|
REPAIR OF KNEE CARTILAGE
|
Facility
|
OP
|
$1,309.00
|
|
|
Service Code
|
CPT 27403
|
| Hospital Charge Code |
6127403
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$357.36 |
| 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 |
$785.40
|
| 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 |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: First Health Workers Compensation |
$505.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$1,047.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| 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 |
$1,191.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| 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 |
$1,243.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| 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 |
$1,217.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$523.60
|
| 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 |
$357.36
|
|
|
REPAIR OF KNEE CARTILAGE
|
Facility
|
IP
|
$1,309.00
|
|
|
Service Code
|
CPT 27403
|
| Hospital Charge Code |
6127403
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$357.36 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$1,112.65
|
| Rate for Payer: First Health Commercial |
$1,178.10
|
| Rate for Payer: First Health Workers Compensation |
$505.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,178.10
|
| Rate for Payer: GEHA Commercial |
$916.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,178.10
|
| Rate for Payer: Multiplan All |
$1,191.19
|
| Rate for Payer: OMNI Networks Commercial |
$916.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,178.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,243.55
|
| Rate for Payer: Three Rivers Provider Network All |
$981.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,217.37
|
| Rate for Payer: Zelis Auto |
$523.60
|
| Rate for Payer: Zelis Worker's Compensation |
$357.36
|
|
|
REPAIR OF KNEE LIGAMENT
|
Facility
|
IP
|
$1,594.00
|
|
|
Service Code
|
CPT 27407
|
| Hospital Charge Code |
6127407
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$435.16 |
| Max. Negotiated Rate |
$1,514.30 |
| Rate for Payer: Cash Price |
$956.40
|
| Rate for Payer: Cigna Commercial |
$1,354.90
|
| Rate for Payer: First Health Commercial |
$1,434.60
|
| Rate for Payer: First Health Workers Compensation |
$615.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,434.60
|
| Rate for Payer: GEHA Commercial |
$1,115.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,434.60
|
| Rate for Payer: Multiplan All |
$1,450.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,115.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,434.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,514.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,195.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,482.42
|
| Rate for Payer: Zelis Auto |
$637.60
|
| Rate for Payer: Zelis Worker's Compensation |
$435.16
|
|
|
REPAIR OF KNEE LIGAMENT
|
Facility
|
IP
|
$1,378.00
|
|
|
Service Code
|
CPT 27405
|
| Hospital Charge Code |
6127405
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$376.19 |
| Max. Negotiated Rate |
$1,309.10 |
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cigna Commercial |
$1,171.30
|
| Rate for Payer: First Health Commercial |
$1,240.20
|
| Rate for Payer: First Health Workers Compensation |
$532.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,240.20
|
| Rate for Payer: GEHA Commercial |
$964.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,240.20
|
| Rate for Payer: Multiplan All |
$1,253.98
|
| Rate for Payer: OMNI Networks Commercial |
$964.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,240.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,309.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,033.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,281.54
|
| Rate for Payer: Zelis Auto |
$551.20
|
| Rate for Payer: Zelis Worker's Compensation |
$376.19
|
|
|
REPAIR OF KNEE LIGAMENT
|
Facility
|
OP
|
$1,594.00
|
|
|
Service Code
|
CPT 27407
|
| Hospital Charge Code |
6127407
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$435.16 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$956.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7,100.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$956.40
|
| Rate for Payer: Cash Price |
$956.40
|
| Rate for Payer: Cigna Commercial |
$1,354.90
|
| Rate for Payer: First Health Commercial |
$1,434.60
|
| Rate for Payer: First Health Workers Compensation |
$615.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,434.60
|
| Rate for Payer: GEHA Commercial |
$1,275.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,434.60
|
| 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 |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,450.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,115.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,434.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8,365.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7,245.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,514.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,195.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,482.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$637.60
|
| 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 |
$435.16
|
|
|
REPAIR OF KNEE LIGAMENT
|
Facility
|
OP
|
$1,378.00
|
|
|
Service Code
|
CPT 27405
|
| Hospital Charge Code |
6127405
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$376.19 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$826.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cash Price |
$826.80
|
| Rate for Payer: Cigna Commercial |
$1,171.30
|
| Rate for Payer: First Health Commercial |
$1,240.20
|
| Rate for Payer: First Health Workers Compensation |
$532.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,240.20
|
| Rate for Payer: GEHA Commercial |
$1,102.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,240.20
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,253.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$964.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,240.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,309.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,033.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,281.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$551.20
|
| 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 |
$376.19
|
|
|
REPAIR OF KNEE LIGAMENTS
|
Facility
|
OP
|
$1,960.00
|
|
|
Service Code
|
CPT 27409
|
| Hospital Charge Code |
6127409
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$535.08 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,176.00
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,176.00
|
| Rate for Payer: Cash Price |
$1,176.00
|
| Rate for Payer: Cigna Commercial |
$1,666.00
|
| Rate for Payer: First Health Commercial |
$1,764.00
|
| Rate for Payer: First Health Workers Compensation |
$756.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,764.00
|
| Rate for Payer: GEHA Commercial |
$1,568.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,764.00
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,783.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,372.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,764.00
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,862.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,470.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,822.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$784.00
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$535.08
|
|
|
REPAIR OF KNEE LIGAMENTS
|
Facility
|
IP
|
$1,960.00
|
|
|
Service Code
|
CPT 27409
|
| Hospital Charge Code |
6127409
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$535.08 |
| Max. Negotiated Rate |
$1,862.00 |
| Rate for Payer: Cash Price |
$1,176.00
|
| Rate for Payer: Cigna Commercial |
$1,666.00
|
| Rate for Payer: First Health Commercial |
$1,764.00
|
| Rate for Payer: First Health Workers Compensation |
$756.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,764.00
|
| Rate for Payer: GEHA Commercial |
$1,372.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,764.00
|
| Rate for Payer: Multiplan All |
$1,783.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,372.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,764.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,862.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,470.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,822.80
|
| Rate for Payer: Zelis Auto |
$784.00
|
| Rate for Payer: Zelis Worker's Compensation |
$535.08
|
|
|
REPAIR OF LEG EPIPHYSES
|
Facility
|
OP
|
$1,577.00
|
|
|
Service Code
|
CPT 27742
|
| Hospital Charge Code |
6127742
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$430.52 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$946.20
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$946.20
|
| Rate for Payer: Cash Price |
$946.20
|
| Rate for Payer: Cigna Commercial |
$1,340.45
|
| Rate for Payer: First Health Commercial |
$1,419.30
|
| Rate for Payer: First Health Workers Compensation |
$608.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,419.30
|
| Rate for Payer: GEHA Commercial |
$1,261.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,419.30
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,435.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,103.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,419.30
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,498.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,182.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,466.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$630.80
|
| 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 |
$430.52
|
|
|
REPAIR OF LEG EPIPHYSES
|
Facility
|
IP
|
$1,451.00
|
|
|
Service Code
|
CPT 27740
|
| Hospital Charge Code |
6127740
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$396.12 |
| Max. Negotiated Rate |
$1,378.45 |
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$1,233.35
|
| Rate for Payer: First Health Commercial |
$1,305.90
|
| Rate for Payer: First Health Workers Compensation |
$560.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,305.90
|
| Rate for Payer: GEHA Commercial |
$1,015.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,305.90
|
| Rate for Payer: Multiplan All |
$1,320.41
|
| Rate for Payer: OMNI Networks Commercial |
$1,015.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,305.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,378.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,088.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,349.43
|
| Rate for Payer: Zelis Auto |
$580.40
|
| Rate for Payer: Zelis Worker's Compensation |
$396.12
|
|
|
REPAIR OF LEG EPIPHYSES
|
Facility
|
OP
|
$1,451.00
|
|
|
Service Code
|
CPT 27740
|
| Hospital Charge Code |
6127740
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$396.12 |
| 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 |
$870.60
|
| 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 |
$870.60
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$1,233.35
|
| Rate for Payer: First Health Commercial |
$1,305.90
|
| Rate for Payer: First Health Workers Compensation |
$560.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,305.90
|
| Rate for Payer: GEHA Commercial |
$1,160.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,305.90
|
| 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 |
$1,320.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,015.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,305.90
|
| 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 |
$1,378.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,088.25
|
| 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 |
$1,349.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$580.40
|
| 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 |
$396.12
|
|
|
REPAIR OF LEG EPIPHYSES
|
Facility
|
IP
|
$1,577.00
|
|
|
Service Code
|
CPT 27742
|
| Hospital Charge Code |
6127742
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$430.52 |
| Max. Negotiated Rate |
$1,498.15 |
| Rate for Payer: Cash Price |
$946.20
|
| Rate for Payer: Cigna Commercial |
$1,340.45
|
| Rate for Payer: First Health Commercial |
$1,419.30
|
| Rate for Payer: First Health Workers Compensation |
$608.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,419.30
|
| Rate for Payer: GEHA Commercial |
$1,103.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,419.30
|
| Rate for Payer: Multiplan All |
$1,435.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,103.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,419.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,498.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,182.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,466.61
|
| Rate for Payer: Zelis Auto |
$630.80
|
| Rate for Payer: Zelis Worker's Compensation |
$430.52
|
|
|
REPAIR OF LEG NERVE
|
Facility
|
OP
|
$2,113.00
|
|
|
Service Code
|
CPT 64840
|
| Hospital Charge Code |
6164840
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$576.85 |
| 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 |
$1,267.80
|
| 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 |
$1,267.80
|
| Rate for Payer: Cash Price |
$1,267.80
|
| Rate for Payer: Cigna Commercial |
$1,796.05
|
| Rate for Payer: First Health Commercial |
$1,901.70
|
| Rate for Payer: First Health Workers Compensation |
$815.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,901.70
|
| Rate for Payer: GEHA Commercial |
$1,690.40
|
| Rate for Payer: GEHA Medicare |
$6,080.92
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,901.70
|
| 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 |
$1,922.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,337.56
|
| Rate for Payer: OMNI Networks Commercial |
$1,479.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,901.70
|
| 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 |
$2,007.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12,161.84
|
| Rate for Payer: Three Rivers Provider Network All |
$1,584.75
|
| 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 |
$1,965.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,080.92
|
| Rate for Payer: Zelis Auto |
$845.20
|
| 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 |
$576.85
|
|
|
REPAIR OF LEG NERVE
|
Facility
|
IP
|
$2,113.00
|
|
|
Service Code
|
CPT 64840
|
| Hospital Charge Code |
6164840
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$576.85 |
| Max. Negotiated Rate |
$2,007.35 |
| Rate for Payer: Cash Price |
$1,267.80
|
| Rate for Payer: Cigna Commercial |
$1,796.05
|
| Rate for Payer: First Health Commercial |
$1,901.70
|
| Rate for Payer: First Health Workers Compensation |
$815.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,901.70
|
| Rate for Payer: GEHA Commercial |
$1,479.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,901.70
|
| Rate for Payer: Multiplan All |
$1,922.83
|
| Rate for Payer: OMNI Networks Commercial |
$1,479.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,901.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,007.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,584.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,965.09
|
| Rate for Payer: Zelis Auto |
$845.20
|
| Rate for Payer: Zelis Worker's Compensation |
$576.85
|
|
|
REPAIR OF LEG TENDON EACH
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
CPT 27665
|
| Hospital Charge Code |
6127665
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$228.77 |
| 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 |
$502.80
|
| 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 |
$502.80
|
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cigna Commercial |
$712.30
|
| Rate for Payer: First Health Commercial |
$754.20
|
| Rate for Payer: First Health Workers Compensation |
$323.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$754.20
|
| Rate for Payer: GEHA Commercial |
$670.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$754.20
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$762.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$586.60
|
| Rate for Payer: One Health Plan PPO/POS |
$754.20
|
| 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 |
$796.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$628.50
|
| 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 |
$779.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$335.20
|
| 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 |
$228.77
|
|
|
REPAIR OF LEG TENDON EACH
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT 27664
|
| Hospital Charge Code |
6127664
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$250.34 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: First Health Workers Compensation |
$354.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$641.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
| Rate for Payer: Zelis Worker's Compensation |
$250.34
|
|
|
REPAIR OF LEG TENDON EACH
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
CPT 27665
|
| Hospital Charge Code |
6127665
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$228.77 |
| Max. Negotiated Rate |
$796.10 |
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cigna Commercial |
$712.30
|
| Rate for Payer: First Health Commercial |
$754.20
|
| Rate for Payer: First Health Workers Compensation |
$323.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$754.20
|
| Rate for Payer: GEHA Commercial |
$586.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$754.20
|
| Rate for Payer: Multiplan All |
$762.58
|
| Rate for Payer: OMNI Networks Commercial |
$586.60
|
| Rate for Payer: One Health Plan PPO/POS |
$754.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$796.10
|
| Rate for Payer: Three Rivers Provider Network All |
$628.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$779.34
|
| Rate for Payer: Zelis Auto |
$335.20
|
| Rate for Payer: Zelis Worker's Compensation |
$228.77
|
|
|
REPAIR OF LEG TENDON EACH
|
Facility
|
IP
|
$949.00
|
|
|
Service Code
|
CPT 27658
|
| Hospital Charge Code |
6127658
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$259.08 |
| Max. Negotiated Rate |
$901.55 |
| Rate for Payer: Cash Price |
$569.40
|
| Rate for Payer: Cigna Commercial |
$806.65
|
| Rate for Payer: First Health Commercial |
$854.10
|
| Rate for Payer: First Health Workers Compensation |
$366.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$854.10
|
| Rate for Payer: GEHA Commercial |
$664.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$854.10
|
| Rate for Payer: Multiplan All |
$863.59
|
| Rate for Payer: OMNI Networks Commercial |
$664.30
|
| Rate for Payer: One Health Plan PPO/POS |
$854.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$901.55
|
| Rate for Payer: Three Rivers Provider Network All |
$711.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$882.57
|
| Rate for Payer: Zelis Auto |
$379.60
|
| Rate for Payer: Zelis Worker's Compensation |
$259.08
|
|
|
REPAIR OF LEG TENDON EACH
|
Facility
|
OP
|
$949.00
|
|
|
Service Code
|
CPT 27658
|
| Hospital Charge Code |
6127658
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$259.08 |
| 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 |
$569.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$569.40
|
| Rate for Payer: Cash Price |
$569.40
|
| Rate for Payer: Cigna Commercial |
$806.65
|
| Rate for Payer: First Health Commercial |
$854.10
|
| Rate for Payer: First Health Workers Compensation |
$366.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$854.10
|
| Rate for Payer: GEHA Commercial |
$759.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$854.10
|
| 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 |
$863.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$664.30
|
| Rate for Payer: One Health Plan PPO/POS |
$854.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$901.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$711.75
|
| 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 |
$882.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$379.60
|
| 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 |
$259.08
|
|
|
REPAIR OF LEG TENDON EACH
|
Facility
|
IP
|
$1,391.73
|
|
|
Service Code
|
CPT 27659
|
| Hospital Charge Code |
6127659
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$379.94 |
| Max. Negotiated Rate |
$1,322.14 |
| Rate for Payer: Cash Price |
$835.04
|
| Rate for Payer: Cigna Commercial |
$1,182.97
|
| Rate for Payer: First Health Commercial |
$1,252.56
|
| Rate for Payer: First Health Workers Compensation |
$537.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,252.56
|
| Rate for Payer: GEHA Commercial |
$974.21
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,252.56
|
| Rate for Payer: Multiplan All |
$1,266.47
|
| Rate for Payer: OMNI Networks Commercial |
$974.21
|
| Rate for Payer: One Health Plan PPO/POS |
$1,252.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,322.14
|
| Rate for Payer: Three Rivers Provider Network All |
$1,043.80
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,294.31
|
| Rate for Payer: Zelis Auto |
$556.69
|
| Rate for Payer: Zelis Worker's Compensation |
$379.94
|
|
|
REPAIR OF LEG TENDON EACH
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT 27664
|
| Hospital Charge Code |
6127664
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$250.34 |
| 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 |
$550.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: First Health Workers Compensation |
$354.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$733.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| 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 |
$852.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$366.80
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$250.34
|
|
|
REPAIR OF LEG TENDON EACH
|
Facility
|
OP
|
$1,391.73
|
|
|
Service Code
|
CPT 27659
|
| Hospital Charge Code |
6127659
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$379.94 |
| 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 |
$835.04
|
| 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 |
$835.04
|
| Rate for Payer: Cash Price |
$835.04
|
| Rate for Payer: Cigna Commercial |
$1,182.97
|
| Rate for Payer: First Health Commercial |
$1,252.56
|
| Rate for Payer: First Health Workers Compensation |
$537.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,252.56
|
| Rate for Payer: GEHA Commercial |
$1,113.38
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,252.56
|
| 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 |
$1,266.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$974.21
|
| Rate for Payer: One Health Plan PPO/POS |
$1,252.56
|
| 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 |
$1,322.14
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,043.80
|
| 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 |
$1,294.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$556.69
|
| 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 |
$379.94
|
|
|
REPAIR OF LOWER LEG
|
Facility
|
IP
|
$2,485.00
|
|
|
Service Code
|
CPT 27725
|
| Hospital Charge Code |
6127725
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$678.40 |
| Max. Negotiated Rate |
$2,360.75 |
| Rate for Payer: Cash Price |
$1,491.00
|
| Rate for Payer: Cigna Commercial |
$2,112.25
|
| Rate for Payer: First Health Commercial |
$2,236.50
|
| Rate for Payer: First Health Workers Compensation |
$959.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,236.50
|
| Rate for Payer: GEHA Commercial |
$1,739.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,236.50
|
| Rate for Payer: Multiplan All |
$2,261.35
|
| Rate for Payer: OMNI Networks Commercial |
$1,739.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,236.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,360.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,863.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,311.05
|
| Rate for Payer: Zelis Auto |
$994.00
|
| Rate for Payer: Zelis Worker's Compensation |
$678.40
|
|
|
REPAIR OF LOWER LEG
|
Facility
|
OP
|
$2,485.00
|
|
|
Service Code
|
CPT 27725
|
| Hospital Charge Code |
6127725
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$621.25 |
| Max. Negotiated Rate |
$2,360.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,491.00
|
| Rate for Payer: Cash Price |
$1,491.00
|
| Rate for Payer: Cigna Commercial |
$2,112.25
|
| Rate for Payer: First Health Commercial |
$2,236.50
|
| Rate for Payer: First Health Workers Compensation |
$959.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,236.50
|
| Rate for Payer: GEHA Commercial |
$1,988.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,236.50
|
| Rate for Payer: Humana ChoiceCare |
$646.10
|
| Rate for Payer: Multiplan All |
$2,261.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,491.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,739.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,236.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,360.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,863.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,186.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$621.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,311.05
|
| Rate for Payer: Zelis Auto |
$994.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,242.50
|
| Rate for Payer: Zelis Worker's Compensation |
$678.40
|
|
|
REPAIR OF LOWER LEG
|
Facility
|
OP
|
$2,137.00
|
|
|
Service Code
|
CPT 27727
|
| Hospital Charge Code |
6127727
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$534.25 |
| Max. Negotiated Rate |
$2,030.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,282.20
|
| Rate for Payer: Cash Price |
$1,282.20
|
| Rate for Payer: Cigna Commercial |
$1,816.45
|
| Rate for Payer: First Health Commercial |
$1,923.30
|
| Rate for Payer: First Health Workers Compensation |
$825.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,923.30
|
| Rate for Payer: GEHA Commercial |
$1,709.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,923.30
|
| Rate for Payer: Humana ChoiceCare |
$555.62
|
| Rate for Payer: Multiplan All |
$1,944.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,282.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,495.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,923.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,030.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,602.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,880.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$534.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,987.41
|
| Rate for Payer: Zelis Auto |
$854.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,068.50
|
| Rate for Payer: Zelis Worker's Compensation |
$583.40
|
|
