|
copper serum/plasma REF001586
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
2299255
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.55 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$22.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$22.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.41
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$23.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$110.40
|
| Rate for Payer: GEHA Medicare |
$12.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Humana ChoiceCare |
$13.65
|
| Rate for Payer: Humana Medicare Advantage |
$12.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.41
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.10
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.85
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.82
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.16
|
| Rate for Payer: United Healthcare Commercial |
$117.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.41
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Medicare |
$10.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.89
|
| Rate for Payer: Zelis Worker's Compensation |
$16.73
|
|
|
copper serum/plasma REF001586
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
2299255
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.73 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$23.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$96.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Worker's Compensation |
$16.73
|
|
|
corn IgE REF602460
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299196
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
corn IgE REF602460
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299196
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
CORPORA CAVERNOSA-GLANS PENIS FISTULIZATION (EG, BIOPSY NEEDLE, WINTER PROCEDURE, RONGEUR, OR PUNCH) FOR PRIAPISM
|
Facility
|
OP
|
$6,549.86
|
|
|
Service Code
|
CPT 54435
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,783.69 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,794.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: First Health Workers Compensation |
$4,214.83
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,851.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,291.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,851.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,851.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$2,980.19
|
|
|
CORRECT FINGER DEFORMITY
|
Facility
|
OP
|
$1,343.00
|
|
|
Service Code
|
CPT 26567
|
| Hospital Charge Code |
6126567
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$366.64 |
| 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 |
$805.80
|
| 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 |
$805.80
|
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cigna Commercial |
$1,141.55
|
| Rate for Payer: First Health Commercial |
$1,208.70
|
| Rate for Payer: First Health Workers Compensation |
$518.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,208.70
|
| Rate for Payer: GEHA Commercial |
$1,074.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,208.70
|
| 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 |
$1,222.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$940.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,208.70
|
| 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 |
$1,275.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,007.25
|
| 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 |
$1,248.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$537.20
|
| 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 |
$366.64
|
|
|
CORRECT FINGER DEFORMITY
|
Facility
|
IP
|
$1,343.00
|
|
|
Service Code
|
CPT 26567
|
| Hospital Charge Code |
6126567
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$366.64 |
| Max. Negotiated Rate |
$1,275.85 |
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cigna Commercial |
$1,141.55
|
| Rate for Payer: First Health Commercial |
$1,208.70
|
| Rate for Payer: First Health Workers Compensation |
$518.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,208.70
|
| Rate for Payer: GEHA Commercial |
$940.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,208.70
|
| Rate for Payer: Multiplan All |
$1,222.13
|
| Rate for Payer: OMNI Networks Commercial |
$940.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,208.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,275.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,007.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,248.99
|
| Rate for Payer: Zelis Auto |
$537.20
|
| Rate for Payer: Zelis Worker's Compensation |
$366.64
|
|
|
CORRECTION HALLUX VALGUS
|
Facility
|
OP
|
$3,711.00
|
|
|
Service Code
|
CPT 28295
|
| Hospital Charge Code |
6191070
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,013.10 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,655.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,226.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,655.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,896.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$2,226.60
|
| Rate for Payer: Cash Price |
$2,226.60
|
| Rate for Payer: Cigna Commercial |
$3,154.35
|
| Rate for Payer: First Health Commercial |
$3,339.90
|
| Rate for Payer: First Health Workers Compensation |
$1,432.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,339.90
|
| Rate for Payer: GEHA Commercial |
$2,968.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,339.90
|
| 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 |
$2,955.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$3,377.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$2,597.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,339.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,412.23
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,955.24
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,525.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$2,783.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,955.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,451.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$1,484.40
|
| 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 |
$1,013.10
|
|
|
CORRECTION HALLUX VALGUS
|
Facility
|
IP
|
$3,711.00
|
|
|
Service Code
|
CPT 28295
|
| Hospital Charge Code |
6191070
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,013.10 |
| Max. Negotiated Rate |
$3,525.45 |
| Rate for Payer: Cash Price |
$2,226.60
|
| Rate for Payer: Cigna Commercial |
$3,154.35
|
| Rate for Payer: First Health Commercial |
$3,339.90
|
| Rate for Payer: First Health Workers Compensation |
$1,432.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,339.90
|
| Rate for Payer: GEHA Commercial |
$2,597.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,339.90
|
| Rate for Payer: Multiplan All |
$3,377.01
|
| Rate for Payer: OMNI Networks Commercial |
$2,597.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,339.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,525.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,783.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,451.23
|
| Rate for Payer: Zelis Auto |
$1,484.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,013.10
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH DISTAL METATARSAL OSTEOTOMY, ANY METHOD
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 28296
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,527.38 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,190.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,190.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,527.38
|
| 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 |
$2,578.85
|
| 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 |
$2,977.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,578.85
|
| 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 |
$2,578.85
|
| 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
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH FIRST METATARSAL AND MEDIAL CUNEIFORM JOINT ARTHRODESIS, ANY METHOD
|
Facility
|
OP
|
$24,435.12
|
|
|
Service Code
|
CPT 28297
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,527.38 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,190.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,190.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,527.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: First Health Workers Compensation |
$15,724.00
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,578.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,977.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,578.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,578.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Medicare |
$10,384.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,661.07
|
| Rate for Payer: Zelis Worker's Compensation |
$11,117.98
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH PROXIMAL METATARSAL OSTEOTOMY, ANY METHOD
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 28295
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,618.76 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,655.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,655.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,896.26
|
| 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 |
$2,955.24
|
| 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 |
$3,412.23
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,955.24
|
| 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 |
$2,955.24
|
| 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
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH RESECTION OF PROXIMAL PHALANX BASE, WHEN PERFORMED, ANY METHOD
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 28292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,527.38 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,190.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,190.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,527.38
|
| 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 |
$2,578.85
|
| 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 |
$2,977.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,578.85
|
| 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 |
$2,578.85
|
| 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
|
|
|
CORRECTION, HAMMERTOE (EG, INTERPHALANGEAL FUSION, PARTIAL OR TOTAL PHALANGECTOMY)
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 28285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,749.66 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: 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 |
$1,785.30
|
| 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 |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: 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
|
|
|
CORRECTION OF BLADDER DEFECT
|
Facility
|
OP
|
$3,432.00
|
|
|
Service Code
|
CPT 51940
|
| Hospital Charge Code |
6151940
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$858.00 |
| Max. Negotiated Rate |
$3,260.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,059.20
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cigna Commercial |
$2,917.20
|
| Rate for Payer: First Health Commercial |
$3,088.80
|
| Rate for Payer: First Health Workers Compensation |
$1,325.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,088.80
|
| Rate for Payer: GEHA Commercial |
$2,745.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,088.80
|
| Rate for Payer: Humana ChoiceCare |
$892.32
|
| Rate for Payer: Multiplan All |
$3,123.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,059.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,402.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,088.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,260.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,574.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,020.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$858.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,191.76
|
| Rate for Payer: Zelis Auto |
$1,372.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,716.00
|
| Rate for Payer: Zelis Worker's Compensation |
$936.94
|
|
|
CORRECTION OF BLADDER DEFECT
|
Facility
|
IP
|
$3,432.00
|
|
|
Service Code
|
CPT 51940
|
| Hospital Charge Code |
6151940
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$936.94 |
| Max. Negotiated Rate |
$3,260.40 |
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cigna Commercial |
$2,917.20
|
| Rate for Payer: First Health Commercial |
$3,088.80
|
| Rate for Payer: First Health Workers Compensation |
$1,325.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,088.80
|
| Rate for Payer: GEHA Commercial |
$2,402.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,088.80
|
| Rate for Payer: Multiplan All |
$3,123.12
|
| Rate for Payer: OMNI Networks Commercial |
$2,402.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,088.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,260.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,574.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,191.76
|
| Rate for Payer: Zelis Auto |
$1,372.80
|
| Rate for Payer: Zelis Worker's Compensation |
$936.94
|
|
|
CORRECTION OF BUNION
|
Facility
|
OP
|
$1,063.00
|
|
|
Service Code
|
CPT 28296
|
| Hospital Charge Code |
6128296
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$290.20 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,190.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$637.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,190.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,527.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$637.80
|
| Rate for Payer: Cash Price |
$637.80
|
| Rate for Payer: Cigna Commercial |
$903.55
|
| Rate for Payer: First Health Commercial |
$956.70
|
| Rate for Payer: First Health Workers Compensation |
$410.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$956.70
|
| Rate for Payer: GEHA Commercial |
$850.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$956.70
|
| 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 |
$2,578.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$967.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$744.10
|
| Rate for Payer: One Health Plan PPO/POS |
$956.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,977.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,578.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,009.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$797.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,578.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$988.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$425.20
|
| 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 |
$290.20
|
|
|
CORRECTION OF BUNION
|
Facility
|
OP
|
$1,194.00
|
|
|
Service Code
|
CPT 28297
|
| Hospital Charge Code |
6128297
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$325.96 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,190.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$716.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,190.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,527.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: Cash Price |
$716.40
|
| Rate for Payer: Cash Price |
$716.40
|
| Rate for Payer: Cigna Commercial |
$1,014.90
|
| Rate for Payer: First Health Commercial |
$1,074.60
|
| Rate for Payer: First Health Workers Compensation |
$461.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,074.60
|
| Rate for Payer: GEHA Commercial |
$955.20
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,074.60
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,578.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,086.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$835.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,074.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,977.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,578.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,134.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$895.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,578.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,110.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$477.60
|
| Rate for Payer: Zelis Medicare |
$10,384.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,661.07
|
| Rate for Payer: Zelis Worker's Compensation |
$325.96
|
|
|
CORRECTION OF BUNION
|
Facility
|
OP
|
$1,993.86
|
|
|
Service Code
|
CPT 28292
|
| Hospital Charge Code |
6128292
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$544.32 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,190.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,196.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,190.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,527.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,196.32
|
| Rate for Payer: Cash Price |
$1,196.32
|
| Rate for Payer: Cigna Commercial |
$1,694.78
|
| Rate for Payer: First Health Commercial |
$1,794.47
|
| Rate for Payer: First Health Workers Compensation |
$769.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,794.47
|
| Rate for Payer: GEHA Commercial |
$1,595.09
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,794.47
|
| 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 |
$2,578.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,814.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,395.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,794.47
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,977.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,578.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,894.17
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,495.39
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,578.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,854.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$797.54
|
| 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 |
$544.32
|
|
|
CORRECTION OF BUNION
|
Facility
|
IP
|
$1,063.00
|
|
|
Service Code
|
CPT 28296
|
| Hospital Charge Code |
6128296
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$290.20 |
| Max. Negotiated Rate |
$1,009.85 |
| Rate for Payer: Cash Price |
$637.80
|
| Rate for Payer: Cigna Commercial |
$903.55
|
| Rate for Payer: First Health Commercial |
$956.70
|
| Rate for Payer: First Health Workers Compensation |
$410.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$956.70
|
| Rate for Payer: GEHA Commercial |
$744.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$956.70
|
| Rate for Payer: Multiplan All |
$967.33
|
| Rate for Payer: OMNI Networks Commercial |
$744.10
|
| Rate for Payer: One Health Plan PPO/POS |
$956.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,009.85
|
| Rate for Payer: Three Rivers Provider Network All |
$797.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$988.59
|
| Rate for Payer: Zelis Auto |
$425.20
|
| Rate for Payer: Zelis Worker's Compensation |
$290.20
|
|
|
CORRECTION OF BUNION
|
Facility
|
IP
|
$1,194.00
|
|
|
Service Code
|
CPT 28297
|
| Hospital Charge Code |
6128297
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$325.96 |
| Max. Negotiated Rate |
$1,134.30 |
| Rate for Payer: Cash Price |
$716.40
|
| Rate for Payer: Cigna Commercial |
$1,014.90
|
| Rate for Payer: First Health Commercial |
$1,074.60
|
| Rate for Payer: First Health Workers Compensation |
$461.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,074.60
|
| Rate for Payer: GEHA Commercial |
$835.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,074.60
|
| Rate for Payer: Multiplan All |
$1,086.54
|
| Rate for Payer: OMNI Networks Commercial |
$835.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,074.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,134.30
|
| Rate for Payer: Three Rivers Provider Network All |
$895.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,110.42
|
| Rate for Payer: Zelis Auto |
$477.60
|
| Rate for Payer: Zelis Worker's Compensation |
$325.96
|
|
|
CORRECTION OF BUNION
|
Facility
|
OP
|
$1,036.00
|
|
|
Service Code
|
CPT 28298
|
| Hospital Charge Code |
6128298
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$282.83 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,190.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$621.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,190.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,527.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Cigna Commercial |
$880.60
|
| Rate for Payer: First Health Commercial |
$932.40
|
| Rate for Payer: First Health Workers Compensation |
$400.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$932.40
|
| Rate for Payer: GEHA Commercial |
$828.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$932.40
|
| 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 |
$2,578.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$942.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$725.20
|
| Rate for Payer: One Health Plan PPO/POS |
$932.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,977.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,578.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$984.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$777.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,578.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$963.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$414.40
|
| 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 |
$282.83
|
|
|
CORRECTION OF BUNION
|
Facility
|
IP
|
$1,036.00
|
|
|
Service Code
|
CPT 28298
|
| Hospital Charge Code |
6128298
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$282.83 |
| Max. Negotiated Rate |
$984.20 |
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Cigna Commercial |
$880.60
|
| Rate for Payer: First Health Commercial |
$932.40
|
| Rate for Payer: First Health Workers Compensation |
$400.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$932.40
|
| Rate for Payer: GEHA Commercial |
$725.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$932.40
|
| Rate for Payer: Multiplan All |
$942.76
|
| Rate for Payer: OMNI Networks Commercial |
$725.20
|
| Rate for Payer: One Health Plan PPO/POS |
$932.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$984.20
|
| Rate for Payer: Three Rivers Provider Network All |
$777.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$963.48
|
| Rate for Payer: Zelis Auto |
$414.40
|
| Rate for Payer: Zelis Worker's Compensation |
$282.83
|
|
|
CORRECTION OF BUNION
|
Facility
|
IP
|
$1,390.00
|
|
|
Service Code
|
CPT 28299
|
| Hospital Charge Code |
6128299
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$379.47 |
| Max. Negotiated Rate |
$1,320.50 |
| Rate for Payer: Cash Price |
$834.00
|
| Rate for Payer: Cigna Commercial |
$1,181.50
|
| Rate for Payer: First Health Commercial |
$1,251.00
|
| Rate for Payer: First Health Workers Compensation |
$536.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,251.00
|
| Rate for Payer: GEHA Commercial |
$973.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,251.00
|
| Rate for Payer: Multiplan All |
$1,264.90
|
| Rate for Payer: OMNI Networks Commercial |
$973.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,251.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,320.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,042.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,292.70
|
| Rate for Payer: Zelis Auto |
$556.00
|
| Rate for Payer: Zelis Worker's Compensation |
$379.47
|
|
|
CORRECTION OF BUNION
|
Facility
|
IP
|
$1,993.86
|
|
|
Service Code
|
CPT 28292
|
| Hospital Charge Code |
6128292
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$544.32 |
| Max. Negotiated Rate |
$1,894.17 |
| Rate for Payer: Cash Price |
$1,196.32
|
| Rate for Payer: Cigna Commercial |
$1,694.78
|
| Rate for Payer: First Health Commercial |
$1,794.47
|
| Rate for Payer: First Health Workers Compensation |
$769.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,794.47
|
| Rate for Payer: GEHA Commercial |
$1,395.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,794.47
|
| Rate for Payer: Multiplan All |
$1,814.41
|
| Rate for Payer: OMNI Networks Commercial |
$1,395.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,794.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,894.17
|
| Rate for Payer: Three Rivers Provider Network All |
$1,495.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,854.29
|
| Rate for Payer: Zelis Auto |
$797.54
|
| Rate for Payer: Zelis Worker's Compensation |
$544.32
|
|
