|
REPAIR OF FOOT BONES
|
Facility
|
OP
|
$1,773.99
|
|
|
Service Code
|
CPT 28320
|
| Hospital Charge Code |
6128320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$484.30 |
| Max. Negotiated Rate |
$24,435.12 |
| 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 |
$1,064.39
|
| 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 |
$12,217.56
|
| Rate for Payer: Cash Price |
$1,064.39
|
| Rate for Payer: Cash Price |
$1,064.39
|
| Rate for Payer: Cigna Commercial |
$1,507.89
|
| Rate for Payer: First Health Commercial |
$1,596.59
|
| Rate for Payer: First Health Workers Compensation |
$684.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,596.59
|
| Rate for Payer: GEHA Commercial |
$1,419.19
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,596.59
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,292.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,614.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,241.79
|
| Rate for Payer: One Health Plan PPO/POS |
$1,596.59
|
| 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 |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,685.29
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,330.49
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,292.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,649.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$709.60
|
| Rate for Payer: Zelis Medicare |
$10,384.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,661.07
|
| Rate for Payer: Zelis Worker's Compensation |
$484.30
|
|
|
REPAIR OF FOOT TENDON
|
Facility
|
IP
|
$818.00
|
|
|
Service Code
|
CPT 28200
|
| Hospital Charge Code |
6128200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$223.31 |
| Max. Negotiated Rate |
$777.10 |
| Rate for Payer: Cash Price |
$490.80
|
| Rate for Payer: Cigna Commercial |
$695.30
|
| Rate for Payer: First Health Commercial |
$736.20
|
| Rate for Payer: First Health Workers Compensation |
$315.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$736.20
|
| Rate for Payer: GEHA Commercial |
$572.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$736.20
|
| Rate for Payer: Multiplan All |
$744.38
|
| Rate for Payer: OMNI Networks Commercial |
$572.60
|
| Rate for Payer: One Health Plan PPO/POS |
$736.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$777.10
|
| Rate for Payer: Three Rivers Provider Network All |
$613.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$760.74
|
| Rate for Payer: Zelis Auto |
$327.20
|
| Rate for Payer: Zelis Worker's Compensation |
$223.31
|
|
|
REPAIR OF FOOT TENDON
|
Facility
|
OP
|
$818.00
|
|
|
Service Code
|
CPT 28200
|
| Hospital Charge Code |
6128200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$223.31 |
| 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 |
$490.80
|
| 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 |
$490.80
|
| Rate for Payer: Cash Price |
$490.80
|
| Rate for Payer: Cigna Commercial |
$695.30
|
| Rate for Payer: First Health Commercial |
$736.20
|
| Rate for Payer: First Health Workers Compensation |
$315.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$736.20
|
| Rate for Payer: GEHA Commercial |
$654.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$736.20
|
| 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 |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$744.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$572.60
|
| Rate for Payer: One Health Plan PPO/POS |
$736.20
|
| 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 |
$777.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$613.50
|
| 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 |
$760.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$327.20
|
| 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 |
$223.31
|
|
|
REPAIR OF FOOT TENDON
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
6128208
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$216.22 |
| 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 |
$475.20
|
| 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 |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cigna Commercial |
$673.20
|
| Rate for Payer: First Health Commercial |
$712.80
|
| Rate for Payer: First Health Workers Compensation |
$305.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$712.80
|
| Rate for Payer: GEHA Commercial |
$633.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$712.80
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$720.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$554.40
|
| Rate for Payer: One Health Plan PPO/POS |
$712.80
|
| 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 |
$752.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$594.00
|
| 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 |
$736.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$316.80
|
| 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 |
$216.22
|
|
|
REPAIR OF FOOT TENDON
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
6128208
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$216.22 |
| Max. Negotiated Rate |
$752.40 |
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cigna Commercial |
$673.20
|
| Rate for Payer: First Health Commercial |
$712.80
|
| Rate for Payer: First Health Workers Compensation |
$305.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$712.80
|
| Rate for Payer: GEHA Commercial |
$554.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$712.80
|
| Rate for Payer: Multiplan All |
$720.72
|
| Rate for Payer: OMNI Networks Commercial |
$554.40
|
| Rate for Payer: One Health Plan PPO/POS |
$712.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$752.40
|
| Rate for Payer: Three Rivers Provider Network All |
$594.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$736.56
|
| Rate for Payer: Zelis Auto |
$316.80
|
| Rate for Payer: Zelis Worker's Compensation |
$216.22
|
|
|
REPAIR OF HAMMERTOE
|
Facility
|
OP
|
$960.00
|
|
|
Service Code
|
CPT 28285
|
| Hospital Charge Code |
6128285
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$262.08 |
| 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 |
$576.00
|
| 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 |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$816.00
|
| Rate for Payer: First Health Commercial |
$864.00
|
| Rate for Payer: First Health Workers Compensation |
$370.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$864.00
|
| Rate for Payer: GEHA Commercial |
$768.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$864.00
|
| 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 |
$873.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$672.00
|
| Rate for Payer: One Health Plan PPO/POS |
$864.00
|
| 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 |
$912.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$720.00
|
| 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 |
$892.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$384.00
|
| 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 |
$262.08
|
|
|
REPAIR OF HAMMERTOE
|
Facility
|
IP
|
$762.00
|
|
|
Service Code
|
CPT 28286
|
| Hospital Charge Code |
6128286
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$208.03 |
| Max. Negotiated Rate |
$723.90 |
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$647.70
|
| Rate for Payer: First Health Commercial |
$685.80
|
| Rate for Payer: First Health Workers Compensation |
$294.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$685.80
|
| Rate for Payer: GEHA Commercial |
$533.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$685.80
|
| Rate for Payer: Multiplan All |
$693.42
|
| Rate for Payer: OMNI Networks Commercial |
$533.40
|
| Rate for Payer: One Health Plan PPO/POS |
$685.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$723.90
|
| Rate for Payer: Three Rivers Provider Network All |
$571.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$708.66
|
| Rate for Payer: Zelis Auto |
$304.80
|
| Rate for Payer: Zelis Worker's Compensation |
$208.03
|
|
|
REPAIR OF HAMMERTOE
|
Facility
|
IP
|
$960.00
|
|
|
Service Code
|
CPT 28285
|
| Hospital Charge Code |
6128285
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$262.08 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$816.00
|
| Rate for Payer: First Health Commercial |
$864.00
|
| Rate for Payer: First Health Workers Compensation |
$370.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$864.00
|
| Rate for Payer: GEHA Commercial |
$672.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$864.00
|
| Rate for Payer: Multiplan All |
$873.60
|
| Rate for Payer: OMNI Networks Commercial |
$672.00
|
| Rate for Payer: One Health Plan PPO/POS |
$864.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$912.00
|
| Rate for Payer: Three Rivers Provider Network All |
$720.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$892.80
|
| Rate for Payer: Zelis Auto |
$384.00
|
| Rate for Payer: Zelis Worker's Compensation |
$262.08
|
|
|
REPAIR OF HAMMERTOE
|
Facility
|
OP
|
$762.00
|
|
|
Service Code
|
CPT 28286
|
| Hospital Charge Code |
6128286
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$208.03 |
| 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 |
$457.20
|
| 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 |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$647.70
|
| Rate for Payer: First Health Commercial |
$685.80
|
| Rate for Payer: First Health Workers Compensation |
$294.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$685.80
|
| Rate for Payer: GEHA Commercial |
$609.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$685.80
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$693.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$533.40
|
| Rate for Payer: One Health Plan PPO/POS |
$685.80
|
| 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 |
$723.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$571.50
|
| 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 |
$708.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$304.80
|
| 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 |
$208.03
|
|
|
REPAIR OF HAND OR FOOT NERVE
|
Facility
|
OP
|
$1,664.00
|
|
|
Service Code
|
CPT 64835
|
| Hospital Charge Code |
6164835
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$454.27 |
| Max. Negotiated Rate |
$12,161.84 |
| 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 |
$998.40
|
| 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: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,080.92
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cigna Commercial |
$1,414.40
|
| Rate for Payer: First Health Commercial |
$1,497.60
|
| Rate for Payer: First Health Workers Compensation |
$642.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,497.60
|
| Rate for Payer: GEHA Commercial |
$1,331.20
|
| Rate for Payer: GEHA Medicare |
$6,080.92
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,497.60
|
| Rate for Payer: Humana ChoiceCare |
$6,689.01
|
| Rate for Payer: Humana Medicare Advantage |
$6,080.92
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10,215.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,046.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,080.92
|
| Rate for Payer: Multiplan All |
$1,514.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,337.56
|
| Rate for Payer: OMNI Networks Commercial |
$1,164.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,497.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,518.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,046.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,080.92
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,580.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12,161.84
|
| Rate for Payer: Three Rivers Provider Network All |
$1,248.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,959.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,046.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,080.92
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,547.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,080.92
|
| Rate for Payer: Zelis Auto |
$665.60
|
| Rate for Payer: Zelis Medicare |
$5,168.78
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,297.10
|
| Rate for Payer: Zelis Worker's Compensation |
$454.27
|
|
|
REPAIR OF HAND OR FOOT NERVE
|
Facility
|
IP
|
$1,664.00
|
|
|
Service Code
|
CPT 64835
|
| Hospital Charge Code |
6164835
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$454.27 |
| Max. Negotiated Rate |
$1,580.80 |
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cigna Commercial |
$1,414.40
|
| Rate for Payer: First Health Commercial |
$1,497.60
|
| Rate for Payer: First Health Workers Compensation |
$642.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,497.60
|
| Rate for Payer: GEHA Commercial |
$1,164.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,497.60
|
| Rate for Payer: Multiplan All |
$1,514.24
|
| Rate for Payer: OMNI Networks Commercial |
$1,164.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,497.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,580.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,248.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,547.52
|
| Rate for Payer: Zelis Auto |
$665.60
|
| Rate for Payer: Zelis Worker's Compensation |
$454.27
|
|
|
REPAIR OF HAND OR FOOT NERVE
|
Facility
|
IP
|
$1,521.00
|
|
|
Service Code
|
CPT 64834
|
| Hospital Charge Code |
6164834
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$415.23 |
| Max. Negotiated Rate |
$1,444.95 |
| Rate for Payer: Cash Price |
$912.60
|
| Rate for Payer: Cigna Commercial |
$1,292.85
|
| Rate for Payer: First Health Commercial |
$1,368.90
|
| Rate for Payer: First Health Workers Compensation |
$587.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,368.90
|
| Rate for Payer: GEHA Commercial |
$1,064.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,368.90
|
| Rate for Payer: Multiplan All |
$1,384.11
|
| Rate for Payer: OMNI Networks Commercial |
$1,064.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,368.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,444.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,140.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,414.53
|
| Rate for Payer: Zelis Auto |
$608.40
|
| Rate for Payer: Zelis Worker's Compensation |
$415.23
|
|
|
REPAIR OF HAND OR FOOT NERVE
|
Facility
|
OP
|
$1,670.00
|
|
|
Service Code
|
CPT 64836
|
| Hospital Charge Code |
6164836
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$455.91 |
| Max. Negotiated Rate |
$12,161.84 |
| 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 |
$1,002.00
|
| 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: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,080.92
|
| Rate for Payer: Cash Price |
$1,002.00
|
| Rate for Payer: Cash Price |
$1,002.00
|
| Rate for Payer: Cigna Commercial |
$1,419.50
|
| Rate for Payer: First Health Commercial |
$1,503.00
|
| Rate for Payer: First Health Workers Compensation |
$644.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,503.00
|
| Rate for Payer: GEHA Commercial |
$1,336.00
|
| Rate for Payer: GEHA Medicare |
$6,080.92
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,503.00
|
| Rate for Payer: Humana ChoiceCare |
$6,689.01
|
| Rate for Payer: Humana Medicare Advantage |
$6,080.92
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10,215.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,046.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,080.92
|
| Rate for Payer: Multiplan All |
$1,519.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,337.56
|
| Rate for Payer: OMNI Networks Commercial |
$1,169.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,503.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,518.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,046.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,080.92
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,586.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12,161.84
|
| Rate for Payer: Three Rivers Provider Network All |
$1,252.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,959.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,046.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,080.92
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,553.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,080.92
|
| Rate for Payer: Zelis Auto |
$668.00
|
| Rate for Payer: Zelis Medicare |
$5,168.78
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,297.10
|
| Rate for Payer: Zelis Worker's Compensation |
$455.91
|
|
|
REPAIR OF HAND OR FOOT NERVE
|
Facility
|
OP
|
$1,521.00
|
|
|
Service Code
|
CPT 64834
|
| Hospital Charge Code |
6164834
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$415.23 |
| Max. Negotiated Rate |
$12,161.84 |
| 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 |
$912.60
|
| 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: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,080.92
|
| Rate for Payer: Cash Price |
$912.60
|
| Rate for Payer: Cash Price |
$912.60
|
| Rate for Payer: Cigna Commercial |
$1,292.85
|
| Rate for Payer: First Health Commercial |
$1,368.90
|
| Rate for Payer: First Health Workers Compensation |
$587.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,368.90
|
| Rate for Payer: GEHA Commercial |
$1,216.80
|
| Rate for Payer: GEHA Medicare |
$6,080.92
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,368.90
|
| Rate for Payer: Humana ChoiceCare |
$6,689.01
|
| Rate for Payer: Humana Medicare Advantage |
$6,080.92
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10,215.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,046.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,080.92
|
| Rate for Payer: Multiplan All |
$1,384.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,337.56
|
| Rate for Payer: OMNI Networks Commercial |
$1,064.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,368.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,518.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,046.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,080.92
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,444.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12,161.84
|
| Rate for Payer: Three Rivers Provider Network All |
$1,140.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,959.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,046.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,080.92
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,414.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,080.92
|
| Rate for Payer: Zelis Auto |
$608.40
|
| Rate for Payer: Zelis Medicare |
$5,168.78
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,297.10
|
| Rate for Payer: Zelis Worker's Compensation |
$415.23
|
|
|
REPAIR OF HAND OR FOOT NERVE
|
Facility
|
IP
|
$1,670.00
|
|
|
Service Code
|
CPT 64836
|
| Hospital Charge Code |
6164836
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$455.91 |
| Max. Negotiated Rate |
$1,586.50 |
| Rate for Payer: Cash Price |
$1,002.00
|
| Rate for Payer: Cigna Commercial |
$1,419.50
|
| Rate for Payer: First Health Commercial |
$1,503.00
|
| Rate for Payer: First Health Workers Compensation |
$644.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,503.00
|
| Rate for Payer: GEHA Commercial |
$1,169.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,503.00
|
| Rate for Payer: Multiplan All |
$1,519.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,169.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,503.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,586.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,252.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,553.10
|
| Rate for Payer: Zelis Auto |
$668.00
|
| Rate for Payer: Zelis Worker's Compensation |
$455.91
|
|
|
REPAIR OF HUMERUS
|
Facility
|
IP
|
$2,173.00
|
|
|
Service Code
|
CPT 24430
|
| Hospital Charge Code |
6124430
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$593.23 |
| Max. Negotiated Rate |
$2,064.35 |
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cigna Commercial |
$1,847.05
|
| Rate for Payer: First Health Commercial |
$1,955.70
|
| Rate for Payer: First Health Workers Compensation |
$839.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,955.70
|
| Rate for Payer: GEHA Commercial |
$1,521.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,955.70
|
| Rate for Payer: Multiplan All |
$1,977.43
|
| Rate for Payer: OMNI Networks Commercial |
$1,521.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,955.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,064.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,629.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,020.89
|
| Rate for Payer: Zelis Auto |
$869.20
|
| Rate for Payer: Zelis Worker's Compensation |
$593.23
|
|
|
REPAIR OF HUMERUS
|
Facility
|
OP
|
$2,173.00
|
|
|
Service Code
|
CPT 24430
|
| Hospital Charge Code |
6124430
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$593.23 |
| Max. Negotiated Rate |
$24,435.12 |
| 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 |
$1,303.80
|
| 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 |
$12,217.56
|
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cigna Commercial |
$1,847.05
|
| Rate for Payer: First Health Commercial |
$1,955.70
|
| Rate for Payer: First Health Workers Compensation |
$839.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,955.70
|
| Rate for Payer: GEHA Commercial |
$1,738.40
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,955.70
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,977.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,521.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,955.70
|
| 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 |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,064.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,629.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,020.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$869.20
|
| Rate for Payer: Zelis Medicare |
$10,384.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,661.07
|
| Rate for Payer: Zelis Worker's Compensation |
$593.23
|
|
|
REPAIR OF HYDROCELE
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
CPT 55060
|
| Hospital Charge Code |
6155060
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$266.18 |
| Max. Negotiated Rate |
$926.25 |
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$828.75
|
| Rate for Payer: First Health Commercial |
$877.50
|
| Rate for Payer: First Health Workers Compensation |
$376.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$877.50
|
| Rate for Payer: GEHA Commercial |
$682.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$877.50
|
| Rate for Payer: Multiplan All |
$887.25
|
| Rate for Payer: OMNI Networks Commercial |
$682.50
|
| Rate for Payer: One Health Plan PPO/POS |
$877.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$926.25
|
| Rate for Payer: Three Rivers Provider Network All |
$731.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$906.75
|
| Rate for Payer: Zelis Auto |
$390.00
|
| Rate for Payer: Zelis Worker's Compensation |
$266.18
|
|
|
REPAIR OF HYDROCELE
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
CPT 55060
|
| Hospital Charge Code |
6155060
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$266.18 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$585.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$828.75
|
| Rate for Payer: First Health Commercial |
$877.50
|
| Rate for Payer: First Health Workers Compensation |
$376.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$877.50
|
| Rate for Payer: GEHA Commercial |
$780.00
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$877.50
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$887.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$682.50
|
| Rate for Payer: One Health Plan PPO/POS |
$877.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$926.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$731.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$906.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$390.00
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$266.18
|
|
|
REPAIR OF IMPERFORATED ANUS
|
Facility
|
OP
|
$5,081.00
|
|
|
Service Code
|
CPT 46742
|
| Hospital Charge Code |
6146742
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,270.25 |
| Max. Negotiated Rate |
$4,826.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,048.60
|
| Rate for Payer: Cash Price |
$3,048.60
|
| Rate for Payer: Cigna Commercial |
$4,318.85
|
| Rate for Payer: First Health Commercial |
$4,572.90
|
| Rate for Payer: First Health Workers Compensation |
$1,961.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,572.90
|
| Rate for Payer: GEHA Commercial |
$4,064.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,572.90
|
| Rate for Payer: Humana ChoiceCare |
$1,321.06
|
| Rate for Payer: Multiplan All |
$4,623.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,048.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,556.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,572.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,826.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,810.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,471.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,270.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,725.33
|
| Rate for Payer: Zelis Auto |
$2,032.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,540.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,387.11
|
|
|
REPAIR OF IMPERFORATED ANUS
|
Facility
|
IP
|
$5,081.00
|
|
|
Service Code
|
CPT 46742
|
| Hospital Charge Code |
6146742
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,387.11 |
| Max. Negotiated Rate |
$4,826.95 |
| Rate for Payer: Cash Price |
$3,048.60
|
| Rate for Payer: Cigna Commercial |
$4,318.85
|
| Rate for Payer: First Health Commercial |
$4,572.90
|
| Rate for Payer: First Health Workers Compensation |
$1,961.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,572.90
|
| Rate for Payer: GEHA Commercial |
$3,556.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,572.90
|
| Rate for Payer: Multiplan All |
$4,623.71
|
| Rate for Payer: OMNI Networks Commercial |
$3,556.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,572.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,826.95
|
| Rate for Payer: Three Rivers Provider Network All |
$3,810.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,725.33
|
| Rate for Payer: Zelis Auto |
$2,032.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,387.11
|
|
|
REPAIR OF KIDNEY WOUND
|
Facility
|
OP
|
$2,676.00
|
|
|
Service Code
|
CPT 50500
|
| Hospital Charge Code |
6150500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$669.00 |
| Max. Negotiated Rate |
$2,542.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,605.60
|
| Rate for Payer: Cash Price |
$1,605.60
|
| Rate for Payer: Cigna Commercial |
$2,274.60
|
| Rate for Payer: First Health Commercial |
$2,408.40
|
| Rate for Payer: First Health Workers Compensation |
$1,033.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,408.40
|
| Rate for Payer: GEHA Commercial |
$2,140.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,408.40
|
| Rate for Payer: Humana ChoiceCare |
$695.76
|
| Rate for Payer: Multiplan All |
$2,435.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,605.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,873.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,408.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,542.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,007.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,354.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$669.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,488.68
|
| Rate for Payer: Zelis Auto |
$1,070.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,338.00
|
| Rate for Payer: Zelis Worker's Compensation |
$730.55
|
|
|
REPAIR OF KIDNEY WOUND
|
Facility
|
IP
|
$2,676.00
|
|
|
Service Code
|
CPT 50500
|
| Hospital Charge Code |
6150500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$730.55 |
| Max. Negotiated Rate |
$2,542.20 |
| Rate for Payer: Cash Price |
$1,605.60
|
| Rate for Payer: Cigna Commercial |
$2,274.60
|
| Rate for Payer: First Health Commercial |
$2,408.40
|
| Rate for Payer: First Health Workers Compensation |
$1,033.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,408.40
|
| Rate for Payer: GEHA Commercial |
$1,873.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,408.40
|
| Rate for Payer: Multiplan All |
$2,435.16
|
| Rate for Payer: OMNI Networks Commercial |
$1,873.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,408.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,542.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,007.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,488.68
|
| Rate for Payer: Zelis Auto |
$1,070.40
|
| Rate for Payer: Zelis Worker's Compensation |
$730.55
|
|
|
REPAIR OF KNEECAP TENDON
|
Facility
|
OP
|
$1,208.00
|
|
|
Service Code
|
CPT 27380
|
| Hospital Charge Code |
6127380
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$329.78 |
| 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 |
$724.80
|
| 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 |
$724.80
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cigna Commercial |
$1,026.80
|
| Rate for Payer: First Health Commercial |
$1,087.20
|
| Rate for Payer: First Health Workers Compensation |
$466.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,087.20
|
| Rate for Payer: GEHA Commercial |
$966.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,087.20
|
| 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 |
$1,099.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$845.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,087.20
|
| 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 |
$1,147.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$906.00
|
| 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 |
$1,123.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$483.20
|
| 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 |
$329.78
|
|
|
REPAIR OF KNEECAP TENDON
|
Facility
|
IP
|
$1,208.00
|
|
|
Service Code
|
CPT 27380
|
| Hospital Charge Code |
6127380
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$329.78 |
| Max. Negotiated Rate |
$1,147.60 |
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cigna Commercial |
$1,026.80
|
| Rate for Payer: First Health Commercial |
$1,087.20
|
| Rate for Payer: First Health Workers Compensation |
$466.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,087.20
|
| Rate for Payer: GEHA Commercial |
$845.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,087.20
|
| Rate for Payer: Multiplan All |
$1,099.28
|
| Rate for Payer: OMNI Networks Commercial |
$845.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,087.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,147.60
|
| Rate for Payer: Three Rivers Provider Network All |
$906.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,123.44
|
| Rate for Payer: Zelis Auto |
$483.20
|
| Rate for Payer: Zelis Worker's Compensation |
$329.78
|
|
