|
RECONSTRUCT EXTRA FINGER
|
Facility
|
IP
|
$1,869.00
|
|
|
Service Code
|
CPT 26587
|
| Hospital Charge Code |
6126587
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$510.24 |
| Max. Negotiated Rate |
$1,775.55 |
| 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 |
$1,308.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,682.10
|
| Rate for Payer: Multiplan All |
$1,700.79
|
| Rate for Payer: OMNI Networks Commercial |
$1,308.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,682.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,775.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,401.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,738.17
|
| Rate for Payer: Zelis Auto |
$747.60
|
| Rate for Payer: Zelis Worker's Compensation |
$510.24
|
|
|
RECONSTRUCT FINGER JOINT
|
Facility
|
OP
|
$1,361.00
|
|
|
Service Code
|
CPT 26545
|
| Hospital Charge Code |
6126545
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$371.55 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$816.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$816.60
|
| Rate for Payer: Cash Price |
$816.60
|
| Rate for Payer: Cigna Commercial |
$1,156.85
|
| Rate for Payer: First Health Commercial |
$1,224.90
|
| Rate for Payer: First Health Workers Compensation |
$525.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,224.90
|
| Rate for Payer: GEHA Commercial |
$1,088.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,224.90
|
| 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 |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,238.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$952.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,224.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,292.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,020.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,265.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$544.40
|
| 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 |
$371.55
|
|
|
RECONSTRUCT FINGER JOINT
|
Facility
|
IP
|
$1,504.00
|
|
|
Service Code
|
CPT 26548
|
| Hospital Charge Code |
6126548
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$410.59 |
| Max. Negotiated Rate |
$1,428.80 |
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Cigna Commercial |
$1,278.40
|
| Rate for Payer: First Health Commercial |
$1,353.60
|
| Rate for Payer: First Health Workers Compensation |
$580.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,353.60
|
| Rate for Payer: GEHA Commercial |
$1,052.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,353.60
|
| Rate for Payer: Multiplan All |
$1,368.64
|
| Rate for Payer: OMNI Networks Commercial |
$1,052.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,353.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,428.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,128.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,398.72
|
| Rate for Payer: Zelis Auto |
$601.60
|
| Rate for Payer: Zelis Worker's Compensation |
$410.59
|
|
|
RECONSTRUCT FINGER JOINT
|
Facility
|
IP
|
$1,361.00
|
|
|
Service Code
|
CPT 26545
|
| Hospital Charge Code |
6126545
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$371.55 |
| Max. Negotiated Rate |
$1,292.95 |
| Rate for Payer: Cash Price |
$816.60
|
| Rate for Payer: Cigna Commercial |
$1,156.85
|
| Rate for Payer: First Health Commercial |
$1,224.90
|
| Rate for Payer: First Health Workers Compensation |
$525.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,224.90
|
| Rate for Payer: GEHA Commercial |
$952.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,224.90
|
| Rate for Payer: Multiplan All |
$1,238.51
|
| Rate for Payer: OMNI Networks Commercial |
$952.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,224.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,292.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,020.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,265.73
|
| Rate for Payer: Zelis Auto |
$544.40
|
| Rate for Payer: Zelis Worker's Compensation |
$371.55
|
|
|
RECONSTRUCT FINGER JOINT
|
Facility
|
OP
|
$1,504.00
|
|
|
Service Code
|
CPT 26548
|
| Hospital Charge Code |
6126548
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$410.59 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$902.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Cigna Commercial |
$1,278.40
|
| Rate for Payer: First Health Commercial |
$1,353.60
|
| Rate for Payer: First Health Workers Compensation |
$580.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,353.60
|
| Rate for Payer: GEHA Commercial |
$1,203.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,353.60
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,368.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,052.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,353.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,428.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,128.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,398.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$601.60
|
| 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 |
$410.59
|
|
|
RECONSTRUCT HEAD OF RADIUS
|
Facility
|
OP
|
$1,302.00
|
|
|
Service Code
|
CPT 24365
|
| Hospital Charge Code |
6124365
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$355.45 |
| Max. Negotiated Rate |
$24,435.12 |
| 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 |
$781.20
|
| 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 |
$12,217.56
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cigna Commercial |
$1,106.70
|
| Rate for Payer: First Health Commercial |
$1,171.80
|
| Rate for Payer: First Health Workers Compensation |
$502.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,171.80
|
| Rate for Payer: GEHA Commercial |
$1,041.60
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,171.80
|
| 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 |
$3,260.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,184.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$911.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,171.80
|
| 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 |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,236.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$976.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,260.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,210.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$520.80
|
| 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 |
$355.45
|
|
|
RECONSTRUCT HEAD OF RADIUS
|
Facility
|
IP
|
$2,010.69
|
|
|
Service Code
|
CPT 24366
|
| Hospital Charge Code |
6124366
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$548.92 |
| Max. Negotiated Rate |
$1,910.16 |
| Rate for Payer: Cash Price |
$1,206.41
|
| Rate for Payer: Cigna Commercial |
$1,709.09
|
| Rate for Payer: First Health Commercial |
$1,809.62
|
| Rate for Payer: First Health Workers Compensation |
$776.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,809.62
|
| Rate for Payer: GEHA Commercial |
$1,407.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,809.62
|
| Rate for Payer: Multiplan All |
$1,829.73
|
| Rate for Payer: OMNI Networks Commercial |
$1,407.48
|
| Rate for Payer: One Health Plan PPO/POS |
$1,809.62
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,910.16
|
| Rate for Payer: Three Rivers Provider Network All |
$1,508.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,869.94
|
| Rate for Payer: Zelis Auto |
$804.28
|
| Rate for Payer: Zelis Worker's Compensation |
$548.92
|
|
|
RECONSTRUCT HEAD OF RADIUS
|
Facility
|
IP
|
$1,302.00
|
|
|
Service Code
|
CPT 24365
|
| Hospital Charge Code |
6124365
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$355.45 |
| Max. Negotiated Rate |
$1,236.90 |
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cigna Commercial |
$1,106.70
|
| Rate for Payer: First Health Commercial |
$1,171.80
|
| Rate for Payer: First Health Workers Compensation |
$502.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,171.80
|
| Rate for Payer: GEHA Commercial |
$911.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,171.80
|
| Rate for Payer: Multiplan All |
$1,184.82
|
| Rate for Payer: OMNI Networks Commercial |
$911.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,171.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,236.90
|
| Rate for Payer: Three Rivers Provider Network All |
$976.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,210.86
|
| Rate for Payer: Zelis Auto |
$520.80
|
| Rate for Payer: Zelis Worker's Compensation |
$355.45
|
|
|
RECONSTRUCT HEAD OF RADIUS
|
Facility
|
OP
|
$2,010.69
|
|
|
Service Code
|
CPT 24366
|
| Hospital Charge Code |
6124366
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$548.92 |
| Max. Negotiated Rate |
$24,435.12 |
| 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 |
$1,206.41
|
| 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 |
$12,217.56
|
| Rate for Payer: Cash Price |
$1,206.41
|
| Rate for Payer: Cash Price |
$1,206.41
|
| Rate for Payer: Cigna Commercial |
$1,709.09
|
| Rate for Payer: First Health Commercial |
$1,809.62
|
| Rate for Payer: First Health Workers Compensation |
$776.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,809.62
|
| Rate for Payer: GEHA Commercial |
$1,608.55
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,809.62
|
| 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 |
$9,706.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,829.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,407.48
|
| Rate for Payer: One Health Plan PPO/POS |
$1,809.62
|
| 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 |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,910.16
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,508.02
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9,706.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,869.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$804.28
|
| 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 |
$548.92
|
|
|
RECONSTRUCTION ANKLE JOINT
|
Facility
|
OP
|
$2,287.00
|
|
|
Service Code
|
CPT 27703
|
| Hospital Charge Code |
6127703
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$571.75 |
| Max. Negotiated Rate |
$2,172.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,372.20
|
| Rate for Payer: Cash Price |
$1,372.20
|
| Rate for Payer: Cigna Commercial |
$1,943.95
|
| Rate for Payer: First Health Commercial |
$2,058.30
|
| Rate for Payer: First Health Workers Compensation |
$883.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,058.30
|
| Rate for Payer: GEHA Commercial |
$1,829.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,058.30
|
| Rate for Payer: Humana ChoiceCare |
$594.62
|
| Rate for Payer: Multiplan All |
$2,081.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,372.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,600.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,058.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,172.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,715.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,012.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$571.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,126.91
|
| Rate for Payer: Zelis Auto |
$914.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,143.50
|
| Rate for Payer: Zelis Worker's Compensation |
$624.35
|
|
|
RECONSTRUCTION ANKLE JOINT
|
Facility
|
IP
|
$2,287.00
|
|
|
Service Code
|
CPT 27703
|
| Hospital Charge Code |
6127703
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$624.35 |
| Max. Negotiated Rate |
$2,172.65 |
| Rate for Payer: Cash Price |
$1,372.20
|
| Rate for Payer: Cigna Commercial |
$1,943.95
|
| Rate for Payer: First Health Commercial |
$2,058.30
|
| Rate for Payer: First Health Workers Compensation |
$883.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,058.30
|
| Rate for Payer: GEHA Commercial |
$1,600.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,058.30
|
| Rate for Payer: Multiplan All |
$2,081.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,600.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,058.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,172.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,715.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,126.91
|
| Rate for Payer: Zelis Auto |
$914.80
|
| Rate for Payer: Zelis Worker's Compensation |
$624.35
|
|
|
RECONSTRUCTION KNEE
|
Facility
|
OP
|
$2,288.00
|
|
|
Service Code
|
CPT 27428
|
| Hospital Charge Code |
6127428
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$624.62 |
| Max. Negotiated Rate |
$24,435.12 |
| 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 |
$1,372.80
|
| 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 |
$12,217.56
|
| Rate for Payer: Cash Price |
$1,372.80
|
| Rate for Payer: Cash Price |
$1,372.80
|
| Rate for Payer: Cigna Commercial |
$1,944.80
|
| Rate for Payer: First Health Commercial |
$2,059.20
|
| Rate for Payer: First Health Workers Compensation |
$883.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,059.20
|
| Rate for Payer: GEHA Commercial |
$1,830.40
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,059.20
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$2,082.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,601.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,059.20
|
| 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 |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,173.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,716.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,127.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$915.20
|
| 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 |
$624.62
|
|
|
RECONSTRUCTION KNEE
|
Facility
|
IP
|
$2,558.00
|
|
|
Service Code
|
CPT 27429
|
| Hospital Charge Code |
6127429
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$698.33 |
| Max. Negotiated Rate |
$2,430.10 |
| Rate for Payer: Cash Price |
$1,534.80
|
| Rate for Payer: Cigna Commercial |
$2,174.30
|
| Rate for Payer: First Health Commercial |
$2,302.20
|
| Rate for Payer: First Health Workers Compensation |
$987.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,302.20
|
| Rate for Payer: GEHA Commercial |
$1,790.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,302.20
|
| Rate for Payer: Multiplan All |
$2,327.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,790.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,302.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,430.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,918.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,378.94
|
| Rate for Payer: Zelis Auto |
$1,023.20
|
| Rate for Payer: Zelis Worker's Compensation |
$698.33
|
|
|
RECONSTRUCTION KNEE
|
Facility
|
OP
|
$2,558.00
|
|
|
Service Code
|
CPT 27429
|
| Hospital Charge Code |
6127429
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$698.33 |
| Max. Negotiated Rate |
$24,435.12 |
| 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 |
$1,534.80
|
| 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 |
$12,217.56
|
| Rate for Payer: Cash Price |
$1,534.80
|
| Rate for Payer: Cash Price |
$1,534.80
|
| Rate for Payer: Cigna Commercial |
$2,174.30
|
| Rate for Payer: First Health Commercial |
$2,302.20
|
| Rate for Payer: First Health Workers Compensation |
$987.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,302.20
|
| Rate for Payer: GEHA Commercial |
$2,046.40
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,302.20
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$2,327.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,790.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,302.20
|
| 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 |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,430.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,918.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,378.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$1,023.20
|
| 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 |
$698.33
|
|
|
RECONSTRUCTION KNEE
|
Facility
|
IP
|
$2,288.00
|
|
|
Service Code
|
CPT 27428
|
| Hospital Charge Code |
6127428
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$624.62 |
| Max. Negotiated Rate |
$2,173.60 |
| Rate for Payer: Cash Price |
$1,372.80
|
| Rate for Payer: Cigna Commercial |
$1,944.80
|
| Rate for Payer: First Health Commercial |
$2,059.20
|
| Rate for Payer: First Health Workers Compensation |
$883.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,059.20
|
| Rate for Payer: GEHA Commercial |
$1,601.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,059.20
|
| Rate for Payer: Multiplan All |
$2,082.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,601.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,059.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,173.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,716.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,127.84
|
| Rate for Payer: Zelis Auto |
$915.20
|
| Rate for Payer: Zelis Worker's Compensation |
$624.62
|
|
|
RECONSTRUCTION KNEE
|
Facility
|
IP
|
$1,458.00
|
|
|
Service Code
|
CPT 27427
|
| Hospital Charge Code |
6127427
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$398.03 |
| Max. Negotiated Rate |
$1,385.10 |
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$1,239.30
|
| Rate for Payer: First Health Commercial |
$1,312.20
|
| Rate for Payer: First Health Workers Compensation |
$562.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,312.20
|
| Rate for Payer: GEHA Commercial |
$1,020.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,312.20
|
| Rate for Payer: Multiplan All |
$1,326.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,020.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,312.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,385.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,093.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,355.94
|
| Rate for Payer: Zelis Auto |
$583.20
|
| Rate for Payer: Zelis Worker's Compensation |
$398.03
|
|
|
RECONSTRUCTION KNEE
|
Facility
|
OP
|
$1,458.00
|
|
|
Service Code
|
CPT 27427
|
| Hospital Charge Code |
6127427
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$398.03 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$874.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$1,239.30
|
| Rate for Payer: First Health Commercial |
$1,312.20
|
| Rate for Payer: First Health Workers Compensation |
$562.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,312.20
|
| Rate for Payer: GEHA Commercial |
$1,166.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,312.20
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,326.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,020.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,312.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,385.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,093.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,355.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$583.20
|
| 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 |
$398.03
|
|
|
RECONSTRUCTION OF ANUS
|
Facility
|
OP
|
$1,271.00
|
|
|
Service Code
|
CPT 46753
|
| Hospital Charge Code |
6146753
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$346.98 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$762.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: Cash Price |
$762.60
|
| Rate for Payer: Cash Price |
$762.60
|
| Rate for Payer: Cigna Commercial |
$1,080.35
|
| Rate for Payer: First Health Commercial |
$1,143.90
|
| Rate for Payer: First Health Workers Compensation |
$490.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,143.90
|
| Rate for Payer: GEHA Commercial |
$1,016.80
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,143.90
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$1,156.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$889.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,143.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,207.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$953.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,182.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$508.40
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$346.98
|
|
|
RECONSTRUCTION OF ANUS
|
Facility
|
IP
|
$1,271.00
|
|
|
Service Code
|
CPT 46753
|
| Hospital Charge Code |
6146753
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$346.98 |
| Max. Negotiated Rate |
$1,207.45 |
| Rate for Payer: Cash Price |
$762.60
|
| Rate for Payer: Cigna Commercial |
$1,080.35
|
| Rate for Payer: First Health Commercial |
$1,143.90
|
| Rate for Payer: First Health Workers Compensation |
$490.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,143.90
|
| Rate for Payer: GEHA Commercial |
$889.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,143.90
|
| Rate for Payer: Multiplan All |
$1,156.61
|
| Rate for Payer: OMNI Networks Commercial |
$889.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,143.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,207.45
|
| Rate for Payer: Three Rivers Provider Network All |
$953.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,182.03
|
| Rate for Payer: Zelis Auto |
$508.40
|
| Rate for Payer: Zelis Worker's Compensation |
$346.98
|
|
|
RECONSTRUCTION OF BILE DUCTS
|
Facility
|
IP
|
$3,315.00
|
|
|
Service Code
|
CPT 47800
|
| Hospital Charge Code |
6147800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$905.00 |
| Max. Negotiated Rate |
$3,149.25 |
| Rate for Payer: Cash Price |
$1,989.00
|
| Rate for Payer: Cigna Commercial |
$2,817.75
|
| Rate for Payer: First Health Commercial |
$2,983.50
|
| Rate for Payer: First Health Workers Compensation |
$1,279.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,983.50
|
| Rate for Payer: GEHA Commercial |
$2,320.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,983.50
|
| Rate for Payer: Multiplan All |
$3,016.65
|
| Rate for Payer: OMNI Networks Commercial |
$2,320.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,983.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,149.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,486.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,082.95
|
| Rate for Payer: Zelis Auto |
$1,326.00
|
| Rate for Payer: Zelis Worker's Compensation |
$905.00
|
|
|
RECONSTRUCTION OF BILE DUCTS
|
Facility
|
OP
|
$3,315.00
|
|
|
Service Code
|
CPT 47800
|
| Hospital Charge Code |
6147800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$828.75 |
| Max. Negotiated Rate |
$3,149.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,989.00
|
| Rate for Payer: Cash Price |
$1,989.00
|
| Rate for Payer: Cigna Commercial |
$2,817.75
|
| Rate for Payer: First Health Commercial |
$2,983.50
|
| Rate for Payer: First Health Workers Compensation |
$1,279.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,983.50
|
| Rate for Payer: GEHA Commercial |
$2,652.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,983.50
|
| Rate for Payer: Humana ChoiceCare |
$861.90
|
| Rate for Payer: Multiplan All |
$3,016.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,989.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,320.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,983.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,149.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,486.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,917.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$828.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,082.95
|
| Rate for Payer: Zelis Auto |
$1,326.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,657.50
|
| Rate for Payer: Zelis Worker's Compensation |
$905.00
|
|
|
RECONSTRUCTION OF HIP SOCKET
|
Facility
|
OP
|
$2,267.00
|
|
|
Service Code
|
CPT 27122
|
| Hospital Charge Code |
6127122
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$566.75 |
| Max. Negotiated Rate |
$2,153.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,360.20
|
| Rate for Payer: Cash Price |
$1,360.20
|
| Rate for Payer: Cigna Commercial |
$1,926.95
|
| Rate for Payer: First Health Commercial |
$2,040.30
|
| Rate for Payer: First Health Workers Compensation |
$875.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,040.30
|
| Rate for Payer: GEHA Commercial |
$1,813.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,040.30
|
| Rate for Payer: Humana ChoiceCare |
$589.42
|
| Rate for Payer: Multiplan All |
$2,062.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,360.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,586.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,040.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,153.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,700.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,994.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$566.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,108.31
|
| Rate for Payer: Zelis Auto |
$906.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,133.50
|
| Rate for Payer: Zelis Worker's Compensation |
$618.89
|
|
|
RECONSTRUCTION OF HIP SOCKET
|
Facility
|
OP
|
$2,688.00
|
|
|
Service Code
|
CPT 27120
|
| Hospital Charge Code |
6127120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$672.00 |
| Max. Negotiated Rate |
$2,553.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,612.80
|
| Rate for Payer: Cash Price |
$1,612.80
|
| Rate for Payer: Cigna Commercial |
$2,284.80
|
| Rate for Payer: First Health Commercial |
$2,419.20
|
| Rate for Payer: First Health Workers Compensation |
$1,037.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,419.20
|
| Rate for Payer: GEHA Commercial |
$2,150.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,419.20
|
| Rate for Payer: Humana ChoiceCare |
$698.88
|
| Rate for Payer: Multiplan All |
$2,446.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,612.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,881.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,419.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,553.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,016.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,365.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$672.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,499.84
|
| Rate for Payer: Zelis Auto |
$1,075.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,344.00
|
| Rate for Payer: Zelis Worker's Compensation |
$733.82
|
|
|
RECONSTRUCTION OF HIP SOCKET
|
Facility
|
IP
|
$2,267.00
|
|
|
Service Code
|
CPT 27122
|
| Hospital Charge Code |
6127122
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$618.89 |
| Max. Negotiated Rate |
$2,153.65 |
| Rate for Payer: Cash Price |
$1,360.20
|
| Rate for Payer: Cigna Commercial |
$1,926.95
|
| Rate for Payer: First Health Commercial |
$2,040.30
|
| Rate for Payer: First Health Workers Compensation |
$875.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,040.30
|
| Rate for Payer: GEHA Commercial |
$1,586.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,040.30
|
| Rate for Payer: Multiplan All |
$2,062.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,586.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,040.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,153.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,700.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,108.31
|
| Rate for Payer: Zelis Auto |
$906.80
|
| Rate for Payer: Zelis Worker's Compensation |
$618.89
|
|
|
RECONSTRUCTION OF HIP SOCKET
|
Facility
|
IP
|
$2,688.00
|
|
|
Service Code
|
CPT 27120
|
| Hospital Charge Code |
6127120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$733.82 |
| Max. Negotiated Rate |
$2,553.60 |
| Rate for Payer: Cash Price |
$1,612.80
|
| Rate for Payer: Cigna Commercial |
$2,284.80
|
| Rate for Payer: First Health Commercial |
$2,419.20
|
| Rate for Payer: First Health Workers Compensation |
$1,037.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,419.20
|
| Rate for Payer: GEHA Commercial |
$1,881.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,419.20
|
| Rate for Payer: Multiplan All |
$2,446.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,881.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,419.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,553.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,016.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,499.84
|
| Rate for Payer: Zelis Auto |
$1,075.20
|
| Rate for Payer: Zelis Worker's Compensation |
$733.82
|
|
