|
REPAIR FINGER TENDON
|
Facility
|
IP
|
$1,041.00
|
|
|
Service Code
|
CPT 26433
|
| Hospital Charge Code |
6126433
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$284.19 |
| Max. Negotiated Rate |
$988.95 |
| Rate for Payer: Cash Price |
$624.60
|
| Rate for Payer: Cigna Commercial |
$884.85
|
| Rate for Payer: First Health Commercial |
$936.90
|
| Rate for Payer: First Health Workers Compensation |
$401.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$936.90
|
| Rate for Payer: GEHA Commercial |
$728.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$936.90
|
| Rate for Payer: Multiplan All |
$947.31
|
| Rate for Payer: OMNI Networks Commercial |
$728.70
|
| Rate for Payer: One Health Plan PPO/POS |
$936.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$988.95
|
| Rate for Payer: Three Rivers Provider Network All |
$780.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$968.13
|
| Rate for Payer: Zelis Auto |
$416.40
|
| Rate for Payer: Zelis Worker's Compensation |
$284.19
|
|
|
REPAIR FINGER TENDON
|
Facility
|
IP
|
$1,126.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
6126418
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$307.40 |
| Max. Negotiated Rate |
$1,069.70 |
| Rate for Payer: Cash Price |
$675.60
|
| Rate for Payer: Cigna Commercial |
$957.10
|
| Rate for Payer: First Health Commercial |
$1,013.40
|
| Rate for Payer: First Health Workers Compensation |
$434.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,013.40
|
| Rate for Payer: GEHA Commercial |
$788.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,013.40
|
| Rate for Payer: Multiplan All |
$1,024.66
|
| Rate for Payer: OMNI Networks Commercial |
$788.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,013.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,069.70
|
| Rate for Payer: Three Rivers Provider Network All |
$844.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,047.18
|
| Rate for Payer: Zelis Auto |
$450.40
|
| Rate for Payer: Zelis Worker's Compensation |
$307.40
|
|
|
REPAIR FISTULA W/COLOSTOMY
|
Facility
|
IP
|
$2,874.00
|
|
|
Service Code
|
CPT 45825
|
| Hospital Charge Code |
6145825
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$784.60 |
| Max. Negotiated Rate |
$2,730.30 |
| Rate for Payer: Cash Price |
$1,724.40
|
| Rate for Payer: Cigna Commercial |
$2,442.90
|
| Rate for Payer: First Health Commercial |
$2,586.60
|
| Rate for Payer: First Health Workers Compensation |
$1,109.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,586.60
|
| Rate for Payer: GEHA Commercial |
$2,011.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,586.60
|
| Rate for Payer: Multiplan All |
$2,615.34
|
| Rate for Payer: OMNI Networks Commercial |
$2,011.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,586.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,730.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,155.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,672.82
|
| Rate for Payer: Zelis Auto |
$1,149.60
|
| Rate for Payer: Zelis Worker's Compensation |
$784.60
|
|
|
REPAIR FISTULA W/COLOSTOMY
|
Facility
|
OP
|
$3,071.00
|
|
|
Service Code
|
CPT 45805
|
| Hospital Charge Code |
6145805
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$767.75 |
| Max. Negotiated Rate |
$2,917.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,842.60
|
| Rate for Payer: Cash Price |
$1,842.60
|
| Rate for Payer: Cigna Commercial |
$2,610.35
|
| Rate for Payer: First Health Commercial |
$2,763.90
|
| Rate for Payer: First Health Workers Compensation |
$1,185.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,763.90
|
| Rate for Payer: GEHA Commercial |
$2,456.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,763.90
|
| Rate for Payer: Humana ChoiceCare |
$798.46
|
| Rate for Payer: Multiplan All |
$2,794.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,842.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,149.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,763.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,917.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,303.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,702.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$767.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,856.03
|
| Rate for Payer: Zelis Auto |
$1,228.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,535.50
|
| Rate for Payer: Zelis Worker's Compensation |
$838.38
|
|
|
REPAIR FISTULA W/COLOSTOMY
|
Facility
|
IP
|
$3,071.00
|
|
|
Service Code
|
CPT 45805
|
| Hospital Charge Code |
6145805
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$838.38 |
| Max. Negotiated Rate |
$2,917.45 |
| Rate for Payer: Cash Price |
$1,842.60
|
| Rate for Payer: Cigna Commercial |
$2,610.35
|
| Rate for Payer: First Health Commercial |
$2,763.90
|
| Rate for Payer: First Health Workers Compensation |
$1,185.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,763.90
|
| Rate for Payer: GEHA Commercial |
$2,149.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,763.90
|
| Rate for Payer: Multiplan All |
$2,794.61
|
| Rate for Payer: OMNI Networks Commercial |
$2,149.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,763.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,917.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,303.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,856.03
|
| Rate for Payer: Zelis Auto |
$1,228.40
|
| Rate for Payer: Zelis Worker's Compensation |
$838.38
|
|
|
REPAIR FISTULA W/COLOSTOMY
|
Facility
|
OP
|
$2,874.00
|
|
|
Service Code
|
CPT 45825
|
| Hospital Charge Code |
6145825
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$718.50 |
| Max. Negotiated Rate |
$2,730.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,724.40
|
| Rate for Payer: Cash Price |
$1,724.40
|
| Rate for Payer: Cigna Commercial |
$2,442.90
|
| Rate for Payer: First Health Commercial |
$2,586.60
|
| Rate for Payer: First Health Workers Compensation |
$1,109.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,586.60
|
| Rate for Payer: GEHA Commercial |
$2,299.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,586.60
|
| Rate for Payer: Humana ChoiceCare |
$747.24
|
| Rate for Payer: Multiplan All |
$2,615.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,724.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,011.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,586.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,730.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,155.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,529.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$718.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,672.82
|
| Rate for Payer: Zelis Auto |
$1,149.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,437.00
|
| Rate for Payer: Zelis Worker's Compensation |
$784.60
|
|
|
REPAIR, FLEXOR TENDON, LEG; SECONDARY, WITH OR WITHOUT GRAFT, EACH TENDON
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 27659
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,763.37 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| 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 |
$6,172.77
|
|
|
REPAIR FOOT DISLOCATION
|
Facility
|
OP
|
$1,612.00
|
|
|
Service Code
|
CPT 28615
|
| Hospital Charge Code |
6128615
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$440.08 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$967.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$967.20
|
| Rate for Payer: Cash Price |
$967.20
|
| Rate for Payer: Cigna Commercial |
$1,370.20
|
| Rate for Payer: First Health Commercial |
$1,450.80
|
| Rate for Payer: First Health Workers Compensation |
$622.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,450.80
|
| Rate for Payer: GEHA Commercial |
$1,289.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,450.80
|
| 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 |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,466.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,128.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,450.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,531.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,209.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,499.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$644.80
|
| 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 |
$440.08
|
|
|
REPAIR FOOT DISLOCATION
|
Facility
|
IP
|
$1,371.00
|
|
|
Service Code
|
CPT 28555
|
| Hospital Charge Code |
6128555
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$374.28 |
| Max. Negotiated Rate |
$1,302.45 |
| Rate for Payer: Cash Price |
$822.60
|
| Rate for Payer: Cigna Commercial |
$1,165.35
|
| Rate for Payer: First Health Commercial |
$1,233.90
|
| Rate for Payer: First Health Workers Compensation |
$529.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,233.90
|
| Rate for Payer: GEHA Commercial |
$959.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,233.90
|
| Rate for Payer: Multiplan All |
$1,247.61
|
| Rate for Payer: OMNI Networks Commercial |
$959.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,233.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,302.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,028.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,275.03
|
| Rate for Payer: Zelis Auto |
$548.40
|
| Rate for Payer: Zelis Worker's Compensation |
$374.28
|
|
|
REPAIR FOOT DISLOCATION
|
Facility
|
OP
|
$1,373.00
|
|
|
Service Code
|
CPT 28585
|
| Hospital Charge Code |
6128585
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$374.83 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$823.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,070.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$823.80
|
| Rate for Payer: Cash Price |
$823.80
|
| Rate for Payer: Cigna Commercial |
$1,167.05
|
| Rate for Payer: First Health Commercial |
$1,235.70
|
| Rate for Payer: First Health Workers Compensation |
$530.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,235.70
|
| Rate for Payer: GEHA Commercial |
$1,098.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,235.70
|
| 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 |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,249.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$961.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,235.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,438.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,112.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,304.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,029.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,276.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$549.20
|
| 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 |
$374.83
|
|
|
REPAIR FOOT DISLOCATION
|
Facility
|
OP
|
$1,371.00
|
|
|
Service Code
|
CPT 28555
|
| Hospital Charge Code |
6128555
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$374.28 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$822.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$822.60
|
| Rate for Payer: Cash Price |
$822.60
|
| Rate for Payer: Cigna Commercial |
$1,165.35
|
| Rate for Payer: First Health Commercial |
$1,233.90
|
| Rate for Payer: First Health Workers Compensation |
$529.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,233.90
|
| Rate for Payer: GEHA Commercial |
$1,096.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,233.90
|
| 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 |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,247.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$959.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,233.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,302.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,028.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,275.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$548.40
|
| 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 |
$374.28
|
|
|
REPAIR FOOT DISLOCATION
|
Facility
|
IP
|
$1,373.00
|
|
|
Service Code
|
CPT 28585
|
| Hospital Charge Code |
6128585
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$374.83 |
| Max. Negotiated Rate |
$1,304.35 |
| Rate for Payer: Cash Price |
$823.80
|
| Rate for Payer: Cigna Commercial |
$1,167.05
|
| Rate for Payer: First Health Commercial |
$1,235.70
|
| Rate for Payer: First Health Workers Compensation |
$530.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,235.70
|
| Rate for Payer: GEHA Commercial |
$961.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,235.70
|
| Rate for Payer: Multiplan All |
$1,249.43
|
| Rate for Payer: OMNI Networks Commercial |
$961.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,235.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,304.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,029.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,276.89
|
| Rate for Payer: Zelis Auto |
$549.20
|
| Rate for Payer: Zelis Worker's Compensation |
$374.83
|
|
|
REPAIR FOOT DISLOCATION
|
Facility
|
IP
|
$1,612.00
|
|
|
Service Code
|
CPT 28615
|
| Hospital Charge Code |
6128615
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$440.08 |
| Max. Negotiated Rate |
$1,531.40 |
| Rate for Payer: Cash Price |
$967.20
|
| Rate for Payer: Cigna Commercial |
$1,370.20
|
| Rate for Payer: First Health Commercial |
$1,450.80
|
| Rate for Payer: First Health Workers Compensation |
$622.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,450.80
|
| Rate for Payer: GEHA Commercial |
$1,128.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,450.80
|
| Rate for Payer: Multiplan All |
$1,466.92
|
| Rate for Payer: OMNI Networks Commercial |
$1,128.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,450.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,531.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,209.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,499.16
|
| Rate for Payer: Zelis Auto |
$644.80
|
| Rate for Payer: Zelis Worker's Compensation |
$440.08
|
|
|
REPAIR FOREARM TENDON/MUSCLE
|
Facility
|
OP
|
$1,124.00
|
|
|
Service Code
|
CPT 25272
|
| Hospital Charge Code |
6125272
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$306.85 |
| 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 |
$674.40
|
| 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 |
$674.40
|
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cigna Commercial |
$955.40
|
| Rate for Payer: First Health Commercial |
$1,011.60
|
| Rate for Payer: First Health Workers Compensation |
$433.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,011.60
|
| Rate for Payer: GEHA Commercial |
$899.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,011.60
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,022.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$786.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,011.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,067.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$843.00
|
| 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 |
$1,045.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$449.60
|
| 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 |
$306.85
|
|
|
REPAIR FOREARM TENDON/MUSCLE
|
Facility
|
OP
|
$1,261.00
|
|
|
Service Code
|
CPT 25263
|
| Hospital Charge Code |
6125263
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$344.25 |
| 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 |
$756.60
|
| 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 |
$756.60
|
| Rate for Payer: Cash Price |
$756.60
|
| Rate for Payer: Cigna Commercial |
$1,071.85
|
| Rate for Payer: First Health Commercial |
$1,134.90
|
| Rate for Payer: First Health Workers Compensation |
$486.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,134.90
|
| Rate for Payer: GEHA Commercial |
$1,008.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,134.90
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,147.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$882.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,134.90
|
| 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 |
$1,197.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$945.75
|
| 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 |
$1,172.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$504.40
|
| 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 |
$344.25
|
|
|
REPAIR FOREARM TENDON/MUSCLE
|
Facility
|
OP
|
$1,529.00
|
|
|
Service Code
|
CPT 25265
|
| Hospital Charge Code |
6125265
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$417.42 |
| 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 |
$917.40
|
| 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 |
$917.40
|
| Rate for Payer: Cash Price |
$917.40
|
| Rate for Payer: Cigna Commercial |
$1,299.65
|
| Rate for Payer: First Health Commercial |
$1,376.10
|
| Rate for Payer: First Health Workers Compensation |
$590.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,376.10
|
| Rate for Payer: GEHA Commercial |
$1,223.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,376.10
|
| 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 |
$1,391.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,070.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,376.10
|
| 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 |
$1,452.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,146.75
|
| 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 |
$1,421.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$611.60
|
| 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 |
$417.42
|
|
|
REPAIR FOREARM TENDON/MUSCLE
|
Facility
|
IP
|
$1,352.00
|
|
|
Service Code
|
CPT 25274
|
| Hospital Charge Code |
6125274
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$369.10 |
| Max. Negotiated Rate |
$1,284.40 |
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Cigna Commercial |
$1,149.20
|
| Rate for Payer: First Health Commercial |
$1,216.80
|
| Rate for Payer: First Health Workers Compensation |
$522.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,216.80
|
| Rate for Payer: GEHA Commercial |
$946.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,216.80
|
| Rate for Payer: Multiplan All |
$1,230.32
|
| Rate for Payer: OMNI Networks Commercial |
$946.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,216.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,284.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,014.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,257.36
|
| Rate for Payer: Zelis Auto |
$540.80
|
| Rate for Payer: Zelis Worker's Compensation |
$369.10
|
|
|
REPAIR FOREARM TENDON/MUSCLE
|
Facility
|
OP
|
$1,352.00
|
|
|
Service Code
|
CPT 25274
|
| Hospital Charge Code |
6125274
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$369.10 |
| 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 |
$811.20
|
| 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 |
$811.20
|
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Cigna Commercial |
$1,149.20
|
| Rate for Payer: First Health Commercial |
$1,216.80
|
| Rate for Payer: First Health Workers Compensation |
$522.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,216.80
|
| Rate for Payer: GEHA Commercial |
$1,081.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,216.80
|
| 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 |
$1,230.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$946.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,216.80
|
| 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 |
$1,284.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,014.00
|
| 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 |
$1,257.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$540.80
|
| 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 |
$369.10
|
|
|
REPAIR FOREARM TENDON/MUSCLE
|
Facility
|
OP
|
$1,278.00
|
|
|
Service Code
|
CPT 25260
|
| Hospital Charge Code |
6125260
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$348.89 |
| 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 |
$766.80
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$766.80
|
| Rate for Payer: Cash Price |
$766.80
|
| Rate for Payer: Cigna Commercial |
$1,086.30
|
| Rate for Payer: First Health Commercial |
$1,150.20
|
| Rate for Payer: First Health Workers Compensation |
$493.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,150.20
|
| Rate for Payer: GEHA Commercial |
$1,022.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,150.20
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,162.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$894.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,150.20
|
| 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 |
$1,214.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$958.50
|
| 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 |
$1,188.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$511.20
|
| 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 |
$348.89
|
|
|
REPAIR FOREARM TENDON/MUSCLE
|
Facility
|
IP
|
$1,278.00
|
|
|
Service Code
|
CPT 25260
|
| Hospital Charge Code |
6125260
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$348.89 |
| Max. Negotiated Rate |
$1,214.10 |
| Rate for Payer: Cash Price |
$766.80
|
| Rate for Payer: Cigna Commercial |
$1,086.30
|
| Rate for Payer: First Health Commercial |
$1,150.20
|
| Rate for Payer: First Health Workers Compensation |
$493.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,150.20
|
| Rate for Payer: GEHA Commercial |
$894.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,150.20
|
| Rate for Payer: Multiplan All |
$1,162.98
|
| Rate for Payer: OMNI Networks Commercial |
$894.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,150.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,214.10
|
| Rate for Payer: Three Rivers Provider Network All |
$958.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,188.54
|
| Rate for Payer: Zelis Auto |
$511.20
|
| Rate for Payer: Zelis Worker's Compensation |
$348.89
|
|
|
REPAIR FOREARM TENDON/MUSCLE
|
Facility
|
IP
|
$1,529.00
|
|
|
Service Code
|
CPT 25265
|
| Hospital Charge Code |
6125265
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$417.42 |
| Max. Negotiated Rate |
$1,452.55 |
| Rate for Payer: Cash Price |
$917.40
|
| Rate for Payer: Cigna Commercial |
$1,299.65
|
| Rate for Payer: First Health Commercial |
$1,376.10
|
| Rate for Payer: First Health Workers Compensation |
$590.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,376.10
|
| Rate for Payer: GEHA Commercial |
$1,070.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,376.10
|
| Rate for Payer: Multiplan All |
$1,391.39
|
| Rate for Payer: OMNI Networks Commercial |
$1,070.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,376.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,452.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,146.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,421.97
|
| Rate for Payer: Zelis Auto |
$611.60
|
| Rate for Payer: Zelis Worker's Compensation |
$417.42
|
|
|
REPAIR FOREARM TENDON/MUSCLE
|
Facility
|
OP
|
$991.00
|
|
|
Service Code
|
CPT 25270
|
| Hospital Charge Code |
6125270
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$270.54 |
| 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 |
$594.60
|
| 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 |
$594.60
|
| Rate for Payer: Cash Price |
$594.60
|
| Rate for Payer: Cigna Commercial |
$842.35
|
| Rate for Payer: First Health Commercial |
$891.90
|
| Rate for Payer: First Health Workers Compensation |
$382.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$891.90
|
| Rate for Payer: GEHA Commercial |
$792.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$891.90
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$901.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$693.70
|
| Rate for Payer: One Health Plan PPO/POS |
$891.90
|
| 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 |
$941.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$743.25
|
| 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 |
$921.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$396.40
|
| 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 |
$270.54
|
|
|
REPAIR FOREARM TENDON/MUSCLE
|
Facility
|
IP
|
$1,124.00
|
|
|
Service Code
|
CPT 25272
|
| Hospital Charge Code |
6125272
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$306.85 |
| Max. Negotiated Rate |
$1,067.80 |
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cigna Commercial |
$955.40
|
| Rate for Payer: First Health Commercial |
$1,011.60
|
| Rate for Payer: First Health Workers Compensation |
$433.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,011.60
|
| Rate for Payer: GEHA Commercial |
$786.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,011.60
|
| Rate for Payer: Multiplan All |
$1,022.84
|
| Rate for Payer: OMNI Networks Commercial |
$786.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,011.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,067.80
|
| Rate for Payer: Three Rivers Provider Network All |
$843.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,045.32
|
| Rate for Payer: Zelis Auto |
$449.60
|
| Rate for Payer: Zelis Worker's Compensation |
$306.85
|
|
|
REPAIR FOREARM TENDON/MUSCLE
|
Facility
|
IP
|
$1,261.00
|
|
|
Service Code
|
CPT 25263
|
| Hospital Charge Code |
6125263
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$344.25 |
| Max. Negotiated Rate |
$1,197.95 |
| Rate for Payer: Cash Price |
$756.60
|
| Rate for Payer: Cigna Commercial |
$1,071.85
|
| Rate for Payer: First Health Commercial |
$1,134.90
|
| Rate for Payer: First Health Workers Compensation |
$486.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,134.90
|
| Rate for Payer: GEHA Commercial |
$882.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,134.90
|
| Rate for Payer: Multiplan All |
$1,147.51
|
| Rate for Payer: OMNI Networks Commercial |
$882.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,134.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,197.95
|
| Rate for Payer: Three Rivers Provider Network All |
$945.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,172.73
|
| Rate for Payer: Zelis Auto |
$504.40
|
| Rate for Payer: Zelis Worker's Compensation |
$344.25
|
|
|
REPAIR FOREARM TENDON/MUSCLE
|
Facility
|
IP
|
$991.00
|
|
|
Service Code
|
CPT 25270
|
| Hospital Charge Code |
6125270
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$270.54 |
| Max. Negotiated Rate |
$941.45 |
| Rate for Payer: Cash Price |
$594.60
|
| Rate for Payer: Cigna Commercial |
$842.35
|
| Rate for Payer: First Health Commercial |
$891.90
|
| Rate for Payer: First Health Workers Compensation |
$382.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$891.90
|
| Rate for Payer: GEHA Commercial |
$693.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$891.90
|
| Rate for Payer: Multiplan All |
$901.81
|
| Rate for Payer: OMNI Networks Commercial |
$693.70
|
| Rate for Payer: One Health Plan PPO/POS |
$891.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$941.45
|
| Rate for Payer: Three Rivers Provider Network All |
$743.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$921.63
|
| Rate for Payer: Zelis Auto |
$396.40
|
| Rate for Payer: Zelis Worker's Compensation |
$270.54
|
|
