|
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
|
OP
|
$966.00
|
|
|
Service Code
|
CPT 64837
|
| Hospital Charge Code |
6164837
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$251.16 |
| Max. Negotiated Rate |
$3,769.41 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,769.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$579.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,769.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,986.13
|
| Rate for Payer: Cash Price |
$579.60
|
| 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 |
$772.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$869.40
|
| Rate for Payer: Humana ChoiceCare |
$251.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,046.94
|
| Rate for Payer: Multiplan All |
$879.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$579.60
|
| Rate for Payer: OMNI Networks Commercial |
$676.20
|
| Rate for Payer: One Health Plan PPO/POS |
$869.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,518.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,046.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$917.70
|
| Rate for Payer: Three Rivers Provider Network All |
$724.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$850.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,046.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$898.38
|
| Rate for Payer: Zelis Auto |
$386.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$483.00
|
| Rate for Payer: Zelis Worker's Compensation |
$263.72
|
|
|
REPAIR NONUNION CARPAL BONE
|
Facility
|
OP
|
$1,610.00
|
|
|
Service Code
|
CPT 25431
|
| Hospital Charge Code |
6125431
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$439.53 |
| Max. Negotiated Rate |
$13,844.26 |
| 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 |
$966.00
|
| 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 |
$6,922.13
|
| Rate for Payer: Cash Price |
$966.00
|
| Rate for Payer: Cash Price |
$966.00
|
| Rate for Payer: Cigna Commercial |
$1,368.50
|
| Rate for Payer: First Health Commercial |
$1,449.00
|
| Rate for Payer: First Health Workers Compensation |
$621.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,449.00
|
| Rate for Payer: GEHA Commercial |
$1,288.00
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,449.00
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,465.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,127.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,449.00
|
| 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 |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,529.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,207.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,497.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$644.00
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$439.53
|
|
|
REPAIR NONUNION CARPAL BONE
|
Facility
|
IP
|
$1,610.00
|
|
|
Service Code
|
CPT 25431
|
| Hospital Charge Code |
6125431
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$439.53 |
| Max. Negotiated Rate |
$1,529.50 |
| Rate for Payer: Cash Price |
$966.00
|
| Rate for Payer: Cigna Commercial |
$1,368.50
|
| Rate for Payer: First Health Commercial |
$1,449.00
|
| Rate for Payer: First Health Workers Compensation |
$621.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,449.00
|
| Rate for Payer: GEHA Commercial |
$1,127.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,449.00
|
| Rate for Payer: Multiplan All |
$1,465.10
|
| Rate for Payer: OMNI Networks Commercial |
$1,127.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,449.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,529.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,207.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,497.30
|
| Rate for Payer: Zelis Auto |
$644.00
|
| Rate for Payer: Zelis Worker's Compensation |
$439.53
|
|
|
REPAIR NONUNION HAND
|
Facility
|
IP
|
$1,970.00
|
|
|
Service Code
|
CPT 26546
|
| Hospital Charge Code |
6126546
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$537.81 |
| Max. Negotiated Rate |
$1,871.50 |
| Rate for Payer: Cash Price |
$1,182.00
|
| Rate for Payer: Cigna Commercial |
$1,674.50
|
| Rate for Payer: First Health Commercial |
$1,773.00
|
| Rate for Payer: First Health Workers Compensation |
$760.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,773.00
|
| Rate for Payer: GEHA Commercial |
$1,379.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,773.00
|
| Rate for Payer: Multiplan All |
$1,792.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,379.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,773.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,871.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,477.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,832.10
|
| Rate for Payer: Zelis Auto |
$788.00
|
| Rate for Payer: Zelis Worker's Compensation |
$537.81
|
|
|
REPAIR NONUNION HAND
|
Facility
|
OP
|
$1,970.00
|
|
|
Service Code
|
CPT 26546
|
| Hospital Charge Code |
6126546
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$537.81 |
| Max. Negotiated Rate |
$13,844.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,182.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,922.13
|
| Rate for Payer: Cash Price |
$1,182.00
|
| Rate for Payer: Cash Price |
$1,182.00
|
| Rate for Payer: Cigna Commercial |
$1,674.50
|
| Rate for Payer: First Health Commercial |
$1,773.00
|
| Rate for Payer: First Health Workers Compensation |
$760.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,773.00
|
| Rate for Payer: GEHA Commercial |
$1,576.00
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,773.00
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,792.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,379.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,773.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,871.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,832.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$788.00
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$537.81
|
|
|
REPAIR, NONUNION OR MALUNION; TARSAL BONES
|
Facility
|
OP
|
$24,935.38
|
|
|
Service Code
|
CPT 28320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,207.24 |
| Max. Negotiated Rate |
$24,935.38 |
| 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 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 |
$12,467.69
|
| Rate for Payer: First Health Workers Compensation |
$16,045.92
|
| Rate for Payer: GEHA Medicare |
$12,467.69
|
| Rate for Payer: Humana ChoiceCare |
$13,714.46
|
| Rate for Payer: Humana Medicare Advantage |
$12,467.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,945.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,292.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,467.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21,195.07
|
| 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 |
$12,467.69
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,935.38
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,218.34
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,292.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,467.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,467.69
|
| Rate for Payer: Zelis Medicare |
$10,597.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,961.23
|
| Rate for Payer: Zelis Worker's Compensation |
$11,345.60
|
|
|
REPAIR OF ABDOMINAL WALL
|
Facility
|
OP
|
$1,697.00
|
|
|
Service Code
|
CPT 49900
|
| Hospital Charge Code |
6149900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$424.25 |
| Max. Negotiated Rate |
$1,612.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,018.20
|
| Rate for Payer: Cash Price |
$1,018.20
|
| Rate for Payer: Cigna Commercial |
$1,442.45
|
| Rate for Payer: First Health Commercial |
$1,527.30
|
| Rate for Payer: First Health Workers Compensation |
$655.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,527.30
|
| Rate for Payer: GEHA Commercial |
$1,357.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,527.30
|
| Rate for Payer: Humana ChoiceCare |
$441.22
|
| Rate for Payer: Multiplan All |
$1,544.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,018.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,187.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,527.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,612.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,272.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,493.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$424.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,578.21
|
| Rate for Payer: Zelis Auto |
$678.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$848.50
|
| Rate for Payer: Zelis Worker's Compensation |
$463.28
|
|
|
REPAIR OF ABDOMINAL WALL
|
Facility
|
IP
|
$1,697.00
|
|
|
Service Code
|
CPT 49900
|
| Hospital Charge Code |
6149900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$463.28 |
| Max. Negotiated Rate |
$1,612.15 |
| Rate for Payer: Cash Price |
$1,018.20
|
| Rate for Payer: Cigna Commercial |
$1,442.45
|
| Rate for Payer: First Health Commercial |
$1,527.30
|
| Rate for Payer: First Health Workers Compensation |
$655.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,527.30
|
| Rate for Payer: GEHA Commercial |
$1,187.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,527.30
|
| Rate for Payer: Multiplan All |
$1,544.27
|
| Rate for Payer: OMNI Networks Commercial |
$1,187.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,527.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,612.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,272.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,578.21
|
| Rate for Payer: Zelis Auto |
$678.80
|
| Rate for Payer: Zelis Worker's Compensation |
$463.28
|
|
|
REPAIR OF ACHILLES TENDON
|
Facility
|
OP
|
$1,447.00
|
|
|
Service Code
|
CPT 27654
|
| Hospital Charge Code |
6127654
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$395.03 |
| Max. Negotiated Rate |
$13,844.26 |
| 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 |
$868.20
|
| 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 |
$6,922.13
|
| Rate for Payer: Cash Price |
$868.20
|
| Rate for Payer: Cash Price |
$868.20
|
| Rate for Payer: Cigna Commercial |
$1,229.95
|
| Rate for Payer: First Health Commercial |
$1,302.30
|
| Rate for Payer: First Health Workers Compensation |
$558.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,302.30
|
| Rate for Payer: GEHA Commercial |
$1,157.60
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,302.30
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,316.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,012.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,302.30
|
| 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 |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,374.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,085.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,345.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$578.80
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$395.03
|
|
|
REPAIR OF ACHILLES TENDON
|
Facility
|
IP
|
$1,447.00
|
|
|
Service Code
|
CPT 27654
|
| Hospital Charge Code |
6127654
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$395.03 |
| Max. Negotiated Rate |
$1,374.65 |
| Rate for Payer: Cash Price |
$868.20
|
| Rate for Payer: Cigna Commercial |
$1,229.95
|
| Rate for Payer: First Health Commercial |
$1,302.30
|
| Rate for Payer: First Health Workers Compensation |
$558.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,302.30
|
| Rate for Payer: GEHA Commercial |
$1,012.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,302.30
|
| Rate for Payer: Multiplan All |
$1,316.77
|
| Rate for Payer: OMNI Networks Commercial |
$1,012.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,302.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,374.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,085.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,345.71
|
| Rate for Payer: Zelis Auto |
$578.80
|
| Rate for Payer: Zelis Worker's Compensation |
$395.03
|
|
|
REPAIR OF ANAL SPHINCTER
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
CPT 46760
|
| Hospital Charge Code |
6146760
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$614.25 |
| Max. Negotiated Rate |
$5,314.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,253.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,253.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,577.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,657.32
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,912.50
|
| Rate for Payer: First Health Commercial |
$2,025.00
|
| Rate for Payer: First Health Workers Compensation |
$868.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,025.00
|
| Rate for Payer: GEHA Commercial |
$1,800.00
|
| Rate for Payer: GEHA Medicare |
$2,657.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,025.00
|
| Rate for Payer: Humana ChoiceCare |
$2,923.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,657.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,464.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,630.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,657.32
|
| Rate for Payer: Multiplan All |
$2,047.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,517.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,575.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,025.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,036.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,630.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,657.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,137.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,314.64
|
| Rate for Payer: Three Rivers Provider Network All |
$1,687.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,604.17
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,630.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,657.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,092.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,657.32
|
| Rate for Payer: Zelis Auto |
$900.00
|
| Rate for Payer: Zelis Medicare |
$2,258.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,188.78
|
| Rate for Payer: Zelis Worker's Compensation |
$614.25
|
|
|
REPAIR OF ANAL SPHINCTER
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
CPT 46760
|
| Hospital Charge Code |
6146760
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$614.25 |
| Max. Negotiated Rate |
$2,137.50 |
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,912.50
|
| Rate for Payer: First Health Commercial |
$2,025.00
|
| Rate for Payer: First Health Workers Compensation |
$868.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,025.00
|
| Rate for Payer: GEHA Commercial |
$1,575.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,025.00
|
| Rate for Payer: Multiplan All |
$2,047.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,575.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,025.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,137.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,687.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,092.50
|
| Rate for Payer: Zelis Auto |
$900.00
|
| Rate for Payer: Zelis Worker's Compensation |
$614.25
|
|
|
REPAIR OF ANAL SPHINCTER
|
Facility
|
IP
|
$1,910.00
|
|
|
Service Code
|
CPT 46761
|
| Hospital Charge Code |
6146761
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$521.43 |
| Max. Negotiated Rate |
$1,814.50 |
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Cigna Commercial |
$1,623.50
|
| Rate for Payer: First Health Commercial |
$1,719.00
|
| Rate for Payer: First Health Workers Compensation |
$737.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,719.00
|
| Rate for Payer: GEHA Commercial |
$1,337.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,719.00
|
| Rate for Payer: Multiplan All |
$1,738.10
|
| Rate for Payer: OMNI Networks Commercial |
$1,337.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,719.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,814.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,432.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,776.30
|
| Rate for Payer: Zelis Auto |
$764.00
|
| Rate for Payer: Zelis Worker's Compensation |
$521.43
|
|
|
REPAIR OF ANAL SPHINCTER
|
Facility
|
OP
|
$1,910.00
|
|
|
Service Code
|
CPT 46761
|
| Hospital Charge Code |
6146761
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$521.43 |
| Max. Negotiated Rate |
$5,314.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,253.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,146.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,253.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,577.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,657.32
|
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Cash Price |
$1,146.00
|
| Rate for Payer: Cigna Commercial |
$1,623.50
|
| Rate for Payer: First Health Commercial |
$1,719.00
|
| Rate for Payer: First Health Workers Compensation |
$737.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,719.00
|
| Rate for Payer: GEHA Commercial |
$1,528.00
|
| Rate for Payer: GEHA Medicare |
$2,657.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,719.00
|
| Rate for Payer: Humana ChoiceCare |
$2,923.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,657.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,464.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,630.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,657.32
|
| Rate for Payer: Multiplan All |
$1,738.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,517.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,337.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,719.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,036.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,630.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,657.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,814.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,314.64
|
| Rate for Payer: Three Rivers Provider Network All |
$1,432.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,604.17
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,630.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,657.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,776.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,657.32
|
| Rate for Payer: Zelis Auto |
$764.00
|
| Rate for Payer: Zelis Medicare |
$2,258.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,188.78
|
| Rate for Payer: Zelis Worker's Compensation |
$521.43
|
|
|
REPAIR OF ANAL SPHINCTER
|
Facility
|
OP
|
$1,226.00
|
|
|
Service Code
|
CPT 46751
|
| Hospital Charge Code |
6146751
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$306.50 |
| Max. Negotiated Rate |
$1,164.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$735.60
|
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Cigna Commercial |
$1,042.10
|
| Rate for Payer: First Health Commercial |
$1,103.40
|
| Rate for Payer: First Health Workers Compensation |
$473.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,103.40
|
| Rate for Payer: GEHA Commercial |
$980.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,103.40
|
| Rate for Payer: Humana ChoiceCare |
$318.76
|
| Rate for Payer: Multiplan All |
$1,115.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$735.60
|
| Rate for Payer: OMNI Networks Commercial |
$858.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,103.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,164.70
|
| Rate for Payer: Three Rivers Provider Network All |
$919.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,078.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$306.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,140.18
|
| Rate for Payer: Zelis Auto |
$490.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$613.00
|
| Rate for Payer: Zelis Worker's Compensation |
$334.70
|
|
|
REPAIR OF ANAL SPHINCTER
|
Facility
|
OP
|
$1,556.00
|
|
|
Service Code
|
CPT 46750
|
| Hospital Charge Code |
6146750
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$424.79 |
| Max. Negotiated Rate |
$5,314.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,253.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$933.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,253.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,577.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,657.32
|
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Cigna Commercial |
$1,322.60
|
| Rate for Payer: First Health Commercial |
$1,400.40
|
| Rate for Payer: First Health Workers Compensation |
$600.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,400.40
|
| Rate for Payer: GEHA Commercial |
$1,244.80
|
| Rate for Payer: GEHA Medicare |
$2,657.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,400.40
|
| Rate for Payer: Humana ChoiceCare |
$2,923.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,657.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,464.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,630.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,657.32
|
| Rate for Payer: Multiplan All |
$1,415.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,517.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,089.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,400.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,036.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,630.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,657.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,478.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,314.64
|
| Rate for Payer: Three Rivers Provider Network All |
$1,167.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,604.17
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,630.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,657.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,447.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,657.32
|
| Rate for Payer: Zelis Auto |
$622.40
|
| Rate for Payer: Zelis Medicare |
$2,258.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,188.78
|
| Rate for Payer: Zelis Worker's Compensation |
$424.79
|
|
|
REPAIR OF ANAL SPHINCTER
|
Facility
|
IP
|
$1,226.00
|
|
|
Service Code
|
CPT 46751
|
| Hospital Charge Code |
6146751
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$334.70 |
| Max. Negotiated Rate |
$1,164.70 |
| Rate for Payer: Cash Price |
$735.60
|
| Rate for Payer: Cigna Commercial |
$1,042.10
|
| Rate for Payer: First Health Commercial |
$1,103.40
|
| Rate for Payer: First Health Workers Compensation |
$473.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,103.40
|
| Rate for Payer: GEHA Commercial |
$858.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,103.40
|
| Rate for Payer: Multiplan All |
$1,115.66
|
| Rate for Payer: OMNI Networks Commercial |
$858.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,103.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,164.70
|
| Rate for Payer: Three Rivers Provider Network All |
$919.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,140.18
|
| Rate for Payer: Zelis Auto |
$490.40
|
| Rate for Payer: Zelis Worker's Compensation |
$334.70
|
|
|
REPAIR OF ANAL SPHINCTER
|
Facility
|
IP
|
$1,556.00
|
|
|
Service Code
|
CPT 46750
|
| Hospital Charge Code |
6146750
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$424.79 |
| Max. Negotiated Rate |
$1,478.20 |
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Cigna Commercial |
$1,322.60
|
| Rate for Payer: First Health Commercial |
$1,400.40
|
| Rate for Payer: First Health Workers Compensation |
$600.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,400.40
|
| Rate for Payer: GEHA Commercial |
$1,089.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,400.40
|
| Rate for Payer: Multiplan All |
$1,415.96
|
| Rate for Payer: OMNI Networks Commercial |
$1,089.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,400.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,478.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,167.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,447.08
|
| Rate for Payer: Zelis Auto |
$622.40
|
| Rate for Payer: Zelis Worker's Compensation |
$424.79
|
|
|
REPAIR OF ANAL STRICTURE
|
Facility
|
OP
|
$1,027.00
|
|
|
Service Code
|
CPT 46705
|
| Hospital Charge Code |
6146705
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$256.75 |
| Max. Negotiated Rate |
$975.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$616.20
|
| Rate for Payer: Cash Price |
$616.20
|
| Rate for Payer: Cigna Commercial |
$872.95
|
| Rate for Payer: First Health Commercial |
$924.30
|
| Rate for Payer: First Health Workers Compensation |
$396.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$924.30
|
| Rate for Payer: GEHA Commercial |
$821.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$924.30
|
| Rate for Payer: Humana ChoiceCare |
$267.02
|
| Rate for Payer: Multiplan All |
$934.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$616.20
|
| Rate for Payer: OMNI Networks Commercial |
$718.90
|
| Rate for Payer: One Health Plan PPO/POS |
$924.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$975.65
|
| Rate for Payer: Three Rivers Provider Network All |
$770.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$903.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$256.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$955.11
|
| Rate for Payer: Zelis Auto |
$410.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$513.50
|
| Rate for Payer: Zelis Worker's Compensation |
$280.37
|
|
|
REPAIR OF ANAL STRICTURE
|
Facility
|
IP
|
$1,348.00
|
|
|
Service Code
|
CPT 46700
|
| Hospital Charge Code |
6146700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$368.00 |
| Max. Negotiated Rate |
$1,280.60 |
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cigna Commercial |
$1,145.80
|
| Rate for Payer: First Health Commercial |
$1,213.20
|
| Rate for Payer: First Health Workers Compensation |
$520.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,213.20
|
| Rate for Payer: GEHA Commercial |
$943.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,213.20
|
| Rate for Payer: Multiplan All |
$1,226.68
|
| Rate for Payer: OMNI Networks Commercial |
$943.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,213.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,280.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,011.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,253.64
|
| Rate for Payer: Zelis Auto |
$539.20
|
| Rate for Payer: Zelis Worker's Compensation |
$368.00
|
|
|
REPAIR OF ANAL STRICTURE
|
Facility
|
IP
|
$1,027.00
|
|
|
Service Code
|
CPT 46705
|
| Hospital Charge Code |
6146705
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$280.37 |
| Max. Negotiated Rate |
$975.65 |
| Rate for Payer: Cash Price |
$616.20
|
| Rate for Payer: Cigna Commercial |
$872.95
|
| Rate for Payer: First Health Commercial |
$924.30
|
| Rate for Payer: First Health Workers Compensation |
$396.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$924.30
|
| Rate for Payer: GEHA Commercial |
$718.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$924.30
|
| Rate for Payer: Multiplan All |
$934.57
|
| Rate for Payer: OMNI Networks Commercial |
$718.90
|
| Rate for Payer: One Health Plan PPO/POS |
$924.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$975.65
|
| Rate for Payer: Three Rivers Provider Network All |
$770.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$955.11
|
| Rate for Payer: Zelis Auto |
$410.80
|
| Rate for Payer: Zelis Worker's Compensation |
$280.37
|
|
|
REPAIR OF ANAL STRICTURE
|
Facility
|
OP
|
$1,348.00
|
|
|
Service Code
|
CPT 46700
|
| Hospital Charge Code |
6146700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$368.00 |
| Max. Negotiated Rate |
$5,314.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$808.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,657.32
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cigna Commercial |
$1,145.80
|
| Rate for Payer: First Health Commercial |
$1,213.20
|
| Rate for Payer: First Health Workers Compensation |
$520.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,213.20
|
| Rate for Payer: GEHA Commercial |
$1,078.40
|
| Rate for Payer: GEHA Medicare |
$2,657.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,213.20
|
| Rate for Payer: Humana ChoiceCare |
$2,923.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,657.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,464.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,657.32
|
| Rate for Payer: Multiplan All |
$1,226.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,517.44
|
| Rate for Payer: OMNI Networks Commercial |
$943.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,213.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,657.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,280.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,314.64
|
| Rate for Payer: Three Rivers Provider Network All |
$1,011.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,604.17
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,657.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,253.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,657.32
|
| Rate for Payer: Zelis Auto |
$539.20
|
| Rate for Payer: Zelis Medicare |
$2,258.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,188.78
|
| Rate for Payer: Zelis Worker's Compensation |
$368.00
|
|
|
REPAIR OF ANKLE LIGAMENT
|
Facility
|
OP
|
$1,878.51
|
|
|
Service Code
|
CPT 27698
|
| Hospital Charge Code |
6127698
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$512.83 |
| Max. Negotiated Rate |
$13,844.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,127.11
|
| 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 |
$6,922.13
|
| Rate for Payer: Cash Price |
$1,127.11
|
| Rate for Payer: Cash Price |
$1,127.11
|
| Rate for Payer: Cigna Commercial |
$1,596.73
|
| Rate for Payer: First Health Commercial |
$1,690.66
|
| Rate for Payer: First Health Workers Compensation |
$725.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,690.66
|
| Rate for Payer: GEHA Commercial |
$1,502.81
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,690.66
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,709.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,314.96
|
| Rate for Payer: One Health Plan PPO/POS |
$1,690.66
|
| 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 |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,784.58
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,408.88
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,747.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$751.40
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$512.83
|
|
|
REPAIR OF ANKLE LIGAMENT
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
CPT 27695
|
| Hospital Charge Code |
6127695
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$264.54 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$823.65
|
| Rate for Payer: First Health Commercial |
$872.10
|
| Rate for Payer: First Health Workers Compensation |
$374.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$872.10
|
| Rate for Payer: GEHA Commercial |
$678.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$872.10
|
| Rate for Payer: Multiplan All |
$881.79
|
| Rate for Payer: OMNI Networks Commercial |
$678.30
|
| Rate for Payer: One Health Plan PPO/POS |
$872.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$920.55
|
| Rate for Payer: Three Rivers Provider Network All |
$726.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$901.17
|
| Rate for Payer: Zelis Auto |
$387.60
|
| Rate for Payer: Zelis Worker's Compensation |
$264.54
|
|
