|
REINFORCE SHOULDER BONES
|
Facility
|
OP
|
$2,085.00
|
|
|
Service Code
|
CPT 23491
|
| Hospital Charge Code |
6123491
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$569.21 |
| Max. Negotiated Rate |
$24,935.38 |
| 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 |
$1,251.00
|
| 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 |
$12,467.69
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$1,772.25
|
| Rate for Payer: First Health Commercial |
$1,876.50
|
| Rate for Payer: First Health Workers Compensation |
$805.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,876.50
|
| Rate for Payer: GEHA Commercial |
$1,668.00
|
| Rate for Payer: GEHA Medicare |
$12,467.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,876.50
|
| Rate for Payer: Humana ChoiceCare |
$13,714.46
|
| Rate for Payer: Humana Medicare Advantage |
$12,467.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,945.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,467.69
|
| Rate for Payer: Multiplan All |
$1,897.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21,195.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,459.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,876.50
|
| 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 |
$12,467.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,980.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,935.38
|
| Rate for Payer: Three Rivers Provider Network All |
$1,563.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,218.34
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,467.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,939.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,467.69
|
| Rate for Payer: Zelis Auto |
$834.00
|
| Rate for Payer: Zelis Medicare |
$10,597.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,961.23
|
| Rate for Payer: Zelis Worker's Compensation |
$569.21
|
|
|
REINFORCE SHOULDER BONES
|
Facility
|
IP
|
$2,085.00
|
|
|
Service Code
|
CPT 23491
|
| Hospital Charge Code |
6123491
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$569.21 |
| Max. Negotiated Rate |
$1,980.75 |
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$1,772.25
|
| Rate for Payer: First Health Commercial |
$1,876.50
|
| Rate for Payer: First Health Workers Compensation |
$805.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,876.50
|
| Rate for Payer: GEHA Commercial |
$1,459.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,876.50
|
| Rate for Payer: Multiplan All |
$1,897.35
|
| Rate for Payer: OMNI Networks Commercial |
$1,459.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,876.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,980.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,563.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,939.05
|
| Rate for Payer: Zelis Auto |
$834.00
|
| Rate for Payer: Zelis Worker's Compensation |
$569.21
|
|
|
REINFORCE THIGH
|
Facility
|
OP
|
$2,326.00
|
|
|
Service Code
|
CPT 27495
|
| Hospital Charge Code |
6127495
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$581.50 |
| Max. Negotiated Rate |
$2,209.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,395.60
|
| Rate for Payer: Cash Price |
$1,395.60
|
| Rate for Payer: Cigna Commercial |
$1,977.10
|
| Rate for Payer: First Health Commercial |
$2,093.40
|
| Rate for Payer: First Health Workers Compensation |
$898.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,093.40
|
| Rate for Payer: GEHA Commercial |
$1,860.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,093.40
|
| Rate for Payer: Humana ChoiceCare |
$604.76
|
| Rate for Payer: Multiplan All |
$2,116.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,395.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,628.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,093.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,209.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,744.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,046.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$581.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,163.18
|
| Rate for Payer: Zelis Auto |
$930.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,163.00
|
| Rate for Payer: Zelis Worker's Compensation |
$635.00
|
|
|
REINFORCE THIGH
|
Facility
|
IP
|
$2,326.00
|
|
|
Service Code
|
CPT 27495
|
| Hospital Charge Code |
6127495
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$635.00 |
| Max. Negotiated Rate |
$2,209.70 |
| Rate for Payer: Cash Price |
$1,395.60
|
| Rate for Payer: Cigna Commercial |
$1,977.10
|
| Rate for Payer: First Health Commercial |
$2,093.40
|
| Rate for Payer: First Health Workers Compensation |
$898.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,093.40
|
| Rate for Payer: GEHA Commercial |
$1,628.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,093.40
|
| Rate for Payer: Multiplan All |
$2,116.66
|
| Rate for Payer: OMNI Networks Commercial |
$1,628.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,093.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,209.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,744.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,163.18
|
| Rate for Payer: Zelis Auto |
$930.40
|
| Rate for Payer: Zelis Worker's Compensation |
$635.00
|
|
|
REINFORCE TIBIA
|
Facility
|
IP
|
$1,549.00
|
|
|
Service Code
|
CPT 27745
|
| Hospital Charge Code |
6127745
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$422.88 |
| Max. Negotiated Rate |
$1,471.55 |
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Cigna Commercial |
$1,316.65
|
| Rate for Payer: First Health Commercial |
$1,394.10
|
| Rate for Payer: First Health Workers Compensation |
$598.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,394.10
|
| Rate for Payer: GEHA Commercial |
$1,084.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,394.10
|
| Rate for Payer: Multiplan All |
$1,409.59
|
| Rate for Payer: OMNI Networks Commercial |
$1,084.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,394.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,471.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,161.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,440.57
|
| Rate for Payer: Zelis Auto |
$619.60
|
| Rate for Payer: Zelis Worker's Compensation |
$422.88
|
|
|
REINFORCE TIBIA
|
Facility
|
OP
|
$1,549.00
|
|
|
Service Code
|
CPT 27745
|
| Hospital Charge Code |
6127745
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$422.88 |
| Max. Negotiated Rate |
$13,844.26 |
| 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 |
$929.40
|
| 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 |
$6,922.13
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Cigna Commercial |
$1,316.65
|
| Rate for Payer: First Health Commercial |
$1,394.10
|
| Rate for Payer: First Health Workers Compensation |
$598.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,394.10
|
| Rate for Payer: GEHA Commercial |
$1,239.20
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,394.10
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,409.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,084.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,394.10
|
| 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 |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,471.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,161.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,440.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$619.60
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$422.88
|
|
|
REINFORCE ULNA
|
Facility
|
IP
|
$1,516.00
|
|
|
Service Code
|
CPT 25491
|
| Hospital Charge Code |
6125491
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$413.87 |
| Max. Negotiated Rate |
$1,440.20 |
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cigna Commercial |
$1,288.60
|
| Rate for Payer: First Health Commercial |
$1,364.40
|
| Rate for Payer: First Health Workers Compensation |
$585.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,364.40
|
| Rate for Payer: GEHA Commercial |
$1,061.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,364.40
|
| Rate for Payer: Multiplan All |
$1,379.56
|
| Rate for Payer: OMNI Networks Commercial |
$1,061.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,364.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,440.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,137.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,409.88
|
| Rate for Payer: Zelis Auto |
$606.40
|
| Rate for Payer: Zelis Worker's Compensation |
$413.87
|
|
|
REINFORCE ULNA
|
Facility
|
OP
|
$1,516.00
|
|
|
Service Code
|
CPT 25491
|
| Hospital Charge Code |
6125491
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$413.87 |
| Max. Negotiated Rate |
$24,935.38 |
| 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 |
$909.60
|
| 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 |
$12,467.69
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cigna Commercial |
$1,288.60
|
| Rate for Payer: First Health Commercial |
$1,364.40
|
| Rate for Payer: First Health Workers Compensation |
$585.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,364.40
|
| Rate for Payer: GEHA Commercial |
$1,212.80
|
| Rate for Payer: GEHA Medicare |
$12,467.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,364.40
|
| Rate for Payer: Humana ChoiceCare |
$13,714.46
|
| Rate for Payer: Humana Medicare Advantage |
$12,467.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,945.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,467.69
|
| Rate for Payer: Multiplan All |
$1,379.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21,195.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,061.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,364.40
|
| 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 |
$12,467.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,440.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,935.38
|
| Rate for Payer: Three Rivers Provider Network All |
$1,137.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,218.34
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,467.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,409.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,467.69
|
| Rate for Payer: Zelis Auto |
$606.40
|
| Rate for Payer: Zelis Medicare |
$10,597.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,961.23
|
| Rate for Payer: Zelis Worker's Compensation |
$413.87
|
|
|
REINNERVATE LARYNX
|
Facility
|
IP
|
$1,786.00
|
|
|
Service Code
|
CPT 31590
|
| Hospital Charge Code |
6131590
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$487.58 |
| Max. Negotiated Rate |
$1,696.70 |
| Rate for Payer: Cash Price |
$1,071.60
|
| Rate for Payer: Cigna Commercial |
$1,518.10
|
| Rate for Payer: First Health Commercial |
$1,607.40
|
| Rate for Payer: First Health Workers Compensation |
$689.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,607.40
|
| Rate for Payer: GEHA Commercial |
$1,250.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,607.40
|
| Rate for Payer: Multiplan All |
$1,625.26
|
| Rate for Payer: OMNI Networks Commercial |
$1,250.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,607.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,696.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,339.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,660.98
|
| Rate for Payer: Zelis Auto |
$714.40
|
| Rate for Payer: Zelis Worker's Compensation |
$487.58
|
|
|
REINNERVATE LARYNX
|
Facility
|
OP
|
$1,786.00
|
|
|
Service Code
|
CPT 31590
|
| Hospital Charge Code |
6131590
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$487.58 |
| Max. Negotiated Rate |
$11,464.32 |
| 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 |
$1,071.60
|
| 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 |
$5,732.16
|
| Rate for Payer: Cash Price |
$1,071.60
|
| Rate for Payer: Cash Price |
$1,071.60
|
| Rate for Payer: Cigna Commercial |
$1,518.10
|
| Rate for Payer: First Health Commercial |
$1,607.40
|
| Rate for Payer: First Health Workers Compensation |
$689.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,607.40
|
| Rate for Payer: GEHA Commercial |
$1,428.80
|
| Rate for Payer: GEHA Medicare |
$5,732.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,607.40
|
| Rate for Payer: Humana ChoiceCare |
$6,305.38
|
| Rate for Payer: Humana Medicare Advantage |
$5,732.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,630.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,732.16
|
| Rate for Payer: Multiplan All |
$1,625.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,744.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,250.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,607.40
|
| 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 |
$5,732.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,696.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,464.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,339.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,617.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,732.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,660.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,732.16
|
| Rate for Payer: Zelis Auto |
$714.40
|
| Rate for Payer: Zelis Medicare |
$4,872.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,878.59
|
| Rate for Payer: Zelis Worker's Compensation |
$487.58
|
|
|
REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON, DISTAL, WITH OR WITHOUT TENDON GRAFT
|
Facility
|
OP
|
$13,844.26
|
|
|
Service Code
|
CPT 24342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,730.88 |
| Max. Negotiated Rate |
$13,844.26 |
| 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 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 |
$6,922.13
|
| Rate for Payer: First Health Workers Compensation |
$8,908.78
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| 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 |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$6,299.14
|
|
|
RELEASE ELBOW JOINT
|
Facility
|
IP
|
$1,444.00
|
|
|
Service Code
|
CPT 24006
|
| Hospital Charge Code |
6124006
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$394.21 |
| Max. Negotiated Rate |
$1,371.80 |
| Rate for Payer: Cash Price |
$866.40
|
| Rate for Payer: Cigna Commercial |
$1,227.40
|
| Rate for Payer: First Health Commercial |
$1,299.60
|
| Rate for Payer: First Health Workers Compensation |
$557.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,299.60
|
| Rate for Payer: GEHA Commercial |
$1,010.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,299.60
|
| Rate for Payer: Multiplan All |
$1,314.04
|
| Rate for Payer: OMNI Networks Commercial |
$1,010.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,299.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,371.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,083.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,342.92
|
| Rate for Payer: Zelis Auto |
$577.60
|
| Rate for Payer: Zelis Worker's Compensation |
$394.21
|
|
|
RELEASE ELBOW JOINT
|
Facility
|
OP
|
$1,444.00
|
|
|
Service Code
|
CPT 24006
|
| Hospital Charge Code |
6124006
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$394.21 |
| Max. Negotiated Rate |
$6,287.92 |
| 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 |
$866.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: Cash Price |
$866.40
|
| Rate for Payer: Cash Price |
$866.40
|
| Rate for Payer: Cigna Commercial |
$1,227.40
|
| Rate for Payer: First Health Commercial |
$1,299.60
|
| Rate for Payer: First Health Workers Compensation |
$557.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,299.60
|
| Rate for Payer: GEHA Commercial |
$1,155.20
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,299.60
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$1,314.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$1,010.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,299.60
|
| 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 |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,371.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,083.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,342.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$577.60
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$394.21
|
|
|
RELEASE FINGER CONTRACTURE
|
Facility
|
OP
|
$1,273.00
|
|
|
Service Code
|
CPT 26525
|
| Hospital Charge Code |
6126525
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$347.53 |
| Max. Negotiated Rate |
$3,101.54 |
| 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 |
$763.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,550.77
|
| Rate for Payer: Cash Price |
$763.80
|
| Rate for Payer: Cash Price |
$763.80
|
| Rate for Payer: Cigna Commercial |
$1,082.05
|
| Rate for Payer: First Health Commercial |
$1,145.70
|
| Rate for Payer: First Health Workers Compensation |
$491.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,145.70
|
| Rate for Payer: GEHA Commercial |
$1,018.40
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,145.70
|
| Rate for Payer: Humana ChoiceCare |
$1,705.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,550.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,605.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$1,158.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$891.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,145.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,209.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$954.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,183.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$509.20
|
| Rate for Payer: Zelis Medicare |
$1,318.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,860.92
|
| Rate for Payer: Zelis Worker's Compensation |
$347.53
|
|
|
RELEASE FINGER CONTRACTURE
|
Facility
|
IP
|
$1,273.00
|
|
|
Service Code
|
CPT 26525
|
| Hospital Charge Code |
6126525
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$347.53 |
| Max. Negotiated Rate |
$1,209.35 |
| Rate for Payer: Cash Price |
$763.80
|
| Rate for Payer: Cigna Commercial |
$1,082.05
|
| Rate for Payer: First Health Commercial |
$1,145.70
|
| Rate for Payer: First Health Workers Compensation |
$491.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,145.70
|
| Rate for Payer: GEHA Commercial |
$891.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,145.70
|
| Rate for Payer: Multiplan All |
$1,158.43
|
| Rate for Payer: OMNI Networks Commercial |
$891.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,145.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,209.35
|
| Rate for Payer: Three Rivers Provider Network All |
$954.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,183.89
|
| Rate for Payer: Zelis Auto |
$509.20
|
| Rate for Payer: Zelis Worker's Compensation |
$347.53
|
|
|
RELEASE FOOT/TOE NERVE
|
Facility
|
OP
|
$697.00
|
|
|
Service Code
|
CPT 64726
|
| Hospital Charge Code |
6164726
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$190.28 |
| Max. Negotiated Rate |
$3,784.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$418.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,892.20
|
| Rate for Payer: Cash Price |
$418.20
|
| Rate for Payer: Cash Price |
$418.20
|
| Rate for Payer: Cigna Commercial |
$592.45
|
| Rate for Payer: First Health Commercial |
$627.30
|
| Rate for Payer: First Health Workers Compensation |
$269.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$627.30
|
| Rate for Payer: GEHA Commercial |
$557.60
|
| Rate for Payer: GEHA Medicare |
$1,892.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$627.30
|
| Rate for Payer: Humana ChoiceCare |
$2,081.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.20
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,178.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,892.20
|
| Rate for Payer: Multiplan All |
$634.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,216.74
|
| Rate for Payer: OMNI Networks Commercial |
$487.90
|
| Rate for Payer: One Health Plan PPO/POS |
$627.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,892.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$662.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,784.40
|
| Rate for Payer: Three Rivers Provider Network All |
$522.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,854.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,892.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$648.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,892.20
|
| Rate for Payer: Zelis Auto |
$278.80
|
| Rate for Payer: Zelis Medicare |
$1,608.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,270.64
|
| Rate for Payer: Zelis Worker's Compensation |
$190.28
|
|
|
RELEASE FOOT/TOE NERVE
|
Facility
|
IP
|
$697.00
|
|
|
Service Code
|
CPT 64726
|
| Hospital Charge Code |
6164726
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$190.28 |
| Max. Negotiated Rate |
$662.15 |
| Rate for Payer: Cash Price |
$418.20
|
| Rate for Payer: Cigna Commercial |
$592.45
|
| Rate for Payer: First Health Commercial |
$627.30
|
| Rate for Payer: First Health Workers Compensation |
$269.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$627.30
|
| Rate for Payer: GEHA Commercial |
$487.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$627.30
|
| Rate for Payer: Multiplan All |
$634.27
|
| Rate for Payer: OMNI Networks Commercial |
$487.90
|
| Rate for Payer: One Health Plan PPO/POS |
$627.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$662.15
|
| Rate for Payer: Three Rivers Provider Network All |
$522.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$648.21
|
| Rate for Payer: Zelis Auto |
$278.80
|
| Rate for Payer: Zelis Worker's Compensation |
$190.28
|
|
|
RELEASE FOREARM/HAND TENDON
|
Facility
|
OP
|
$1,404.00
|
|
|
Service Code
|
CPT 26449
|
| Hospital Charge Code |
6126449
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$383.29 |
| Max. Negotiated Rate |
$6,287.92 |
| 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 |
$842.40
|
| 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 |
$3,143.96
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cigna Commercial |
$1,193.40
|
| Rate for Payer: First Health Commercial |
$1,263.60
|
| Rate for Payer: First Health Workers Compensation |
$542.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,263.60
|
| Rate for Payer: GEHA Commercial |
$1,123.20
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,263.60
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$1,277.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$982.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,263.60
|
| 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 |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,333.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,053.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,305.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$561.60
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$383.29
|
|
|
RELEASE FOREARM/HAND TENDON
|
Facility
|
IP
|
$1,404.00
|
|
|
Service Code
|
CPT 26449
|
| Hospital Charge Code |
6126449
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$383.29 |
| Max. Negotiated Rate |
$1,333.80 |
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cigna Commercial |
$1,193.40
|
| Rate for Payer: First Health Commercial |
$1,263.60
|
| Rate for Payer: First Health Workers Compensation |
$542.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,263.60
|
| Rate for Payer: GEHA Commercial |
$982.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,263.60
|
| Rate for Payer: Multiplan All |
$1,277.64
|
| Rate for Payer: OMNI Networks Commercial |
$982.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,263.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,333.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,053.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,305.72
|
| Rate for Payer: Zelis Auto |
$561.60
|
| Rate for Payer: Zelis Worker's Compensation |
$383.29
|
|
|
RELEASE HAND/FINGER TENDON
|
Facility
|
OP
|
$1,123.00
|
|
|
Service Code
|
CPT 26445
|
| Hospital Charge Code |
6126445
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$306.58 |
| Max. Negotiated Rate |
$6,287.92 |
| 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 |
$673.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: Cash Price |
$673.80
|
| Rate for Payer: Cash Price |
$673.80
|
| Rate for Payer: Cigna Commercial |
$954.55
|
| Rate for Payer: First Health Commercial |
$1,010.70
|
| Rate for Payer: First Health Workers Compensation |
$433.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,010.70
|
| Rate for Payer: GEHA Commercial |
$898.40
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,010.70
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$1,021.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$786.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,010.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,066.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$842.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,044.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$449.20
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$306.58
|
|
|
RELEASE HAND/FINGER TENDON
|
Facility
|
IP
|
$1,123.00
|
|
|
Service Code
|
CPT 26445
|
| Hospital Charge Code |
6126445
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$306.58 |
| Max. Negotiated Rate |
$1,066.85 |
| Rate for Payer: Cash Price |
$673.80
|
| Rate for Payer: Cigna Commercial |
$954.55
|
| Rate for Payer: First Health Commercial |
$1,010.70
|
| Rate for Payer: First Health Workers Compensation |
$433.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,010.70
|
| Rate for Payer: GEHA Commercial |
$786.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,010.70
|
| Rate for Payer: Multiplan All |
$1,021.93
|
| Rate for Payer: OMNI Networks Commercial |
$786.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,010.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,066.85
|
| Rate for Payer: Three Rivers Provider Network All |
$842.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,044.39
|
| Rate for Payer: Zelis Auto |
$449.20
|
| Rate for Payer: Zelis Worker's Compensation |
$306.58
|
|
|
RELEASE KNUCKLE CONTRACTURE
|
Facility
|
OP
|
$1,272.00
|
|
|
Service Code
|
CPT 26520
|
| Hospital Charge Code |
6126520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$347.26 |
| Max. Negotiated Rate |
$6,287.92 |
| 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 |
$763.20
|
| 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 |
$3,143.96
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cigna Commercial |
$1,081.20
|
| Rate for Payer: First Health Commercial |
$1,144.80
|
| Rate for Payer: First Health Workers Compensation |
$491.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,144.80
|
| Rate for Payer: GEHA Commercial |
$1,017.60
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,144.80
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$1,157.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$890.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,144.80
|
| 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 |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,208.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$954.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,182.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$508.80
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$347.26
|
|
|
RELEASE KNUCKLE CONTRACTURE
|
Facility
|
IP
|
$1,272.00
|
|
|
Service Code
|
CPT 26520
|
| Hospital Charge Code |
6126520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$347.26 |
| Max. Negotiated Rate |
$1,208.40 |
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cigna Commercial |
$1,081.20
|
| Rate for Payer: First Health Commercial |
$1,144.80
|
| Rate for Payer: First Health Workers Compensation |
$491.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,144.80
|
| Rate for Payer: GEHA Commercial |
$890.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,144.80
|
| Rate for Payer: Multiplan All |
$1,157.52
|
| Rate for Payer: OMNI Networks Commercial |
$890.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,144.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,208.40
|
| Rate for Payer: Three Rivers Provider Network All |
$954.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,182.96
|
| Rate for Payer: Zelis Auto |
$508.80
|
| Rate for Payer: Zelis Worker's Compensation |
$347.26
|
|
|
RELEASE MIDDLE EAR BONE
|
Facility
|
OP
|
$1,638.00
|
|
|
Service Code
|
CPT 69650
|
| Hospital Charge Code |
6169650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$447.17 |
| Max. Negotiated Rate |
$6,284.94 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$982.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,142.47
|
| Rate for Payer: Cash Price |
$982.80
|
| Rate for Payer: Cash Price |
$982.80
|
| Rate for Payer: Cigna Commercial |
$1,392.30
|
| Rate for Payer: First Health Commercial |
$1,474.20
|
| Rate for Payer: First Health Workers Compensation |
$632.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,474.20
|
| Rate for Payer: GEHA Commercial |
$1,310.40
|
| Rate for Payer: GEHA Medicare |
$3,142.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,474.20
|
| Rate for Payer: Humana ChoiceCare |
$3,456.72
|
| Rate for Payer: Humana Medicare Advantage |
$3,142.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,279.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,142.47
|
| Rate for Payer: Multiplan All |
$1,490.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,342.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,146.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,474.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,142.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,556.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,284.94
|
| Rate for Payer: Three Rivers Provider Network All |
$1,228.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,079.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,142.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,523.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,142.47
|
| Rate for Payer: Zelis Auto |
$655.20
|
| Rate for Payer: Zelis Medicare |
$2,671.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,770.96
|
| Rate for Payer: Zelis Worker's Compensation |
$447.17
|
|
|
RELEASE MIDDLE EAR BONE
|
Facility
|
IP
|
$1,638.00
|
|
|
Service Code
|
CPT 69650
|
| Hospital Charge Code |
6169650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$447.17 |
| Max. Negotiated Rate |
$1,556.10 |
| Rate for Payer: Cash Price |
$982.80
|
| Rate for Payer: Cigna Commercial |
$1,392.30
|
| Rate for Payer: First Health Commercial |
$1,474.20
|
| Rate for Payer: First Health Workers Compensation |
$632.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,474.20
|
| Rate for Payer: GEHA Commercial |
$1,146.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,474.20
|
| Rate for Payer: Multiplan All |
$1,490.58
|
| Rate for Payer: OMNI Networks Commercial |
$1,146.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,474.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,556.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,228.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,523.34
|
| Rate for Payer: Zelis Auto |
$655.20
|
| Rate for Payer: Zelis Worker's Compensation |
$447.17
|
|
