|
REPAIR/GRAFT OF FOOT TENDON
|
Facility
|
OP
|
$834.00
|
|
|
Service Code
|
CPT 28210
|
| Hospital Charge Code |
6128210
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$227.68 |
| 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 |
$500.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,207.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$500.40
|
| 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 |
$667.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$750.60
|
| 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 |
$4,292.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$758.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$583.80
|
| Rate for Payer: One Health Plan PPO/POS |
$750.60
|
| 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 |
$792.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$625.50
|
| 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 |
$775.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$333.60
|
| 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 |
$227.68
|
|
|
REPAIR/GRAFT OF FOOT TENDON
|
Facility
|
IP
|
$873.00
|
|
|
Service Code
|
CPT 28202
|
| Hospital Charge Code |
6128202
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$238.33 |
| Max. Negotiated Rate |
$829.35 |
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cigna Commercial |
$742.05
|
| Rate for Payer: First Health Commercial |
$785.70
|
| Rate for Payer: First Health Workers Compensation |
$337.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$785.70
|
| Rate for Payer: GEHA Commercial |
$611.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$785.70
|
| Rate for Payer: Multiplan All |
$794.43
|
| Rate for Payer: OMNI Networks Commercial |
$611.10
|
| Rate for Payer: One Health Plan PPO/POS |
$785.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$829.35
|
| Rate for Payer: Three Rivers Provider Network All |
$654.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$811.89
|
| Rate for Payer: Zelis Auto |
$349.20
|
| Rate for Payer: Zelis Worker's Compensation |
$238.33
|
|
|
REPAIR/GRAFT OF FOOT TENDON
|
Facility
|
OP
|
$873.00
|
|
|
Service Code
|
CPT 28202
|
| Hospital Charge Code |
6128202
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$238.33 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$523.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cigna Commercial |
$742.05
|
| Rate for Payer: First Health Commercial |
$785.70
|
| Rate for Payer: First Health Workers Compensation |
$337.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$785.70
|
| Rate for Payer: GEHA Commercial |
$698.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$785.70
|
| 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 |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$794.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$611.10
|
| Rate for Payer: One Health Plan PPO/POS |
$785.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$829.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$654.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$811.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$349.20
|
| 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 |
$238.33
|
|
|
REPAIR/GRAFT OF THIGH
|
Facility
|
OP
|
$2,607.00
|
|
|
Service Code
|
CPT 27472
|
| Hospital Charge Code |
6127472
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$651.75 |
| Max. Negotiated Rate |
$2,476.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,564.20
|
| Rate for Payer: Cash Price |
$1,564.20
|
| Rate for Payer: Cigna Commercial |
$2,215.95
|
| Rate for Payer: First Health Commercial |
$2,346.30
|
| Rate for Payer: First Health Workers Compensation |
$1,006.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,346.30
|
| Rate for Payer: GEHA Commercial |
$2,085.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,346.30
|
| Rate for Payer: Humana ChoiceCare |
$677.82
|
| Rate for Payer: Multiplan All |
$2,372.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,564.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,824.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,346.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,476.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,955.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,294.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$651.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,424.51
|
| Rate for Payer: Zelis Auto |
$1,042.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,303.50
|
| Rate for Payer: Zelis Worker's Compensation |
$711.71
|
|
|
REPAIR/GRAFT OF THIGH
|
Facility
|
IP
|
$2,607.00
|
|
|
Service Code
|
CPT 27472
|
| Hospital Charge Code |
6127472
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$711.71 |
| Max. Negotiated Rate |
$2,476.65 |
| Rate for Payer: Cash Price |
$1,564.20
|
| Rate for Payer: Cigna Commercial |
$2,215.95
|
| Rate for Payer: First Health Commercial |
$2,346.30
|
| Rate for Payer: First Health Workers Compensation |
$1,006.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,346.30
|
| Rate for Payer: GEHA Commercial |
$1,824.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,346.30
|
| Rate for Payer: Multiplan All |
$2,372.37
|
| Rate for Payer: OMNI Networks Commercial |
$1,824.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,346.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,476.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,955.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,424.51
|
| Rate for Payer: Zelis Auto |
$1,042.80
|
| Rate for Payer: Zelis Worker's Compensation |
$711.71
|
|
|
REPAIR/GRAFT OF THIGH MUSCLE
|
Facility
|
OP
|
$1,695.00
|
|
|
Service Code
|
CPT 27386
|
| Hospital Charge Code |
6127386
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$462.74 |
| 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 Community HMO |
$1,017.00
|
| 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: Cash Price |
$1,017.00
|
| Rate for Payer: Cash Price |
$1,017.00
|
| Rate for Payer: Cigna Commercial |
$1,440.75
|
| Rate for Payer: First Health Commercial |
$1,525.50
|
| Rate for Payer: First Health Workers Compensation |
$654.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,525.50
|
| Rate for Payer: GEHA Commercial |
$1,356.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,525.50
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,542.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,186.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,525.50
|
| 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 Commercial |
$1,610.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,271.25
|
| 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: United Payors & United Providers UP&UP |
$1,576.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$678.00
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$462.74
|
|
|
REPAIR/GRAFT OF THIGH MUSCLE
|
Facility
|
IP
|
$1,695.00
|
|
|
Service Code
|
CPT 27386
|
| Hospital Charge Code |
6127386
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$462.74 |
| Max. Negotiated Rate |
$1,610.25 |
| Rate for Payer: Cash Price |
$1,017.00
|
| Rate for Payer: Cigna Commercial |
$1,440.75
|
| Rate for Payer: First Health Commercial |
$1,525.50
|
| Rate for Payer: First Health Workers Compensation |
$654.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,525.50
|
| Rate for Payer: GEHA Commercial |
$1,186.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,525.50
|
| Rate for Payer: Multiplan All |
$1,542.45
|
| Rate for Payer: OMNI Networks Commercial |
$1,186.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,525.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,610.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,271.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,576.35
|
| Rate for Payer: Zelis Auto |
$678.00
|
| Rate for Payer: Zelis Worker's Compensation |
$462.74
|
|
|
REPAIR/GRAFT OF TIBIA
|
Facility
|
OP
|
$2,618.00
|
|
|
Service Code
|
CPT 27724
|
| Hospital Charge Code |
6127724
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$654.50 |
| Max. Negotiated Rate |
$2,487.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,570.80
|
| Rate for Payer: Cash Price |
$1,570.80
|
| Rate for Payer: Cigna Commercial |
$2,225.30
|
| Rate for Payer: First Health Commercial |
$2,356.20
|
| Rate for Payer: First Health Workers Compensation |
$1,010.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,356.20
|
| Rate for Payer: GEHA Commercial |
$2,094.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,356.20
|
| Rate for Payer: Humana ChoiceCare |
$680.68
|
| Rate for Payer: Multiplan All |
$2,382.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,570.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,832.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,356.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,487.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,963.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,303.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$654.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,434.74
|
| Rate for Payer: Zelis Auto |
$1,047.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,309.00
|
| Rate for Payer: Zelis Worker's Compensation |
$714.71
|
|
|
REPAIR/GRAFT OF TIBIA
|
Facility
|
IP
|
$2,618.00
|
|
|
Service Code
|
CPT 27724
|
| Hospital Charge Code |
6127724
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$714.71 |
| Max. Negotiated Rate |
$2,487.10 |
| Rate for Payer: Cash Price |
$1,570.80
|
| Rate for Payer: Cigna Commercial |
$2,225.30
|
| Rate for Payer: First Health Commercial |
$2,356.20
|
| Rate for Payer: First Health Workers Compensation |
$1,010.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,356.20
|
| Rate for Payer: GEHA Commercial |
$1,832.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,356.20
|
| Rate for Payer: Multiplan All |
$2,382.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,832.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,356.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,487.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,963.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,434.74
|
| Rate for Payer: Zelis Auto |
$1,047.20
|
| Rate for Payer: Zelis Worker's Compensation |
$714.71
|
|
|
REPAIR/GRAFT OF TIBIA
|
Facility
|
IP
|
$1,807.00
|
|
|
Service Code
|
CPT 27722
|
| Hospital Charge Code |
6127722
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$493.31 |
| Max. Negotiated Rate |
$1,716.65 |
| Rate for Payer: Cash Price |
$1,084.20
|
| Rate for Payer: Cigna Commercial |
$1,535.95
|
| Rate for Payer: First Health Commercial |
$1,626.30
|
| Rate for Payer: First Health Workers Compensation |
$697.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,626.30
|
| Rate for Payer: GEHA Commercial |
$1,264.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,626.30
|
| Rate for Payer: Multiplan All |
$1,644.37
|
| Rate for Payer: OMNI Networks Commercial |
$1,264.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,626.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,716.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,355.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,680.51
|
| Rate for Payer: Zelis Auto |
$722.80
|
| Rate for Payer: Zelis Worker's Compensation |
$493.31
|
|
|
REPAIR/GRAFT OF TIBIA
|
Facility
|
OP
|
$1,807.00
|
|
|
Service Code
|
CPT 27722
|
| Hospital Charge Code |
6127722
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$493.31 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,084.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,244.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,084.20
|
| Rate for Payer: Cash Price |
$1,084.20
|
| Rate for Payer: Cigna Commercial |
$1,535.95
|
| Rate for Payer: First Health Commercial |
$1,626.30
|
| Rate for Payer: First Health Workers Compensation |
$697.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,626.30
|
| Rate for Payer: GEHA Commercial |
$1,445.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,626.30
|
| 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 |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,644.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,264.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,626.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,178.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,351.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,716.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,355.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,680.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$722.80
|
| 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 |
$493.31
|
|
|
REPAIR/GRAFT RADIUS OR ULNA
|
Facility
|
OP
|
$1,981.00
|
|
|
Service Code
|
CPT 25425
|
| Hospital Charge Code |
6125425
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$540.81 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,188.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,188.60
|
| Rate for Payer: Cash Price |
$1,188.60
|
| Rate for Payer: Cigna Commercial |
$1,683.85
|
| Rate for Payer: First Health Commercial |
$1,782.90
|
| Rate for Payer: First Health Workers Compensation |
$764.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,782.90
|
| Rate for Payer: GEHA Commercial |
$1,584.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,782.90
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,802.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,386.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,782.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,881.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,485.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,842.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$792.40
|
| 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 |
$540.81
|
|
|
REPAIR/GRAFT RADIUS OR ULNA
|
Facility
|
IP
|
$1,981.00
|
|
|
Service Code
|
CPT 25425
|
| Hospital Charge Code |
6125425
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$540.81 |
| Max. Negotiated Rate |
$1,881.95 |
| Rate for Payer: Cash Price |
$1,188.60
|
| Rate for Payer: Cigna Commercial |
$1,683.85
|
| Rate for Payer: First Health Commercial |
$1,782.90
|
| Rate for Payer: First Health Workers Compensation |
$764.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,782.90
|
| Rate for Payer: GEHA Commercial |
$1,386.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,782.90
|
| Rate for Payer: Multiplan All |
$1,802.71
|
| Rate for Payer: OMNI Networks Commercial |
$1,386.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,782.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,881.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,485.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,842.33
|
| Rate for Payer: Zelis Auto |
$792.40
|
| Rate for Payer: Zelis Worker's Compensation |
$540.81
|
|
|
REPAIR/GRAFT RADIUS OR ULNA
|
Facility
|
OP
|
$2,127.00
|
|
|
Service Code
|
CPT 25405
|
| Hospital Charge Code |
6125405
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$580.67 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,276.20
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,276.20
|
| Rate for Payer: Cash Price |
$1,276.20
|
| Rate for Payer: Cigna Commercial |
$1,807.95
|
| Rate for Payer: First Health Commercial |
$1,914.30
|
| Rate for Payer: First Health Workers Compensation |
$821.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,914.30
|
| Rate for Payer: GEHA Commercial |
$1,701.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,914.30
|
| 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 |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,935.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,488.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,914.30
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,020.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,595.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,978.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$850.80
|
| 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 |
$580.67
|
|
|
REPAIR/GRAFT RADIUS OR ULNA
|
Facility
|
IP
|
$2,127.00
|
|
|
Service Code
|
CPT 25405
|
| Hospital Charge Code |
6125405
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$580.67 |
| Max. Negotiated Rate |
$2,020.65 |
| Rate for Payer: Cash Price |
$1,276.20
|
| Rate for Payer: Cigna Commercial |
$1,807.95
|
| Rate for Payer: First Health Commercial |
$1,914.30
|
| Rate for Payer: First Health Workers Compensation |
$821.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,914.30
|
| Rate for Payer: GEHA Commercial |
$1,488.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,914.30
|
| Rate for Payer: Multiplan All |
$1,935.57
|
| Rate for Payer: OMNI Networks Commercial |
$1,488.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,914.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,020.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,595.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,978.11
|
| Rate for Payer: Zelis Auto |
$850.80
|
| Rate for Payer: Zelis Worker's Compensation |
$580.67
|
|
|
REPAIR/GRAFT RADIUS & ULNA
|
Facility
|
OP
|
$2,318.00
|
|
|
Service Code
|
CPT 25426
|
| Hospital Charge Code |
6125426
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$632.81 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,390.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,390.80
|
| Rate for Payer: Cash Price |
$1,390.80
|
| Rate for Payer: Cigna Commercial |
$1,970.30
|
| Rate for Payer: First Health Commercial |
$2,086.20
|
| Rate for Payer: First Health Workers Compensation |
$894.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,086.20
|
| Rate for Payer: GEHA Commercial |
$1,854.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,086.20
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$2,109.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,622.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,086.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,202.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,738.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,155.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$927.20
|
| 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 |
$632.81
|
|
|
REPAIR/GRAFT RADIUS & ULNA
|
Facility
|
IP
|
$2,318.00
|
|
|
Service Code
|
CPT 25426
|
| Hospital Charge Code |
6125426
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$632.81 |
| Max. Negotiated Rate |
$2,202.10 |
| Rate for Payer: Cash Price |
$1,390.80
|
| Rate for Payer: Cigna Commercial |
$1,970.30
|
| Rate for Payer: First Health Commercial |
$2,086.20
|
| Rate for Payer: First Health Workers Compensation |
$894.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,086.20
|
| Rate for Payer: GEHA Commercial |
$1,622.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,086.20
|
| Rate for Payer: Multiplan All |
$2,109.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,622.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,086.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,202.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,738.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,155.74
|
| Rate for Payer: Zelis Auto |
$927.20
|
| Rate for Payer: Zelis Worker's Compensation |
$632.81
|
|
|
REPAIR/GRAFT RADIUS & ULNA
|
Facility
|
IP
|
$2,403.00
|
|
|
Service Code
|
CPT 25420
|
| Hospital Charge Code |
6125420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$656.02 |
| Max. Negotiated Rate |
$2,282.85 |
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cigna Commercial |
$2,042.55
|
| Rate for Payer: First Health Commercial |
$2,162.70
|
| Rate for Payer: First Health Workers Compensation |
$927.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,162.70
|
| Rate for Payer: GEHA Commercial |
$1,682.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,162.70
|
| Rate for Payer: Multiplan All |
$2,186.73
|
| Rate for Payer: OMNI Networks Commercial |
$1,682.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,162.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,282.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,802.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,234.79
|
| Rate for Payer: Zelis Auto |
$961.20
|
| Rate for Payer: Zelis Worker's Compensation |
$656.02
|
|
|
REPAIR/GRAFT RADIUS & ULNA
|
Facility
|
OP
|
$2,403.00
|
|
|
Service Code
|
CPT 25420
|
| Hospital Charge Code |
6125420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$656.02 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,441.80
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cigna Commercial |
$2,042.55
|
| Rate for Payer: First Health Commercial |
$2,162.70
|
| Rate for Payer: First Health Workers Compensation |
$927.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,162.70
|
| Rate for Payer: GEHA Commercial |
$1,922.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,162.70
|
| 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 |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$2,186.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,682.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,162.70
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,282.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,802.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,234.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$961.20
|
| 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 |
$656.02
|
|
|
REPAIR/GRAFT WRIST BONE
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
CPT 25440
|
| Hospital Charge Code |
6125440
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$427.25 |
| Max. Negotiated Rate |
$1,486.75 |
| Rate for Payer: Cash Price |
$939.00
|
| Rate for Payer: Cigna Commercial |
$1,330.25
|
| Rate for Payer: First Health Commercial |
$1,408.50
|
| Rate for Payer: First Health Workers Compensation |
$604.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,408.50
|
| Rate for Payer: GEHA Commercial |
$1,095.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,408.50
|
| Rate for Payer: Multiplan All |
$1,424.15
|
| Rate for Payer: OMNI Networks Commercial |
$1,095.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,408.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,486.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,173.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,455.45
|
| Rate for Payer: Zelis Auto |
$626.00
|
| Rate for Payer: Zelis Worker's Compensation |
$427.25
|
|
|
REPAIR/GRAFT WRIST BONE
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
CPT 25440
|
| Hospital Charge Code |
6125440
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$427.25 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$939.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7,100.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$939.00
|
| Rate for Payer: Cash Price |
$939.00
|
| Rate for Payer: Cigna Commercial |
$1,330.25
|
| Rate for Payer: First Health Commercial |
$1,408.50
|
| Rate for Payer: First Health Workers Compensation |
$604.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,408.50
|
| Rate for Payer: GEHA Commercial |
$1,252.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,408.50
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,424.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,095.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,408.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8,365.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7,245.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,486.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,173.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,455.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$626.00
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$427.25
|
|
|
REPAIR HALLUX RIGIDUS
|
Facility
|
IP
|
$1,959.66
|
|
|
Service Code
|
CPT 28289
|
| Hospital Charge Code |
6128289
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$534.99 |
| Max. Negotiated Rate |
$1,861.68 |
| Rate for Payer: Cash Price |
$1,175.80
|
| Rate for Payer: Cigna Commercial |
$1,665.71
|
| Rate for Payer: First Health Commercial |
$1,763.69
|
| Rate for Payer: First Health Workers Compensation |
$756.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,763.69
|
| Rate for Payer: GEHA Commercial |
$1,371.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,763.69
|
| Rate for Payer: Multiplan All |
$1,783.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,371.76
|
| Rate for Payer: One Health Plan PPO/POS |
$1,763.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,861.68
|
| Rate for Payer: Three Rivers Provider Network All |
$1,469.74
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,822.48
|
| Rate for Payer: Zelis Auto |
$783.86
|
| Rate for Payer: Zelis Worker's Compensation |
$534.99
|
|
|
REPAIR HALLUX RIGIDUS
|
Facility
|
OP
|
$1,959.66
|
|
|
Service Code
|
CPT 28289
|
| Hospital Charge Code |
6128289
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$534.99 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,175.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,175.80
|
| Rate for Payer: Cash Price |
$1,175.80
|
| Rate for Payer: Cigna Commercial |
$1,665.71
|
| Rate for Payer: First Health Commercial |
$1,763.69
|
| Rate for Payer: First Health Workers Compensation |
$756.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,763.69
|
| Rate for Payer: GEHA Commercial |
$1,567.73
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,763.69
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,783.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,371.76
|
| Rate for Payer: One Health Plan PPO/POS |
$1,763.69
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,861.68
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,469.74
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,822.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$783.86
|
| 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 |
$534.99
|
|
|
REPAIR HAND DEFORMITY
|
Facility
|
IP
|
$2,957.00
|
|
|
Service Code
|
CPT 26580
|
| Hospital Charge Code |
6126580
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$807.26 |
| Max. Negotiated Rate |
$2,809.15 |
| Rate for Payer: Cash Price |
$1,774.20
|
| Rate for Payer: Cigna Commercial |
$2,513.45
|
| Rate for Payer: First Health Commercial |
$2,661.30
|
| Rate for Payer: First Health Workers Compensation |
$1,141.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,661.30
|
| Rate for Payer: GEHA Commercial |
$2,069.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,661.30
|
| Rate for Payer: Multiplan All |
$2,690.87
|
| Rate for Payer: OMNI Networks Commercial |
$2,069.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,661.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,809.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,217.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,750.01
|
| Rate for Payer: Zelis Auto |
$1,182.80
|
| Rate for Payer: Zelis Worker's Compensation |
$807.26
|
|
|
REPAIR HAND DEFORMITY
|
Facility
|
OP
|
$2,957.00
|
|
|
Service Code
|
CPT 26580
|
| Hospital Charge Code |
6126580
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$807.26 |
| 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 |
$1,774.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,774.20
|
| Rate for Payer: Cash Price |
$1,774.20
|
| Rate for Payer: Cigna Commercial |
$2,513.45
|
| Rate for Payer: First Health Commercial |
$2,661.30
|
| Rate for Payer: First Health Workers Compensation |
$1,141.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,661.30
|
| Rate for Payer: GEHA Commercial |
$2,365.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,661.30
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$2,690.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$2,069.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,661.30
|
| 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 |
$2,809.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$2,217.75
|
| 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 |
$2,750.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$1,182.80
|
| 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 |
$807.26
|
|
