|
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
|
|
|
FUSION OF ANKLE JOINT OPEN
|
Facility
|
IP
|
$2,122.00
|
|
|
Service Code
|
CPT 27870
|
| Hospital Charge Code |
6127870
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$579.31 |
| Max. Negotiated Rate |
$2,015.90 |
| Rate for Payer: Cash Price |
$1,273.20
|
| Rate for Payer: Cigna Commercial |
$1,803.70
|
| Rate for Payer: First Health Commercial |
$1,909.80
|
| Rate for Payer: First Health Workers Compensation |
$819.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,909.80
|
| Rate for Payer: GEHA Commercial |
$1,485.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,909.80
|
| Rate for Payer: Multiplan All |
$1,931.02
|
| Rate for Payer: OMNI Networks Commercial |
$1,485.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,909.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,015.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,591.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,973.46
|
| Rate for Payer: Zelis Auto |
$848.80
|
| Rate for Payer: Zelis Worker's Compensation |
$579.31
|
|
|
FUSION OF ANKLE JOINT OPEN
|
Facility
|
OP
|
$2,122.00
|
|
|
Service Code
|
CPT 27870
|
| Hospital Charge Code |
6127870
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$579.31 |
| 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 |
$1,273.20
|
| 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 |
$1,273.20
|
| Rate for Payer: Cash Price |
$1,273.20
|
| Rate for Payer: Cigna Commercial |
$1,803.70
|
| Rate for Payer: First Health Commercial |
$1,909.80
|
| Rate for Payer: First Health Workers Compensation |
$819.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,909.80
|
| Rate for Payer: GEHA Commercial |
$1,697.60
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,909.80
|
| 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 |
$1,931.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,485.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,909.80
|
| 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 |
$2,015.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,591.50
|
| 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 |
$1,973.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$848.80
|
| 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 |
$579.31
|
|
|
FUSION OF BIG TOE JOINT
|
Facility
|
IP
|
$1,209.00
|
|
|
Service Code
|
CPT 28750
|
| Hospital Charge Code |
6128750
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$330.06 |
| Max. Negotiated Rate |
$1,148.55 |
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cigna Commercial |
$1,027.65
|
| Rate for Payer: First Health Commercial |
$1,088.10
|
| Rate for Payer: First Health Workers Compensation |
$466.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,088.10
|
| Rate for Payer: GEHA Commercial |
$846.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,088.10
|
| Rate for Payer: Multiplan All |
$1,100.19
|
| Rate for Payer: OMNI Networks Commercial |
$846.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,088.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,148.55
|
| Rate for Payer: Three Rivers Provider Network All |
$906.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,124.37
|
| Rate for Payer: Zelis Auto |
$483.60
|
| Rate for Payer: Zelis Worker's Compensation |
$330.06
|
|
|
FUSION OF BIG TOE JOINT
|
Facility
|
IP
|
$842.00
|
|
|
Service Code
|
CPT 28755
|
| Hospital Charge Code |
6128755
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$229.87 |
| Max. Negotiated Rate |
$799.90 |
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$715.70
|
| Rate for Payer: First Health Commercial |
$757.80
|
| Rate for Payer: First Health Workers Compensation |
$325.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$757.80
|
| Rate for Payer: GEHA Commercial |
$589.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$757.80
|
| Rate for Payer: Multiplan All |
$766.22
|
| Rate for Payer: OMNI Networks Commercial |
$589.40
|
| Rate for Payer: One Health Plan PPO/POS |
$757.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$799.90
|
| Rate for Payer: Three Rivers Provider Network All |
$631.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.06
|
| Rate for Payer: Zelis Auto |
$336.80
|
| Rate for Payer: Zelis Worker's Compensation |
$229.87
|
|
|
FUSION OF BIG TOE JOINT
|
Facility
|
OP
|
$1,209.00
|
|
|
Service Code
|
CPT 28750
|
| Hospital Charge Code |
6128750
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$330.06 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$725.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,207.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cigna Commercial |
$1,027.65
|
| Rate for Payer: First Health Commercial |
$1,088.10
|
| Rate for Payer: First Health Workers Compensation |
$466.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,088.10
|
| Rate for Payer: GEHA Commercial |
$967.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,088.10
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,292.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,100.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$846.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,088.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,956.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,292.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,148.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$906.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,292.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,124.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$483.60
|
| 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 |
$330.06
|
|
|
FUSION OF BIG TOE JOINT
|
Facility
|
OP
|
$842.00
|
|
|
Service Code
|
CPT 28755
|
| Hospital Charge Code |
6128755
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$229.87 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$505.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$715.70
|
| Rate for Payer: First Health Commercial |
$757.80
|
| Rate for Payer: First Health Workers Compensation |
$325.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$757.80
|
| Rate for Payer: GEHA Commercial |
$673.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$757.80
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$766.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$589.40
|
| Rate for Payer: One Health Plan PPO/POS |
$757.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$799.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$631.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$336.80
|
| 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 |
$229.87
|
|
|
FUSION OF ELBOW JOINT
|
Facility
|
IP
|
$1,702.00
|
|
|
Service Code
|
CPT 24800
|
| Hospital Charge Code |
6124800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$464.65 |
| Max. Negotiated Rate |
$1,616.90 |
| Rate for Payer: Cash Price |
$1,021.20
|
| Rate for Payer: Cigna Commercial |
$1,446.70
|
| Rate for Payer: First Health Commercial |
$1,531.80
|
| Rate for Payer: First Health Workers Compensation |
$657.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,531.80
|
| Rate for Payer: GEHA Commercial |
$1,191.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,531.80
|
| Rate for Payer: Multiplan All |
$1,548.82
|
| Rate for Payer: OMNI Networks Commercial |
$1,191.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,531.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,616.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,276.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,582.86
|
| Rate for Payer: Zelis Auto |
$680.80
|
| Rate for Payer: Zelis Worker's Compensation |
$464.65
|
|
|
FUSION OF ELBOW JOINT
|
Facility
|
OP
|
$1,702.00
|
|
|
Service Code
|
CPT 24800
|
| Hospital Charge Code |
6124800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$464.65 |
| 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 |
$1,021.20
|
| 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 |
$1,021.20
|
| Rate for Payer: Cash Price |
$1,021.20
|
| Rate for Payer: Cigna Commercial |
$1,446.70
|
| Rate for Payer: First Health Commercial |
$1,531.80
|
| Rate for Payer: First Health Workers Compensation |
$657.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,531.80
|
| Rate for Payer: GEHA Commercial |
$1,361.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,531.80
|
| 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 |
$1,548.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,191.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,531.80
|
| 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 |
$1,616.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,276.50
|
| 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 |
$1,582.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$680.80
|
| 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 |
$464.65
|
|
|
FUSION OF FINGER JNT ADD-ON
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 26861
|
| Hospital Charge Code |
6126861
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$83.98 |
| 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 |
$193.80
|
| 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: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$274.55
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: First Health Workers Compensation |
$124.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$290.70
|
| Rate for Payer: GEHA Commercial |
$258.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$290.70
|
| Rate for Payer: Humana ChoiceCare |
$83.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Multiplan All |
$293.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$193.80
|
| Rate for Payer: OMNI Networks Commercial |
$226.10
|
| Rate for Payer: One Health Plan PPO/POS |
$290.70
|
| 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 |
$306.85
|
| Rate for Payer: Three Rivers Provider Network All |
$242.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$284.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Payors & United Providers UP&UP |
$300.39
|
| Rate for Payer: Zelis Auto |
$129.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$161.50
|
| Rate for Payer: Zelis Worker's Compensation |
$88.18
|
|
|
FUSION OF FINGER JNT ADD-ON
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 26861
|
| Hospital Charge Code |
6126861
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$88.18 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$274.55
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: First Health Workers Compensation |
$124.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$290.70
|
| Rate for Payer: GEHA Commercial |
$226.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$290.70
|
| Rate for Payer: Multiplan All |
$293.93
|
| Rate for Payer: OMNI Networks Commercial |
$226.10
|
| Rate for Payer: One Health Plan PPO/POS |
$290.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$306.85
|
| Rate for Payer: Three Rivers Provider Network All |
$242.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$300.39
|
| Rate for Payer: Zelis Auto |
$129.20
|
| Rate for Payer: Zelis Worker's Compensation |
$88.18
|
|
|
FUSION OF FINGER JOINT
|
Facility
|
IP
|
$1,105.00
|
|
|
Service Code
|
CPT 26860
|
| Hospital Charge Code |
6126860
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$301.67 |
| Max. Negotiated Rate |
$1,049.75 |
| Rate for Payer: Cash Price |
$663.00
|
| Rate for Payer: Cigna Commercial |
$939.25
|
| Rate for Payer: First Health Commercial |
$994.50
|
| Rate for Payer: First Health Workers Compensation |
$426.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$994.50
|
| Rate for Payer: GEHA Commercial |
$773.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$994.50
|
| Rate for Payer: Multiplan All |
$1,005.55
|
| Rate for Payer: OMNI Networks Commercial |
$773.50
|
| Rate for Payer: One Health Plan PPO/POS |
$994.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,049.75
|
| Rate for Payer: Three Rivers Provider Network All |
$828.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,027.65
|
| Rate for Payer: Zelis Auto |
$442.00
|
| Rate for Payer: Zelis Worker's Compensation |
$301.67
|
|
|
FUSION OF FINGER JOINT
|
Facility
|
OP
|
$1,105.00
|
|
|
Service Code
|
CPT 26860
|
| Hospital Charge Code |
6126860
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$301.67 |
| 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 |
$663.00
|
| 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 |
$663.00
|
| Rate for Payer: Cash Price |
$663.00
|
| Rate for Payer: Cigna Commercial |
$939.25
|
| Rate for Payer: First Health Commercial |
$994.50
|
| Rate for Payer: First Health Workers Compensation |
$426.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$994.50
|
| Rate for Payer: GEHA Commercial |
$884.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$994.50
|
| 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 |
$1,005.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$773.50
|
| Rate for Payer: One Health Plan PPO/POS |
$994.50
|
| 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 |
$1,049.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$828.75
|
| 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 |
$1,027.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$442.00
|
| 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 |
$301.67
|
|
|
FUSION OF FINGER TENDONS
|
Facility
|
OP
|
$1,206.00
|
|
|
Service Code
|
CPT 26471
|
| Hospital Charge Code |
6126471
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$329.24 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$723.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna Commercial |
$1,025.10
|
| Rate for Payer: First Health Commercial |
$1,085.40
|
| Rate for Payer: First Health Workers Compensation |
$465.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,085.40
|
| Rate for Payer: GEHA Commercial |
$964.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,085.40
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,097.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$844.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,085.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,145.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$904.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,121.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$482.40
|
| 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 |
$329.24
|
|
|
FUSION OF FINGER TENDONS
|
Facility
|
OP
|
$1,183.00
|
|
|
Service Code
|
CPT 26474
|
| Hospital Charge Code |
6126474
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$322.96 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$709.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$709.80
|
| Rate for Payer: Cash Price |
$709.80
|
| Rate for Payer: Cigna Commercial |
$1,005.55
|
| Rate for Payer: First Health Commercial |
$1,064.70
|
| Rate for Payer: First Health Workers Compensation |
$456.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,064.70
|
| Rate for Payer: GEHA Commercial |
$946.40
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,064.70
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$1,076.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$828.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,064.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,123.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$887.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,100.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$473.20
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$322.96
|
|
|
FUSION OF FINGER TENDONS
|
Facility
|
IP
|
$1,183.00
|
|
|
Service Code
|
CPT 26474
|
| Hospital Charge Code |
6126474
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$322.96 |
| Max. Negotiated Rate |
$1,123.85 |
| Rate for Payer: Cash Price |
$709.80
|
| Rate for Payer: Cigna Commercial |
$1,005.55
|
| Rate for Payer: First Health Commercial |
$1,064.70
|
| Rate for Payer: First Health Workers Compensation |
$456.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,064.70
|
| Rate for Payer: GEHA Commercial |
$828.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,064.70
|
| Rate for Payer: Multiplan All |
$1,076.53
|
| Rate for Payer: OMNI Networks Commercial |
$828.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,064.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,123.85
|
| Rate for Payer: Three Rivers Provider Network All |
$887.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,100.19
|
| Rate for Payer: Zelis Auto |
$473.20
|
| Rate for Payer: Zelis Worker's Compensation |
$322.96
|
|
|
FUSION OF FINGER TENDONS
|
Facility
|
IP
|
$1,206.00
|
|
|
Service Code
|
CPT 26471
|
| Hospital Charge Code |
6126471
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$329.24 |
| Max. Negotiated Rate |
$1,145.70 |
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna Commercial |
$1,025.10
|
| Rate for Payer: First Health Commercial |
$1,085.40
|
| Rate for Payer: First Health Workers Compensation |
$465.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,085.40
|
| Rate for Payer: GEHA Commercial |
$844.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,085.40
|
| Rate for Payer: Multiplan All |
$1,097.46
|
| Rate for Payer: OMNI Networks Commercial |
$844.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,085.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,145.70
|
| Rate for Payer: Three Rivers Provider Network All |
$904.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,121.58
|
| Rate for Payer: Zelis Auto |
$482.40
|
| Rate for Payer: Zelis Worker's Compensation |
$329.24
|
|
|
FUSION OF FOOT BONES
|
Facility
|
OP
|
$1,606.00
|
|
|
Service Code
|
CPT 28735
|
| Hospital Charge Code |
6128735
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$438.44 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$963.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,207.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: Cash Price |
$963.60
|
| Rate for Payer: Cash Price |
$963.60
|
| Rate for Payer: Cigna Commercial |
$1,365.10
|
| Rate for Payer: First Health Commercial |
$1,445.40
|
| Rate for Payer: First Health Workers Compensation |
$620.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,445.40
|
| Rate for Payer: GEHA Commercial |
$1,284.80
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,445.40
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,292.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,461.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,124.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,445.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,956.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,292.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,525.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,204.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,292.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,493.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$642.40
|
| 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 |
$438.44
|
|
|
FUSION OF FOOT BONES
|
Facility
|
OP
|
$1,501.00
|
|
|
Service Code
|
CPT 28730
|
| Hospital Charge Code |
6128730
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$409.77 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$900.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,207.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: Cash Price |
$900.60
|
| Rate for Payer: Cash Price |
$900.60
|
| Rate for Payer: Cigna Commercial |
$1,275.85
|
| Rate for Payer: First Health Commercial |
$1,350.90
|
| Rate for Payer: First Health Workers Compensation |
$579.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,350.90
|
| Rate for Payer: GEHA Commercial |
$1,200.80
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,350.90
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,292.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,365.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,050.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,350.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,956.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,292.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,425.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,125.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,292.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,395.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$600.40
|
| 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 |
$409.77
|
|
|
FUSION OF FOOT BONES
|
Facility
|
IP
|
$1,276.00
|
|
|
Service Code
|
CPT 28740
|
| Hospital Charge Code |
6128740
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$348.35 |
| Max. Negotiated Rate |
$1,212.20 |
| Rate for Payer: Cash Price |
$765.60
|
| Rate for Payer: Cigna Commercial |
$1,084.60
|
| Rate for Payer: First Health Commercial |
$1,148.40
|
| Rate for Payer: First Health Workers Compensation |
$492.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,148.40
|
| Rate for Payer: GEHA Commercial |
$893.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,148.40
|
| Rate for Payer: Multiplan All |
$1,161.16
|
| Rate for Payer: OMNI Networks Commercial |
$893.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,148.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,212.20
|
| Rate for Payer: Three Rivers Provider Network All |
$957.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,186.68
|
| Rate for Payer: Zelis Auto |
$510.40
|
| Rate for Payer: Zelis Worker's Compensation |
$348.35
|
|
|
FUSION OF FOOT BONES
|
Facility
|
OP
|
$1,923.00
|
|
|
Service Code
|
CPT 28715
|
| Hospital Charge Code |
6128715
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$524.98 |
| 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 |
$1,153.80
|
| 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 |
$1,153.80
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cigna Commercial |
$1,634.55
|
| Rate for Payer: First Health Commercial |
$1,730.70
|
| Rate for Payer: First Health Workers Compensation |
$742.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,730.70
|
| Rate for Payer: GEHA Commercial |
$1,538.40
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,730.70
|
| 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 |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,749.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,346.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,730.70
|
| 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 |
$1,826.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,442.25
|
| 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 |
$1,788.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$769.20
|
| 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 |
$524.98
|
|
|
FUSION OF FOOT BONES
|
Facility
|
OP
|
$1,276.00
|
|
|
Service Code
|
CPT 28740
|
| Hospital Charge Code |
6128740
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$348.35 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$765.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,207.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$765.60
|
| Rate for Payer: Cash Price |
$765.60
|
| Rate for Payer: Cigna Commercial |
$1,084.60
|
| Rate for Payer: First Health Commercial |
$1,148.40
|
| Rate for Payer: First Health Workers Compensation |
$492.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,148.40
|
| Rate for Payer: GEHA Commercial |
$1,020.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,148.40
|
| 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 |
$4,292.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,161.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$893.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,148.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,956.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,292.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,212.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$957.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,292.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,186.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$510.40
|
| 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 |
$348.35
|
|
|
FUSION OF FOOT BONES
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
CPT 28705
|
| Hospital Charge Code |
6128705
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$706.52 |
| Max. Negotiated Rate |
$34,924.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,552.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,207.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17,462.09
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cigna Commercial |
$2,199.80
|
| Rate for Payer: First Health Commercial |
$2,329.20
|
| Rate for Payer: First Health Workers Compensation |
$999.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,329.20
|
| Rate for Payer: GEHA Commercial |
$2,070.40
|
| Rate for Payer: GEHA Medicare |
$17,462.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,329.20
|
| Rate for Payer: Humana ChoiceCare |
$19,208.30
|
| Rate for Payer: Humana Medicare Advantage |
$17,462.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29,336.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,292.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,462.09
|
| Rate for Payer: Multiplan All |
$2,355.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29,685.55
|
| Rate for Payer: OMNI Networks Commercial |
$1,811.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,329.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,956.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,292.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17,462.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,458.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34,924.18
|
| Rate for Payer: Three Rivers Provider Network All |
$1,941.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17,112.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,292.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,462.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,406.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17,462.09
|
| Rate for Payer: Zelis Auto |
$1,035.20
|
| Rate for Payer: Zelis Medicare |
$14,842.78
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20,954.51
|
| Rate for Payer: Zelis Worker's Compensation |
$706.52
|
|
|
FUSION OF FOOT BONES
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
CPT 28705
|
| Hospital Charge Code |
6128705
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$706.52 |
| Max. Negotiated Rate |
$2,458.60 |
| Rate for Payer: Cash Price |
$1,552.80
|
| Rate for Payer: Cigna Commercial |
$2,199.80
|
| Rate for Payer: First Health Commercial |
$2,329.20
|
| Rate for Payer: First Health Workers Compensation |
$999.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,329.20
|
| Rate for Payer: GEHA Commercial |
$1,811.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,329.20
|
| Rate for Payer: Multiplan All |
$2,355.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,811.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,329.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,458.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,941.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,406.84
|
| Rate for Payer: Zelis Auto |
$1,035.20
|
| Rate for Payer: Zelis Worker's Compensation |
$706.52
|
|
|
FUSION OF FOOT BONES
|
Facility
|
IP
|
$1,923.00
|
|
|
Service Code
|
CPT 28715
|
| Hospital Charge Code |
6128715
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$524.98 |
| Max. Negotiated Rate |
$1,826.85 |
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cigna Commercial |
$1,634.55
|
| Rate for Payer: First Health Commercial |
$1,730.70
|
| Rate for Payer: First Health Workers Compensation |
$742.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,730.70
|
| Rate for Payer: GEHA Commercial |
$1,346.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,730.70
|
| Rate for Payer: Multiplan All |
$1,749.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,346.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,730.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,826.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,442.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,788.39
|
| Rate for Payer: Zelis Auto |
$769.20
|
| Rate for Payer: Zelis Worker's Compensation |
$524.98
|
|
