|
REVISION OF COLOSTOMY
|
Facility
|
IP
|
$2,204.00
|
|
|
Service Code
|
CPT 44345
|
| Hospital Charge Code |
6144345
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$601.69 |
| Max. Negotiated Rate |
$2,093.80 |
| Rate for Payer: Cash Price |
$1,322.40
|
| Rate for Payer: Cigna Commercial |
$1,873.40
|
| Rate for Payer: First Health Commercial |
$1,983.60
|
| Rate for Payer: First Health Workers Compensation |
$850.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,983.60
|
| Rate for Payer: GEHA Commercial |
$1,542.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,983.60
|
| Rate for Payer: Multiplan All |
$2,005.64
|
| Rate for Payer: OMNI Networks Commercial |
$1,542.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,983.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,093.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,653.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,049.72
|
| Rate for Payer: Zelis Auto |
$881.60
|
| Rate for Payer: Zelis Worker's Compensation |
$601.69
|
|
|
REVISION OF COLOSTOMY
|
Facility
|
IP
|
$2,482.00
|
|
|
Service Code
|
CPT 44346
|
| Hospital Charge Code |
6144346
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$677.59 |
| Max. Negotiated Rate |
$2,357.90 |
| Rate for Payer: Cash Price |
$1,489.20
|
| Rate for Payer: Cigna Commercial |
$2,109.70
|
| Rate for Payer: First Health Commercial |
$2,233.80
|
| Rate for Payer: First Health Workers Compensation |
$958.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,233.80
|
| Rate for Payer: GEHA Commercial |
$1,737.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,233.80
|
| Rate for Payer: Multiplan All |
$2,258.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,737.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,233.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,357.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,861.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,308.26
|
| Rate for Payer: Zelis Auto |
$992.80
|
| Rate for Payer: Zelis Worker's Compensation |
$677.59
|
|
|
REVISION OF CRANIAL NERVE
|
Facility
|
IP
|
$1,095.00
|
|
|
Service Code
|
CPT 64716
|
| Hospital Charge Code |
6164716
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$298.94 |
| Max. Negotiated Rate |
$1,040.25 |
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$930.75
|
| Rate for Payer: First Health Commercial |
$985.50
|
| Rate for Payer: First Health Workers Compensation |
$422.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$985.50
|
| Rate for Payer: GEHA Commercial |
$766.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$985.50
|
| Rate for Payer: Multiplan All |
$996.45
|
| Rate for Payer: OMNI Networks Commercial |
$766.50
|
| Rate for Payer: One Health Plan PPO/POS |
$985.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,040.25
|
| Rate for Payer: Three Rivers Provider Network All |
$821.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,018.35
|
| Rate for Payer: Zelis Auto |
$438.00
|
| Rate for Payer: Zelis Worker's Compensation |
$298.94
|
|
|
REVISION OF CRANIAL NERVE
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT 64716
|
| Hospital Charge Code |
6164716
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$298.94 |
| 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 |
$657.00
|
| 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 |
$657.00
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$930.75
|
| Rate for Payer: First Health Commercial |
$985.50
|
| Rate for Payer: First Health Workers Compensation |
$422.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$985.50
|
| Rate for Payer: GEHA Commercial |
$876.00
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$985.50
|
| 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 |
$996.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$766.50
|
| Rate for Payer: One Health Plan PPO/POS |
$985.50
|
| 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 |
$1,040.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$821.25
|
| 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 |
$1,018.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$438.00
|
| 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 |
$298.94
|
|
|
REVISION OF ELBOW JOINT
|
Facility
|
OP
|
$1,160.00
|
|
|
Service Code
|
CPT 24470
|
| Hospital Charge Code |
6124470
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$316.68 |
| 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 |
$696.00
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$986.00
|
| Rate for Payer: First Health Commercial |
$1,044.00
|
| Rate for Payer: First Health Workers Compensation |
$447.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.00
|
| Rate for Payer: GEHA Commercial |
$928.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.00
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,055.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$812.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.00
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,102.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$870.00
|
| 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 |
$1,078.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$464.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$316.68
|
|
|
REVISION OF ELBOW JOINT
|
Facility
|
IP
|
$1,160.00
|
|
|
Service Code
|
CPT 24470
|
| Hospital Charge Code |
6124470
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$316.68 |
| Max. Negotiated Rate |
$1,102.00 |
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$986.00
|
| Rate for Payer: First Health Commercial |
$1,044.00
|
| Rate for Payer: First Health Workers Compensation |
$447.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.00
|
| Rate for Payer: GEHA Commercial |
$812.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.00
|
| Rate for Payer: Multiplan All |
$1,055.60
|
| Rate for Payer: OMNI Networks Commercial |
$812.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,102.00
|
| Rate for Payer: Three Rivers Provider Network All |
$870.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,078.80
|
| Rate for Payer: Zelis Auto |
$464.00
|
| Rate for Payer: Zelis Worker's Compensation |
$316.68
|
|
|
REVISION OF ETHMOID SINUS
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
CPT 31254
|
| Hospital Charge Code |
6131254
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$193.01 |
| Max. Negotiated Rate |
$671.65 |
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cigna Commercial |
$600.95
|
| Rate for Payer: First Health Commercial |
$636.30
|
| Rate for Payer: First Health Workers Compensation |
$272.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$636.30
|
| Rate for Payer: GEHA Commercial |
$494.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$636.30
|
| Rate for Payer: Multiplan All |
$643.37
|
| Rate for Payer: OMNI Networks Commercial |
$494.90
|
| Rate for Payer: One Health Plan PPO/POS |
$636.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$671.65
|
| Rate for Payer: Three Rivers Provider Network All |
$530.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$657.51
|
| Rate for Payer: Zelis Auto |
$282.80
|
| Rate for Payer: Zelis Worker's Compensation |
$193.01
|
|
|
REVISION OF ETHMOID SINUS
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
CPT 31254
|
| Hospital Charge Code |
6131254
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$193.01 |
| Max. Negotiated Rate |
$13,146.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,959.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$424.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,959.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,344.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,573.16
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cigna Commercial |
$600.95
|
| Rate for Payer: First Health Commercial |
$636.30
|
| Rate for Payer: First Health Workers Compensation |
$272.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$636.30
|
| Rate for Payer: GEHA Commercial |
$565.60
|
| Rate for Payer: GEHA Medicare |
$6,573.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$636.30
|
| Rate for Payer: Humana ChoiceCare |
$7,230.48
|
| Rate for Payer: Humana Medicare Advantage |
$6,573.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,042.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,392.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,573.16
|
| Rate for Payer: Multiplan All |
$643.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,174.37
|
| Rate for Payer: OMNI Networks Commercial |
$494.90
|
| Rate for Payer: One Health Plan PPO/POS |
$636.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,762.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,392.37
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,573.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$671.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,146.32
|
| Rate for Payer: Three Rivers Provider Network All |
$530.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,441.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,392.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,573.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$657.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,573.16
|
| Rate for Payer: Zelis Auto |
$282.80
|
| Rate for Payer: Zelis Medicare |
$5,587.19
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,887.79
|
| Rate for Payer: Zelis Worker's Compensation |
$193.01
|
|
|
REVISION OF FEMUR EPIPHYSIS
|
Facility
|
OP
|
$1,249.00
|
|
|
Service Code
|
CPT 27185
|
| Hospital Charge Code |
6127185
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$312.25 |
| Max. Negotiated Rate |
$1,186.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$749.40
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cigna Commercial |
$1,061.65
|
| Rate for Payer: First Health Commercial |
$1,124.10
|
| Rate for Payer: First Health Workers Compensation |
$482.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,124.10
|
| Rate for Payer: GEHA Commercial |
$999.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,124.10
|
| Rate for Payer: Humana ChoiceCare |
$324.74
|
| Rate for Payer: Multiplan All |
$1,136.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$749.40
|
| Rate for Payer: OMNI Networks Commercial |
$874.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,124.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,186.55
|
| Rate for Payer: Three Rivers Provider Network All |
$936.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,099.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$312.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,161.57
|
| Rate for Payer: Zelis Auto |
$499.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$624.50
|
| Rate for Payer: Zelis Worker's Compensation |
$340.98
|
|
|
REVISION OF FEMUR EPIPHYSIS
|
Facility
|
IP
|
$1,249.00
|
|
|
Service Code
|
CPT 27185
|
| Hospital Charge Code |
6127185
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$340.98 |
| Max. Negotiated Rate |
$1,186.55 |
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cigna Commercial |
$1,061.65
|
| Rate for Payer: First Health Commercial |
$1,124.10
|
| Rate for Payer: First Health Workers Compensation |
$482.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,124.10
|
| Rate for Payer: GEHA Commercial |
$874.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,124.10
|
| Rate for Payer: Multiplan All |
$1,136.59
|
| Rate for Payer: OMNI Networks Commercial |
$874.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,124.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,186.55
|
| Rate for Payer: Three Rivers Provider Network All |
$936.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,161.57
|
| Rate for Payer: Zelis Auto |
$499.60
|
| Rate for Payer: Zelis Worker's Compensation |
$340.98
|
|
|
REVISION OF FINGER
|
Facility
|
OP
|
$1,656.00
|
|
|
Service Code
|
CPT 26499
|
| Hospital Charge Code |
6126499
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$452.09 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$993.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$993.60
|
| Rate for Payer: Cash Price |
$993.60
|
| Rate for Payer: Cigna Commercial |
$1,407.60
|
| Rate for Payer: First Health Commercial |
$1,490.40
|
| Rate for Payer: First Health Workers Compensation |
$639.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,490.40
|
| Rate for Payer: GEHA Commercial |
$1,324.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,490.40
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,506.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,159.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,490.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,573.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,242.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,540.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$662.40
|
| 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 |
$452.09
|
|
|
REVISION OF FINGER
|
Facility
|
IP
|
$1,656.00
|
|
|
Service Code
|
CPT 26499
|
| Hospital Charge Code |
6126499
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$452.09 |
| Max. Negotiated Rate |
$1,573.20 |
| Rate for Payer: Cash Price |
$993.60
|
| Rate for Payer: Cigna Commercial |
$1,407.60
|
| Rate for Payer: First Health Commercial |
$1,490.40
|
| Rate for Payer: First Health Workers Compensation |
$639.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,490.40
|
| Rate for Payer: GEHA Commercial |
$1,159.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,490.40
|
| Rate for Payer: Multiplan All |
$1,506.96
|
| Rate for Payer: OMNI Networks Commercial |
$1,159.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,490.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,573.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,242.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,540.08
|
| Rate for Payer: Zelis Auto |
$662.40
|
| Rate for Payer: Zelis Worker's Compensation |
$452.09
|
|
|
REVISION OF FOOT
|
Facility
|
IP
|
$1,168.00
|
|
|
Service Code
|
CPT 28116
|
| Hospital Charge Code |
6128116
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$318.86 |
| Max. Negotiated Rate |
$1,109.60 |
| Rate for Payer: Cash Price |
$700.80
|
| Rate for Payer: Cigna Commercial |
$992.80
|
| Rate for Payer: First Health Commercial |
$1,051.20
|
| Rate for Payer: First Health Workers Compensation |
$450.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,051.20
|
| Rate for Payer: GEHA Commercial |
$817.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,051.20
|
| Rate for Payer: Multiplan All |
$1,062.88
|
| Rate for Payer: OMNI Networks Commercial |
$817.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,051.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,109.60
|
| Rate for Payer: Three Rivers Provider Network All |
$876.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,086.24
|
| Rate for Payer: Zelis Auto |
$467.20
|
| Rate for Payer: Zelis Worker's Compensation |
$318.86
|
|
|
REVISION OF FOOT
|
Facility
|
OP
|
$1,168.00
|
|
|
Service Code
|
CPT 28116
|
| Hospital Charge Code |
6128116
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$318.86 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$700.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$700.80
|
| Rate for Payer: Cash Price |
$700.80
|
| Rate for Payer: Cigna Commercial |
$992.80
|
| Rate for Payer: First Health Commercial |
$1,051.20
|
| Rate for Payer: First Health Workers Compensation |
$450.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,051.20
|
| Rate for Payer: GEHA Commercial |
$934.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,051.20
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,062.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$817.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,051.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,109.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$876.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,086.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$467.20
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$318.86
|
|
|
REVISION OF FOOT AND ANKLE
|
Facility
|
IP
|
$2,443.00
|
|
|
Service Code
|
CPT 28262
|
| Hospital Charge Code |
6128262
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$666.94 |
| Max. Negotiated Rate |
$2,320.85 |
| Rate for Payer: Cash Price |
$1,465.80
|
| Rate for Payer: Cigna Commercial |
$2,076.55
|
| Rate for Payer: First Health Commercial |
$2,198.70
|
| Rate for Payer: First Health Workers Compensation |
$943.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,198.70
|
| Rate for Payer: GEHA Commercial |
$1,710.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,198.70
|
| Rate for Payer: Multiplan All |
$2,223.13
|
| Rate for Payer: OMNI Networks Commercial |
$1,710.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,198.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,320.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,832.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,271.99
|
| Rate for Payer: Zelis Auto |
$977.20
|
| Rate for Payer: Zelis Worker's Compensation |
$666.94
|
|
|
REVISION OF FOOT AND ANKLE
|
Facility
|
OP
|
$2,443.00
|
|
|
Service Code
|
CPT 28262
|
| Hospital Charge Code |
6128262
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$666.94 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,465.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,465.80
|
| Rate for Payer: Cash Price |
$1,465.80
|
| Rate for Payer: Cigna Commercial |
$2,076.55
|
| Rate for Payer: First Health Commercial |
$2,198.70
|
| Rate for Payer: First Health Workers Compensation |
$943.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,198.70
|
| Rate for Payer: GEHA Commercial |
$1,954.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,198.70
|
| 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 |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$2,223.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,710.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,198.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,320.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,832.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,271.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$977.20
|
| 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 |
$666.94
|
|
|
REVISION OF FOOT BONES
|
Facility
|
IP
|
$1,415.00
|
|
|
Service Code
|
CPT 28737
|
| Hospital Charge Code |
6128737
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$386.30 |
| Max. Negotiated Rate |
$1,344.25 |
| Rate for Payer: Cash Price |
$849.00
|
| Rate for Payer: Cigna Commercial |
$1,202.75
|
| Rate for Payer: First Health Commercial |
$1,273.50
|
| Rate for Payer: First Health Workers Compensation |
$546.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,273.50
|
| Rate for Payer: GEHA Commercial |
$990.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,273.50
|
| Rate for Payer: Multiplan All |
$1,287.65
|
| Rate for Payer: OMNI Networks Commercial |
$990.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,273.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,344.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,061.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,315.95
|
| Rate for Payer: Zelis Auto |
$566.00
|
| Rate for Payer: Zelis Worker's Compensation |
$386.30
|
|
|
REVISION OF FOOT BONES
|
Facility
|
OP
|
$1,415.00
|
|
|
Service Code
|
CPT 28737
|
| Hospital Charge Code |
6128737
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$386.30 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$849.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,207.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: Cash Price |
$849.00
|
| Rate for Payer: Cash Price |
$849.00
|
| Rate for Payer: Cigna Commercial |
$1,202.75
|
| Rate for Payer: First Health Commercial |
$1,273.50
|
| Rate for Payer: First Health Workers Compensation |
$546.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,273.50
|
| Rate for Payer: GEHA Commercial |
$1,132.00
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,273.50
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,292.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,287.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$990.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,273.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,956.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,292.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,344.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,061.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,292.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,315.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$566.00
|
| 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 |
$386.30
|
|
|
REVISION OF FOOT FASCIA
|
Facility
|
IP
|
$830.00
|
|
|
Service Code
|
CPT 28250
|
| Hospital Charge Code |
6128250
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$226.59 |
| Max. Negotiated Rate |
$788.50 |
| Rate for Payer: Cash Price |
$498.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$747.00
|
| Rate for Payer: First Health Workers Compensation |
$320.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$747.00
|
| Rate for Payer: GEHA Commercial |
$581.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$747.00
|
| Rate for Payer: Multiplan All |
$755.30
|
| Rate for Payer: OMNI Networks Commercial |
$581.00
|
| Rate for Payer: One Health Plan PPO/POS |
$747.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$788.50
|
| Rate for Payer: Three Rivers Provider Network All |
$622.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$771.90
|
| Rate for Payer: Zelis Auto |
$332.00
|
| Rate for Payer: Zelis Worker's Compensation |
$226.59
|
|
|
REVISION OF FOOT FASCIA
|
Facility
|
OP
|
$830.00
|
|
|
Service Code
|
CPT 28250
|
| Hospital Charge Code |
6128250
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$226.59 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$498.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$498.00
|
| Rate for Payer: Cash Price |
$498.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$747.00
|
| Rate for Payer: First Health Workers Compensation |
$320.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$747.00
|
| Rate for Payer: GEHA Commercial |
$664.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$747.00
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$755.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$581.00
|
| Rate for Payer: One Health Plan PPO/POS |
$747.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$788.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$622.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$771.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$332.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$226.59
|
|
|
REVISION OF FOOT TENDON
|
Facility
|
OP
|
$998.00
|
|
|
Service Code
|
CPT 28238
|
| Hospital Charge Code |
6128238
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$272.45 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$598.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,207.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$598.80
|
| Rate for Payer: Cash Price |
$598.80
|
| Rate for Payer: Cigna Commercial |
$848.30
|
| Rate for Payer: First Health Commercial |
$898.20
|
| Rate for Payer: First Health Workers Compensation |
$385.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$898.20
|
| Rate for Payer: GEHA Commercial |
$798.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$898.20
|
| 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 |
$4,292.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$908.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$698.60
|
| Rate for Payer: One Health Plan PPO/POS |
$898.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,956.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,292.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$948.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$748.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,292.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$928.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$399.20
|
| 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 |
$272.45
|
|
|
REVISION OF FOOT TENDON
|
Facility
|
IP
|
$998.00
|
|
|
Service Code
|
CPT 28238
|
| Hospital Charge Code |
6128238
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$272.45 |
| Max. Negotiated Rate |
$948.10 |
| Rate for Payer: Cash Price |
$598.80
|
| Rate for Payer: Cigna Commercial |
$848.30
|
| Rate for Payer: First Health Commercial |
$898.20
|
| Rate for Payer: First Health Workers Compensation |
$385.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$898.20
|
| Rate for Payer: GEHA Commercial |
$698.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$898.20
|
| Rate for Payer: Multiplan All |
$908.18
|
| Rate for Payer: OMNI Networks Commercial |
$698.60
|
| Rate for Payer: One Health Plan PPO/POS |
$898.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$948.10
|
| Rate for Payer: Three Rivers Provider Network All |
$748.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$928.14
|
| Rate for Payer: Zelis Auto |
$399.20
|
| Rate for Payer: Zelis Worker's Compensation |
$272.45
|
|
|
REVISION OF FOOT TENDON
|
Facility
|
IP
|
$1,594.00
|
|
|
Service Code
|
CPT 28261
|
| Hospital Charge Code |
6128261
|
|
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
|
|
|
REVISION OF FOOT TENDON
|
Facility
|
OP
|
$1,594.00
|
|
|
Service Code
|
CPT 28261
|
| Hospital Charge Code |
6128261
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$435.16 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$956.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| 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 |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,434.60
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$1,450.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| 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 |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,514.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,195.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,482.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$637.60
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$435.16
|
|
|
REVISION OF HIP BONE
|
Facility
|
IP
|
$3,047.00
|
|
|
Service Code
|
CPT 27147
|
| Hospital Charge Code |
6127147
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$831.83 |
| Max. Negotiated Rate |
$2,894.65 |
| Rate for Payer: Cash Price |
$1,828.20
|
| Rate for Payer: Cigna Commercial |
$2,589.95
|
| Rate for Payer: First Health Commercial |
$2,742.30
|
| Rate for Payer: First Health Workers Compensation |
$1,176.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,742.30
|
| Rate for Payer: GEHA Commercial |
$2,132.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,742.30
|
| Rate for Payer: Multiplan All |
$2,772.77
|
| Rate for Payer: OMNI Networks Commercial |
$2,132.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,742.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,894.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,285.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,833.71
|
| Rate for Payer: Zelis Auto |
$1,218.80
|
| Rate for Payer: Zelis Worker's Compensation |
$831.83
|
|
