|
REPAIR INTERMED N/H/F/XTRNL GEN7.6-12.5C
|
Facility
|
IP
|
$1,134.00
|
|
| Hospital Charge Code |
8150016
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$309.58 |
| Max. Negotiated Rate |
$1,077.30 |
| Rate for Payer: Cash Price |
$680.40
|
| Rate for Payer: Cigna Commercial |
$963.90
|
| Rate for Payer: First Health Commercial |
$1,020.60
|
| Rate for Payer: First Health Workers Compensation |
$437.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,020.60
|
| Rate for Payer: GEHA Commercial |
$793.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,020.60
|
| Rate for Payer: Multiplan All |
$1,031.94
|
| Rate for Payer: OMNI Networks Commercial |
$793.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,020.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,077.30
|
| Rate for Payer: Three Rivers Provider Network All |
$850.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,054.62
|
| Rate for Payer: Zelis Auto |
$453.60
|
| Rate for Payer: Zelis Worker's Compensation |
$309.58
|
|
|
REPAIR INTERMED N/H/F/XTRNL GEN7.6-12.5C
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
6112044
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$108.47 |
| Max. Negotiated Rate |
$1,162.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$330.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$467.50
|
| Rate for Payer: First Health Commercial |
$495.00
|
| Rate for Payer: First Health Workers Compensation |
$212.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$495.00
|
| Rate for Payer: GEHA Commercial |
$440.00
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$495.00
|
| Rate for Payer: Humana ChoiceCare |
$639.36
|
| Rate for Payer: Humana Medicare Advantage |
$581.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$976.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$110.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$500.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$385.00
|
| Rate for Payer: One Health Plan PPO/POS |
$495.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$127.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$110.68
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$522.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$412.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$511.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$220.00
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$150.15
|
|
|
REPAIR INTERMED N/H/F/XTRNL GEN7.6-12.5C
|
Facility
|
OP
|
$1,134.00
|
|
| Hospital Charge Code |
8150016
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$1,077.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$680.40
|
| Rate for Payer: Cash Price |
$680.40
|
| Rate for Payer: Cigna Commercial |
$963.90
|
| Rate for Payer: First Health Commercial |
$1,020.60
|
| Rate for Payer: First Health Workers Compensation |
$437.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,020.60
|
| Rate for Payer: GEHA Commercial |
$907.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,020.60
|
| Rate for Payer: Humana ChoiceCare |
$294.84
|
| Rate for Payer: Multiplan All |
$1,031.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$680.40
|
| Rate for Payer: OMNI Networks Commercial |
$793.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,020.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,077.30
|
| Rate for Payer: Three Rivers Provider Network All |
$850.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$997.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$283.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,054.62
|
| Rate for Payer: Zelis Auto |
$453.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$567.00
|
| Rate for Payer: Zelis Worker's Compensation |
$309.58
|
|
|
REPAIR INTERMED N/H/F/XTRNL GEN7.6-12.5C
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
6112044
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$150.15 |
| Max. Negotiated Rate |
$522.50 |
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$467.50
|
| Rate for Payer: First Health Commercial |
$495.00
|
| Rate for Payer: First Health Workers Compensation |
$212.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$495.00
|
| Rate for Payer: GEHA Commercial |
$385.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$495.00
|
| Rate for Payer: Multiplan All |
$500.50
|
| Rate for Payer: OMNI Networks Commercial |
$385.00
|
| Rate for Payer: One Health Plan PPO/POS |
$495.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$522.50
|
| Rate for Payer: Three Rivers Provider Network All |
$412.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$511.50
|
| Rate for Payer: Zelis Auto |
$220.00
|
| Rate for Payer: Zelis Worker's Compensation |
$150.15
|
|
|
REPAIR INTERMED N/H/F/XTRNL GEN7.6-12.5C
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
21600184
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$108.47 |
| Max. Negotiated Rate |
$1,162.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$330.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$467.50
|
| Rate for Payer: First Health Commercial |
$495.00
|
| Rate for Payer: First Health Workers Compensation |
$212.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$495.00
|
| Rate for Payer: GEHA Commercial |
$440.00
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$495.00
|
| Rate for Payer: Humana ChoiceCare |
$639.36
|
| Rate for Payer: Humana Medicare Advantage |
$581.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$976.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$110.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$500.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$385.00
|
| Rate for Payer: One Health Plan PPO/POS |
$495.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$127.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$110.68
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$522.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$412.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$511.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$220.00
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$150.15
|
|
|
REPAIR LEG FASCIA DEFECT
|
Facility
|
IP
|
$1,007.00
|
|
|
Service Code
|
CPT 27656
|
| Hospital Charge Code |
6127656
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$274.91 |
| Max. Negotiated Rate |
$956.65 |
| Rate for Payer: Cash Price |
$604.20
|
| Rate for Payer: Cigna Commercial |
$855.95
|
| Rate for Payer: First Health Commercial |
$906.30
|
| Rate for Payer: First Health Workers Compensation |
$388.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$906.30
|
| Rate for Payer: GEHA Commercial |
$704.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$906.30
|
| Rate for Payer: Multiplan All |
$916.37
|
| Rate for Payer: OMNI Networks Commercial |
$704.90
|
| Rate for Payer: One Health Plan PPO/POS |
$906.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$956.65
|
| Rate for Payer: Three Rivers Provider Network All |
$755.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$936.51
|
| Rate for Payer: Zelis Auto |
$402.80
|
| Rate for Payer: Zelis Worker's Compensation |
$274.91
|
|
|
REPAIR LEG FASCIA DEFECT
|
Facility
|
OP
|
$1,007.00
|
|
|
Service Code
|
CPT 27656
|
| Hospital Charge Code |
6127656
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$274.91 |
| Max. Negotiated Rate |
$6,161.78 |
| 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 |
$604.20
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$604.20
|
| Rate for Payer: Cash Price |
$604.20
|
| Rate for Payer: Cigna Commercial |
$855.95
|
| Rate for Payer: First Health Commercial |
$906.30
|
| Rate for Payer: First Health Workers Compensation |
$388.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$906.30
|
| Rate for Payer: GEHA Commercial |
$805.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$906.30
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$916.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$704.90
|
| Rate for Payer: One Health Plan PPO/POS |
$906.30
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$956.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$755.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$936.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$402.80
|
| 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 |
$274.91
|
|
|
REPAIR LOWER LEG EPIPHYSES
|
Facility
|
OP
|
$1,344.00
|
|
|
Service Code
|
CPT 27734
|
| Hospital Charge Code |
6127734
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$366.91 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$806.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cigna Commercial |
$1,142.40
|
| Rate for Payer: First Health Commercial |
$1,209.60
|
| Rate for Payer: First Health Workers Compensation |
$518.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,209.60
|
| Rate for Payer: GEHA Commercial |
$1,075.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,209.60
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,223.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$940.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,209.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,276.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,008.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,249.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$537.60
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$366.91
|
|
|
REPAIR LOWER LEG EPIPHYSES
|
Facility
|
IP
|
$1,344.00
|
|
|
Service Code
|
CPT 27734
|
| Hospital Charge Code |
6127734
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$366.91 |
| Max. Negotiated Rate |
$1,276.80 |
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cigna Commercial |
$1,142.40
|
| Rate for Payer: First Health Commercial |
$1,209.60
|
| Rate for Payer: First Health Workers Compensation |
$518.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,209.60
|
| Rate for Payer: GEHA Commercial |
$940.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,209.60
|
| Rate for Payer: Multiplan All |
$1,223.04
|
| Rate for Payer: OMNI Networks Commercial |
$940.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,209.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,276.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,008.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,249.92
|
| Rate for Payer: Zelis Auto |
$537.60
|
| Rate for Payer: Zelis Worker's Compensation |
$366.91
|
|
|
REPAIR LOWER LEG TENDONS
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 27676
|
| Hospital Charge Code |
6127676
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$336.88 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$740.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$740.40
|
| Rate for Payer: Cash Price |
$740.40
|
| Rate for Payer: Cigna Commercial |
$1,048.90
|
| Rate for Payer: First Health Commercial |
$1,110.60
|
| Rate for Payer: First Health Workers Compensation |
$476.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,110.60
|
| Rate for Payer: GEHA Commercial |
$987.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,110.60
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,122.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$863.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,110.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,172.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$925.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,147.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$493.60
|
| 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 |
$336.88
|
|
|
REPAIR LOWER LEG TENDONS
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
CPT 27675
|
| Hospital Charge Code |
6127675
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$271.63 |
| Max. Negotiated Rate |
$945.25 |
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cigna Commercial |
$845.75
|
| Rate for Payer: First Health Commercial |
$895.50
|
| Rate for Payer: First Health Workers Compensation |
$384.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$895.50
|
| Rate for Payer: GEHA Commercial |
$696.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$895.50
|
| Rate for Payer: Multiplan All |
$905.45
|
| Rate for Payer: OMNI Networks Commercial |
$696.50
|
| Rate for Payer: One Health Plan PPO/POS |
$895.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$945.25
|
| Rate for Payer: Three Rivers Provider Network All |
$746.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$925.35
|
| Rate for Payer: Zelis Auto |
$398.00
|
| Rate for Payer: Zelis Worker's Compensation |
$271.63
|
|
|
REPAIR LOWER LEG TENDONS
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
CPT 27675
|
| Hospital Charge Code |
6127675
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$271.63 |
| Max. Negotiated Rate |
$6,161.78 |
| 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 |
$597.00
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cigna Commercial |
$845.75
|
| Rate for Payer: First Health Commercial |
$895.50
|
| Rate for Payer: First Health Workers Compensation |
$384.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$895.50
|
| Rate for Payer: GEHA Commercial |
$796.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$895.50
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$905.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$696.50
|
| Rate for Payer: One Health Plan PPO/POS |
$895.50
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$945.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$746.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$925.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$398.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$271.63
|
|
|
REPAIR LOWER LEG TENDONS
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 27676
|
| Hospital Charge Code |
6127676
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$336.88 |
| Max. Negotiated Rate |
$1,172.30 |
| Rate for Payer: Cash Price |
$740.40
|
| Rate for Payer: Cigna Commercial |
$1,048.90
|
| Rate for Payer: First Health Commercial |
$1,110.60
|
| Rate for Payer: First Health Workers Compensation |
$476.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,110.60
|
| Rate for Payer: GEHA Commercial |
$863.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,110.60
|
| Rate for Payer: Multiplan All |
$1,122.94
|
| Rate for Payer: OMNI Networks Commercial |
$863.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,110.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,172.30
|
| Rate for Payer: Three Rivers Provider Network All |
$925.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,147.62
|
| Rate for Payer: Zelis Auto |
$493.60
|
| Rate for Payer: Zelis Worker's Compensation |
$336.88
|
|
|
REPAIR MOUTH LACERATION
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 40830
|
| Hospital Charge Code |
6140830
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$138.96 |
| Max. Negotiated Rate |
$483.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$305.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$274.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$220.50
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cigna Commercial |
$432.65
|
| Rate for Payer: First Health Commercial |
$458.10
|
| Rate for Payer: First Health Workers Compensation |
$196.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$458.10
|
| Rate for Payer: GEHA Commercial |
$407.20
|
| Rate for Payer: GEHA Medicare |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$458.10
|
| Rate for Payer: Humana ChoiceCare |
$242.55
|
| Rate for Payer: Humana Medicare Advantage |
$220.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$370.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$279.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$220.50
|
| Rate for Payer: Multiplan All |
$463.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$374.85
|
| Rate for Payer: OMNI Networks Commercial |
$356.30
|
| Rate for Payer: One Health Plan PPO/POS |
$458.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$323.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$279.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$483.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$441.00
|
| Rate for Payer: Three Rivers Provider Network All |
$381.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$216.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$473.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$220.50
|
| Rate for Payer: Zelis Auto |
$203.60
|
| Rate for Payer: Zelis Medicare |
$187.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.60
|
| Rate for Payer: Zelis Worker's Compensation |
$138.96
|
|
|
REPAIR MOUTH LACERATION
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 40830
|
| Hospital Charge Code |
6140830
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$138.96 |
| Max. Negotiated Rate |
$483.55 |
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cigna Commercial |
$432.65
|
| Rate for Payer: First Health Commercial |
$458.10
|
| Rate for Payer: First Health Workers Compensation |
$196.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$458.10
|
| Rate for Payer: GEHA Commercial |
$356.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$458.10
|
| Rate for Payer: Multiplan All |
$463.19
|
| Rate for Payer: OMNI Networks Commercial |
$356.30
|
| Rate for Payer: One Health Plan PPO/POS |
$458.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$483.55
|
| Rate for Payer: Three Rivers Provider Network All |
$381.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$473.37
|
| Rate for Payer: Zelis Auto |
$203.60
|
| Rate for Payer: Zelis Worker's Compensation |
$138.96
|
|
|
REPAIR MULTI-COMP PENIS PROS
|
Facility
|
OP
|
$1,626.00
|
|
|
Service Code
|
CPT 54408
|
| Hospital Charge Code |
6154408
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$443.90 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$975.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,794.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$975.60
|
| Rate for Payer: Cash Price |
$975.60
|
| Rate for Payer: Cigna Commercial |
$1,382.10
|
| Rate for Payer: First Health Commercial |
$1,463.40
|
| Rate for Payer: First Health Workers Compensation |
$627.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,463.40
|
| Rate for Payer: GEHA Commercial |
$1,300.80
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,463.40
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,851.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$1,479.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,138.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,463.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,291.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,851.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,544.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,219.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,851.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,512.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$650.40
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$443.90
|
|
|
REPAIR MULTI-COMP PENIS PROS
|
Facility
|
IP
|
$1,626.00
|
|
|
Service Code
|
CPT 54408
|
| Hospital Charge Code |
6154408
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$443.90 |
| Max. Negotiated Rate |
$1,544.70 |
| Rate for Payer: Cash Price |
$975.60
|
| Rate for Payer: Cigna Commercial |
$1,382.10
|
| Rate for Payer: First Health Commercial |
$1,463.40
|
| Rate for Payer: First Health Workers Compensation |
$627.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,463.40
|
| Rate for Payer: GEHA Commercial |
$1,138.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,463.40
|
| Rate for Payer: Multiplan All |
$1,479.66
|
| Rate for Payer: OMNI Networks Commercial |
$1,138.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,463.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,544.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,219.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,512.18
|
| Rate for Payer: Zelis Auto |
$650.40
|
| Rate for Payer: Zelis Worker's Compensation |
$443.90
|
|
|
REPAIR MUSCLES OF HAND
|
Facility
|
IP
|
$848.00
|
|
|
Service Code
|
CPT 26591
|
| Hospital Charge Code |
6126591
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$231.50 |
| Max. Negotiated Rate |
$805.60 |
| Rate for Payer: Cash Price |
$508.80
|
| Rate for Payer: Cigna Commercial |
$720.80
|
| Rate for Payer: First Health Commercial |
$763.20
|
| Rate for Payer: First Health Workers Compensation |
$327.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$763.20
|
| Rate for Payer: GEHA Commercial |
$593.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$763.20
|
| Rate for Payer: Multiplan All |
$771.68
|
| Rate for Payer: OMNI Networks Commercial |
$593.60
|
| Rate for Payer: One Health Plan PPO/POS |
$763.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$805.60
|
| Rate for Payer: Three Rivers Provider Network All |
$636.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$788.64
|
| Rate for Payer: Zelis Auto |
$339.20
|
| Rate for Payer: Zelis Worker's Compensation |
$231.50
|
|
|
REPAIR MUSCLES OF HAND
|
Facility
|
OP
|
$848.00
|
|
|
Service Code
|
CPT 26591
|
| Hospital Charge Code |
6126591
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$231.50 |
| Max. Negotiated Rate |
$6,161.78 |
| 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 |
$508.80
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$508.80
|
| Rate for Payer: Cash Price |
$508.80
|
| Rate for Payer: Cigna Commercial |
$720.80
|
| Rate for Payer: First Health Commercial |
$763.20
|
| Rate for Payer: First Health Workers Compensation |
$327.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$763.20
|
| Rate for Payer: GEHA Commercial |
$678.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$763.20
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$771.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$593.60
|
| Rate for Payer: One Health Plan PPO/POS |
$763.20
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$805.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$636.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$788.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$339.20
|
| 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 |
$231.50
|
|
|
REPAIR NASAL SEPTUM DEFECT
|
Facility
|
OP
|
$1,253.00
|
|
|
Service Code
|
CPT 30630
|
| Hospital Charge Code |
6130630
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$342.07 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$751.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cigna Commercial |
$1,065.05
|
| Rate for Payer: First Health Commercial |
$1,127.70
|
| Rate for Payer: First Health Workers Compensation |
$483.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,127.70
|
| Rate for Payer: GEHA Commercial |
$1,002.40
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,127.70
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$1,140.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$877.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,127.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,190.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$939.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,165.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$501.20
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$342.07
|
|
|
REPAIR NASAL SEPTUM DEFECT
|
Facility
|
IP
|
$1,253.00
|
|
|
Service Code
|
CPT 30630
|
| Hospital Charge Code |
6130630
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$342.07 |
| Max. Negotiated Rate |
$1,190.35 |
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cigna Commercial |
$1,065.05
|
| Rate for Payer: First Health Commercial |
$1,127.70
|
| Rate for Payer: First Health Workers Compensation |
$483.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,127.70
|
| Rate for Payer: GEHA Commercial |
$877.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,127.70
|
| Rate for Payer: Multiplan All |
$1,140.23
|
| Rate for Payer: OMNI Networks Commercial |
$877.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,127.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,190.35
|
| Rate for Payer: Three Rivers Provider Network All |
$939.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,165.29
|
| Rate for Payer: Zelis Auto |
$501.20
|
| Rate for Payer: Zelis Worker's Compensation |
$342.07
|
|
|
REPAIR NASAL STENOSIS
|
Facility
|
IP
|
$1,981.00
|
|
|
Service Code
|
CPT 30465
|
| Hospital Charge Code |
6130465
|
|
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 NASAL STENOSIS
|
Facility
|
OP
|
$1,981.00
|
|
|
Service Code
|
CPT 30465
|
| Hospital Charge Code |
6130465
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$540.81 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| 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 |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| 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 |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,782.90
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,802.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| 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 |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,881.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,485.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,842.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$792.40
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$540.81
|
|
|
REPAIR NERVE ADD-ON
|
Facility
|
IP
|
$966.00
|
|
|
Service Code
|
CPT 64837
|
| Hospital Charge Code |
6164837
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$263.72 |
| Max. Negotiated Rate |
$917.70 |
| Rate for Payer: Cash Price |
$579.60
|
| Rate for Payer: Cigna Commercial |
$821.10
|
| Rate for Payer: First Health Commercial |
$869.40
|
| Rate for Payer: First Health Workers Compensation |
$372.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$869.40
|
| Rate for Payer: GEHA Commercial |
$676.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$869.40
|
| Rate for Payer: Multiplan All |
$879.06
|
| Rate for Payer: OMNI Networks Commercial |
$676.20
|
| Rate for Payer: One Health Plan PPO/POS |
$869.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$917.70
|
| Rate for Payer: Three Rivers Provider Network All |
$724.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$898.38
|
| Rate for Payer: Zelis Auto |
$386.40
|
| Rate for Payer: Zelis Worker's Compensation |
$263.72
|
|
|
REPAIR NERVE ADD-ON
|
Facility
|
IP
|
$879.00
|
|
|
Service Code
|
CPT 64832
|
| Hospital Charge Code |
6164832
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$239.97 |
| Max. Negotiated Rate |
$835.05 |
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cigna Commercial |
$747.15
|
| Rate for Payer: First Health Commercial |
$791.10
|
| Rate for Payer: First Health Workers Compensation |
$339.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$791.10
|
| Rate for Payer: GEHA Commercial |
$615.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$791.10
|
| Rate for Payer: Multiplan All |
$799.89
|
| Rate for Payer: OMNI Networks Commercial |
$615.30
|
| Rate for Payer: One Health Plan PPO/POS |
$791.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$835.05
|
| Rate for Payer: Three Rivers Provider Network All |
$659.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$817.47
|
| Rate for Payer: Zelis Auto |
$351.60
|
| Rate for Payer: Zelis Worker's Compensation |
$239.97
|
|
