|
REMOVE FOREIGN BODY LARYNX
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 31511
|
| Hospital Charge Code |
6131511
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$110.56 |
| Max. Negotiated Rate |
$384.75 |
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$344.25
|
| Rate for Payer: First Health Commercial |
$364.50
|
| Rate for Payer: First Health Workers Compensation |
$156.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$364.50
|
| Rate for Payer: GEHA Commercial |
$283.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$364.50
|
| Rate for Payer: Multiplan All |
$368.55
|
| Rate for Payer: OMNI Networks Commercial |
$283.50
|
| Rate for Payer: One Health Plan PPO/POS |
$364.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$384.75
|
| Rate for Payer: Three Rivers Provider Network All |
$303.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$376.65
|
| Rate for Payer: Zelis Auto |
$162.00
|
| Rate for Payer: Zelis Worker's Compensation |
$110.56
|
|
|
REMOVE FOREIGN BODY LARYNX
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 31511
|
| Hospital Charge Code |
6131511
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$110.56 |
| Max. Negotiated Rate |
$384.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$186.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$243.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$186.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$147.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$184.34
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$344.25
|
| Rate for Payer: First Health Commercial |
$364.50
|
| Rate for Payer: First Health Workers Compensation |
$156.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$364.50
|
| Rate for Payer: GEHA Commercial |
$324.00
|
| Rate for Payer: GEHA Medicare |
$184.34
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$364.50
|
| Rate for Payer: Humana ChoiceCare |
$202.77
|
| Rate for Payer: Humana Medicare Advantage |
$184.34
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$309.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$150.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$184.34
|
| Rate for Payer: Multiplan All |
$368.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$313.38
|
| Rate for Payer: OMNI Networks Commercial |
$283.50
|
| Rate for Payer: One Health Plan PPO/POS |
$364.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$173.88
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$150.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$184.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$384.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$368.68
|
| Rate for Payer: Three Rivers Provider Network All |
$303.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$180.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$150.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.34
|
| Rate for Payer: United Payors & United Providers UP&UP |
$376.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$184.34
|
| Rate for Payer: Zelis Auto |
$162.00
|
| Rate for Payer: Zelis Medicare |
$156.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$221.21
|
| Rate for Payer: Zelis Worker's Compensation |
$110.56
|
|
|
REMOVE FOREIGN BODY LARYNX
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
CPT 31577
|
| Hospital Charge Code |
6131577
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$127.22 |
| Max. Negotiated Rate |
$737.44 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$446.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$279.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$446.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$353.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$368.72
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cigna Commercial |
$396.10
|
| Rate for Payer: First Health Commercial |
$419.40
|
| Rate for Payer: First Health Workers Compensation |
$179.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$419.40
|
| Rate for Payer: GEHA Commercial |
$372.80
|
| Rate for Payer: GEHA Medicare |
$368.72
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$419.40
|
| Rate for Payer: Humana ChoiceCare |
$405.59
|
| Rate for Payer: Humana Medicare Advantage |
$368.72
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$619.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$360.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$368.72
|
| Rate for Payer: Multiplan All |
$424.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$626.82
|
| Rate for Payer: OMNI Networks Commercial |
$326.20
|
| Rate for Payer: One Health Plan PPO/POS |
$419.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$416.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$360.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$368.72
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$442.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$737.44
|
| Rate for Payer: Three Rivers Provider Network All |
$349.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$361.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$360.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$368.72
|
| Rate for Payer: United Payors & United Providers UP&UP |
$433.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$368.72
|
| Rate for Payer: Zelis Auto |
$186.40
|
| Rate for Payer: Zelis Medicare |
$313.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$442.46
|
| Rate for Payer: Zelis Worker's Compensation |
$127.22
|
|
|
REMOVE GASTRIC PORT, OPEN
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
CPT 43887
|
| Hospital Charge Code |
6143887
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$209.00 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$501.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cigna Commercial |
$710.60
|
| Rate for Payer: First Health Commercial |
$752.40
|
| Rate for Payer: First Health Workers Compensation |
$322.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$752.40
|
| Rate for Payer: GEHA Commercial |
$668.80
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$752.40
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$760.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$585.20
|
| Rate for Payer: One Health Plan PPO/POS |
$752.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$794.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$627.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$209.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$777.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$334.40
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$228.23
|
|
|
REMOVE GASTRIC PORT, OPEN
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
CPT 43887
|
| Hospital Charge Code |
6143887
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$228.23 |
| Max. Negotiated Rate |
$794.20 |
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cigna Commercial |
$710.60
|
| Rate for Payer: First Health Commercial |
$752.40
|
| Rate for Payer: First Health Workers Compensation |
$322.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$752.40
|
| Rate for Payer: GEHA Commercial |
$585.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$752.40
|
| Rate for Payer: Multiplan All |
$760.76
|
| Rate for Payer: OMNI Networks Commercial |
$585.20
|
| Rate for Payer: One Health Plan PPO/POS |
$752.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$794.20
|
| Rate for Payer: Three Rivers Provider Network All |
$627.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$777.48
|
| Rate for Payer: Zelis Auto |
$334.40
|
| Rate for Payer: Zelis Worker's Compensation |
$228.23
|
|
|
REMOVE/GRAFT BONE LESION
|
Facility
|
OP
|
$1,774.00
|
|
|
Service Code
|
CPT 24116
|
| Hospital Charge Code |
6124116
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$484.30 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,064.40
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,064.40
|
| Rate for Payer: Cash Price |
$1,064.40
|
| Rate for Payer: Cigna Commercial |
$1,507.90
|
| Rate for Payer: First Health Commercial |
$1,596.60
|
| Rate for Payer: First Health Workers Compensation |
$684.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,596.60
|
| Rate for Payer: GEHA Commercial |
$1,419.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,596.60
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,614.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,241.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,596.60
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,685.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,330.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,649.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$709.60
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$484.30
|
|
|
REMOVE/GRAFT BONE LESION
|
Facility
|
OP
|
$1,329.00
|
|
|
Service Code
|
CPT 24126
|
| Hospital Charge Code |
6124126
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$362.82 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$797.40
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$797.40
|
| Rate for Payer: Cash Price |
$797.40
|
| Rate for Payer: Cigna Commercial |
$1,129.65
|
| Rate for Payer: First Health Commercial |
$1,196.10
|
| Rate for Payer: First Health Workers Compensation |
$513.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,196.10
|
| Rate for Payer: GEHA Commercial |
$1,063.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,196.10
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,209.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$930.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,196.10
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,262.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$996.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,235.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$531.60
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$362.82
|
|
|
REMOVE/GRAFT BONE LESION
|
Facility
|
OP
|
$1,231.00
|
|
|
Service Code
|
CPT 26205
|
| Hospital Charge Code |
6126205
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$336.06 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$738.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$738.60
|
| Rate for Payer: Cash Price |
$738.60
|
| Rate for Payer: Cigna Commercial |
$1,046.35
|
| Rate for Payer: First Health Commercial |
$1,107.90
|
| Rate for Payer: First Health Workers Compensation |
$475.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,107.90
|
| Rate for Payer: GEHA Commercial |
$984.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,107.90
|
| 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 |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,120.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$861.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,107.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,169.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$923.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,144.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$492.40
|
| 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 |
$336.06
|
|
|
REMOVE/GRAFT BONE LESION
|
Facility
|
IP
|
$1,329.00
|
|
|
Service Code
|
CPT 24126
|
| Hospital Charge Code |
6124126
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$362.82 |
| Max. Negotiated Rate |
$1,262.55 |
| Rate for Payer: Cash Price |
$797.40
|
| Rate for Payer: Cigna Commercial |
$1,129.65
|
| Rate for Payer: First Health Commercial |
$1,196.10
|
| Rate for Payer: First Health Workers Compensation |
$513.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,196.10
|
| Rate for Payer: GEHA Commercial |
$930.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,196.10
|
| Rate for Payer: Multiplan All |
$1,209.39
|
| Rate for Payer: OMNI Networks Commercial |
$930.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,196.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,262.55
|
| Rate for Payer: Three Rivers Provider Network All |
$996.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,235.97
|
| Rate for Payer: Zelis Auto |
$531.60
|
| Rate for Payer: Zelis Worker's Compensation |
$362.82
|
|
|
REMOVE/GRAFT BONE LESION
|
Facility
|
OP
|
$1,249.00
|
|
|
Service Code
|
CPT 24125
|
| Hospital Charge Code |
6124125
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$340.98 |
| 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 |
$749.40
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cigna Commercial |
$1,061.65
|
| Rate for Payer: First Health Commercial |
$1,124.10
|
| Rate for Payer: First Health Workers Compensation |
$482.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,124.10
|
| Rate for Payer: GEHA Commercial |
$999.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,124.10
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,136.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$874.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,124.10
|
| 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 |
$1,186.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$936.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,161.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$499.60
|
| 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 |
$340.98
|
|
|
REMOVE/GRAFT BONE LESION
|
Facility
|
IP
|
$1,513.00
|
|
|
Service Code
|
CPT 24115
|
| Hospital Charge Code |
6124115
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$413.05 |
| Max. Negotiated Rate |
$1,437.35 |
| Rate for Payer: Cash Price |
$907.80
|
| Rate for Payer: Cigna Commercial |
$1,286.05
|
| Rate for Payer: First Health Commercial |
$1,361.70
|
| Rate for Payer: First Health Workers Compensation |
$584.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,361.70
|
| Rate for Payer: GEHA Commercial |
$1,059.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,361.70
|
| Rate for Payer: Multiplan All |
$1,376.83
|
| Rate for Payer: OMNI Networks Commercial |
$1,059.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,361.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,437.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,134.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,407.09
|
| Rate for Payer: Zelis Auto |
$605.20
|
| Rate for Payer: Zelis Worker's Compensation |
$413.05
|
|
|
REMOVE/GRAFT BONE LESION
|
Facility
|
OP
|
$1,513.00
|
|
|
Service Code
|
CPT 24115
|
| Hospital Charge Code |
6124115
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$413.05 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$907.80
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$907.80
|
| Rate for Payer: Cash Price |
$907.80
|
| Rate for Payer: Cigna Commercial |
$1,286.05
|
| Rate for Payer: First Health Commercial |
$1,361.70
|
| Rate for Payer: First Health Workers Compensation |
$584.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,361.70
|
| Rate for Payer: GEHA Commercial |
$1,210.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,361.70
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,376.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,059.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,361.70
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,437.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,134.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,407.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$605.20
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$413.05
|
|
|
REMOVE/GRAFT BONE LESION
|
Facility
|
IP
|
$1,774.00
|
|
|
Service Code
|
CPT 24116
|
| Hospital Charge Code |
6124116
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$484.30 |
| Max. Negotiated Rate |
$1,685.30 |
| Rate for Payer: Cash Price |
$1,064.40
|
| Rate for Payer: Cigna Commercial |
$1,507.90
|
| Rate for Payer: First Health Commercial |
$1,596.60
|
| Rate for Payer: First Health Workers Compensation |
$684.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,596.60
|
| Rate for Payer: GEHA Commercial |
$1,241.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,596.60
|
| Rate for Payer: Multiplan All |
$1,614.34
|
| Rate for Payer: OMNI Networks Commercial |
$1,241.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,596.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,685.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,330.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,649.82
|
| Rate for Payer: Zelis Auto |
$709.60
|
| Rate for Payer: Zelis Worker's Compensation |
$484.30
|
|
|
REMOVE/GRAFT BONE LESION
|
Facility
|
IP
|
$1,231.00
|
|
|
Service Code
|
CPT 26205
|
| Hospital Charge Code |
6126205
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$336.06 |
| Max. Negotiated Rate |
$1,169.45 |
| Rate for Payer: Cash Price |
$738.60
|
| Rate for Payer: Cigna Commercial |
$1,046.35
|
| Rate for Payer: First Health Commercial |
$1,107.90
|
| Rate for Payer: First Health Workers Compensation |
$475.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,107.90
|
| Rate for Payer: GEHA Commercial |
$861.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,107.90
|
| Rate for Payer: Multiplan All |
$1,120.21
|
| Rate for Payer: OMNI Networks Commercial |
$861.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,107.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,169.45
|
| Rate for Payer: Three Rivers Provider Network All |
$923.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,144.83
|
| Rate for Payer: Zelis Auto |
$492.40
|
| Rate for Payer: Zelis Worker's Compensation |
$336.06
|
|
|
REMOVE/GRAFT BONE LESION
|
Facility
|
IP
|
$1,249.00
|
|
|
Service Code
|
CPT 24125
|
| Hospital Charge Code |
6124125
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$340.98 |
| Max. Negotiated Rate |
$1,186.55 |
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cigna Commercial |
$1,061.65
|
| Rate for Payer: First Health Commercial |
$1,124.10
|
| Rate for Payer: First Health Workers Compensation |
$482.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,124.10
|
| Rate for Payer: GEHA Commercial |
$874.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,124.10
|
| Rate for Payer: Multiplan All |
$1,136.59
|
| Rate for Payer: OMNI Networks Commercial |
$874.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,124.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,186.55
|
| Rate for Payer: Three Rivers Provider Network All |
$936.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,161.57
|
| Rate for Payer: Zelis Auto |
$499.60
|
| Rate for Payer: Zelis Worker's Compensation |
$340.98
|
|
|
REMOVE/GRAFT FINGER LESION
|
Facility
|
IP
|
$1,148.00
|
|
|
Service Code
|
CPT 26215
|
| Hospital Charge Code |
6126215
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$1,090.60 |
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: Cigna Commercial |
$975.80
|
| Rate for Payer: First Health Commercial |
$1,033.20
|
| Rate for Payer: First Health Workers Compensation |
$443.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,033.20
|
| Rate for Payer: GEHA Commercial |
$803.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,033.20
|
| Rate for Payer: Multiplan All |
$1,044.68
|
| Rate for Payer: OMNI Networks Commercial |
$803.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,033.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,090.60
|
| Rate for Payer: Three Rivers Provider Network All |
$861.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,067.64
|
| Rate for Payer: Zelis Auto |
$459.20
|
| Rate for Payer: Zelis Worker's Compensation |
$313.40
|
|
|
REMOVE/GRAFT FINGER LESION
|
Facility
|
OP
|
$1,148.00
|
|
|
Service Code
|
CPT 26215
|
| Hospital Charge Code |
6126215
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$313.40 |
| 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 |
$688.80
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: Cigna Commercial |
$975.80
|
| Rate for Payer: First Health Commercial |
$1,033.20
|
| Rate for Payer: First Health Workers Compensation |
$443.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,033.20
|
| Rate for Payer: GEHA Commercial |
$918.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,033.20
|
| 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 |
$1,044.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$803.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,033.20
|
| 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 |
$1,090.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$861.00
|
| 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 |
$1,067.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$459.20
|
| 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 |
$313.40
|
|
|
REMOVE/GRAFT FOOT LESION
|
Facility
|
OP
|
$953.00
|
|
|
Service Code
|
CPT 28107
|
| Hospital Charge Code |
6128107
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$260.17 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$571.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,207.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$571.80
|
| Rate for Payer: Cash Price |
$571.80
|
| Rate for Payer: Cigna Commercial |
$810.05
|
| Rate for Payer: First Health Commercial |
$857.70
|
| Rate for Payer: First Health Workers Compensation |
$367.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$857.70
|
| Rate for Payer: GEHA Commercial |
$762.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$857.70
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,292.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$867.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$667.10
|
| Rate for Payer: One Health Plan PPO/POS |
$857.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,956.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,292.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$905.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$714.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,292.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$886.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$381.20
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$260.17
|
|
|
REMOVE/GRAFT FOOT LESION
|
Facility
|
IP
|
$948.00
|
|
|
Service Code
|
CPT 28106
|
| Hospital Charge Code |
6128106
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$258.80 |
| Max. Negotiated Rate |
$900.60 |
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Cigna Commercial |
$805.80
|
| Rate for Payer: First Health Commercial |
$853.20
|
| Rate for Payer: First Health Workers Compensation |
$366.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$853.20
|
| Rate for Payer: GEHA Commercial |
$663.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$853.20
|
| Rate for Payer: Multiplan All |
$862.68
|
| Rate for Payer: OMNI Networks Commercial |
$663.60
|
| Rate for Payer: One Health Plan PPO/POS |
$853.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$900.60
|
| Rate for Payer: Three Rivers Provider Network All |
$711.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$881.64
|
| Rate for Payer: Zelis Auto |
$379.20
|
| Rate for Payer: Zelis Worker's Compensation |
$258.80
|
|
|
REMOVE/GRAFT FOOT LESION
|
Facility
|
IP
|
$1,236.00
|
|
|
Service Code
|
CPT 28102
|
| Hospital Charge Code |
6128102
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$337.43 |
| Max. Negotiated Rate |
$1,174.20 |
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cigna Commercial |
$1,050.60
|
| Rate for Payer: First Health Commercial |
$1,112.40
|
| Rate for Payer: First Health Workers Compensation |
$477.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,112.40
|
| Rate for Payer: GEHA Commercial |
$865.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,112.40
|
| Rate for Payer: Multiplan All |
$1,124.76
|
| Rate for Payer: OMNI Networks Commercial |
$865.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,112.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,174.20
|
| Rate for Payer: Three Rivers Provider Network All |
$927.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,149.48
|
| Rate for Payer: Zelis Auto |
$494.40
|
| Rate for Payer: Zelis Worker's Compensation |
$337.43
|
|
|
REMOVE/GRAFT FOOT LESION
|
Facility
|
OP
|
$1,236.00
|
|
|
Service Code
|
CPT 28102
|
| Hospital Charge Code |
6128102
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$337.43 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$741.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,207.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cigna Commercial |
$1,050.60
|
| Rate for Payer: First Health Commercial |
$1,112.40
|
| Rate for Payer: First Health Workers Compensation |
$477.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,112.40
|
| Rate for Payer: GEHA Commercial |
$988.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,112.40
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,292.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,124.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$865.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,112.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,956.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,292.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,174.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$927.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,292.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,149.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$494.40
|
| 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 |
$337.43
|
|
|
REMOVE/GRAFT FOOT LESION
|
Facility
|
OP
|
$1,001.00
|
|
|
Service Code
|
CPT 28103
|
| Hospital Charge Code |
6128103
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$273.27 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$600.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,207.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cigna Commercial |
$850.85
|
| Rate for Payer: First Health Commercial |
$900.90
|
| Rate for Payer: First Health Workers Compensation |
$386.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$900.90
|
| Rate for Payer: GEHA Commercial |
$800.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$900.90
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,292.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$910.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$700.70
|
| Rate for Payer: One Health Plan PPO/POS |
$900.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,956.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,292.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$950.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$750.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,292.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$930.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$400.40
|
| 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 |
$273.27
|
|
|
REMOVE/GRAFT FOOT LESION
|
Facility
|
IP
|
$953.00
|
|
|
Service Code
|
CPT 28107
|
| Hospital Charge Code |
6128107
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$260.17 |
| Max. Negotiated Rate |
$905.35 |
| Rate for Payer: Cash Price |
$571.80
|
| Rate for Payer: Cigna Commercial |
$810.05
|
| Rate for Payer: First Health Commercial |
$857.70
|
| Rate for Payer: First Health Workers Compensation |
$367.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$857.70
|
| Rate for Payer: GEHA Commercial |
$667.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$857.70
|
| Rate for Payer: Multiplan All |
$867.23
|
| Rate for Payer: OMNI Networks Commercial |
$667.10
|
| Rate for Payer: One Health Plan PPO/POS |
$857.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$905.35
|
| Rate for Payer: Three Rivers Provider Network All |
$714.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$886.29
|
| Rate for Payer: Zelis Auto |
$381.20
|
| Rate for Payer: Zelis Worker's Compensation |
$260.17
|
|
|
REMOVE/GRAFT FOOT LESION
|
Facility
|
OP
|
$948.00
|
|
|
Service Code
|
CPT 28106
|
| Hospital Charge Code |
6128106
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$258.80 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$568.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,207.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Cigna Commercial |
$805.80
|
| Rate for Payer: First Health Commercial |
$853.20
|
| Rate for Payer: First Health Workers Compensation |
$366.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$853.20
|
| Rate for Payer: GEHA Commercial |
$758.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$853.20
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,292.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$862.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$663.60
|
| Rate for Payer: One Health Plan PPO/POS |
$853.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,956.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,292.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$900.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$711.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,292.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$881.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$379.20
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$258.80
|
|
|
REMOVE/GRAFT FOOT LESION
|
Facility
|
IP
|
$1,001.00
|
|
|
Service Code
|
CPT 28103
|
| Hospital Charge Code |
6128103
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$273.27 |
| Max. Negotiated Rate |
$950.95 |
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cigna Commercial |
$850.85
|
| Rate for Payer: First Health Commercial |
$900.90
|
| Rate for Payer: First Health Workers Compensation |
$386.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$900.90
|
| Rate for Payer: GEHA Commercial |
$700.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$900.90
|
| Rate for Payer: Multiplan All |
$910.91
|
| Rate for Payer: OMNI Networks Commercial |
$700.70
|
| Rate for Payer: One Health Plan PPO/POS |
$900.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$950.95
|
| Rate for Payer: Three Rivers Provider Network All |
$750.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$930.93
|
| Rate for Payer: Zelis Auto |
$400.40
|
| Rate for Payer: Zelis Worker's Compensation |
$273.27
|
|
