|
TENECTEPLASE (ACUTE MI) 50MG KIT
|
Facility
|
OP
|
$23,860.00
|
|
|
Service Code
|
CPT J3101
|
| Hospital Charge Code |
3300873
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.44 |
| Max. Negotiated Rate |
$22,667.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$129.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$14,316.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$129.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$102.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$172.22
|
| Rate for Payer: Cash Price |
$14,316.00
|
| Rate for Payer: Cash Price |
$14,316.00
|
| Rate for Payer: Cigna Commercial |
$20,281.00
|
| Rate for Payer: First Health Commercial |
$21,474.00
|
| Rate for Payer: First Health Workers Compensation |
$9,212.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$21,474.00
|
| Rate for Payer: GEHA Commercial |
$189.44
|
| Rate for Payer: GEHA Medicare |
$172.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$21,474.00
|
| Rate for Payer: Humana ChoiceCare |
$189.44
|
| Rate for Payer: Humana Medicare Advantage |
$172.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$289.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$104.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$172.22
|
| Rate for Payer: Multiplan All |
$21,712.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$292.77
|
| Rate for Payer: OMNI Networks Commercial |
$16,702.00
|
| Rate for Payer: One Health Plan PPO/POS |
$21,474.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$120.69
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$104.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$172.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$22,667.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$344.44
|
| Rate for Payer: Three Rivers Provider Network All |
$17,895.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$168.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$104.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$22,189.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$172.22
|
| Rate for Payer: Zelis Auto |
$9,544.00
|
| Rate for Payer: Zelis Medicare |
$146.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$206.66
|
| Rate for Payer: Zelis Worker's Compensation |
$6,513.78
|
|
|
TENODESIS OF BICEPS TENDON AT ELBOW (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 24340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,730.88 |
| 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 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: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| 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: New Mexico Health Connections Medicare |
$11,531.54
|
| 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 Worker's Compensation |
$13,566.52
|
| 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: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| 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 |
$6,172.77
|
|
|
TENOLYSIS TRICEPS
|
Facility
|
OP
|
$1,248.00
|
|
|
Service Code
|
CPT 24332
|
| Hospital Charge Code |
6124332
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$340.70 |
| 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 |
$748.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$1,060.80
|
| Rate for Payer: First Health Commercial |
$1,123.20
|
| Rate for Payer: First Health Workers Compensation |
$481.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,123.20
|
| Rate for Payer: GEHA Commercial |
$998.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,123.20
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,135.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$873.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,123.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,185.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$936.00
|
| 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 |
$1,160.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$499.20
|
| 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 |
$340.70
|
|
|
TENOLYSIS TRICEPS
|
Facility
|
IP
|
$1,248.00
|
|
|
Service Code
|
CPT 24332
|
| Hospital Charge Code |
6124332
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$340.70 |
| Max. Negotiated Rate |
$1,185.60 |
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cigna Commercial |
$1,060.80
|
| Rate for Payer: First Health Commercial |
$1,123.20
|
| Rate for Payer: First Health Workers Compensation |
$481.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,123.20
|
| Rate for Payer: GEHA Commercial |
$873.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,123.20
|
| Rate for Payer: Multiplan All |
$1,135.68
|
| Rate for Payer: OMNI Networks Commercial |
$873.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,123.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,185.60
|
| Rate for Payer: Three Rivers Provider Network All |
$936.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,160.64
|
| Rate for Payer: Zelis Auto |
$499.20
|
| Rate for Payer: Zelis Worker's Compensation |
$340.70
|
|
|
TENOTOMY, PERCUTANEOUS, ACHILLES TENDON (SEPARATE PROCEDURE); GENERAL ANESTHESIA
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 27606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,763.37 |
| 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 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: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| 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: New Mexico Health Connections Medicare |
$5,237.51
|
| 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 Worker's Compensation |
$6,161.78
|
| 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: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| 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 |
$2,803.61
|
|
|
TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT
|
Facility
|
IP
|
$786.00
|
|
|
Service Code
|
CPT 26060
|
| Hospital Charge Code |
8826060
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$214.58 |
| Max. Negotiated Rate |
$746.70 |
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cigna Commercial |
$668.10
|
| Rate for Payer: First Health Commercial |
$707.40
|
| Rate for Payer: First Health Workers Compensation |
$303.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$707.40
|
| Rate for Payer: GEHA Commercial |
$550.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$707.40
|
| Rate for Payer: Multiplan All |
$715.26
|
| Rate for Payer: OMNI Networks Commercial |
$550.20
|
| Rate for Payer: One Health Plan PPO/POS |
$707.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$746.70
|
| Rate for Payer: Three Rivers Provider Network All |
$589.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$730.98
|
| Rate for Payer: Zelis Auto |
$314.40
|
| Rate for Payer: Zelis Worker's Compensation |
$214.58
|
|
|
TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
CPT 26060
|
| Hospital Charge Code |
8826060
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$214.58 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$471.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cigna Commercial |
$668.10
|
| Rate for Payer: First Health Commercial |
$707.40
|
| Rate for Payer: First Health Workers Compensation |
$303.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$707.40
|
| Rate for Payer: GEHA Commercial |
$628.80
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$707.40
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$715.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$550.20
|
| Rate for Payer: One Health Plan PPO/POS |
$707.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$746.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$589.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$730.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$314.40
|
| 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 |
$214.58
|
|
|
TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
CPT 26060
|
| Hospital Charge Code |
8226060
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$214.58 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$471.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cigna Commercial |
$668.10
|
| Rate for Payer: First Health Commercial |
$707.40
|
| Rate for Payer: First Health Workers Compensation |
$303.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$707.40
|
| Rate for Payer: GEHA Commercial |
$628.80
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$707.40
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$715.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$550.20
|
| Rate for Payer: One Health Plan PPO/POS |
$707.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$746.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$589.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$730.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$314.40
|
| 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 |
$214.58
|
|
|
TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT
|
Facility
|
IP
|
$786.00
|
|
|
Service Code
|
CPT 26060
|
| Hospital Charge Code |
8226060
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$214.58 |
| Max. Negotiated Rate |
$746.70 |
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cigna Commercial |
$668.10
|
| Rate for Payer: First Health Commercial |
$707.40
|
| Rate for Payer: First Health Workers Compensation |
$303.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$707.40
|
| Rate for Payer: GEHA Commercial |
$550.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$707.40
|
| Rate for Payer: Multiplan All |
$715.26
|
| Rate for Payer: OMNI Networks Commercial |
$550.20
|
| Rate for Payer: One Health Plan PPO/POS |
$707.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$746.70
|
| Rate for Payer: Three Rivers Provider Network All |
$589.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$730.98
|
| Rate for Payer: Zelis Auto |
$314.40
|
| Rate for Payer: Zelis Worker's Compensation |
$214.58
|
|
|
TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
CPT 26060
|
| Hospital Charge Code |
6126060
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$214.58 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$471.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cigna Commercial |
$668.10
|
| Rate for Payer: First Health Commercial |
$707.40
|
| Rate for Payer: First Health Workers Compensation |
$303.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$707.40
|
| Rate for Payer: GEHA Commercial |
$628.80
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$707.40
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$715.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$550.20
|
| Rate for Payer: One Health Plan PPO/POS |
$707.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$746.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$589.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$730.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$314.40
|
| 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 |
$214.58
|
|
|
TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT
|
Facility
|
IP
|
$786.00
|
|
|
Service Code
|
CPT 26060
|
| Hospital Charge Code |
6126060
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$214.58 |
| Max. Negotiated Rate |
$746.70 |
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cigna Commercial |
$668.10
|
| Rate for Payer: First Health Commercial |
$707.40
|
| Rate for Payer: First Health Workers Compensation |
$303.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$707.40
|
| Rate for Payer: GEHA Commercial |
$550.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$707.40
|
| Rate for Payer: Multiplan All |
$715.26
|
| Rate for Payer: OMNI Networks Commercial |
$550.20
|
| Rate for Payer: One Health Plan PPO/POS |
$707.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$746.70
|
| Rate for Payer: Three Rivers Provider Network All |
$589.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$730.98
|
| Rate for Payer: Zelis Auto |
$314.40
|
| Rate for Payer: Zelis Worker's Compensation |
$214.58
|
|
|
TENOTOMY PERCUTANEOUS TOE MULTIPLE TENDO
|
Facility
|
IP
|
$990.00
|
|
|
Service Code
|
CPT 28011
|
| Hospital Charge Code |
8229721
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$270.27 |
| Max. Negotiated Rate |
$940.50 |
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna Commercial |
$841.50
|
| Rate for Payer: First Health Commercial |
$891.00
|
| Rate for Payer: First Health Workers Compensation |
$382.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$891.00
|
| Rate for Payer: GEHA Commercial |
$693.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$891.00
|
| Rate for Payer: Multiplan All |
$900.90
|
| Rate for Payer: OMNI Networks Commercial |
$693.00
|
| Rate for Payer: One Health Plan PPO/POS |
$891.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$940.50
|
| Rate for Payer: Three Rivers Provider Network All |
$742.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$920.70
|
| Rate for Payer: Zelis Auto |
$396.00
|
| Rate for Payer: Zelis Worker's Compensation |
$270.27
|
|
|
TENOTOMY PERCUTANEOUS TOE MULTIPLE TENDO
|
Facility
|
OP
|
$990.00
|
|
|
Service Code
|
CPT 28011
|
| Hospital Charge Code |
8229721
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$270.27 |
| 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 |
$594.00
|
| 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 |
$1,519.65
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna Commercial |
$841.50
|
| Rate for Payer: First Health Commercial |
$891.00
|
| Rate for Payer: First Health Workers Compensation |
$382.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$891.00
|
| Rate for Payer: GEHA Commercial |
$792.00
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$891.00
|
| 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 |
$900.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$693.00
|
| Rate for Payer: One Health Plan PPO/POS |
$891.00
|
| 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 |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$940.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$742.50
|
| 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 |
$920.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$396.00
|
| 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 |
$270.27
|
|
|
TENOTOMY PERCUTANEOUS TOE MULTIPLE TENDO
|
Facility
|
IP
|
$990.00
|
|
|
Service Code
|
CPT 28011
|
| Hospital Charge Code |
6128011
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$270.27 |
| Max. Negotiated Rate |
$940.50 |
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna Commercial |
$841.50
|
| Rate for Payer: First Health Commercial |
$891.00
|
| Rate for Payer: First Health Workers Compensation |
$382.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$891.00
|
| Rate for Payer: GEHA Commercial |
$693.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$891.00
|
| Rate for Payer: Multiplan All |
$900.90
|
| Rate for Payer: OMNI Networks Commercial |
$693.00
|
| Rate for Payer: One Health Plan PPO/POS |
$891.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$940.50
|
| Rate for Payer: Three Rivers Provider Network All |
$742.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$920.70
|
| Rate for Payer: Zelis Auto |
$396.00
|
| Rate for Payer: Zelis Worker's Compensation |
$270.27
|
|
|
TENOTOMY PERCUTANEOUS TOE MULTIPLE TENDO
|
Facility
|
OP
|
$990.00
|
|
|
Service Code
|
CPT 28011
|
| Hospital Charge Code |
6128011
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$270.27 |
| 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 |
$594.00
|
| 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 |
$1,519.65
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna Commercial |
$841.50
|
| Rate for Payer: First Health Commercial |
$891.00
|
| Rate for Payer: First Health Workers Compensation |
$382.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$891.00
|
| Rate for Payer: GEHA Commercial |
$792.00
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$891.00
|
| 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 |
$900.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$693.00
|
| Rate for Payer: One Health Plan PPO/POS |
$891.00
|
| 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 |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$940.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$742.50
|
| 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 |
$920.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$396.00
|
| 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 |
$270.27
|
|
|
TENOTOMY PERCUTANEOUS TOE MULTIPLE TENDO
|
Facility
|
IP
|
$5,012.00
|
|
|
Service Code
|
CPT 28011
|
| Hospital Charge Code |
9628011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,368.28 |
| Max. Negotiated Rate |
$4,761.40 |
| Rate for Payer: Cash Price |
$3,007.20
|
| Rate for Payer: Cigna Commercial |
$4,260.20
|
| Rate for Payer: First Health Commercial |
$4,510.80
|
| Rate for Payer: First Health Workers Compensation |
$1,935.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,510.80
|
| Rate for Payer: GEHA Commercial |
$3,508.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,510.80
|
| Rate for Payer: Multiplan All |
$4,560.92
|
| Rate for Payer: OMNI Networks Commercial |
$3,508.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,510.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,761.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,759.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,661.16
|
| Rate for Payer: Zelis Auto |
$2,004.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,368.28
|
|
|
TENOTOMY PERCUTANEOUS TOE MULTIPLE TENDO
|
Facility
|
OP
|
$5,012.00
|
|
|
Service Code
|
CPT 28011
|
| Hospital Charge Code |
9628011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,291.70 |
| Max. Negotiated Rate |
$4,761.40 |
| 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 |
$3,007.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$3,007.20
|
| Rate for Payer: Cash Price |
$3,007.20
|
| Rate for Payer: Cigna Commercial |
$4,260.20
|
| Rate for Payer: First Health Commercial |
$4,510.80
|
| Rate for Payer: First Health Workers Compensation |
$1,935.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,510.80
|
| Rate for Payer: GEHA Commercial |
$4,009.60
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,510.80
|
| 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 |
$4,560.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$3,508.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,510.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,761.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,759.00
|
| 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 |
$4,661.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$2,004.80
|
| 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 |
$1,368.28
|
|
|
TENOTOMY PERCUTANEOUS TOE SINGLE TENDON
|
Facility
|
IP
|
$4,229.00
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
9628010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,154.52 |
| Max. Negotiated Rate |
$4,017.55 |
| Rate for Payer: Cash Price |
$2,537.40
|
| Rate for Payer: Cigna Commercial |
$3,594.65
|
| Rate for Payer: First Health Commercial |
$3,806.10
|
| Rate for Payer: First Health Workers Compensation |
$1,632.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,806.10
|
| Rate for Payer: GEHA Commercial |
$2,960.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,806.10
|
| Rate for Payer: Multiplan All |
$3,848.39
|
| Rate for Payer: OMNI Networks Commercial |
$2,960.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,806.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,017.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,171.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,932.97
|
| Rate for Payer: Zelis Auto |
$1,691.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,154.52
|
|
|
TENOTOMY PERCUTANEOUS TOE SINGLE TENDON
|
Facility
|
OP
|
$4,229.00
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
9628010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,154.52 |
| Max. Negotiated Rate |
$4,017.55 |
| 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 |
$2,537.40
|
| 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 |
$2,537.40
|
| Rate for Payer: Cash Price |
$2,537.40
|
| Rate for Payer: Cigna Commercial |
$3,594.65
|
| Rate for Payer: First Health Commercial |
$3,806.10
|
| Rate for Payer: First Health Workers Compensation |
$1,632.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,806.10
|
| Rate for Payer: GEHA Commercial |
$3,383.20
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,806.10
|
| 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 |
$3,848.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$2,960.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,806.10
|
| 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 |
$4,017.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,171.75
|
| 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 |
$3,932.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$1,691.60
|
| 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 |
$1,154.52
|
|
|
TENOTOMY, PERCUTANEOUS, TOE; SINGLE TENDON
|
Facility
|
OP
|
$3,039.30
|
|
|
Service Code
|
CPT 28010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,291.70 |
| 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 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: First Health Workers Compensation |
$1,955.79
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| 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: New Mexico Health Connections Medicare |
$2,583.41
|
| 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 Worker's Compensation |
$3,039.30
|
| 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: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| 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 |
$1,382.88
|
|
|
TENOTOMY PRQ ACHILLES TENDON SPX LOCAL A
|
Facility
|
IP
|
$5,774.00
|
|
|
Service Code
|
CPT 27605
|
| Hospital Charge Code |
9627605
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,576.30 |
| Max. Negotiated Rate |
$5,485.30 |
| Rate for Payer: Cash Price |
$3,464.40
|
| Rate for Payer: Cigna Commercial |
$4,907.90
|
| Rate for Payer: First Health Commercial |
$5,196.60
|
| Rate for Payer: First Health Workers Compensation |
$2,229.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,196.60
|
| Rate for Payer: GEHA Commercial |
$4,041.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,196.60
|
| Rate for Payer: Multiplan All |
$5,254.34
|
| Rate for Payer: OMNI Networks Commercial |
$4,041.80
|
| Rate for Payer: One Health Plan PPO/POS |
$5,196.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,485.30
|
| Rate for Payer: Three Rivers Provider Network All |
$4,330.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,369.82
|
| Rate for Payer: Zelis Auto |
$2,309.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,576.30
|
|
|
TENOTOMY PRQ ACHILLES TENDON SPX LOCAL A
|
Facility
|
OP
|
$5,774.00
|
|
|
Service Code
|
CPT 27605
|
| Hospital Charge Code |
9627605
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,291.70 |
| Max. Negotiated Rate |
$5,485.30 |
| 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 |
$3,464.40
|
| 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 |
$3,464.40
|
| Rate for Payer: Cash Price |
$3,464.40
|
| Rate for Payer: Cigna Commercial |
$4,907.90
|
| Rate for Payer: First Health Commercial |
$5,196.60
|
| Rate for Payer: First Health Workers Compensation |
$2,229.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,196.60
|
| Rate for Payer: GEHA Commercial |
$4,619.20
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,196.60
|
| 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 |
$5,254.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$4,041.80
|
| Rate for Payer: One Health Plan PPO/POS |
$5,196.60
|
| 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 |
$5,485.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$4,330.50
|
| 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 |
$5,369.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$2,309.60
|
| 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 |
$1,576.30
|
|
|
TEPROTUMUMAB 500 MG POWDER VIAL
|
Facility
|
IP
|
$49,740.00
|
|
|
Service Code
|
CPT J3241
|
| Hospital Charge Code |
3303215
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,579.02 |
| Max. Negotiated Rate |
$47,253.00 |
| Rate for Payer: Cash Price |
$29,844.00
|
| Rate for Payer: Cigna Commercial |
$42,279.00
|
| Rate for Payer: First Health Commercial |
$44,766.00
|
| Rate for Payer: First Health Workers Compensation |
$19,204.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$44,766.00
|
| Rate for Payer: GEHA Commercial |
$34,818.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$44,766.00
|
| Rate for Payer: Multiplan All |
$45,263.40
|
| Rate for Payer: OMNI Networks Commercial |
$34,818.00
|
| Rate for Payer: One Health Plan PPO/POS |
$44,766.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$47,253.00
|
| Rate for Payer: Three Rivers Provider Network All |
$37,305.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$46,258.20
|
| Rate for Payer: Zelis Auto |
$19,896.00
|
| Rate for Payer: Zelis Worker's Compensation |
$13,579.02
|
|
|
TEPROTUMUMAB 500 MG POWDER VIAL
|
Facility
|
OP
|
$49,740.00
|
|
|
Service Code
|
CPT J3241
|
| Hospital Charge Code |
3303215
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$305.31 |
| Max. Negotiated Rate |
$47,253.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$520.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$29,844.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$520.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$412.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$359.19
|
| Rate for Payer: Cash Price |
$29,844.00
|
| Rate for Payer: Cash Price |
$29,844.00
|
| Rate for Payer: Cigna Commercial |
$42,279.00
|
| Rate for Payer: First Health Commercial |
$44,766.00
|
| Rate for Payer: First Health Workers Compensation |
$19,204.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$44,766.00
|
| Rate for Payer: GEHA Commercial |
$395.11
|
| Rate for Payer: GEHA Medicare |
$359.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$44,766.00
|
| Rate for Payer: Humana ChoiceCare |
$395.11
|
| Rate for Payer: Humana Medicare Advantage |
$359.19
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$603.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$420.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$359.19
|
| Rate for Payer: Multiplan All |
$45,263.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$610.62
|
| Rate for Payer: OMNI Networks Commercial |
$34,818.00
|
| Rate for Payer: One Health Plan PPO/POS |
$44,766.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$485.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$420.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$359.19
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$47,253.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$718.38
|
| Rate for Payer: Three Rivers Provider Network All |
$37,305.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$352.01
|
| Rate for Payer: United Healthcare Managed Medicaid |
$420.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$359.19
|
| Rate for Payer: United Payors & United Providers UP&UP |
$46,258.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$359.19
|
| Rate for Payer: Zelis Auto |
$19,896.00
|
| Rate for Payer: Zelis Medicare |
$305.31
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$431.03
|
| Rate for Payer: Zelis Worker's Compensation |
$13,579.02
|
|
|
TERBUTALINE SULFATE INJ 1MG/ML
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT J3105
|
| Hospital Charge Code |
3300877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: First Health Workers Compensation |
$14.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$34.20
|
| Rate for Payer: GEHA Commercial |
$8.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$34.20
|
| Rate for Payer: Humana ChoiceCare |
$9.88
|
| Rate for Payer: Multiplan All |
$34.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.80
|
| Rate for Payer: OMNI Networks Commercial |
$26.60
|
| Rate for Payer: One Health Plan PPO/POS |
$34.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$36.10
|
| Rate for Payer: Three Rivers Provider Network All |
$28.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$33.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$35.34
|
| Rate for Payer: Zelis Auto |
$15.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.00
|
| Rate for Payer: Zelis Worker's Compensation |
$10.37
|
|
