|
TRANSFERRIN (Vitros)
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
2232212
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.76
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$127.50
|
| Rate for Payer: First Health Commercial |
$135.00
|
| Rate for Payer: First Health Workers Compensation |
$19.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.00
|
| Rate for Payer: GEHA Commercial |
$120.00
|
| Rate for Payer: GEHA Medicare |
$12.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.00
|
| Rate for Payer: Humana ChoiceCare |
$14.04
|
| Rate for Payer: Humana Medicare Advantage |
$12.76
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$21.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.76
|
| Rate for Payer: Multiplan All |
$136.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.69
|
| Rate for Payer: OMNI Networks Commercial |
$105.00
|
| Rate for Payer: One Health Plan PPO/POS |
$135.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$21.43
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.56
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.76
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$142.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$25.52
|
| Rate for Payer: Three Rivers Provider Network All |
$112.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.50
|
| Rate for Payer: United Healthcare Commercial |
$127.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$139.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.76
|
| Rate for Payer: Zelis Auto |
$60.00
|
| Rate for Payer: Zelis Medicare |
$10.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.31
|
| Rate for Payer: Zelis Worker's Compensation |
$13.84
|
|
|
TRANSFER SKIN PEDICLE FLAP
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 15650
|
| Hospital Charge Code |
6115650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$263.99 |
| Max. Negotiated Rate |
$918.65 |
| Rate for Payer: Cash Price |
$580.20
|
| Rate for Payer: Cigna Commercial |
$821.95
|
| Rate for Payer: First Health Commercial |
$870.30
|
| Rate for Payer: First Health Workers Compensation |
$373.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$870.30
|
| Rate for Payer: GEHA Commercial |
$676.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$870.30
|
| Rate for Payer: Multiplan All |
$879.97
|
| Rate for Payer: OMNI Networks Commercial |
$676.90
|
| Rate for Payer: One Health Plan PPO/POS |
$870.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$918.65
|
| Rate for Payer: Three Rivers Provider Network All |
$725.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$899.31
|
| Rate for Payer: Zelis Auto |
$386.80
|
| Rate for Payer: Zelis Worker's Compensation |
$263.99
|
|
|
TRANSFER SKIN PEDICLE FLAP
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 15650
|
| Hospital Charge Code |
6115650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$263.99 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$580.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$580.20
|
| Rate for Payer: Cash Price |
$580.20
|
| Rate for Payer: Cigna Commercial |
$821.95
|
| Rate for Payer: First Health Commercial |
$870.30
|
| Rate for Payer: First Health Workers Compensation |
$373.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$870.30
|
| Rate for Payer: GEHA Commercial |
$773.60
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$870.30
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$879.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$676.90
|
| Rate for Payer: One Health Plan PPO/POS |
$870.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$918.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$725.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$899.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$386.80
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$263.99
|
|
|
TRANSFER TENDON TO PELVIS
|
Facility
|
OP
|
$1,367.00
|
|
|
Service Code
|
CPT 27098
|
| Hospital Charge Code |
6127098
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$373.19 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$820.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$820.20
|
| Rate for Payer: Cash Price |
$820.20
|
| Rate for Payer: Cigna Commercial |
$1,161.95
|
| Rate for Payer: First Health Commercial |
$1,230.30
|
| Rate for Payer: First Health Workers Compensation |
$527.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,230.30
|
| Rate for Payer: GEHA Commercial |
$1,093.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,230.30
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,243.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$956.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,230.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,298.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,025.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,271.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$546.80
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$373.19
|
|
|
TRANSFER TENDON TO PELVIS
|
Facility
|
IP
|
$1,367.00
|
|
|
Service Code
|
CPT 27098
|
| Hospital Charge Code |
6127098
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$373.19 |
| Max. Negotiated Rate |
$1,298.65 |
| Rate for Payer: Cash Price |
$820.20
|
| Rate for Payer: Cigna Commercial |
$1,161.95
|
| Rate for Payer: First Health Commercial |
$1,230.30
|
| Rate for Payer: First Health Workers Compensation |
$527.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,230.30
|
| Rate for Payer: GEHA Commercial |
$956.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,230.30
|
| Rate for Payer: Multiplan All |
$1,243.97
|
| Rate for Payer: OMNI Networks Commercial |
$956.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,230.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,298.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,025.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,271.31
|
| Rate for Payer: Zelis Auto |
$546.80
|
| Rate for Payer: Zelis Worker's Compensation |
$373.19
|
|
|
TRANSPERI NEEDLE PLACE PROS
|
Facility
|
IP
|
$1,569.00
|
|
|
Service Code
|
CPT 55875
|
| Hospital Charge Code |
6155875
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$428.34 |
| Max. Negotiated Rate |
$1,490.55 |
| Rate for Payer: Cash Price |
$941.40
|
| Rate for Payer: Cigna Commercial |
$1,333.65
|
| Rate for Payer: First Health Commercial |
$1,412.10
|
| Rate for Payer: First Health Workers Compensation |
$605.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,412.10
|
| Rate for Payer: GEHA Commercial |
$1,098.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,412.10
|
| Rate for Payer: Multiplan All |
$1,427.79
|
| Rate for Payer: OMNI Networks Commercial |
$1,098.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,412.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,490.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,176.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,459.17
|
| Rate for Payer: Zelis Auto |
$627.60
|
| Rate for Payer: Zelis Worker's Compensation |
$428.34
|
|
|
TRANSPERI NEEDLE PLACE PROS
|
Facility
|
OP
|
$1,569.00
|
|
|
Service Code
|
CPT 55875
|
| Hospital Charge Code |
6155875
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$428.34 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,660.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$941.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,660.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,899.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$941.40
|
| Rate for Payer: Cash Price |
$941.40
|
| Rate for Payer: Cigna Commercial |
$1,333.65
|
| Rate for Payer: First Health Commercial |
$1,412.10
|
| Rate for Payer: First Health Workers Compensation |
$605.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,412.10
|
| Rate for Payer: GEHA Commercial |
$1,255.20
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,412.10
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,958.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$1,427.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,098.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,412.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,416.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,958.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,490.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,176.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,958.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,459.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$627.60
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$428.34
|
|
|
TRANSPERI PLMT BIODEGRAD MATRL 1/MLT NJX
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT 55874
|
| Hospital Charge Code |
6169675
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$143.32 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,558.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$315.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,558.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,403.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$446.25
|
| Rate for Payer: First Health Commercial |
$472.50
|
| Rate for Payer: First Health Workers Compensation |
$202.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$472.50
|
| Rate for Payer: GEHA Commercial |
$420.00
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$472.50
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,493.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$477.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$367.50
|
| Rate for Payer: One Health Plan PPO/POS |
$472.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5,188.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,493.25
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$498.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$393.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,493.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$488.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$210.00
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$143.32
|
|
|
TRANSPERI PLMT BIODEGRAD MATRL 1/MLT NJX
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT 55874
|
| Hospital Charge Code |
6169675
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$143.32 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$446.25
|
| Rate for Payer: First Health Commercial |
$472.50
|
| Rate for Payer: First Health Workers Compensation |
$202.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$472.50
|
| Rate for Payer: GEHA Commercial |
$367.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$472.50
|
| Rate for Payer: Multiplan All |
$477.75
|
| Rate for Payer: OMNI Networks Commercial |
$367.50
|
| Rate for Payer: One Health Plan PPO/POS |
$472.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$498.75
|
| Rate for Payer: Three Rivers Provider Network All |
$393.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$488.25
|
| Rate for Payer: Zelis Auto |
$210.00
|
| Rate for Payer: Zelis Worker's Compensation |
$143.32
|
|
|
TRANSPL ALLOGRAFT PANCREAS
|
Facility
|
OP
|
$5,325.00
|
|
|
Service Code
|
CPT 48554
|
| Hospital Charge Code |
6148554
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,331.25 |
| Max. Negotiated Rate |
$5,058.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,195.00
|
| Rate for Payer: Cash Price |
$3,195.00
|
| Rate for Payer: Cigna Commercial |
$4,526.25
|
| Rate for Payer: First Health Commercial |
$4,792.50
|
| Rate for Payer: First Health Workers Compensation |
$2,055.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,792.50
|
| Rate for Payer: GEHA Commercial |
$4,260.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,792.50
|
| Rate for Payer: Humana ChoiceCare |
$1,384.50
|
| Rate for Payer: Multiplan All |
$4,845.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,195.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,727.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,792.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,058.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,993.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,686.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,331.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,952.25
|
| Rate for Payer: Zelis Auto |
$2,130.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,662.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,453.72
|
|
|
TRANSPL ALLOGRAFT PANCREAS
|
Facility
|
IP
|
$5,325.00
|
|
|
Service Code
|
CPT 48554
|
| Hospital Charge Code |
6148554
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,453.72 |
| Max. Negotiated Rate |
$5,058.75 |
| Rate for Payer: Cash Price |
$3,195.00
|
| Rate for Payer: Cigna Commercial |
$4,526.25
|
| Rate for Payer: First Health Commercial |
$4,792.50
|
| Rate for Payer: First Health Workers Compensation |
$2,055.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,792.50
|
| Rate for Payer: GEHA Commercial |
$3,727.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,792.50
|
| Rate for Payer: Multiplan All |
$4,845.75
|
| Rate for Payer: OMNI Networks Commercial |
$3,727.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,792.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,058.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,993.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,952.25
|
| Rate for Payer: Zelis Auto |
$2,130.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,453.72
|
|
|
TRANSPLANT FEMUR RIDGE
|
Facility
|
IP
|
$1,838.00
|
|
|
Service Code
|
CPT 27140
|
| Hospital Charge Code |
6127140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$501.77 |
| Max. Negotiated Rate |
$1,746.10 |
| Rate for Payer: Cash Price |
$1,102.80
|
| Rate for Payer: Cigna Commercial |
$1,562.30
|
| Rate for Payer: First Health Commercial |
$1,654.20
|
| Rate for Payer: First Health Workers Compensation |
$709.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,654.20
|
| Rate for Payer: GEHA Commercial |
$1,286.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,654.20
|
| Rate for Payer: Multiplan All |
$1,672.58
|
| Rate for Payer: OMNI Networks Commercial |
$1,286.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,654.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,746.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,378.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,709.34
|
| Rate for Payer: Zelis Auto |
$735.20
|
| Rate for Payer: Zelis Worker's Compensation |
$501.77
|
|
|
TRANSPLANT FEMUR RIDGE
|
Facility
|
OP
|
$1,838.00
|
|
|
Service Code
|
CPT 27140
|
| Hospital Charge Code |
6127140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$459.50 |
| Max. Negotiated Rate |
$1,746.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,102.80
|
| Rate for Payer: Cash Price |
$1,102.80
|
| Rate for Payer: Cigna Commercial |
$1,562.30
|
| Rate for Payer: First Health Commercial |
$1,654.20
|
| Rate for Payer: First Health Workers Compensation |
$709.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,654.20
|
| Rate for Payer: GEHA Commercial |
$1,470.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,654.20
|
| Rate for Payer: Humana ChoiceCare |
$477.88
|
| Rate for Payer: Multiplan All |
$1,672.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,102.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,286.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,654.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,746.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,378.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,617.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$459.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,709.34
|
| Rate for Payer: Zelis Auto |
$735.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$919.00
|
| Rate for Payer: Zelis Worker's Compensation |
$501.77
|
|
|
TRANSPLANT FOREARM TENDON
|
Facility
|
IP
|
$1,259.00
|
|
|
Service Code
|
CPT 25310
|
| Hospital Charge Code |
6125310
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$343.71 |
| Max. Negotiated Rate |
$1,196.05 |
| Rate for Payer: Cash Price |
$755.40
|
| Rate for Payer: Cigna Commercial |
$1,070.15
|
| Rate for Payer: First Health Commercial |
$1,133.10
|
| Rate for Payer: First Health Workers Compensation |
$486.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,133.10
|
| Rate for Payer: GEHA Commercial |
$881.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,133.10
|
| Rate for Payer: Multiplan All |
$1,145.69
|
| Rate for Payer: OMNI Networks Commercial |
$881.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,133.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,196.05
|
| Rate for Payer: Three Rivers Provider Network All |
$944.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,170.87
|
| Rate for Payer: Zelis Auto |
$503.60
|
| Rate for Payer: Zelis Worker's Compensation |
$343.71
|
|
|
TRANSPLANT FOREARM TENDON
|
Facility
|
OP
|
$1,259.00
|
|
|
Service Code
|
CPT 25310
|
| Hospital Charge Code |
6125310
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$343.71 |
| 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 |
$755.40
|
| 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 |
$755.40
|
| Rate for Payer: Cash Price |
$755.40
|
| Rate for Payer: Cigna Commercial |
$1,070.15
|
| Rate for Payer: First Health Commercial |
$1,133.10
|
| Rate for Payer: First Health Workers Compensation |
$486.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,133.10
|
| Rate for Payer: GEHA Commercial |
$1,007.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,133.10
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,145.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$881.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,133.10
|
| 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 |
$1,196.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$944.25
|
| 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 |
$1,170.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$503.60
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$343.71
|
|
|
TRANSPLANT FOREARM TENDON
|
Facility
|
IP
|
$1,459.00
|
|
|
Service Code
|
CPT 25312
|
| Hospital Charge Code |
6125312
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$398.31 |
| Max. Negotiated Rate |
$1,386.05 |
| Rate for Payer: Cash Price |
$875.40
|
| Rate for Payer: Cigna Commercial |
$1,240.15
|
| Rate for Payer: First Health Commercial |
$1,313.10
|
| Rate for Payer: First Health Workers Compensation |
$563.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,313.10
|
| Rate for Payer: GEHA Commercial |
$1,021.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,313.10
|
| Rate for Payer: Multiplan All |
$1,327.69
|
| Rate for Payer: OMNI Networks Commercial |
$1,021.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,313.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,386.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,094.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,356.87
|
| Rate for Payer: Zelis Auto |
$583.60
|
| Rate for Payer: Zelis Worker's Compensation |
$398.31
|
|
|
TRANSPLANT FOREARM TENDON
|
Facility
|
OP
|
$1,459.00
|
|
|
Service Code
|
CPT 25312
|
| Hospital Charge Code |
6125312
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$398.31 |
| 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 |
$875.40
|
| 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 |
$875.40
|
| Rate for Payer: Cash Price |
$875.40
|
| Rate for Payer: Cigna Commercial |
$1,240.15
|
| Rate for Payer: First Health Commercial |
$1,313.10
|
| Rate for Payer: First Health Workers Compensation |
$563.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,313.10
|
| Rate for Payer: GEHA Commercial |
$1,167.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,313.10
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,327.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,021.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,313.10
|
| 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 |
$1,386.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,094.25
|
| 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 |
$1,356.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$583.60
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$398.31
|
|
|
TRANSPLANT/GRAFT HAND TENDON
|
Facility
|
OP
|
$1,665.00
|
|
|
Service Code
|
CPT 26483
|
| Hospital Charge Code |
6126483
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$454.55 |
| 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 |
$999.00
|
| 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 |
$999.00
|
| Rate for Payer: Cash Price |
$999.00
|
| Rate for Payer: Cigna Commercial |
$1,415.25
|
| Rate for Payer: First Health Commercial |
$1,498.50
|
| Rate for Payer: First Health Workers Compensation |
$642.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,498.50
|
| Rate for Payer: GEHA Commercial |
$1,332.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,498.50
|
| 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 |
$1,515.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,165.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,498.50
|
| 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 |
$1,581.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,248.75
|
| 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 |
$1,548.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$666.00
|
| 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 |
$454.55
|
|
|
TRANSPLANT/GRAFT HAND TENDON
|
Facility
|
IP
|
$1,665.00
|
|
|
Service Code
|
CPT 26483
|
| Hospital Charge Code |
6126483
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$454.55 |
| Max. Negotiated Rate |
$1,581.75 |
| Rate for Payer: Cash Price |
$999.00
|
| Rate for Payer: Cigna Commercial |
$1,415.25
|
| Rate for Payer: First Health Commercial |
$1,498.50
|
| Rate for Payer: First Health Workers Compensation |
$642.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,498.50
|
| Rate for Payer: GEHA Commercial |
$1,165.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,498.50
|
| Rate for Payer: Multiplan All |
$1,515.15
|
| Rate for Payer: OMNI Networks Commercial |
$1,165.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,498.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,581.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,248.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,548.45
|
| Rate for Payer: Zelis Auto |
$666.00
|
| Rate for Payer: Zelis Worker's Compensation |
$454.55
|
|
|
TRANSPLANT/GRAFT PALM TENDON
|
Facility
|
IP
|
$1,801.00
|
|
|
Service Code
|
CPT 26489
|
| Hospital Charge Code |
6126489
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$491.67 |
| Max. Negotiated Rate |
$1,710.95 |
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cigna Commercial |
$1,530.85
|
| Rate for Payer: First Health Commercial |
$1,620.90
|
| Rate for Payer: First Health Workers Compensation |
$695.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,620.90
|
| Rate for Payer: GEHA Commercial |
$1,260.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,620.90
|
| Rate for Payer: Multiplan All |
$1,638.91
|
| Rate for Payer: OMNI Networks Commercial |
$1,260.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,620.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,710.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,350.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,674.93
|
| Rate for Payer: Zelis Auto |
$720.40
|
| Rate for Payer: Zelis Worker's Compensation |
$491.67
|
|
|
TRANSPLANT/GRAFT PALM TENDON
|
Facility
|
OP
|
$1,801.00
|
|
|
Service Code
|
CPT 26489
|
| Hospital Charge Code |
6126489
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$491.67 |
| 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 |
$1,080.60
|
| 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 |
$1,080.60
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cigna Commercial |
$1,530.85
|
| Rate for Payer: First Health Commercial |
$1,620.90
|
| Rate for Payer: First Health Workers Compensation |
$695.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,620.90
|
| Rate for Payer: GEHA Commercial |
$1,440.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,620.90
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,638.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,260.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,620.90
|
| 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 |
$1,710.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,350.75
|
| 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 |
$1,674.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$720.40
|
| 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 |
$491.67
|
|
|
TRANSPLANT HAND TENDON
|
Facility
|
IP
|
$2,325.87
|
|
|
Service Code
|
CPT 26480
|
| Hospital Charge Code |
6126480
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$634.96 |
| Max. Negotiated Rate |
$2,209.58 |
| Rate for Payer: Cash Price |
$1,395.52
|
| Rate for Payer: Cigna Commercial |
$1,976.99
|
| Rate for Payer: First Health Commercial |
$2,093.28
|
| Rate for Payer: First Health Workers Compensation |
$898.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,093.28
|
| Rate for Payer: GEHA Commercial |
$1,628.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,093.28
|
| Rate for Payer: Multiplan All |
$2,116.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,628.11
|
| Rate for Payer: One Health Plan PPO/POS |
$2,093.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,209.58
|
| Rate for Payer: Three Rivers Provider Network All |
$1,744.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,163.06
|
| Rate for Payer: Zelis Auto |
$930.35
|
| Rate for Payer: Zelis Worker's Compensation |
$634.96
|
|
|
TRANSPLANT HAND TENDON
|
Facility
|
OP
|
$2,325.87
|
|
|
Service Code
|
CPT 26480
|
| Hospital Charge Code |
6126480
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$634.96 |
| 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 |
$1,395.52
|
| 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 |
$1,395.52
|
| Rate for Payer: Cash Price |
$1,395.52
|
| Rate for Payer: Cigna Commercial |
$1,976.99
|
| Rate for Payer: First Health Commercial |
$2,093.28
|
| Rate for Payer: First Health Workers Compensation |
$898.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,093.28
|
| Rate for Payer: GEHA Commercial |
$1,860.70
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,093.28
|
| 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 |
$2,116.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,628.11
|
| Rate for Payer: One Health Plan PPO/POS |
$2,093.28
|
| 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 |
$2,209.58
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,744.40
|
| 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 |
$2,163.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$930.35
|
| 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 |
$634.96
|
|
|
TRANSPLANT OF THIGH TENDON
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
CPT 27396
|
| Hospital Charge Code |
6127396
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$343.98 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$756.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Cigna Commercial |
$1,071.00
|
| Rate for Payer: First Health Commercial |
$1,134.00
|
| Rate for Payer: First Health Workers Compensation |
$486.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,134.00
|
| Rate for Payer: GEHA Commercial |
$1,008.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,134.00
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,146.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$882.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,134.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,197.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$945.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,171.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$504.00
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$343.98
|
|
|
TRANSPLANT OF THIGH TENDON
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT 27396
|
| Hospital Charge Code |
6127396
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$343.98 |
| Max. Negotiated Rate |
$1,197.00 |
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Cigna Commercial |
$1,071.00
|
| Rate for Payer: First Health Commercial |
$1,134.00
|
| Rate for Payer: First Health Workers Compensation |
$486.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,134.00
|
| Rate for Payer: GEHA Commercial |
$882.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,134.00
|
| Rate for Payer: Multiplan All |
$1,146.60
|
| Rate for Payer: OMNI Networks Commercial |
$882.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,134.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,197.00
|
| Rate for Payer: Three Rivers Provider Network All |
$945.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,171.80
|
| Rate for Payer: Zelis Auto |
$504.00
|
| Rate for Payer: Zelis Worker's Compensation |
$343.98
|
|
