|
REVISE HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$3,172.00
|
|
|
Service Code
|
CPT 27138
|
| Hospital Charge Code |
6127138
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$865.96 |
| Max. Negotiated Rate |
$3,013.40 |
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$2,696.20
|
| Rate for Payer: First Health Commercial |
$2,854.80
|
| Rate for Payer: First Health Workers Compensation |
$1,224.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,854.80
|
| Rate for Payer: GEHA Commercial |
$2,220.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,854.80
|
| Rate for Payer: Multiplan All |
$2,886.52
|
| Rate for Payer: OMNI Networks Commercial |
$2,220.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,854.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,013.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,379.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,949.96
|
| Rate for Payer: Zelis Auto |
$1,268.80
|
| Rate for Payer: Zelis Worker's Compensation |
$865.96
|
|
|
REVISE HIP JOINT REPLACEMENT
|
Facility
|
OP
|
$3,172.00
|
|
|
Service Code
|
CPT 27138
|
| Hospital Charge Code |
6127138
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$793.00 |
| Max. Negotiated Rate |
$3,013.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,903.20
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$2,696.20
|
| Rate for Payer: First Health Commercial |
$2,854.80
|
| Rate for Payer: First Health Workers Compensation |
$1,224.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,854.80
|
| Rate for Payer: GEHA Commercial |
$2,537.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,854.80
|
| Rate for Payer: Humana ChoiceCare |
$824.72
|
| Rate for Payer: Multiplan All |
$2,886.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,903.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,220.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,854.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,013.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,379.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,791.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$793.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,949.96
|
| Rate for Payer: Zelis Auto |
$1,268.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,586.00
|
| Rate for Payer: Zelis Worker's Compensation |
$865.96
|
|
|
REVISE/IMPLANT FINGER JOINT
|
Facility
|
IP
|
$1,398.00
|
|
|
Service Code
|
CPT 26536
|
| Hospital Charge Code |
6126536
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$381.65 |
| Max. Negotiated Rate |
$1,328.10 |
| Rate for Payer: Cash Price |
$838.80
|
| Rate for Payer: Cigna Commercial |
$1,188.30
|
| Rate for Payer: First Health Commercial |
$1,258.20
|
| Rate for Payer: First Health Workers Compensation |
$539.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,258.20
|
| Rate for Payer: GEHA Commercial |
$978.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,258.20
|
| Rate for Payer: Multiplan All |
$1,272.18
|
| Rate for Payer: OMNI Networks Commercial |
$978.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,258.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,328.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,048.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,300.14
|
| Rate for Payer: Zelis Auto |
$559.20
|
| Rate for Payer: Zelis Worker's Compensation |
$381.65
|
|
|
REVISE/IMPLANT FINGER JOINT
|
Facility
|
OP
|
$1,398.00
|
|
|
Service Code
|
CPT 26536
|
| Hospital Charge Code |
6126536
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$381.65 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,872.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$838.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,872.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,652.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$838.80
|
| Rate for Payer: Cash Price |
$838.80
|
| Rate for Payer: Cigna Commercial |
$1,188.30
|
| Rate for Payer: First Health Commercial |
$1,258.20
|
| Rate for Payer: First Health Workers Compensation |
$539.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,258.20
|
| Rate for Payer: GEHA Commercial |
$1,118.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,258.20
|
| 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 |
$4,747.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,272.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$978.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,258.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5,481.28
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,747.18
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,328.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,048.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,747.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,300.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$559.20
|
| 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 |
$381.65
|
|
|
REVISE KNEECAP
|
Facility
|
OP
|
$1,353.00
|
|
|
Service Code
|
CPT 27437
|
| Hospital Charge Code |
6127437
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$369.37 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,033.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$811.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,033.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,194.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cigna Commercial |
$1,150.05
|
| Rate for Payer: First Health Commercial |
$1,217.70
|
| Rate for Payer: First Health Workers Compensation |
$522.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,217.70
|
| Rate for Payer: GEHA Commercial |
$1,082.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,217.70
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,260.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,231.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$947.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,217.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,764.14
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,260.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,285.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,014.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,260.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,258.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$541.20
|
| 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 |
$369.37
|
|
|
REVISE KNEECAP
|
Facility
|
IP
|
$1,353.00
|
|
|
Service Code
|
CPT 27437
|
| Hospital Charge Code |
6127437
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$369.37 |
| Max. Negotiated Rate |
$1,285.35 |
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cigna Commercial |
$1,150.05
|
| Rate for Payer: First Health Commercial |
$1,217.70
|
| Rate for Payer: First Health Workers Compensation |
$522.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,217.70
|
| Rate for Payer: GEHA Commercial |
$947.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,217.70
|
| Rate for Payer: Multiplan All |
$1,231.23
|
| Rate for Payer: OMNI Networks Commercial |
$947.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,217.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,285.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,014.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,258.29
|
| Rate for Payer: Zelis Auto |
$541.20
|
| Rate for Payer: Zelis Worker's Compensation |
$369.37
|
|
|
REVISE KNEECAP WITH IMPLANT
|
Facility
|
IP
|
$1,726.00
|
|
|
Service Code
|
CPT 27438
|
| Hospital Charge Code |
6127438
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$471.20 |
| Max. Negotiated Rate |
$1,639.70 |
| Rate for Payer: Cash Price |
$1,035.60
|
| Rate for Payer: Cigna Commercial |
$1,467.10
|
| Rate for Payer: First Health Commercial |
$1,553.40
|
| Rate for Payer: First Health Workers Compensation |
$666.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,553.40
|
| Rate for Payer: GEHA Commercial |
$1,208.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,553.40
|
| Rate for Payer: Multiplan All |
$1,570.66
|
| Rate for Payer: OMNI Networks Commercial |
$1,208.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,553.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,639.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,294.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,605.18
|
| Rate for Payer: Zelis Auto |
$690.40
|
| Rate for Payer: Zelis Worker's Compensation |
$471.20
|
|
|
REVISE KNEECAP WITH IMPLANT
|
Facility
|
OP
|
$1,726.00
|
|
|
Service Code
|
CPT 27438
|
| Hospital Charge Code |
6127438
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$471.20 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,872.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,035.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,872.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,652.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: Cash Price |
$1,035.60
|
| Rate for Payer: Cash Price |
$1,035.60
|
| Rate for Payer: Cigna Commercial |
$1,467.10
|
| Rate for Payer: First Health Commercial |
$1,553.40
|
| Rate for Payer: First Health Workers Compensation |
$666.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,553.40
|
| Rate for Payer: GEHA Commercial |
$1,380.80
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,553.40
|
| 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 |
$4,747.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,570.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,208.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,553.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5,481.28
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,747.18
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,639.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,294.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,747.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,605.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$690.40
|
| 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 |
$471.20
|
|
|
REVISE KNUCKLE JOINT
|
Facility
|
IP
|
$1,088.00
|
|
|
Service Code
|
CPT 26530
|
| Hospital Charge Code |
6126530
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$297.02 |
| Max. Negotiated Rate |
$1,033.60 |
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cigna Commercial |
$924.80
|
| Rate for Payer: First Health Commercial |
$979.20
|
| Rate for Payer: First Health Workers Compensation |
$420.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$979.20
|
| Rate for Payer: GEHA Commercial |
$761.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$979.20
|
| Rate for Payer: Multiplan All |
$990.08
|
| Rate for Payer: OMNI Networks Commercial |
$761.60
|
| Rate for Payer: One Health Plan PPO/POS |
$979.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,033.60
|
| Rate for Payer: Three Rivers Provider Network All |
$816.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,011.84
|
| Rate for Payer: Zelis Auto |
$435.20
|
| Rate for Payer: Zelis Worker's Compensation |
$297.02
|
|
|
REVISE KNUCKLE JOINT
|
Facility
|
OP
|
$1,088.00
|
|
|
Service Code
|
CPT 26530
|
| Hospital Charge Code |
6126530
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$297.02 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,033.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$652.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,033.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,194.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cigna Commercial |
$924.80
|
| Rate for Payer: First Health Commercial |
$979.20
|
| Rate for Payer: First Health Workers Compensation |
$420.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$979.20
|
| Rate for Payer: GEHA Commercial |
$870.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$979.20
|
| 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 |
$3,260.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$990.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$761.60
|
| Rate for Payer: One Health Plan PPO/POS |
$979.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,764.14
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,260.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,033.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$816.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,260.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,011.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$435.20
|
| 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 |
$297.02
|
|
|
REVISE KNUCKLE WITH IMPLANT
|
Facility
|
IP
|
$1,267.00
|
|
|
Service Code
|
CPT 26531
|
| Hospital Charge Code |
6126531
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$345.89 |
| Max. Negotiated Rate |
$1,203.65 |
| Rate for Payer: Cash Price |
$760.20
|
| Rate for Payer: Cigna Commercial |
$1,076.95
|
| Rate for Payer: First Health Commercial |
$1,140.30
|
| Rate for Payer: First Health Workers Compensation |
$489.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,140.30
|
| Rate for Payer: GEHA Commercial |
$886.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,140.30
|
| Rate for Payer: Multiplan All |
$1,152.97
|
| Rate for Payer: OMNI Networks Commercial |
$886.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,140.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,203.65
|
| Rate for Payer: Three Rivers Provider Network All |
$950.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,178.31
|
| Rate for Payer: Zelis Auto |
$506.80
|
| Rate for Payer: Zelis Worker's Compensation |
$345.89
|
|
|
REVISE KNUCKLE WITH IMPLANT
|
Facility
|
OP
|
$1,267.00
|
|
|
Service Code
|
CPT 26531
|
| Hospital Charge Code |
6126531
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$345.89 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,872.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$760.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,872.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,652.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$760.20
|
| Rate for Payer: Cash Price |
$760.20
|
| Rate for Payer: Cigna Commercial |
$1,076.95
|
| Rate for Payer: First Health Commercial |
$1,140.30
|
| Rate for Payer: First Health Workers Compensation |
$489.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,140.30
|
| Rate for Payer: GEHA Commercial |
$1,013.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,140.30
|
| 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 |
$4,747.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,152.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$886.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,140.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5,481.28
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,747.18
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,203.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$950.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,747.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,178.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$506.80
|
| 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 |
$345.89
|
|
|
REVISE LEG VEIN
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 37700
|
| Hospital Charge Code |
6137700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$180.18 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: First Health Workers Compensation |
$254.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$462.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
| Rate for Payer: Zelis Worker's Compensation |
$180.18
|
|
|
REVISE LEG VEIN
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 37700
|
| Hospital Charge Code |
6137700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$180.18 |
| Max. Negotiated Rate |
$5,977.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,686.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$396.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,686.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,128.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: First Health Workers Compensation |
$254.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$528.00
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,171.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,507.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,171.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,171.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$264.00
|
| Rate for Payer: Zelis Medicare |
$2,540.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,586.42
|
| Rate for Payer: Zelis Worker's Compensation |
$180.18
|
|
|
REVISE LOW BACK NERVE(S)
|
Facility
|
IP
|
$1,318.00
|
|
|
Service Code
|
CPT 64714
|
| Hospital Charge Code |
6164714
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$359.81 |
| Max. Negotiated Rate |
$1,252.10 |
| Rate for Payer: Cash Price |
$790.80
|
| Rate for Payer: Cigna Commercial |
$1,120.30
|
| Rate for Payer: First Health Commercial |
$1,186.20
|
| Rate for Payer: First Health Workers Compensation |
$508.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,186.20
|
| Rate for Payer: GEHA Commercial |
$922.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,186.20
|
| Rate for Payer: Multiplan All |
$1,199.38
|
| Rate for Payer: OMNI Networks Commercial |
$922.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,186.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,252.10
|
| Rate for Payer: Three Rivers Provider Network All |
$988.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,225.74
|
| Rate for Payer: Zelis Auto |
$527.20
|
| Rate for Payer: Zelis Worker's Compensation |
$359.81
|
|
|
REVISE LOW BACK NERVE(S)
|
Facility
|
OP
|
$1,318.00
|
|
|
Service Code
|
CPT 64714
|
| Hospital Charge Code |
6164714
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$359.81 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$790.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$790.80
|
| Rate for Payer: Cash Price |
$790.80
|
| Rate for Payer: Cigna Commercial |
$1,120.30
|
| Rate for Payer: First Health Commercial |
$1,186.20
|
| Rate for Payer: First Health Workers Compensation |
$508.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,186.20
|
| Rate for Payer: GEHA Commercial |
$1,054.40
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,186.20
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$1,199.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$922.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,186.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,252.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$988.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,225.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$527.20
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$359.81
|
|
|
REVISE LOWER LEG TENDON
|
Facility
|
IP
|
$1,285.00
|
|
|
Service Code
|
CPT 27690
|
| Hospital Charge Code |
6127690
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$350.81 |
| Max. Negotiated Rate |
$1,220.75 |
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,092.25
|
| Rate for Payer: First Health Commercial |
$1,156.50
|
| Rate for Payer: First Health Workers Compensation |
$496.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,156.50
|
| Rate for Payer: GEHA Commercial |
$899.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,156.50
|
| Rate for Payer: Multiplan All |
$1,169.35
|
| Rate for Payer: OMNI Networks Commercial |
$899.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,156.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,220.75
|
| Rate for Payer: Three Rivers Provider Network All |
$963.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,195.05
|
| Rate for Payer: Zelis Auto |
$514.00
|
| Rate for Payer: Zelis Worker's Compensation |
$350.81
|
|
|
REVISE LOWER LEG TENDON
|
Facility
|
OP
|
$2,140.74
|
|
|
Service Code
|
CPT 27691
|
| Hospital Charge Code |
6127691
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$584.42 |
| 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 |
$1,284.44
|
| 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 |
$1,284.44
|
| Rate for Payer: Cash Price |
$1,284.44
|
| Rate for Payer: Cigna Commercial |
$1,819.63
|
| Rate for Payer: First Health Commercial |
$1,926.67
|
| Rate for Payer: First Health Workers Compensation |
$826.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,926.67
|
| Rate for Payer: GEHA Commercial |
$1,712.59
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,926.67
|
| 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 |
$1,948.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,498.52
|
| Rate for Payer: One Health Plan PPO/POS |
$1,926.67
|
| 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 |
$2,033.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,605.56
|
| 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 |
$1,990.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$856.30
|
| 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 |
$584.42
|
|
|
REVISE LOWER LEG TENDON
|
Facility
|
OP
|
$1,285.00
|
|
|
Service Code
|
CPT 27690
|
| Hospital Charge Code |
6127690
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$350.81 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$771.00
|
| 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 |
$771.00
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,092.25
|
| Rate for Payer: First Health Commercial |
$1,156.50
|
| Rate for Payer: First Health Workers Compensation |
$496.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,156.50
|
| Rate for Payer: GEHA Commercial |
$1,028.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,156.50
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,169.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$899.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,156.50
|
| 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 |
$1,220.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$963.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,195.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$514.00
|
| 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 |
$350.81
|
|
|
REVISE LOWER LEG TENDON
|
Facility
|
IP
|
$2,140.74
|
|
|
Service Code
|
CPT 27691
|
| Hospital Charge Code |
6127691
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$584.42 |
| Max. Negotiated Rate |
$2,033.70 |
| Rate for Payer: Cash Price |
$1,284.44
|
| Rate for Payer: Cigna Commercial |
$1,819.63
|
| Rate for Payer: First Health Commercial |
$1,926.67
|
| Rate for Payer: First Health Workers Compensation |
$826.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,926.67
|
| Rate for Payer: GEHA Commercial |
$1,498.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,926.67
|
| Rate for Payer: Multiplan All |
$1,948.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,498.52
|
| Rate for Payer: One Health Plan PPO/POS |
$1,926.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,033.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,605.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,990.89
|
| Rate for Payer: Zelis Auto |
$856.30
|
| Rate for Payer: Zelis Worker's Compensation |
$584.42
|
|
|
REVISE LOWER LEG TENDONS
|
Facility
|
OP
|
$1,559.00
|
|
|
Service Code
|
CPT 27686
|
| Hospital Charge Code |
6127686
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$425.61 |
| 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 |
$935.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$935.40
|
| Rate for Payer: Cash Price |
$935.40
|
| Rate for Payer: Cigna Commercial |
$1,325.15
|
| Rate for Payer: First Health Commercial |
$1,403.10
|
| Rate for Payer: First Health Workers Compensation |
$601.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,403.10
|
| Rate for Payer: GEHA Commercial |
$1,247.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,403.10
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,418.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,091.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,403.10
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,481.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,169.25
|
| 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 |
$1,449.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$623.60
|
| 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 |
$425.61
|
|
|
REVISE LOWER LEG TENDONS
|
Facility
|
IP
|
$1,559.00
|
|
|
Service Code
|
CPT 27686
|
| Hospital Charge Code |
6127686
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$425.61 |
| Max. Negotiated Rate |
$1,481.05 |
| Rate for Payer: Cash Price |
$935.40
|
| Rate for Payer: Cigna Commercial |
$1,325.15
|
| Rate for Payer: First Health Commercial |
$1,403.10
|
| Rate for Payer: First Health Workers Compensation |
$601.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,403.10
|
| Rate for Payer: GEHA Commercial |
$1,091.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,403.10
|
| Rate for Payer: Multiplan All |
$1,418.69
|
| Rate for Payer: OMNI Networks Commercial |
$1,091.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,403.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,481.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,169.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,449.87
|
| Rate for Payer: Zelis Auto |
$623.60
|
| Rate for Payer: Zelis Worker's Compensation |
$425.61
|
|
|
REVISE MIDDLE EAR BONE
|
Facility
|
IP
|
$1,893.00
|
|
|
Service Code
|
CPT 69660
|
| Hospital Charge Code |
6169660
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$516.79 |
| Max. Negotiated Rate |
$1,798.35 |
| Rate for Payer: Cash Price |
$1,135.80
|
| Rate for Payer: Cigna Commercial |
$1,609.05
|
| Rate for Payer: First Health Commercial |
$1,703.70
|
| Rate for Payer: First Health Workers Compensation |
$730.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,703.70
|
| Rate for Payer: GEHA Commercial |
$1,325.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,703.70
|
| Rate for Payer: Multiplan All |
$1,722.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,325.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,703.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,798.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,419.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,760.49
|
| Rate for Payer: Zelis Auto |
$757.20
|
| Rate for Payer: Zelis Worker's Compensation |
$516.79
|
|
|
REVISE MIDDLE EAR BONE
|
Facility
|
IP
|
$2,470.00
|
|
|
Service Code
|
CPT 69661
|
| Hospital Charge Code |
6169661
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$674.31 |
| Max. Negotiated Rate |
$2,346.50 |
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cigna Commercial |
$2,099.50
|
| Rate for Payer: First Health Commercial |
$2,223.00
|
| Rate for Payer: First Health Workers Compensation |
$953.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,223.00
|
| Rate for Payer: GEHA Commercial |
$1,729.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,223.00
|
| Rate for Payer: Multiplan All |
$2,247.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,729.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,223.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,346.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,852.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,297.10
|
| Rate for Payer: Zelis Auto |
$988.00
|
| Rate for Payer: Zelis Worker's Compensation |
$674.31
|
|
|
REVISE MIDDLE EAR BONE
|
Facility
|
OP
|
$2,470.00
|
|
|
Service Code
|
CPT 69661
|
| Hospital Charge Code |
6169661
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$674.31 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,482.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cigna Commercial |
$2,099.50
|
| Rate for Payer: First Health Commercial |
$2,223.00
|
| Rate for Payer: First Health Workers Compensation |
$953.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,223.00
|
| Rate for Payer: GEHA Commercial |
$1,976.00
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,223.00
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$2,247.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,729.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,223.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,346.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,852.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,297.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$988.00
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$674.31
|
|
