|
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 HAND BONES
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
CPT 25820
|
| Hospital Charge Code |
6125820
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$339.88 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$747.00
|
| 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 |
$747.00
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cigna Commercial |
$1,058.25
|
| Rate for Payer: First Health Commercial |
$1,120.50
|
| Rate for Payer: First Health Workers Compensation |
$480.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,120.50
|
| Rate for Payer: GEHA Commercial |
$996.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,120.50
|
| 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 |
$1,132.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$871.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,120.50
|
| 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 |
$1,182.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$933.75
|
| 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 |
$1,157.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$498.00
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$339.88
|
|
|
FUSION OF HAND BONES
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
CPT 25820
|
| Hospital Charge Code |
6125820
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$339.88 |
| Max. Negotiated Rate |
$1,182.75 |
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cigna Commercial |
$1,058.25
|
| Rate for Payer: First Health Commercial |
$1,120.50
|
| Rate for Payer: First Health Workers Compensation |
$480.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,120.50
|
| Rate for Payer: GEHA Commercial |
$871.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,120.50
|
| Rate for Payer: Multiplan All |
$1,132.95
|
| Rate for Payer: OMNI Networks Commercial |
$871.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,120.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,182.75
|
| Rate for Payer: Three Rivers Provider Network All |
$933.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,157.85
|
| Rate for Payer: Zelis Auto |
$498.00
|
| Rate for Payer: Zelis Worker's Compensation |
$339.88
|
|
|
FUSION OF HAND JOINT
|
Facility
|
IP
|
$1,469.00
|
|
|
Service Code
|
CPT 26843
|
| Hospital Charge Code |
6126843
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$401.04 |
| Max. Negotiated Rate |
$1,395.55 |
| Rate for Payer: Cash Price |
$881.40
|
| Rate for Payer: Cigna Commercial |
$1,248.65
|
| Rate for Payer: First Health Commercial |
$1,322.10
|
| Rate for Payer: First Health Workers Compensation |
$567.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,322.10
|
| Rate for Payer: GEHA Commercial |
$1,028.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,322.10
|
| Rate for Payer: Multiplan All |
$1,336.79
|
| Rate for Payer: OMNI Networks Commercial |
$1,028.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,322.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,395.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,101.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,366.17
|
| Rate for Payer: Zelis Auto |
$587.60
|
| Rate for Payer: Zelis Worker's Compensation |
$401.04
|
|
|
FUSION OF HAND JOINT
|
Facility
|
OP
|
$1,469.00
|
|
|
Service Code
|
CPT 26843
|
| Hospital Charge Code |
6126843
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$401.04 |
| 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 |
$881.40
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$881.40
|
| Rate for Payer: Cash Price |
$881.40
|
| Rate for Payer: Cigna Commercial |
$1,248.65
|
| Rate for Payer: First Health Commercial |
$1,322.10
|
| Rate for Payer: First Health Workers Compensation |
$567.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,322.10
|
| Rate for Payer: GEHA Commercial |
$1,175.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,322.10
|
| 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 |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,336.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,028.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,322.10
|
| 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 |
$1,395.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,101.75
|
| 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 |
$1,366.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$587.60
|
| 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 |
$401.04
|
|
|
FUSION OF HIP JOINT
|
Facility
|
OP
|
$3,380.00
|
|
|
Service Code
|
CPT 27286
|
| Hospital Charge Code |
6127286
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$845.00 |
| Max. Negotiated Rate |
$3,211.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,028.00
|
| Rate for Payer: Cash Price |
$2,028.00
|
| Rate for Payer: Cigna Commercial |
$2,873.00
|
| Rate for Payer: First Health Commercial |
$3,042.00
|
| Rate for Payer: First Health Workers Compensation |
$1,305.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,042.00
|
| Rate for Payer: GEHA Commercial |
$2,704.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,042.00
|
| Rate for Payer: Humana ChoiceCare |
$878.80
|
| Rate for Payer: Multiplan All |
$3,075.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,028.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,366.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,042.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,211.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,535.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,974.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$845.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,143.40
|
| Rate for Payer: Zelis Auto |
$1,352.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,690.00
|
| Rate for Payer: Zelis Worker's Compensation |
$922.74
|
|
|
FUSION OF HIP JOINT
|
Facility
|
OP
|
$3,233.00
|
|
|
Service Code
|
CPT 27284
|
| Hospital Charge Code |
6127284
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$808.25 |
| Max. Negotiated Rate |
$3,071.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,939.80
|
| Rate for Payer: Cash Price |
$1,939.80
|
| Rate for Payer: Cigna Commercial |
$2,748.05
|
| Rate for Payer: First Health Commercial |
$2,909.70
|
| Rate for Payer: First Health Workers Compensation |
$1,248.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,909.70
|
| Rate for Payer: GEHA Commercial |
$2,586.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,909.70
|
| Rate for Payer: Humana ChoiceCare |
$840.58
|
| Rate for Payer: Multiplan All |
$2,942.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,939.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,263.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,909.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,071.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,424.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,845.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$808.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,006.69
|
| Rate for Payer: Zelis Auto |
$1,293.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,616.50
|
| Rate for Payer: Zelis Worker's Compensation |
$882.61
|
|
|
FUSION OF HIP JOINT
|
Facility
|
IP
|
$3,233.00
|
|
|
Service Code
|
CPT 27284
|
| Hospital Charge Code |
6127284
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$882.61 |
| Max. Negotiated Rate |
$3,071.35 |
| Rate for Payer: Cash Price |
$1,939.80
|
| Rate for Payer: Cigna Commercial |
$2,748.05
|
| Rate for Payer: First Health Commercial |
$2,909.70
|
| Rate for Payer: First Health Workers Compensation |
$1,248.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,909.70
|
| Rate for Payer: GEHA Commercial |
$2,263.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,909.70
|
| Rate for Payer: Multiplan All |
$2,942.03
|
| Rate for Payer: OMNI Networks Commercial |
$2,263.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,909.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,071.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,424.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,006.69
|
| Rate for Payer: Zelis Auto |
$1,293.20
|
| Rate for Payer: Zelis Worker's Compensation |
$882.61
|
|
|
FUSION OF HIP JOINT
|
Facility
|
IP
|
$3,380.00
|
|
|
Service Code
|
CPT 27286
|
| Hospital Charge Code |
6127286
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$922.74 |
| Max. Negotiated Rate |
$3,211.00 |
| Rate for Payer: Cash Price |
$2,028.00
|
| Rate for Payer: Cigna Commercial |
$2,873.00
|
| Rate for Payer: First Health Commercial |
$3,042.00
|
| Rate for Payer: First Health Workers Compensation |
$1,305.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,042.00
|
| Rate for Payer: GEHA Commercial |
$2,366.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,042.00
|
| Rate for Payer: Multiplan All |
$3,075.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,366.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,042.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,211.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,535.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,143.40
|
| Rate for Payer: Zelis Auto |
$1,352.00
|
| Rate for Payer: Zelis Worker's Compensation |
$922.74
|
|
|
FUSION OF KNEE
|
Facility
|
IP
|
$2,964.00
|
|
|
Service Code
|
CPT 27580
|
| Hospital Charge Code |
6127580
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$809.17 |
| Max. Negotiated Rate |
$2,815.80 |
| Rate for Payer: Cash Price |
$1,778.40
|
| Rate for Payer: Cigna Commercial |
$2,519.40
|
| Rate for Payer: First Health Commercial |
$2,667.60
|
| Rate for Payer: First Health Workers Compensation |
$1,144.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,667.60
|
| Rate for Payer: GEHA Commercial |
$2,074.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,667.60
|
| Rate for Payer: Multiplan All |
$2,697.24
|
| Rate for Payer: OMNI Networks Commercial |
$2,074.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,667.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,815.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,223.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,756.52
|
| Rate for Payer: Zelis Auto |
$1,185.60
|
| Rate for Payer: Zelis Worker's Compensation |
$809.17
|
|
|
FUSION OF KNEE
|
Facility
|
OP
|
$2,964.00
|
|
|
Service Code
|
CPT 27580
|
| Hospital Charge Code |
6127580
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$741.00 |
| Max. Negotiated Rate |
$2,815.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,778.40
|
| Rate for Payer: Cash Price |
$1,778.40
|
| Rate for Payer: Cigna Commercial |
$2,519.40
|
| Rate for Payer: First Health Commercial |
$2,667.60
|
| Rate for Payer: First Health Workers Compensation |
$1,144.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,667.60
|
| Rate for Payer: GEHA Commercial |
$2,371.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,667.60
|
| Rate for Payer: Humana ChoiceCare |
$770.64
|
| Rate for Payer: Multiplan All |
$2,697.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,778.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,074.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,667.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,815.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,223.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,608.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$741.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,756.52
|
| Rate for Payer: Zelis Auto |
$1,185.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,482.00
|
| Rate for Payer: Zelis Worker's Compensation |
$809.17
|
|
|
FUSION OF KNUCKLE
|
Facility
|
IP
|
$1,364.00
|
|
|
Service Code
|
CPT 26850
|
| Hospital Charge Code |
6126850
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$372.37 |
| Max. Negotiated Rate |
$1,295.80 |
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cigna Commercial |
$1,159.40
|
| Rate for Payer: First Health Commercial |
$1,227.60
|
| Rate for Payer: First Health Workers Compensation |
$526.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,227.60
|
| Rate for Payer: GEHA Commercial |
$954.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,227.60
|
| Rate for Payer: Multiplan All |
$1,241.24
|
| Rate for Payer: OMNI Networks Commercial |
$954.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,227.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,295.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,023.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,268.52
|
| Rate for Payer: Zelis Auto |
$545.60
|
| Rate for Payer: Zelis Worker's Compensation |
$372.37
|
|
|
FUSION OF KNUCKLE
|
Facility
|
OP
|
$1,364.00
|
|
|
Service Code
|
CPT 26850
|
| Hospital Charge Code |
6126850
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$372.37 |
| 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 |
$818.40
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cigna Commercial |
$1,159.40
|
| Rate for Payer: First Health Commercial |
$1,227.60
|
| Rate for Payer: First Health Workers Compensation |
$526.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,227.60
|
| Rate for Payer: GEHA Commercial |
$1,091.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,227.60
|
| 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 |
$1,241.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$954.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,227.60
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,295.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,023.00
|
| 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 |
$1,268.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$545.60
|
| 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 |
$372.37
|
|
|
FUSION OF KNUCKLE JOINT
|
Facility
|
OP
|
$1,380.00
|
|
|
Service Code
|
CPT 26516
|
| Hospital Charge Code |
6126516
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$376.74 |
| 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 |
$828.00
|
| 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 |
$828.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cigna Commercial |
$1,173.00
|
| Rate for Payer: First Health Commercial |
$1,242.00
|
| Rate for Payer: First Health Workers Compensation |
$532.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,242.00
|
| Rate for Payer: GEHA Commercial |
$1,104.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,242.00
|
| 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 |
$1,255.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$966.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,242.00
|
| 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 |
$1,311.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,035.00
|
| 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 |
$1,283.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$552.00
|
| 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 |
$376.74
|
|
|
FUSION OF KNUCKLE JOINT
|
Facility
|
IP
|
$1,380.00
|
|
|
Service Code
|
CPT 26516
|
| Hospital Charge Code |
6126516
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$376.74 |
| Max. Negotiated Rate |
$1,311.00 |
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cigna Commercial |
$1,173.00
|
| Rate for Payer: First Health Commercial |
$1,242.00
|
| Rate for Payer: First Health Workers Compensation |
$532.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,242.00
|
| Rate for Payer: GEHA Commercial |
$966.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,242.00
|
| Rate for Payer: Multiplan All |
$1,255.80
|
| Rate for Payer: OMNI Networks Commercial |
$966.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,242.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,311.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,035.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,283.40
|
| Rate for Payer: Zelis Auto |
$552.00
|
| Rate for Payer: Zelis Worker's Compensation |
$376.74
|
|
|
FUSION OF KNUCKLE JOINTS
|
Facility
|
OP
|
$1,633.00
|
|
|
Service Code
|
CPT 26518
|
| Hospital Charge Code |
6126518
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$445.81 |
| 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 |
$979.80
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$979.80
|
| Rate for Payer: Cash Price |
$979.80
|
| Rate for Payer: Cigna Commercial |
$1,388.05
|
| Rate for Payer: First Health Commercial |
$1,469.70
|
| Rate for Payer: First Health Workers Compensation |
$630.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,469.70
|
| Rate for Payer: GEHA Commercial |
$1,306.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,469.70
|
| 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 |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,486.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,143.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,469.70
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,551.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,224.75
|
| 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 |
$1,518.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$653.20
|
| 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 |
$445.81
|
|
|
FUSION OF KNUCKLE JOINTS
|
Facility
|
OP
|
$1,640.00
|
|
|
Service Code
|
CPT 26517
|
| Hospital Charge Code |
6126517
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$447.72 |
| 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 |
$984.00
|
| 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 |
$984.00
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cigna Commercial |
$1,394.00
|
| Rate for Payer: First Health Commercial |
$1,476.00
|
| Rate for Payer: First Health Workers Compensation |
$633.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,476.00
|
| Rate for Payer: GEHA Commercial |
$1,312.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,476.00
|
| 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 |
$1,492.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,148.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,476.00
|
| 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 |
$1,558.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,230.00
|
| 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 |
$1,525.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$656.00
|
| 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 |
$447.72
|
|
|
FUSION OF KNUCKLE JOINTS
|
Facility
|
IP
|
$1,633.00
|
|
|
Service Code
|
CPT 26518
|
| Hospital Charge Code |
6126518
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$445.81 |
| Max. Negotiated Rate |
$1,551.35 |
| Rate for Payer: Cash Price |
$979.80
|
| Rate for Payer: Cigna Commercial |
$1,388.05
|
| Rate for Payer: First Health Commercial |
$1,469.70
|
| Rate for Payer: First Health Workers Compensation |
$630.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,469.70
|
| Rate for Payer: GEHA Commercial |
$1,143.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,469.70
|
| Rate for Payer: Multiplan All |
$1,486.03
|
| Rate for Payer: OMNI Networks Commercial |
$1,143.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,469.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,551.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,224.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,518.69
|
| Rate for Payer: Zelis Auto |
$653.20
|
| Rate for Payer: Zelis Worker's Compensation |
$445.81
|
|
|
FUSION OF KNUCKLE JOINTS
|
Facility
|
IP
|
$1,640.00
|
|
|
Service Code
|
CPT 26517
|
| Hospital Charge Code |
6126517
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$447.72 |
| Max. Negotiated Rate |
$1,558.00 |
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cigna Commercial |
$1,394.00
|
| Rate for Payer: First Health Commercial |
$1,476.00
|
| Rate for Payer: First Health Workers Compensation |
$633.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,476.00
|
| Rate for Payer: GEHA Commercial |
$1,148.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,476.00
|
| Rate for Payer: Multiplan All |
$1,492.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,148.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,476.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,558.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,230.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,525.20
|
| Rate for Payer: Zelis Auto |
$656.00
|
| Rate for Payer: Zelis Worker's Compensation |
$447.72
|
|
|
FUSION OF KNUCKLE WITH GRAFT
|
Facility
|
OP
|
$1,575.00
|
|
|
Service Code
|
CPT 26852
|
| Hospital Charge Code |
6126852
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$429.98 |
| 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 |
$945.00
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Cigna Commercial |
$1,338.75
|
| Rate for Payer: First Health Commercial |
$1,417.50
|
| Rate for Payer: First Health Workers Compensation |
$608.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,417.50
|
| Rate for Payer: GEHA Commercial |
$1,260.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,417.50
|
| 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 |
$1,433.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,102.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,417.50
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,496.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,181.25
|
| 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 |
$1,464.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$630.00
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$429.98
|
|
|
FUSION OF KNUCKLE WITH GRAFT
|
Facility
|
IP
|
$1,575.00
|
|
|
Service Code
|
CPT 26852
|
| Hospital Charge Code |
6126852
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$429.98 |
| Max. Negotiated Rate |
$1,496.25 |
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Cigna Commercial |
$1,338.75
|
| Rate for Payer: First Health Commercial |
$1,417.50
|
| Rate for Payer: First Health Workers Compensation |
$608.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,417.50
|
| Rate for Payer: GEHA Commercial |
$1,102.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,417.50
|
| Rate for Payer: Multiplan All |
$1,433.25
|
| Rate for Payer: OMNI Networks Commercial |
$1,102.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,417.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,496.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,181.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,464.75
|
| Rate for Payer: Zelis Auto |
$630.00
|
| Rate for Payer: Zelis Worker's Compensation |
$429.98
|
|
|
FUSION OF PUBIC BONES
|
Facility
|
OP
|
$1,693.00
|
|
|
Service Code
|
CPT 27282
|
| Hospital Charge Code |
6127282
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$423.25 |
| Max. Negotiated Rate |
$1,608.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$1,439.05
|
| Rate for Payer: First Health Commercial |
$1,523.70
|
| Rate for Payer: First Health Workers Compensation |
$653.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,523.70
|
| Rate for Payer: GEHA Commercial |
$1,354.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,523.70
|
| Rate for Payer: Humana ChoiceCare |
$440.18
|
| Rate for Payer: Multiplan All |
$1,540.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,015.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,185.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,523.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,608.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,269.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,574.49
|
| Rate for Payer: Zelis Auto |
$677.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$846.50
|
| Rate for Payer: Zelis Worker's Compensation |
$462.19
|
|
|
FUSION OF PUBIC BONES
|
Facility
|
IP
|
$1,693.00
|
|
|
Service Code
|
CPT 27282
|
| Hospital Charge Code |
6127282
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$462.19 |
| Max. Negotiated Rate |
$1,608.35 |
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$1,439.05
|
| Rate for Payer: First Health Commercial |
$1,523.70
|
| Rate for Payer: First Health Workers Compensation |
$653.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,523.70
|
| Rate for Payer: GEHA Commercial |
$1,185.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,523.70
|
| Rate for Payer: Multiplan All |
$1,540.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,185.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,523.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,608.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,269.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,574.49
|
| Rate for Payer: Zelis Auto |
$677.20
|
| Rate for Payer: Zelis Worker's Compensation |
$462.19
|
|
|
FUSION OF SHOULDER JOINT
|
Facility
|
IP
|
$2,114.00
|
|
|
Service Code
|
CPT 23800
|
| Hospital Charge Code |
6123800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$577.12 |
| Max. Negotiated Rate |
$2,008.30 |
| Rate for Payer: Cash Price |
$1,268.40
|
| Rate for Payer: Cigna Commercial |
$1,796.90
|
| Rate for Payer: First Health Commercial |
$1,902.60
|
| Rate for Payer: First Health Workers Compensation |
$816.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,902.60
|
| Rate for Payer: GEHA Commercial |
$1,479.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,902.60
|
| Rate for Payer: Multiplan All |
$1,923.74
|
| Rate for Payer: OMNI Networks Commercial |
$1,479.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,902.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,008.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,585.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,966.02
|
| Rate for Payer: Zelis Auto |
$845.60
|
| Rate for Payer: Zelis Worker's Compensation |
$577.12
|
|
