|
REPAIR FOREARM TENDON SHEATH
|
Facility
|
IP
|
$1,367.00
|
|
|
Service Code
|
CPT 25275
|
| Hospital Charge Code |
6125275
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$373.19 |
| Max. Negotiated Rate |
$1,298.65 |
| Rate for Payer: Cash Price |
$820.20
|
| Rate for Payer: Cigna Commercial |
$1,161.95
|
| Rate for Payer: First Health Commercial |
$1,230.30
|
| Rate for Payer: First Health Workers Compensation |
$527.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,230.30
|
| Rate for Payer: GEHA Commercial |
$956.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,230.30
|
| Rate for Payer: Multiplan All |
$1,243.97
|
| Rate for Payer: OMNI Networks Commercial |
$956.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,230.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,298.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,025.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,271.31
|
| Rate for Payer: Zelis Auto |
$546.80
|
| Rate for Payer: Zelis Worker's Compensation |
$373.19
|
|
|
REPAIR FOREARM TENDON SHEATH
|
Facility
|
OP
|
$1,367.00
|
|
|
Service Code
|
CPT 25275
|
| Hospital Charge Code |
6125275
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$373.19 |
| Max. Negotiated Rate |
$6,287.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$820.20
|
| 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 |
$3,143.96
|
| Rate for Payer: Cash Price |
$820.20
|
| Rate for Payer: Cash Price |
$820.20
|
| Rate for Payer: Cigna Commercial |
$1,161.95
|
| Rate for Payer: First Health Commercial |
$1,230.30
|
| Rate for Payer: First Health Workers Compensation |
$527.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,230.30
|
| Rate for Payer: GEHA Commercial |
$1,093.60
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,230.30
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$1,243.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$956.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,230.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,298.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,025.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,271.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$546.80
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$373.19
|
|
|
REPAIR/GRAFT ACHILLES TENDON
|
Facility
|
OP
|
$1,402.00
|
|
|
Service Code
|
CPT 27652
|
| Hospital Charge Code |
6127652
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$382.75 |
| Max. Negotiated Rate |
$13,844.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$841.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7,100.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,922.13
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$1,191.70
|
| Rate for Payer: First Health Commercial |
$1,261.80
|
| Rate for Payer: First Health Workers Compensation |
$541.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,261.80
|
| Rate for Payer: GEHA Commercial |
$1,121.60
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,261.80
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,275.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$981.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,261.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8,365.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7,245.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,331.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,051.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,303.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$560.80
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$382.75
|
|
|
REPAIR/GRAFT ACHILLES TENDON
|
Facility
|
IP
|
$1,402.00
|
|
|
Service Code
|
CPT 27652
|
| Hospital Charge Code |
6127652
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$382.75 |
| Max. Negotiated Rate |
$1,331.90 |
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$1,191.70
|
| Rate for Payer: First Health Commercial |
$1,261.80
|
| Rate for Payer: First Health Workers Compensation |
$541.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,261.80
|
| Rate for Payer: GEHA Commercial |
$981.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,261.80
|
| Rate for Payer: Multiplan All |
$1,275.82
|
| Rate for Payer: OMNI Networks Commercial |
$981.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,261.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,331.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,051.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,303.86
|
| Rate for Payer: Zelis Auto |
$560.80
|
| Rate for Payer: Zelis Worker's Compensation |
$382.75
|
|
|
REPAIR/GRAFT FEMUR HEAD/NECK
|
Facility
|
OP
|
$2,430.00
|
|
|
Service Code
|
CPT 27170
|
| Hospital Charge Code |
6127170
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$607.50 |
| Max. Negotiated Rate |
$2,308.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,458.00
|
| Rate for Payer: Cash Price |
$1,458.00
|
| Rate for Payer: Cigna Commercial |
$2,065.50
|
| Rate for Payer: First Health Commercial |
$2,187.00
|
| Rate for Payer: First Health Workers Compensation |
$938.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,187.00
|
| Rate for Payer: GEHA Commercial |
$1,944.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,187.00
|
| Rate for Payer: Humana ChoiceCare |
$631.80
|
| Rate for Payer: Multiplan All |
$2,211.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,458.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,701.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,187.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,308.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,822.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,138.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$607.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,259.90
|
| Rate for Payer: Zelis Auto |
$972.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,215.00
|
| Rate for Payer: Zelis Worker's Compensation |
$663.39
|
|
|
REPAIR/GRAFT FEMUR HEAD/NECK
|
Facility
|
IP
|
$2,430.00
|
|
|
Service Code
|
CPT 27170
|
| Hospital Charge Code |
6127170
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$663.39 |
| Max. Negotiated Rate |
$2,308.50 |
| Rate for Payer: Cash Price |
$1,458.00
|
| Rate for Payer: Cigna Commercial |
$2,065.50
|
| Rate for Payer: First Health Commercial |
$2,187.00
|
| Rate for Payer: First Health Workers Compensation |
$938.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,187.00
|
| Rate for Payer: GEHA Commercial |
$1,701.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,187.00
|
| Rate for Payer: Multiplan All |
$2,211.30
|
| Rate for Payer: OMNI Networks Commercial |
$1,701.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,187.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,308.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,822.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,259.90
|
| Rate for Payer: Zelis Auto |
$972.00
|
| Rate for Payer: Zelis Worker's Compensation |
$663.39
|
|
|
REPAIR/GRAFT FINGER TENDON
|
Facility
|
IP
|
$1,277.00
|
|
|
Service Code
|
CPT 26434
|
| Hospital Charge Code |
6126434
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$348.62 |
| Max. Negotiated Rate |
$1,213.15 |
| Rate for Payer: Cash Price |
$766.20
|
| Rate for Payer: Cigna Commercial |
$1,085.45
|
| Rate for Payer: First Health Commercial |
$1,149.30
|
| Rate for Payer: First Health Workers Compensation |
$493.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,149.30
|
| Rate for Payer: GEHA Commercial |
$893.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,149.30
|
| Rate for Payer: Multiplan All |
$1,162.07
|
| Rate for Payer: OMNI Networks Commercial |
$893.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,149.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,213.15
|
| Rate for Payer: Three Rivers Provider Network All |
$957.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,187.61
|
| Rate for Payer: Zelis Auto |
$510.80
|
| Rate for Payer: Zelis Worker's Compensation |
$348.62
|
|
|
REPAIR/GRAFT FINGER TENDON
|
Facility
|
OP
|
$1,489.00
|
|
|
Service Code
|
CPT 26428
|
| Hospital Charge Code |
6126428
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$406.50 |
| Max. Negotiated Rate |
$6,287.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$893.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: Cash Price |
$893.40
|
| Rate for Payer: Cash Price |
$893.40
|
| Rate for Payer: Cigna Commercial |
$1,265.65
|
| Rate for Payer: First Health Commercial |
$1,340.10
|
| Rate for Payer: First Health Workers Compensation |
$574.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,340.10
|
| Rate for Payer: GEHA Commercial |
$1,191.20
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,340.10
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$1,354.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$1,042.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,340.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,414.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,116.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,384.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$595.60
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$406.50
|
|
|
REPAIR/GRAFT FINGER TENDON
|
Facility
|
IP
|
$1,489.00
|
|
|
Service Code
|
CPT 26428
|
| Hospital Charge Code |
6126428
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$406.50 |
| Max. Negotiated Rate |
$1,414.55 |
| Rate for Payer: Cash Price |
$893.40
|
| Rate for Payer: Cigna Commercial |
$1,265.65
|
| Rate for Payer: First Health Commercial |
$1,340.10
|
| Rate for Payer: First Health Workers Compensation |
$574.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,340.10
|
| Rate for Payer: GEHA Commercial |
$1,042.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,340.10
|
| Rate for Payer: Multiplan All |
$1,354.99
|
| Rate for Payer: OMNI Networks Commercial |
$1,042.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,340.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,414.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,116.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,384.77
|
| Rate for Payer: Zelis Auto |
$595.60
|
| Rate for Payer: Zelis Worker's Compensation |
$406.50
|
|
|
REPAIR/GRAFT FINGER TENDON
|
Facility
|
OP
|
$1,277.00
|
|
|
Service Code
|
CPT 26434
|
| Hospital Charge Code |
6126434
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$348.62 |
| Max. Negotiated Rate |
$6,287.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$766.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: Cash Price |
$766.20
|
| Rate for Payer: Cash Price |
$766.20
|
| Rate for Payer: Cigna Commercial |
$1,085.45
|
| Rate for Payer: First Health Commercial |
$1,149.30
|
| Rate for Payer: First Health Workers Compensation |
$493.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,149.30
|
| Rate for Payer: GEHA Commercial |
$1,021.60
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,149.30
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$1,162.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$893.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,149.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,213.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$957.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,187.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$510.80
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$348.62
|
|
|
REPAIR/GRAFT FINGER TENDON
|
Facility
|
OP
|
$1,394.00
|
|
|
Service Code
|
CPT 26420
|
| Hospital Charge Code |
6126420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$380.56 |
| Max. Negotiated Rate |
$6,287.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$836.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: Cash Price |
$836.40
|
| Rate for Payer: Cash Price |
$836.40
|
| Rate for Payer: Cigna Commercial |
$1,184.90
|
| Rate for Payer: First Health Commercial |
$1,254.60
|
| Rate for Payer: First Health Workers Compensation |
$538.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,254.60
|
| Rate for Payer: GEHA Commercial |
$1,115.20
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,254.60
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$1,268.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$975.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,254.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,324.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,045.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,296.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$557.60
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$380.56
|
|
|
REPAIR/GRAFT FINGER TENDON
|
Facility
|
IP
|
$1,394.00
|
|
|
Service Code
|
CPT 26420
|
| Hospital Charge Code |
6126420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$380.56 |
| Max. Negotiated Rate |
$1,324.30 |
| Rate for Payer: Cash Price |
$836.40
|
| Rate for Payer: Cigna Commercial |
$1,184.90
|
| Rate for Payer: First Health Commercial |
$1,254.60
|
| Rate for Payer: First Health Workers Compensation |
$538.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,254.60
|
| Rate for Payer: GEHA Commercial |
$975.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,254.60
|
| Rate for Payer: Multiplan All |
$1,268.54
|
| Rate for Payer: OMNI Networks Commercial |
$975.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,254.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,324.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,045.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,296.42
|
| Rate for Payer: Zelis Auto |
$557.60
|
| Rate for Payer: Zelis Worker's Compensation |
$380.56
|
|
|
REPAIR/GRAFT HAND TENDON
|
Facility
|
IP
|
$1,942.00
|
|
|
Service Code
|
CPT 26358
|
| Hospital Charge Code |
6126358
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$530.17 |
| Max. Negotiated Rate |
$1,844.90 |
| Rate for Payer: Cash Price |
$1,165.20
|
| Rate for Payer: Cigna Commercial |
$1,650.70
|
| Rate for Payer: First Health Commercial |
$1,747.80
|
| Rate for Payer: First Health Workers Compensation |
$749.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,747.80
|
| Rate for Payer: GEHA Commercial |
$1,359.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,747.80
|
| Rate for Payer: Multiplan All |
$1,767.22
|
| Rate for Payer: OMNI Networks Commercial |
$1,359.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,747.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,844.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,456.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,806.06
|
| Rate for Payer: Zelis Auto |
$776.80
|
| Rate for Payer: Zelis Worker's Compensation |
$530.17
|
|
|
REPAIR/GRAFT HAND TENDON
|
Facility
|
IP
|
$1,341.00
|
|
|
Service Code
|
CPT 26412
|
| Hospital Charge Code |
6126412
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$366.09 |
| Max. Negotiated Rate |
$1,273.95 |
| Rate for Payer: Cash Price |
$804.60
|
| Rate for Payer: Cigna Commercial |
$1,139.85
|
| Rate for Payer: First Health Commercial |
$1,206.90
|
| Rate for Payer: First Health Workers Compensation |
$517.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,206.90
|
| Rate for Payer: GEHA Commercial |
$938.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,206.90
|
| Rate for Payer: Multiplan All |
$1,220.31
|
| Rate for Payer: OMNI Networks Commercial |
$938.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,206.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,273.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,005.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,247.13
|
| Rate for Payer: Zelis Auto |
$536.40
|
| Rate for Payer: Zelis Worker's Compensation |
$366.09
|
|
|
REPAIR/GRAFT HAND TENDON
|
Facility
|
IP
|
$1,742.00
|
|
|
Service Code
|
CPT 26372
|
| Hospital Charge Code |
6126372
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$475.57 |
| Max. Negotiated Rate |
$1,654.90 |
| Rate for Payer: Cash Price |
$1,045.20
|
| Rate for Payer: Cigna Commercial |
$1,480.70
|
| Rate for Payer: First Health Commercial |
$1,567.80
|
| Rate for Payer: First Health Workers Compensation |
$672.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,567.80
|
| Rate for Payer: GEHA Commercial |
$1,219.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,567.80
|
| Rate for Payer: Multiplan All |
$1,585.22
|
| Rate for Payer: OMNI Networks Commercial |
$1,219.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,567.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,654.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,306.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,620.06
|
| Rate for Payer: Zelis Auto |
$696.80
|
| Rate for Payer: Zelis Worker's Compensation |
$475.57
|
|
|
REPAIR/GRAFT HAND TENDON
|
Facility
|
IP
|
$1,925.00
|
|
|
Service Code
|
CPT 26392
|
| Hospital Charge Code |
6126392
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$525.52 |
| Max. Negotiated Rate |
$1,828.75 |
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: Cigna Commercial |
$1,636.25
|
| Rate for Payer: First Health Commercial |
$1,732.50
|
| Rate for Payer: First Health Workers Compensation |
$743.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,732.50
|
| Rate for Payer: GEHA Commercial |
$1,347.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,732.50
|
| Rate for Payer: Multiplan All |
$1,751.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,347.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,732.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,828.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,443.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,790.25
|
| Rate for Payer: Zelis Auto |
$770.00
|
| Rate for Payer: Zelis Worker's Compensation |
$525.52
|
|
|
REPAIR/GRAFT HAND TENDON
|
Facility
|
OP
|
$1,619.00
|
|
|
Service Code
|
CPT 26352
|
| Hospital Charge Code |
6126352
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$441.99 |
| Max. Negotiated Rate |
$13,844.26 |
| 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 |
$971.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,922.13
|
| Rate for Payer: Cash Price |
$971.40
|
| Rate for Payer: Cash Price |
$971.40
|
| Rate for Payer: Cigna Commercial |
$1,376.15
|
| Rate for Payer: First Health Commercial |
$1,457.10
|
| Rate for Payer: First Health Workers Compensation |
$625.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,457.10
|
| Rate for Payer: GEHA Commercial |
$1,295.20
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,457.10
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,473.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,133.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,457.10
|
| 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 |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,538.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,214.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,505.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$647.60
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$441.99
|
|
|
REPAIR/GRAFT HAND TENDON
|
Facility
|
OP
|
$1,341.00
|
|
|
Service Code
|
CPT 26412
|
| Hospital Charge Code |
6126412
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$366.09 |
| Max. Negotiated Rate |
$6,287.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$804.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: Cash Price |
$804.60
|
| Rate for Payer: Cash Price |
$804.60
|
| Rate for Payer: Cigna Commercial |
$1,139.85
|
| Rate for Payer: First Health Commercial |
$1,206.90
|
| Rate for Payer: First Health Workers Compensation |
$517.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,206.90
|
| Rate for Payer: GEHA Commercial |
$1,072.80
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,206.90
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$1,220.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$938.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,206.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,273.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,005.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,247.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$536.40
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$366.09
|
|
|
REPAIR/GRAFT HAND TENDON
|
Facility
|
IP
|
$1,619.00
|
|
|
Service Code
|
CPT 26352
|
| Hospital Charge Code |
6126352
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$441.99 |
| Max. Negotiated Rate |
$1,538.05 |
| Rate for Payer: Cash Price |
$971.40
|
| Rate for Payer: Cigna Commercial |
$1,376.15
|
| Rate for Payer: First Health Commercial |
$1,457.10
|
| Rate for Payer: First Health Workers Compensation |
$625.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,457.10
|
| Rate for Payer: GEHA Commercial |
$1,133.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,457.10
|
| Rate for Payer: Multiplan All |
$1,473.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,133.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,457.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,538.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,214.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,505.67
|
| Rate for Payer: Zelis Auto |
$647.60
|
| Rate for Payer: Zelis Worker's Compensation |
$441.99
|
|
|
REPAIR/GRAFT HAND TENDON
|
Facility
|
OP
|
$1,942.00
|
|
|
Service Code
|
CPT 26358
|
| Hospital Charge Code |
6126358
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$530.17 |
| Max. Negotiated Rate |
$13,844.26 |
| 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 |
$1,165.20
|
| 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 |
$6,922.13
|
| Rate for Payer: Cash Price |
$1,165.20
|
| Rate for Payer: Cash Price |
$1,165.20
|
| Rate for Payer: Cigna Commercial |
$1,650.70
|
| Rate for Payer: First Health Commercial |
$1,747.80
|
| Rate for Payer: First Health Workers Compensation |
$749.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,747.80
|
| Rate for Payer: GEHA Commercial |
$1,553.60
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,747.80
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,767.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,359.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,747.80
|
| 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 |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,844.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,456.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,806.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$776.80
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$530.17
|
|
|
REPAIR/GRAFT HAND TENDON
|
Facility
|
OP
|
$1,742.00
|
|
|
Service Code
|
CPT 26372
|
| Hospital Charge Code |
6126372
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$475.57 |
| Max. Negotiated Rate |
$13,844.26 |
| 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 |
$1,045.20
|
| 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 |
$6,922.13
|
| Rate for Payer: Cash Price |
$1,045.20
|
| Rate for Payer: Cash Price |
$1,045.20
|
| Rate for Payer: Cigna Commercial |
$1,480.70
|
| Rate for Payer: First Health Commercial |
$1,567.80
|
| Rate for Payer: First Health Workers Compensation |
$672.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,567.80
|
| Rate for Payer: GEHA Commercial |
$1,393.60
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,567.80
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,585.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,219.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,567.80
|
| 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 |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,654.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,306.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,620.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$696.80
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$475.57
|
|
|
REPAIR/GRAFT HAND TENDON
|
Facility
|
OP
|
$1,925.00
|
|
|
Service Code
|
CPT 26392
|
| Hospital Charge Code |
6126392
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$525.52 |
| Max. Negotiated Rate |
$13,844.26 |
| 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 |
$1,155.00
|
| 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 |
$6,922.13
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: Cigna Commercial |
$1,636.25
|
| Rate for Payer: First Health Commercial |
$1,732.50
|
| Rate for Payer: First Health Workers Compensation |
$743.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,732.50
|
| Rate for Payer: GEHA Commercial |
$1,540.00
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,732.50
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,751.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,347.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,732.50
|
| 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 |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,828.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,443.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,790.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$770.00
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$525.52
|
|
|
REPAIR/GRAFT KNEECAP TENDON
|
Facility
|
IP
|
$1,629.00
|
|
|
Service Code
|
CPT 27381
|
| Hospital Charge Code |
6127381
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$444.72 |
| Max. Negotiated Rate |
$1,547.55 |
| Rate for Payer: Cash Price |
$977.40
|
| Rate for Payer: Cigna Commercial |
$1,384.65
|
| Rate for Payer: First Health Commercial |
$1,466.10
|
| Rate for Payer: First Health Workers Compensation |
$628.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,466.10
|
| Rate for Payer: GEHA Commercial |
$1,140.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,466.10
|
| Rate for Payer: Multiplan All |
$1,482.39
|
| Rate for Payer: OMNI Networks Commercial |
$1,140.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,466.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,547.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,221.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,514.97
|
| Rate for Payer: Zelis Auto |
$651.60
|
| Rate for Payer: Zelis Worker's Compensation |
$444.72
|
|
|
REPAIR/GRAFT KNEECAP TENDON
|
Facility
|
OP
|
$1,629.00
|
|
|
Service Code
|
CPT 27381
|
| Hospital Charge Code |
6127381
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$444.72 |
| Max. Negotiated Rate |
$13,844.26 |
| 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 Community HMO |
$977.40
|
| 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 |
$6,922.13
|
| Rate for Payer: Cash Price |
$977.40
|
| Rate for Payer: Cash Price |
$977.40
|
| Rate for Payer: Cigna Commercial |
$1,384.65
|
| Rate for Payer: First Health Commercial |
$1,466.10
|
| Rate for Payer: First Health Workers Compensation |
$628.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,466.10
|
| Rate for Payer: GEHA Commercial |
$1,303.20
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,466.10
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,482.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,140.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,466.10
|
| 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 |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,547.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,221.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,514.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$651.60
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$444.72
|
|
|
REPAIR/GRAFT OF FOOT TENDON
|
Facility
|
IP
|
$834.00
|
|
|
Service Code
|
CPT 28210
|
| Hospital Charge Code |
6128210
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$227.68 |
| Max. Negotiated Rate |
$792.30 |
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cigna Commercial |
$708.90
|
| Rate for Payer: First Health Commercial |
$750.60
|
| Rate for Payer: First Health Workers Compensation |
$322.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$750.60
|
| Rate for Payer: GEHA Commercial |
$583.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$750.60
|
| Rate for Payer: Multiplan All |
$758.94
|
| Rate for Payer: OMNI Networks Commercial |
$583.80
|
| Rate for Payer: One Health Plan PPO/POS |
$750.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$792.30
|
| Rate for Payer: Three Rivers Provider Network All |
$625.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$775.62
|
| Rate for Payer: Zelis Auto |
$333.60
|
| Rate for Payer: Zelis Worker's Compensation |
$227.68
|
|
