|
RELEASE MUSCLES OF HAND
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
CPT 26593
|
| Hospital Charge Code |
6126593
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$320.77 |
| Max. Negotiated Rate |
$1,116.25 |
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cigna Commercial |
$998.75
|
| Rate for Payer: First Health Commercial |
$1,057.50
|
| Rate for Payer: First Health Workers Compensation |
$453.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,057.50
|
| Rate for Payer: GEHA Commercial |
$822.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,057.50
|
| Rate for Payer: Multiplan All |
$1,069.25
|
| Rate for Payer: OMNI Networks Commercial |
$822.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,057.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,116.25
|
| Rate for Payer: Three Rivers Provider Network All |
$881.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,092.75
|
| Rate for Payer: Zelis Auto |
$470.00
|
| Rate for Payer: Zelis Worker's Compensation |
$320.77
|
|
|
RELEASE MUSCLES OF HAND
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
CPT 26593
|
| Hospital Charge Code |
6126593
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$320.77 |
| 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 |
$705.00
|
| 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 |
$705.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cigna Commercial |
$998.75
|
| Rate for Payer: First Health Commercial |
$1,057.50
|
| Rate for Payer: First Health Workers Compensation |
$453.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,057.50
|
| Rate for Payer: GEHA Commercial |
$940.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,057.50
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,069.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$822.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,057.50
|
| 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 |
$1,116.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$881.25
|
| 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 |
$1,092.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$470.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$320.77
|
|
|
RELEASE OF BIG TOE
|
Facility
|
IP
|
$739.00
|
|
|
Service Code
|
CPT 28240
|
| Hospital Charge Code |
6128240
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$201.75 |
| Max. Negotiated Rate |
$702.05 |
| Rate for Payer: Cash Price |
$443.40
|
| Rate for Payer: Cigna Commercial |
$628.15
|
| Rate for Payer: First Health Commercial |
$665.10
|
| Rate for Payer: First Health Workers Compensation |
$285.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$665.10
|
| Rate for Payer: GEHA Commercial |
$517.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$665.10
|
| Rate for Payer: Multiplan All |
$672.49
|
| Rate for Payer: OMNI Networks Commercial |
$517.30
|
| Rate for Payer: One Health Plan PPO/POS |
$665.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$702.05
|
| Rate for Payer: Three Rivers Provider Network All |
$554.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$687.27
|
| Rate for Payer: Zelis Auto |
$295.60
|
| Rate for Payer: Zelis Worker's Compensation |
$201.75
|
|
|
RELEASE OF BIG TOE
|
Facility
|
OP
|
$739.00
|
|
|
Service Code
|
CPT 28240
|
| Hospital Charge Code |
6128240
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$201.75 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$443.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$443.40
|
| Rate for Payer: Cash Price |
$443.40
|
| Rate for Payer: Cigna Commercial |
$628.15
|
| Rate for Payer: First Health Commercial |
$665.10
|
| Rate for Payer: First Health Workers Compensation |
$285.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$665.10
|
| Rate for Payer: GEHA Commercial |
$591.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$665.10
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$672.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$517.30
|
| Rate for Payer: One Health Plan PPO/POS |
$665.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$702.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$554.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$687.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$295.60
|
| 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 |
$201.75
|
|
|
RELEASE OF FOOT CONTRACTURE
|
Facility
|
OP
|
$849.00
|
|
|
Service Code
|
CPT 28270
|
| Hospital Charge Code |
6128270
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$231.78 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$509.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$509.40
|
| Rate for Payer: Cash Price |
$509.40
|
| Rate for Payer: Cigna Commercial |
$721.65
|
| Rate for Payer: First Health Commercial |
$764.10
|
| Rate for Payer: First Health Workers Compensation |
$327.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$764.10
|
| Rate for Payer: GEHA Commercial |
$679.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$764.10
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$772.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$594.30
|
| Rate for Payer: One Health Plan PPO/POS |
$764.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$806.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$636.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$789.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$339.60
|
| 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 |
$231.78
|
|
|
RELEASE OF FOOT CONTRACTURE
|
Facility
|
IP
|
$849.00
|
|
|
Service Code
|
CPT 28270
|
| Hospital Charge Code |
6128270
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$231.78 |
| Max. Negotiated Rate |
$806.55 |
| Rate for Payer: Cash Price |
$509.40
|
| Rate for Payer: Cigna Commercial |
$721.65
|
| Rate for Payer: First Health Commercial |
$764.10
|
| Rate for Payer: First Health Workers Compensation |
$327.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$764.10
|
| Rate for Payer: GEHA Commercial |
$594.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$764.10
|
| Rate for Payer: Multiplan All |
$772.59
|
| Rate for Payer: OMNI Networks Commercial |
$594.30
|
| Rate for Payer: One Health Plan PPO/POS |
$764.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$806.55
|
| Rate for Payer: Three Rivers Provider Network All |
$636.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$789.57
|
| Rate for Payer: Zelis Auto |
$339.60
|
| Rate for Payer: Zelis Worker's Compensation |
$231.78
|
|
|
RELEASE OF FOOT TENDON
|
Facility
|
IP
|
$767.00
|
|
|
Service Code
|
CPT 28220
|
| Hospital Charge Code |
6128220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$209.39 |
| Max. Negotiated Rate |
$728.65 |
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Cigna Commercial |
$651.95
|
| Rate for Payer: First Health Commercial |
$690.30
|
| Rate for Payer: First Health Workers Compensation |
$296.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$690.30
|
| Rate for Payer: GEHA Commercial |
$536.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$690.30
|
| Rate for Payer: Multiplan All |
$697.97
|
| Rate for Payer: OMNI Networks Commercial |
$536.90
|
| Rate for Payer: One Health Plan PPO/POS |
$690.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$728.65
|
| Rate for Payer: Three Rivers Provider Network All |
$575.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$713.31
|
| Rate for Payer: Zelis Auto |
$306.80
|
| Rate for Payer: Zelis Worker's Compensation |
$209.39
|
|
|
RELEASE OF FOOT TENDON
|
Facility
|
IP
|
$659.00
|
|
|
Service Code
|
CPT 28225
|
| Hospital Charge Code |
6128225
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$179.91 |
| Max. Negotiated Rate |
$626.05 |
| Rate for Payer: Cash Price |
$395.40
|
| Rate for Payer: Cigna Commercial |
$560.15
|
| Rate for Payer: First Health Commercial |
$593.10
|
| Rate for Payer: First Health Workers Compensation |
$254.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$593.10
|
| Rate for Payer: GEHA Commercial |
$461.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$593.10
|
| Rate for Payer: Multiplan All |
$599.69
|
| Rate for Payer: OMNI Networks Commercial |
$461.30
|
| Rate for Payer: One Health Plan PPO/POS |
$593.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$626.05
|
| Rate for Payer: Three Rivers Provider Network All |
$494.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$612.87
|
| Rate for Payer: Zelis Auto |
$263.60
|
| Rate for Payer: Zelis Worker's Compensation |
$179.91
|
|
|
RELEASE OF FOOT TENDON
|
Facility
|
OP
|
$767.00
|
|
|
Service Code
|
CPT 28220
|
| Hospital Charge Code |
6128220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$209.39 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$460.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Cigna Commercial |
$651.95
|
| Rate for Payer: First Health Commercial |
$690.30
|
| Rate for Payer: First Health Workers Compensation |
$296.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$690.30
|
| Rate for Payer: GEHA Commercial |
$613.60
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$690.30
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$697.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$536.90
|
| Rate for Payer: One Health Plan PPO/POS |
$690.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$728.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$575.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$713.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$306.80
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$209.39
|
|
|
RELEASE OF FOOT TENDON
|
Facility
|
OP
|
$659.00
|
|
|
Service Code
|
CPT 28225
|
| Hospital Charge Code |
6128225
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$179.91 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$395.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$395.40
|
| Rate for Payer: Cash Price |
$395.40
|
| Rate for Payer: Cigna Commercial |
$560.15
|
| Rate for Payer: First Health Commercial |
$593.10
|
| Rate for Payer: First Health Workers Compensation |
$254.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$593.10
|
| Rate for Payer: GEHA Commercial |
$527.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$593.10
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$599.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$461.30
|
| Rate for Payer: One Health Plan PPO/POS |
$593.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$626.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$494.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$612.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$263.60
|
| 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 |
$179.91
|
|
|
RELEASE OF FOOT TENDONS
|
Facility
|
OP
|
$890.00
|
|
|
Service Code
|
CPT 28222
|
| Hospital Charge Code |
6128222
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$242.97 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$534.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$534.00
|
| Rate for Payer: Cash Price |
$534.00
|
| Rate for Payer: Cigna Commercial |
$756.50
|
| Rate for Payer: First Health Commercial |
$801.00
|
| Rate for Payer: First Health Workers Compensation |
$343.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$801.00
|
| Rate for Payer: GEHA Commercial |
$712.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$801.00
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$809.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$623.00
|
| Rate for Payer: One Health Plan PPO/POS |
$801.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$845.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$667.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$827.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$356.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$242.97
|
|
|
RELEASE OF FOOT TENDONS
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT 28226
|
| Hospital Charge Code |
6128226
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$272.18 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: First Health Workers Compensation |
$384.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$697.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: Zelis Auto |
$398.80
|
| Rate for Payer: Zelis Worker's Compensation |
$272.18
|
|
|
RELEASE OF FOOT TENDONS
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT 28226
|
| Hospital Charge Code |
6128226
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$272.18 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$598.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: First Health Workers Compensation |
$384.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$797.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$398.80
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$272.18
|
|
|
RELEASE OF FOOT TENDONS
|
Facility
|
IP
|
$890.00
|
|
|
Service Code
|
CPT 28222
|
| Hospital Charge Code |
6128222
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$242.97 |
| Max. Negotiated Rate |
$845.50 |
| Rate for Payer: Cash Price |
$534.00
|
| Rate for Payer: Cigna Commercial |
$756.50
|
| Rate for Payer: First Health Commercial |
$801.00
|
| Rate for Payer: First Health Workers Compensation |
$343.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$801.00
|
| Rate for Payer: GEHA Commercial |
$623.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$801.00
|
| Rate for Payer: Multiplan All |
$809.90
|
| Rate for Payer: OMNI Networks Commercial |
$623.00
|
| Rate for Payer: One Health Plan PPO/POS |
$801.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$845.50
|
| Rate for Payer: Three Rivers Provider Network All |
$667.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$827.70
|
| Rate for Payer: Zelis Auto |
$356.00
|
| Rate for Payer: Zelis Worker's Compensation |
$242.97
|
|
|
RELEASE OF LOWER LEG TENDON
|
Facility
|
IP
|
$877.00
|
|
|
Service Code
|
CPT 27680
|
| Hospital Charge Code |
6127680
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$239.42 |
| Max. Negotiated Rate |
$833.15 |
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cigna Commercial |
$745.45
|
| Rate for Payer: First Health Commercial |
$789.30
|
| Rate for Payer: First Health Workers Compensation |
$338.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$789.30
|
| Rate for Payer: GEHA Commercial |
$613.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$789.30
|
| Rate for Payer: Multiplan All |
$798.07
|
| Rate for Payer: OMNI Networks Commercial |
$613.90
|
| Rate for Payer: One Health Plan PPO/POS |
$789.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$833.15
|
| Rate for Payer: Three Rivers Provider Network All |
$657.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$815.61
|
| Rate for Payer: Zelis Auto |
$350.80
|
| Rate for Payer: Zelis Worker's Compensation |
$239.42
|
|
|
RELEASE OF LOWER LEG TENDON
|
Facility
|
OP
|
$877.00
|
|
|
Service Code
|
CPT 27680
|
| Hospital Charge Code |
6127680
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$239.42 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$526.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cigna Commercial |
$745.45
|
| Rate for Payer: First Health Commercial |
$789.30
|
| Rate for Payer: First Health Workers Compensation |
$338.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$789.30
|
| Rate for Payer: GEHA Commercial |
$701.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$789.30
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$798.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$613.90
|
| Rate for Payer: One Health Plan PPO/POS |
$789.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$833.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$657.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$815.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$350.80
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$239.42
|
|
|
RELEASE OF LOWER LEG TENDONS
|
Facility
|
OP
|
$1,112.00
|
|
|
Service Code
|
CPT 27681
|
| Hospital Charge Code |
6127681
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$303.58 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$667.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$667.20
|
| Rate for Payer: Cash Price |
$667.20
|
| Rate for Payer: Cigna Commercial |
$945.20
|
| Rate for Payer: First Health Commercial |
$1,000.80
|
| Rate for Payer: First Health Workers Compensation |
$429.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,000.80
|
| Rate for Payer: GEHA Commercial |
$889.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,000.80
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,011.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$778.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,000.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,056.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$834.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,034.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$444.80
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$303.58
|
|
|
RELEASE OF LOWER LEG TENDONS
|
Facility
|
IP
|
$1,112.00
|
|
|
Service Code
|
CPT 27681
|
| Hospital Charge Code |
6127681
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$303.58 |
| Max. Negotiated Rate |
$1,056.40 |
| Rate for Payer: Cash Price |
$667.20
|
| Rate for Payer: Cigna Commercial |
$945.20
|
| Rate for Payer: First Health Commercial |
$1,000.80
|
| Rate for Payer: First Health Workers Compensation |
$429.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,000.80
|
| Rate for Payer: GEHA Commercial |
$778.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,000.80
|
| Rate for Payer: Multiplan All |
$1,011.92
|
| Rate for Payer: OMNI Networks Commercial |
$778.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,000.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,056.40
|
| Rate for Payer: Three Rivers Provider Network All |
$834.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,034.16
|
| Rate for Payer: Zelis Auto |
$444.80
|
| Rate for Payer: Zelis Worker's Compensation |
$303.58
|
|
|
RELEASE OF LUNG
|
Facility
|
IP
|
$3,336.00
|
|
|
Service Code
|
CPT 32220
|
| Hospital Charge Code |
6132220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$910.73 |
| Max. Negotiated Rate |
$3,169.20 |
| Rate for Payer: Cash Price |
$2,001.60
|
| Rate for Payer: Cigna Commercial |
$2,835.60
|
| Rate for Payer: First Health Commercial |
$3,002.40
|
| Rate for Payer: First Health Workers Compensation |
$1,288.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,002.40
|
| Rate for Payer: GEHA Commercial |
$2,335.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,002.40
|
| Rate for Payer: Multiplan All |
$3,035.76
|
| Rate for Payer: OMNI Networks Commercial |
$2,335.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,002.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,169.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,502.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,102.48
|
| Rate for Payer: Zelis Auto |
$1,334.40
|
| Rate for Payer: Zelis Worker's Compensation |
$910.73
|
|
|
RELEASE OF LUNG
|
Facility
|
OP
|
$3,336.00
|
|
|
Service Code
|
CPT 32220
|
| Hospital Charge Code |
6132220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$834.00 |
| Max. Negotiated Rate |
$3,169.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,001.60
|
| Rate for Payer: Cash Price |
$2,001.60
|
| Rate for Payer: Cigna Commercial |
$2,835.60
|
| Rate for Payer: First Health Commercial |
$3,002.40
|
| Rate for Payer: First Health Workers Compensation |
$1,288.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,002.40
|
| Rate for Payer: GEHA Commercial |
$2,668.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,002.40
|
| Rate for Payer: Humana ChoiceCare |
$867.36
|
| Rate for Payer: Multiplan All |
$3,035.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,001.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,335.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,002.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,169.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,502.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,935.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$834.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,102.48
|
| Rate for Payer: Zelis Auto |
$1,334.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,668.00
|
| Rate for Payer: Zelis Worker's Compensation |
$910.73
|
|
|
RELEASE OF MIDFOOT JOINT
|
Facility
|
IP
|
$1,046.00
|
|
|
Service Code
|
CPT 28260
|
| Hospital Charge Code |
6128260
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$285.56 |
| Max. Negotiated Rate |
$993.70 |
| Rate for Payer: Cash Price |
$627.60
|
| Rate for Payer: Cigna Commercial |
$889.10
|
| Rate for Payer: First Health Commercial |
$941.40
|
| Rate for Payer: First Health Workers Compensation |
$403.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$941.40
|
| Rate for Payer: GEHA Commercial |
$732.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$941.40
|
| Rate for Payer: Multiplan All |
$951.86
|
| Rate for Payer: OMNI Networks Commercial |
$732.20
|
| Rate for Payer: One Health Plan PPO/POS |
$941.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$993.70
|
| Rate for Payer: Three Rivers Provider Network All |
$784.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$972.78
|
| Rate for Payer: Zelis Auto |
$418.40
|
| Rate for Payer: Zelis Worker's Compensation |
$285.56
|
|
|
RELEASE OF MIDFOOT JOINT
|
Facility
|
OP
|
$1,046.00
|
|
|
Service Code
|
CPT 28260
|
| Hospital Charge Code |
6128260
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$285.56 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$627.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$627.60
|
| Rate for Payer: Cash Price |
$627.60
|
| Rate for Payer: Cigna Commercial |
$889.10
|
| Rate for Payer: First Health Commercial |
$941.40
|
| Rate for Payer: First Health Workers Compensation |
$403.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$941.40
|
| Rate for Payer: GEHA Commercial |
$836.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$941.40
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$951.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$732.20
|
| Rate for Payer: One Health Plan PPO/POS |
$941.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$993.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$784.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$972.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$418.40
|
| 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 |
$285.56
|
|
|
RELEASE OF MIDFOOT JOINT
|
Facility
|
OP
|
$1,569.00
|
|
|
Service Code
|
CPT 28264
|
| Hospital Charge Code |
6128264
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$428.34 |
| Max. Negotiated Rate |
$5,310.82 |
| 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 |
$941.40
|
| 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 |
$1,519.65
|
| Rate for Payer: Cash Price |
$941.40
|
| Rate for Payer: Cash Price |
$941.40
|
| Rate for Payer: Cigna Commercial |
$1,333.65
|
| Rate for Payer: First Health Commercial |
$1,412.10
|
| Rate for Payer: First Health Workers Compensation |
$605.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,412.10
|
| Rate for Payer: GEHA Commercial |
$1,255.20
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,412.10
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,292.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$1,427.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$1,098.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,412.10
|
| 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 |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,490.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,176.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,292.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,459.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$627.60
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$428.34
|
|
|
RELEASE OF MIDFOOT JOINT
|
Facility
|
IP
|
$1,569.00
|
|
|
Service Code
|
CPT 28264
|
| Hospital Charge Code |
6128264
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$428.34 |
| Max. Negotiated Rate |
$1,490.55 |
| Rate for Payer: Cash Price |
$941.40
|
| Rate for Payer: Cigna Commercial |
$1,333.65
|
| Rate for Payer: First Health Commercial |
$1,412.10
|
| Rate for Payer: First Health Workers Compensation |
$605.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,412.10
|
| Rate for Payer: GEHA Commercial |
$1,098.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,412.10
|
| Rate for Payer: Multiplan All |
$1,427.79
|
| Rate for Payer: OMNI Networks Commercial |
$1,098.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,412.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,490.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,176.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,459.17
|
| Rate for Payer: Zelis Auto |
$627.60
|
| Rate for Payer: Zelis Worker's Compensation |
$428.34
|
|
|
RELEASE OF SHOULDER LIGAMENT
|
Facility
|
OP
|
$1,425.00
|
|
|
Service Code
|
CPT 23415
|
| Hospital Charge Code |
6123415
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$389.02 |
| 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 |
$855.00
|
| 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 |
$855.00
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cigna Commercial |
$1,211.25
|
| Rate for Payer: First Health Commercial |
$1,282.50
|
| Rate for Payer: First Health Workers Compensation |
$550.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,282.50
|
| Rate for Payer: GEHA Commercial |
$1,140.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,282.50
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,296.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$997.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,282.50
|
| 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 |
$1,353.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,068.75
|
| 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 |
$1,325.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$570.00
|
| 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 |
$389.02
|
|
