|
FUSE/GRAFT ADDED JOINT
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
CPT 26863
|
| Hospital Charge Code |
6126863
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$156.52 |
| Max. Negotiated Rate |
$2,855.07 |
| 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 |
$361.20
|
| 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: Cash Price |
$361.20
|
| Rate for Payer: Cash Price |
$361.20
|
| Rate for Payer: Cigna Commercial |
$511.70
|
| Rate for Payer: First Health Commercial |
$541.80
|
| Rate for Payer: First Health Workers Compensation |
$232.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$541.80
|
| Rate for Payer: GEHA Commercial |
$481.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$541.80
|
| Rate for Payer: Humana ChoiceCare |
$156.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Multiplan All |
$547.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$361.20
|
| Rate for Payer: OMNI Networks Commercial |
$421.40
|
| Rate for Payer: One Health Plan PPO/POS |
$541.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$571.90
|
| Rate for Payer: Three Rivers Provider Network All |
$451.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$529.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Payors & United Providers UP&UP |
$559.86
|
| Rate for Payer: Zelis Auto |
$240.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$301.00
|
| Rate for Payer: Zelis Worker's Compensation |
$164.35
|
|
|
FUSE/GRAFT ADDED JOINT
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
CPT 26863
|
| Hospital Charge Code |
6126863
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$164.35 |
| Max. Negotiated Rate |
$571.90 |
| Rate for Payer: Cash Price |
$361.20
|
| Rate for Payer: Cigna Commercial |
$511.70
|
| Rate for Payer: First Health Commercial |
$541.80
|
| Rate for Payer: First Health Workers Compensation |
$232.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$541.80
|
| Rate for Payer: GEHA Commercial |
$421.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$541.80
|
| Rate for Payer: Multiplan All |
$547.82
|
| Rate for Payer: OMNI Networks Commercial |
$421.40
|
| Rate for Payer: One Health Plan PPO/POS |
$541.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$571.90
|
| Rate for Payer: Three Rivers Provider Network All |
$451.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$559.86
|
| Rate for Payer: Zelis Auto |
$240.80
|
| Rate for Payer: Zelis Worker's Compensation |
$164.35
|
|
|
FUSE HAND BONES WITH GRAFT
|
Facility
|
IP
|
$1,536.00
|
|
|
Service Code
|
CPT 25825
|
| Hospital Charge Code |
6125825
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$419.33 |
| Max. Negotiated Rate |
$1,459.20 |
| Rate for Payer: Cash Price |
$921.60
|
| Rate for Payer: Cigna Commercial |
$1,305.60
|
| Rate for Payer: First Health Commercial |
$1,382.40
|
| Rate for Payer: First Health Workers Compensation |
$593.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,382.40
|
| Rate for Payer: GEHA Commercial |
$1,075.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,382.40
|
| Rate for Payer: Multiplan All |
$1,397.76
|
| Rate for Payer: OMNI Networks Commercial |
$1,075.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,382.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,459.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,152.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,428.48
|
| Rate for Payer: Zelis Auto |
$614.40
|
| Rate for Payer: Zelis Worker's Compensation |
$419.33
|
|
|
FUSE HAND BONES WITH GRAFT
|
Facility
|
OP
|
$1,536.00
|
|
|
Service Code
|
CPT 25825
|
| Hospital Charge Code |
6125825
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$419.33 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$921.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7,100.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$921.60
|
| Rate for Payer: Cash Price |
$921.60
|
| Rate for Payer: Cigna Commercial |
$1,305.60
|
| Rate for Payer: First Health Commercial |
$1,382.40
|
| Rate for Payer: First Health Workers Compensation |
$593.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,382.40
|
| Rate for Payer: GEHA Commercial |
$1,228.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,382.40
|
| 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 |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,397.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,075.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,382.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8,365.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7,245.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,459.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,152.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,428.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$614.40
|
| 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 |
$419.33
|
|
|
FUSE LIVER DUCT & INTESTINE
|
Facility
|
IP
|
$3,173.00
|
|
|
Service Code
|
CPT 47802
|
| Hospital Charge Code |
6147802
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$866.23 |
| Max. Negotiated Rate |
$3,014.35 |
| Rate for Payer: Cash Price |
$1,903.80
|
| Rate for Payer: Cigna Commercial |
$2,697.05
|
| Rate for Payer: First Health Commercial |
$2,855.70
|
| Rate for Payer: First Health Workers Compensation |
$1,225.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,855.70
|
| Rate for Payer: GEHA Commercial |
$2,221.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,855.70
|
| Rate for Payer: Multiplan All |
$2,887.43
|
| Rate for Payer: OMNI Networks Commercial |
$2,221.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,855.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,014.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,379.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,950.89
|
| Rate for Payer: Zelis Auto |
$1,269.20
|
| Rate for Payer: Zelis Worker's Compensation |
$866.23
|
|
|
FUSE LIVER DUCT & INTESTINE
|
Facility
|
OP
|
$3,173.00
|
|
|
Service Code
|
CPT 47802
|
| Hospital Charge Code |
6147802
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$793.25 |
| Max. Negotiated Rate |
$3,014.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,903.80
|
| Rate for Payer: Cash Price |
$1,903.80
|
| Rate for Payer: Cigna Commercial |
$2,697.05
|
| Rate for Payer: First Health Commercial |
$2,855.70
|
| Rate for Payer: First Health Workers Compensation |
$1,225.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,855.70
|
| Rate for Payer: GEHA Commercial |
$2,538.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,855.70
|
| Rate for Payer: Humana ChoiceCare |
$824.98
|
| Rate for Payer: Multiplan All |
$2,887.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,903.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,221.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,855.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,014.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,379.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,792.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$793.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,950.89
|
| Rate for Payer: Zelis Auto |
$1,269.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,586.50
|
| Rate for Payer: Zelis Worker's Compensation |
$866.23
|
|
|
FUSE LIVER DUCTS & BOWEL
|
Facility
|
OP
|
$6,407.00
|
|
|
Service Code
|
CPT 47765
|
| Hospital Charge Code |
6147765
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,601.75 |
| Max. Negotiated Rate |
$6,086.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,844.20
|
| Rate for Payer: Cash Price |
$3,844.20
|
| Rate for Payer: Cigna Commercial |
$5,445.95
|
| Rate for Payer: First Health Commercial |
$5,766.30
|
| Rate for Payer: First Health Workers Compensation |
$2,473.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,766.30
|
| Rate for Payer: GEHA Commercial |
$5,125.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,766.30
|
| Rate for Payer: Humana ChoiceCare |
$1,665.82
|
| Rate for Payer: Multiplan All |
$5,830.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,844.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,484.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,766.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,086.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,805.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,638.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,601.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,958.51
|
| Rate for Payer: Zelis Auto |
$2,562.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,203.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,749.11
|
|
|
FUSE LIVER DUCTS & BOWEL
|
Facility
|
IP
|
$6,407.00
|
|
|
Service Code
|
CPT 47765
|
| Hospital Charge Code |
6147765
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,749.11 |
| Max. Negotiated Rate |
$6,086.65 |
| Rate for Payer: Cash Price |
$3,844.20
|
| Rate for Payer: Cigna Commercial |
$5,445.95
|
| Rate for Payer: First Health Commercial |
$5,766.30
|
| Rate for Payer: First Health Workers Compensation |
$2,473.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,766.30
|
| Rate for Payer: GEHA Commercial |
$4,484.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,766.30
|
| Rate for Payer: Multiplan All |
$5,830.37
|
| Rate for Payer: OMNI Networks Commercial |
$4,484.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,766.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,086.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,805.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,958.51
|
| Rate for Payer: Zelis Auto |
$2,562.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,749.11
|
|
|
FUSE PANCREAS AND BOWEL
|
Facility
|
IP
|
$3,507.00
|
|
|
Service Code
|
CPT 48548
|
| Hospital Charge Code |
6148548
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$957.41 |
| Max. Negotiated Rate |
$3,331.65 |
| Rate for Payer: Cash Price |
$2,104.20
|
| Rate for Payer: Cigna Commercial |
$2,980.95
|
| Rate for Payer: First Health Commercial |
$3,156.30
|
| Rate for Payer: First Health Workers Compensation |
$1,354.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,156.30
|
| Rate for Payer: GEHA Commercial |
$2,454.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,156.30
|
| Rate for Payer: Multiplan All |
$3,191.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,454.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,156.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,331.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,630.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,261.51
|
| Rate for Payer: Zelis Auto |
$1,402.80
|
| Rate for Payer: Zelis Worker's Compensation |
$957.41
|
|
|
FUSE PANCREAS AND BOWEL
|
Facility
|
OP
|
$3,507.00
|
|
|
Service Code
|
CPT 48548
|
| Hospital Charge Code |
6148548
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$876.75 |
| Max. Negotiated Rate |
$3,331.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,104.20
|
| Rate for Payer: Cash Price |
$2,104.20
|
| Rate for Payer: Cigna Commercial |
$2,980.95
|
| Rate for Payer: First Health Commercial |
$3,156.30
|
| Rate for Payer: First Health Workers Compensation |
$1,354.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,156.30
|
| Rate for Payer: GEHA Commercial |
$2,805.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,156.30
|
| Rate for Payer: Humana ChoiceCare |
$911.82
|
| Rate for Payer: Multiplan All |
$3,191.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,104.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,454.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,156.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,331.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,630.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,086.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$876.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,261.51
|
| Rate for Payer: Zelis Auto |
$1,402.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,753.50
|
| Rate for Payer: Zelis Worker's Compensation |
$957.41
|
|
|
FUSE PANCREAS CYST AND BOWEL
|
Facility
|
OP
|
$2,739.00
|
|
|
Service Code
|
CPT 48540
|
| Hospital Charge Code |
6148540
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$684.75 |
| Max. Negotiated Rate |
$2,602.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,643.40
|
| Rate for Payer: Cash Price |
$1,643.40
|
| Rate for Payer: Cigna Commercial |
$2,328.15
|
| Rate for Payer: First Health Commercial |
$2,465.10
|
| Rate for Payer: First Health Workers Compensation |
$1,057.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,465.10
|
| Rate for Payer: GEHA Commercial |
$2,191.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,465.10
|
| Rate for Payer: Humana ChoiceCare |
$712.14
|
| Rate for Payer: Multiplan All |
$2,492.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,643.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,917.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,465.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,602.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,054.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,410.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$684.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,547.27
|
| Rate for Payer: Zelis Auto |
$1,095.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,369.50
|
| Rate for Payer: Zelis Worker's Compensation |
$747.75
|
|
|
FUSE PANCREAS CYST AND BOWEL
|
Facility
|
IP
|
$2,739.00
|
|
|
Service Code
|
CPT 48540
|
| Hospital Charge Code |
6148540
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$747.75 |
| Max. Negotiated Rate |
$2,602.05 |
| Rate for Payer: Cash Price |
$1,643.40
|
| Rate for Payer: Cigna Commercial |
$2,328.15
|
| Rate for Payer: First Health Commercial |
$2,465.10
|
| Rate for Payer: First Health Workers Compensation |
$1,057.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,465.10
|
| Rate for Payer: GEHA Commercial |
$1,917.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,465.10
|
| Rate for Payer: Multiplan All |
$2,492.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,917.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,465.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,602.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,054.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,547.27
|
| Rate for Payer: Zelis Auto |
$1,095.60
|
| Rate for Payer: Zelis Worker's Compensation |
$747.75
|
|
|
FUSE PANCREAS CYST AND BOWEL
|
Facility
|
OP
|
$2,301.00
|
|
|
Service Code
|
CPT 48520
|
| Hospital Charge Code |
6148520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$575.25 |
| Max. Negotiated Rate |
$2,185.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,380.60
|
| Rate for Payer: Cash Price |
$1,380.60
|
| Rate for Payer: Cigna Commercial |
$1,955.85
|
| Rate for Payer: First Health Commercial |
$2,070.90
|
| Rate for Payer: First Health Workers Compensation |
$888.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,070.90
|
| Rate for Payer: GEHA Commercial |
$1,840.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,070.90
|
| Rate for Payer: Humana ChoiceCare |
$598.26
|
| Rate for Payer: Multiplan All |
$2,093.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,380.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,610.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,070.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,185.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,725.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,024.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$575.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,139.93
|
| Rate for Payer: Zelis Auto |
$920.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,150.50
|
| Rate for Payer: Zelis Worker's Compensation |
$628.17
|
|
|
FUSE PANCREAS CYST AND BOWEL
|
Facility
|
IP
|
$2,301.00
|
|
|
Service Code
|
CPT 48520
|
| Hospital Charge Code |
6148520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$628.17 |
| Max. Negotiated Rate |
$2,185.95 |
| Rate for Payer: Cash Price |
$1,380.60
|
| Rate for Payer: Cigna Commercial |
$1,955.85
|
| Rate for Payer: First Health Commercial |
$2,070.90
|
| Rate for Payer: First Health Workers Compensation |
$888.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,070.90
|
| Rate for Payer: GEHA Commercial |
$1,610.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,070.90
|
| Rate for Payer: Multiplan All |
$2,093.91
|
| Rate for Payer: OMNI Networks Commercial |
$1,610.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,070.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,185.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,725.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,139.93
|
| Rate for Payer: Zelis Auto |
$920.40
|
| Rate for Payer: Zelis Worker's Compensation |
$628.17
|
|
|
FUSE UPPER GI STRUCTURES
|
Facility
|
OP
|
$2,852.00
|
|
|
Service Code
|
CPT 47721
|
| Hospital Charge Code |
6147721
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$713.00 |
| Max. Negotiated Rate |
$2,709.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,711.20
|
| Rate for Payer: Cash Price |
$1,711.20
|
| Rate for Payer: Cigna Commercial |
$2,424.20
|
| Rate for Payer: First Health Commercial |
$2,566.80
|
| Rate for Payer: First Health Workers Compensation |
$1,101.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,566.80
|
| Rate for Payer: GEHA Commercial |
$2,281.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,566.80
|
| Rate for Payer: Humana ChoiceCare |
$741.52
|
| Rate for Payer: Multiplan All |
$2,595.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,711.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,996.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,566.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,709.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,139.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,509.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$713.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,652.36
|
| Rate for Payer: Zelis Auto |
$1,140.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,426.00
|
| Rate for Payer: Zelis Worker's Compensation |
$778.60
|
|
|
FUSE UPPER GI STRUCTURES
|
Facility
|
IP
|
$2,852.00
|
|
|
Service Code
|
CPT 47721
|
| Hospital Charge Code |
6147721
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$778.60 |
| Max. Negotiated Rate |
$2,709.40 |
| Rate for Payer: Cash Price |
$1,711.20
|
| Rate for Payer: Cigna Commercial |
$2,424.20
|
| Rate for Payer: First Health Commercial |
$2,566.80
|
| Rate for Payer: First Health Workers Compensation |
$1,101.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,566.80
|
| Rate for Payer: GEHA Commercial |
$1,996.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,566.80
|
| Rate for Payer: Multiplan All |
$2,595.32
|
| Rate for Payer: OMNI Networks Commercial |
$1,996.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,566.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,709.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,139.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,652.36
|
| Rate for Payer: Zelis Auto |
$1,140.80
|
| Rate for Payer: Zelis Worker's Compensation |
$778.60
|
|
|
FUSION/GRAFT OF ELBOW JOINT
|
Facility
|
IP
|
$2,013.00
|
|
|
Service Code
|
CPT 24802
|
| Hospital Charge Code |
6124802
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$549.55 |
| Max. Negotiated Rate |
$1,912.35 |
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cigna Commercial |
$1,711.05
|
| Rate for Payer: First Health Commercial |
$1,811.70
|
| Rate for Payer: First Health Workers Compensation |
$777.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,811.70
|
| Rate for Payer: GEHA Commercial |
$1,409.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,811.70
|
| Rate for Payer: Multiplan All |
$1,831.83
|
| Rate for Payer: OMNI Networks Commercial |
$1,409.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,811.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,912.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,509.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,872.09
|
| Rate for Payer: Zelis Auto |
$805.20
|
| Rate for Payer: Zelis Worker's Compensation |
$549.55
|
|
|
FUSION/GRAFT OF ELBOW JOINT
|
Facility
|
OP
|
$2,013.00
|
|
|
Service Code
|
CPT 24802
|
| Hospital Charge Code |
6124802
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$549.55 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,207.80
|
| 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 |
$12,217.56
|
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cigna Commercial |
$1,711.05
|
| Rate for Payer: First Health Commercial |
$1,811.70
|
| Rate for Payer: First Health Workers Compensation |
$777.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,811.70
|
| Rate for Payer: GEHA Commercial |
$1,610.40
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,811.70
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,831.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,409.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,811.70
|
| 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 |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,912.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,509.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,872.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$805.20
|
| 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 |
$549.55
|
|
|
FUSION/GRAFT OF FINGER JOINT
|
Facility
|
OP
|
$1,434.00
|
|
|
Service Code
|
CPT 26862
|
| Hospital Charge Code |
6126862
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$391.48 |
| 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 |
$860.40
|
| 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 |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$1,218.90
|
| Rate for Payer: First Health Commercial |
$1,290.60
|
| Rate for Payer: First Health Workers Compensation |
$553.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,290.60
|
| Rate for Payer: GEHA Commercial |
$1,147.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,290.60
|
| 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 |
$1,304.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,003.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,290.60
|
| 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 |
$1,362.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,075.50
|
| 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 |
$1,333.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$573.60
|
| 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 |
$391.48
|
|
|
FUSION/GRAFT OF FINGER JOINT
|
Facility
|
IP
|
$1,434.00
|
|
|
Service Code
|
CPT 26862
|
| Hospital Charge Code |
6126862
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$391.48 |
| Max. Negotiated Rate |
$1,362.30 |
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$1,218.90
|
| Rate for Payer: First Health Commercial |
$1,290.60
|
| Rate for Payer: First Health Workers Compensation |
$553.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,290.60
|
| Rate for Payer: GEHA Commercial |
$1,003.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,290.60
|
| Rate for Payer: Multiplan All |
$1,304.94
|
| Rate for Payer: OMNI Networks Commercial |
$1,003.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,290.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,362.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,075.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,333.62
|
| Rate for Payer: Zelis Auto |
$573.60
|
| Rate for Payer: Zelis Worker's Compensation |
$391.48
|
|
|
FUSION/GRAFT OF HAND JOINT
|
Facility
|
OP
|
$1,607.00
|
|
|
Service Code
|
CPT 26844
|
| Hospital Charge Code |
6126844
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$438.71 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$964.20
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$964.20
|
| Rate for Payer: Cash Price |
$964.20
|
| Rate for Payer: Cigna Commercial |
$1,365.95
|
| Rate for Payer: First Health Commercial |
$1,446.30
|
| Rate for Payer: First Health Workers Compensation |
$620.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,446.30
|
| Rate for Payer: GEHA Commercial |
$1,285.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,446.30
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,462.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,124.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,446.30
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,526.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,205.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,494.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$642.80
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$438.71
|
|
|
FUSION/GRAFT OF HAND JOINT
|
Facility
|
IP
|
$1,607.00
|
|
|
Service Code
|
CPT 26844
|
| Hospital Charge Code |
6126844
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$438.71 |
| Max. Negotiated Rate |
$1,526.65 |
| Rate for Payer: Cash Price |
$964.20
|
| Rate for Payer: Cigna Commercial |
$1,365.95
|
| Rate for Payer: First Health Commercial |
$1,446.30
|
| Rate for Payer: First Health Workers Compensation |
$620.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,446.30
|
| Rate for Payer: GEHA Commercial |
$1,124.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,446.30
|
| Rate for Payer: Multiplan All |
$1,462.37
|
| Rate for Payer: OMNI Networks Commercial |
$1,124.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,446.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,526.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,205.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,494.51
|
| Rate for Payer: Zelis Auto |
$642.80
|
| Rate for Payer: Zelis Worker's Compensation |
$438.71
|
|
|
FUSION/GRAFT OF WRIST JOINT
|
Facility
|
OP
|
$1,770.00
|
|
|
Service Code
|
CPT 25810
|
| Hospital Charge Code |
6125810
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$483.21 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,062.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7,100.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cigna Commercial |
$1,504.50
|
| Rate for Payer: First Health Commercial |
$1,593.00
|
| Rate for Payer: First Health Workers Compensation |
$683.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,593.00
|
| Rate for Payer: GEHA Commercial |
$1,416.00
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,593.00
|
| 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 |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,610.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,239.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,593.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8,365.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7,245.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,681.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,327.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,646.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$708.00
|
| Rate for Payer: Zelis Medicare |
$10,384.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,661.07
|
| Rate for Payer: Zelis Worker's Compensation |
$483.21
|
|
|
FUSION/GRAFT OF WRIST JOINT
|
Facility
|
OP
|
$1,733.00
|
|
|
Service Code
|
CPT 25805
|
| Hospital Charge Code |
6125805
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$473.11 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,039.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,039.80
|
| Rate for Payer: Cash Price |
$1,039.80
|
| Rate for Payer: Cigna Commercial |
$1,473.05
|
| Rate for Payer: First Health Commercial |
$1,559.70
|
| Rate for Payer: First Health Workers Compensation |
$669.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,559.70
|
| Rate for Payer: GEHA Commercial |
$1,386.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,559.70
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,577.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,213.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,559.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,646.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,299.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,611.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$693.20
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$473.11
|
|
|
FUSION/GRAFT OF WRIST JOINT
|
Facility
|
IP
|
$1,770.00
|
|
|
Service Code
|
CPT 25810
|
| Hospital Charge Code |
6125810
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$483.21 |
| Max. Negotiated Rate |
$1,681.50 |
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cigna Commercial |
$1,504.50
|
| Rate for Payer: First Health Commercial |
$1,593.00
|
| Rate for Payer: First Health Workers Compensation |
$683.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,593.00
|
| Rate for Payer: GEHA Commercial |
$1,239.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,593.00
|
| Rate for Payer: Multiplan All |
$1,610.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,239.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,593.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,681.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,327.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,646.10
|
| Rate for Payer: Zelis Auto |
$708.00
|
| Rate for Payer: Zelis Worker's Compensation |
$483.21
|
|
