.10
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$2,547.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,959.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,519.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,659.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$2,099.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,603.07
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$1,119.60
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$764.13
|
|
|
REBUILD EARDRUM STRUCTURES
|
Facility
|
OP
|
$2,783.00
|
|
|
Service Code
|
CPT 69637
|
| Hospital Charge Code |
6169637
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$759.76 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,669.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,669.80
|
| Rate for Payer: Cash Price |
$1,669.80
|
| Rate for Payer: Cigna Commercial |
$2,365.55
|
| Rate for Payer: First Health Commercial |
$2,504.70
|
| Rate for Payer: First Health Workers Compensation |
$1,074.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,504.70
|
| Rate for Payer: GEHA Commercial |
$2,226.40
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,504.70
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$2,532.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,948.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,504.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,643.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$2,087.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,588.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$1,113.20
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$759.76
|
|
|
REBUILD EARDRUM STRUCTURES
|
Facility
|
IP
|
$2,783.00
|
|
|
Service Code
|
CPT 69637
|
| Hospital Charge Code |
6169637
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$759.76 |
| Max. Negotiated Rate |
$2,643.85 |
| Rate for Payer: Cash Price |
$1,669.80
|
| Rate for Payer: Cigna Commercial |
$2,365.55
|
| Rate for Payer: First Health Commercial |
$2,504.70
|
| Rate for Payer: First Health Workers Compensation |
$1,074.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,504.70
|
| Rate for Payer: GEHA Commercial |
$1,948.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,504.70
|
| Rate for Payer: Multiplan All |
$2,532.53
|
| Rate for Payer: OMNI Networks Commercial |
$1,948.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,504.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,643.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,087.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,588.19
|
| Rate for Payer: Zelis Auto |
$1,113.20
|
| Rate for Payer: Zelis Worker's Compensation |
$759.76
|
|
|
RECHARGER NEUROSTIMULATOR INTELLIS
|
Facility
|
OP
|
$5,146.00
|
|
|
Service Code
|
CPT C1820
|
| Hospital Charge Code |
7003156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.50 |
| Max. Negotiated Rate |
$4,888.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,087.60
|
| Rate for Payer: Cash Price |
$3,087.60
|
| Rate for Payer: Cash Price |
$3,087.60
|
| Rate for Payer: Cigna Commercial |
$4,374.10
|
| Rate for Payer: First Health Commercial |
$4,631.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,631.40
|
| Rate for Payer: GEHA Commercial |
$4,116.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,631.40
|
| Rate for Payer: Humana ChoiceCare |
$1,337.96
|
| Rate for Payer: Multiplan All |
$4,682.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,087.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,602.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,631.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,888.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,859.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,528.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,286.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,785.78
|
| Rate for Payer: Zelis Auto |
$2,058.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,573.00
|
|
|
RECHARGER NEUROSTIMULATOR INTELLIS
|
Facility
|
IP
|
$5,146.00
|
|
|
Service Code
|
CPT C1820
|
| Hospital Charge Code |
7003156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,058.40 |
| Max. Negotiated Rate |
$4,888.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,116.80
|
| Rate for Payer: Cash Price |
$3,087.60
|
| Rate for Payer: Cash Price |
$3,087.60
|
| Rate for Payer: Cigna Commercial |
$4,374.10
|
| Rate for Payer: First Health Commercial |
$4,631.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,631.40
|
| Rate for Payer: GEHA Commercial |
$3,602.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,631.40
|
| Rate for Payer: Multiplan All |
$4,682.86
|
| Rate for Payer: OMNI Networks Commercial |
$3,602.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,631.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,888.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,859.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,785.78
|
| Rate for Payer: Zelis Auto |
$2,058.40
|
|
|
RECONSTRUCT ANKLE JOINT
|
Facility
|
OP
|
$1,990.00
|
|
|
Service Code
|
CPT 27702
|
| Hospital Charge Code |
6127702
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$543.27 |
| Max. Negotiated Rate |
$34,924.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$26,634.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,194.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$26,634.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21,099.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17,462.09
|
| Rate for Payer: Cash Price |
$1,194.00
|
| Rate for Payer: Cash Price |
$1,194.00
|
| Rate for Payer: Cigna Commercial |
$1,691.50
|
| Rate for Payer: First Health Commercial |
$1,791.00
|
| Rate for Payer: First Health Workers Compensation |
$768.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,791.00
|
| Rate for Payer: GEHA Commercial |
$1,592.00
|
| Rate for Payer: GEHA Medicare |
$17,462.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,791.00
|
| Rate for Payer: Humana ChoiceCare |
$19,208.30
|
| Rate for Payer: Humana Medicare Advantage |
$17,462.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29,336.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21,529.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,462.09
|
| Rate for Payer: Multiplan All |
$1,810.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29,685.55
|
| Rate for Payer: OMNI Networks Commercial |
$1,393.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,791.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$24,858.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21,529.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17,462.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,890.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34,924.18
|
| Rate for Payer: Three Rivers Provider Network All |
$1,492.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17,112.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21,529.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,462.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,850.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17,462.09
|
| Rate for Payer: Zelis Auto |
$796.00
|
| Rate for Payer: Zelis Medicare |
$14,842.78
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20,954.51
|
| Rate for Payer: Zelis Worker's Compensation |
$543.27
|
|
|
RECONSTRUCT ANKLE JOINT
|
Facility
|
IP
|
$1,990.00
|
|
|
Service Code
|
CPT 27702
|
| Hospital Charge Code |
6127702
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$543.27 |
| Max. Negotiated Rate |
$1,890.50 |
| Rate for Payer: Cash Price |
$1,194.00
|
| Rate for Payer: Cigna Commercial |
$1,691.50
|
| Rate for Payer: First Health Commercial |
$1,791.00
|
| Rate for Payer: First Health Workers Compensation |
$768.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,791.00
|
| Rate for Payer: GEHA Commercial |
$1,393.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,791.00
|
| Rate for Payer: Multiplan All |
$1,810.90
|
| Rate for Payer: OMNI Networks Commercial |
$1,393.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,791.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,890.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,492.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,850.70
|
| Rate for Payer: Zelis Auto |
$796.00
|
| Rate for Payer: Zelis Worker's Compensation |
$543.27
|
|
|
RECONSTRUCT CLEFT FOOT
|
Facility
|
OP
|
$1,895.00
|
|
|
Service Code
|
CPT 28360
|
| Hospital Charge Code |
6128360
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$517.34 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,137.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,207.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,137.00
|
| Rate for Payer: Cash Price |
$1,137.00
|
| Rate for Payer: Cigna Commercial |
$1,610.75
|
| Rate for Payer: First Health Commercial |
$1,705.50
|
| Rate for Payer: First Health Workers Compensation |
$731.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,705.50
|
| Rate for Payer: GEHA Commercial |
$1,516.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,705.50
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,292.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,724.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,326.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,705.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,956.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,292.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,800.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,421.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,292.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,762.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$758.00
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$517.34
|
|
|
RECONSTRUCT CLEFT FOOT
|
Facility
|
IP
|
$1,895.00
|
|
|
Service Code
|
CPT 28360
|
| Hospital Charge Code |
6128360
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$517.34 |
| Max. Negotiated Rate |
$1,800.25 |
| Rate for Payer: Cash Price |
$1,137.00
|
| Rate for Payer: Cigna Commercial |
$1,610.75
|
| Rate for Payer: First Health Commercial |
$1,705.50
|
| Rate for Payer: First Health Workers Compensation |
$731.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,705.50
|
| Rate for Payer: GEHA Commercial |
$1,326.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,705.50
|
| Rate for Payer: Multiplan All |
$1,724.45
|
| Rate for Payer: OMNI Networks Commercial |
$1,326.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,705.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,800.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,421.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,762.35
|
| Rate for Payer: Zelis Auto |
$758.00
|
| Rate for Payer: Zelis Worker's Compensation |
$517.34
|
|
|
RECONSTRUCT ELBOW JOINT
|
Facility
|
IP
|
$1,819.00
|
|
|
Service Code
|
CPT 24360
|
| Hospital Charge Code |
6124360
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$496.59 |
| Max. Negotiated Rate |
$1,728.05 |
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cigna Commercial |
$1,546.15
|
| Rate for Payer: First Health Commercial |
$1,637.10
|
| Rate for Payer: First Health Workers Compensation |
$702.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,637.10
|
| Rate for Payer: GEHA Commercial |
$1,273.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,637.10
|
| Rate for Payer: Multiplan All |
$1,655.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,273.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,637.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,728.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,364.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,691.67
|
| Rate for Payer: Zelis Auto |
$727.60
|
| Rate for Payer: Zelis Worker's Compensation |
$496.59
|
|
|
RECONSTRUCT ELBOW JOINT
|
Facility
|
OP
|
$2,054.00
|
|
|
Service Code
|
CPT 24361
|
| Hospital Charge Code |
6124361
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$560.74 |
| Max. Negotiated Rate |
$34,924.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$12,008.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,232.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$12,008.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9,513.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17,462.09
|
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cigna Commercial |
$1,745.90
|
| Rate for Payer: First Health Commercial |
$1,848.60
|
| Rate for Payer: First Health Workers Compensation |
$793.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,848.60
|
| Rate for Payer: GEHA Commercial |
$1,643.20
|
| Rate for Payer: GEHA Medicare |
$17,462.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,848.60
|
| Rate for Payer: Humana ChoiceCare |
$19,208.30
|
| Rate for Payer: Humana Medicare Advantage |
$17,462.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29,336.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9,706.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,462.09
|
| Rate for Payer: Multiplan All |
$1,869.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29,685.55
|
| Rate for Payer: OMNI Networks Commercial |
$1,437.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,848.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11,207.85
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9,706.80
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17,462.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,951.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34,924.18
|
| Rate for Payer: Three Rivers Provider Network All |
$1,540.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17,112.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9,706.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,462.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,910.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17,462.09
|
| Rate for Payer: Zelis Auto |
$821.60
|
| Rate for Payer: Zelis Medicare |
$14,842.78
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20,954.51
|
| Rate for Payer: Zelis Worker's Compensation |
$560.74
|
|
|
RECONSTRUCT ELBOW JOINT
|
Facility
|
OP
|
$1,819.00
|
|
|
Service Code
|
CPT 24360
|
| Hospital Charge Code |
6124360
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$496.59 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,033.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,091.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,033.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,194.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cash Price |
$1,091.40
|
| Rate for Payer: Cigna Commercial |
$1,546.15
|
| Rate for Payer: First Health Commercial |
$1,637.10
|
| Rate for Payer: First Health Workers Compensation |
$702.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,637.10
|
| Rate for Payer: GEHA Commercial |
$1,455.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,637.10
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,260.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,655.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,273.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,637.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,764.14
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,260.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,728.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,364.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,260.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,691.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$727.60
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$496.59
|
|
|
RECONSTRUCT ELBOW JOINT
|
Facility
|
OP
|
$2,185.00
|
|
|
Service Code
|
CPT 24362
|
| Hospital Charge Code |
6124362
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$596.50 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,872.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,311.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,872.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,652.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: Cash Price |
$1,311.00
|
| Rate for Payer: Cash Price |
$1,311.00
|
| Rate for Payer: Cigna Commercial |
$1,857.25
|
| Rate for Payer: First Health Commercial |
$1,966.50
|
| Rate for Payer: First Health Workers Compensation |
$843.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,966.50
|
| Rate for Payer: GEHA Commercial |
$1,748.00
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,966.50
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,747.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,988.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,529.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,966.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5,481.28
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,747.18
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,075.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,638.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,747.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,032.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$874.00
|
| Rate for Payer: Zelis Medicare |
$10,384.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,661.07
|
| Rate for Payer: Zelis Worker's Compensation |
$596.50
|
|
|
RECONSTRUCT ELBOW JOINT
|
Facility
|
IP
|
$2,185.00
|
|
|
Service Code
|
CPT 24362
|
| Hospital Charge Code |
6124362
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$596.50 |
| Max. Negotiated Rate |
$2,075.75 |
| Rate for Payer: Cash Price |
$1,311.00
|
| Rate for Payer: Cigna Commercial |
$1,857.25
|
| Rate for Payer: First Health Commercial |
$1,966.50
|
| Rate for Payer: First Health Workers Compensation |
$843.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,966.50
|
| Rate for Payer: GEHA Commercial |
$1,529.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,966.50
|
| Rate for Payer: Multiplan All |
$1,988.35
|
| Rate for Payer: OMNI Networks Commercial |
$1,529.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,966.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,075.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,638.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,032.05
|
| Rate for Payer: Zelis Auto |
$874.00
|
| Rate for Payer: Zelis Worker's Compensation |
$596.50
|
|
|
RECONSTRUCT ELBOW JOINT
|
Facility
|
IP
|
$2,054.00
|
|
|
Service Code
|
CPT 24361
|
| Hospital Charge Code |
6124361
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$560.74 |
| Max. Negotiated Rate |
$1,951.30 |
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cigna Commercial |
$1,745.90
|
| Rate for Payer: First Health Commercial |
$1,848.60
|
| Rate for Payer: First Health Workers Compensation |
$793.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,848.60
|
| Rate for Payer: GEHA Commercial |
$1,437.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,848.60
|
| Rate for Payer: Multiplan All |
$1,869.14
|
| Rate for Payer: OMNI Networks Commercial |
$1,437.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,848.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,951.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,540.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,910.22
|
| Rate for Payer: Zelis Auto |
$821.60
|
| Rate for Payer: Zelis Worker's Compensation |
$560.74
|
|
|
RECONSTRUCT ELBOW LAT LIGMNT
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
CPT 24344
|
| Hospital Charge Code |
6124344
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$614.25 |
| Max. Negotiated Rate |
$2,137.50 |
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,912.50
|
| Rate for Payer: First Health Commercial |
$2,025.00
|
| Rate for Payer: First Health Workers Compensation |
$868.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,025.00
|
| Rate for Payer: GEHA Commercial |
$1,575.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,025.00
|
| Rate for Payer: Multiplan All |
$2,047.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,575.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,025.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,137.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,687.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,092.50
|
| Rate for Payer: Zelis Auto |
$900.00
|
| Rate for Payer: Zelis Worker's Compensation |
$614.25
|
|
|
RECONSTRUCT ELBOW LAT LIGMNT
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
CPT 24344
|
| Hospital Charge Code |
6124344
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$614.25 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7,100.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,912.50
|
| Rate for Payer: First Health Commercial |
$2,025.00
|
| Rate for Payer: First Health Workers Compensation |
$868.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,025.00
|
| Rate for Payer: GEHA Commercial |
$1,800.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,025.00
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$2,047.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,575.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,025.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8,365.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7,245.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,137.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,687.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,092.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$900.00
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$614.25
|
|
|
RECONSTRUCT ELBOW MED LIGMNT
|
Facility
|
IP
|
$2,244.00
|
|
|
Service Code
|
CPT 24346
|
| Hospital Charge Code |
6124346
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$612.61 |
| Max. Negotiated Rate |
$2,131.80 |
| Rate for Payer: Cash Price |
$1,346.40
|
| Rate for Payer: Cigna Commercial |
$1,907.40
|
| Rate for Payer: First Health Commercial |
$2,019.60
|
| Rate for Payer: First Health Workers Compensation |
$866.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,019.60
|
| Rate for Payer: GEHA Commercial |
$1,570.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,019.60
|
| Rate for Payer: Multiplan All |
$2,042.04
|
| Rate for Payer: OMNI Networks Commercial |
$1,570.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,019.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,131.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,683.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,086.92
|
| Rate for Payer: Zelis Auto |
$897.60
|
| Rate for Payer: Zelis Worker's Compensation |
$612.61
|
|
|
RECONSTRUCT ELBOW MED LIGMNT
|
Facility
|
OP
|
$2,244.00
|
|
|
Service Code
|
CPT 24346
|
| Hospital Charge Code |
6124346
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$612.61 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,346.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: Cash Price |
$1,346.40
|
| Rate for Payer: Cash Price |
$1,346.40
|
| Rate for Payer: Cigna Commercial |
$1,907.40
|
| Rate for Payer: First Health Commercial |
$2,019.60
|
| Rate for Payer: First Health Workers Compensation |
$866.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,019.60
|
| Rate for Payer: GEHA Commercial |
$1,795.20
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,019.60
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$2,042.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,570.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,019.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,131.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,683.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,086.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$897.60
|
| Rate for Payer: Zelis Medicare |
$10,384.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,661.07
|
| Rate for Payer: Zelis Worker's Compensation |
$612.61
|
|
|
RECONSTRUCT EXTRA FINGER
|
Facility
|
OP
|
$1,869.00
|
|
|
Service Code
|
CPT 26587
|
| Hospital Charge Code |
6126587
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$510.24 |
| 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 |
$1,121.40
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,121.40
|
| Rate for Payer: Cash Price |
$1,121.40
|
| Rate for Payer: Cigna Commercial |
$1,588.65
|
| Rate for Payer: First Health Commercial |
$1,682.10
|
| Rate for Payer: First Health Workers Compensation |
$721.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,682.10
|
| Rate for Payer: GEHA Commercial |
$1,495.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,682.10
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,700.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,308.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,682.10
|
| 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 |
$1,775.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,401.75
|
| 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 |
$1,738.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$747.60
|
| 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 |
$510.24
|
|
