|
AMPUTATE UPPER ARM & IMPLANT
|
Facility
|
OP
|
$1,651.00
|
|
|
Service Code
|
CPT 24931
|
| Hospital Charge Code |
6124931
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$412.75 |
| Max. Negotiated Rate |
$1,568.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$990.60
|
| Rate for Payer: Cash Price |
$990.60
|
| Rate for Payer: Cigna Commercial |
$1,403.35
|
| Rate for Payer: First Health Commercial |
$1,485.90
|
| Rate for Payer: First Health Workers Compensation |
$637.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,485.90
|
| Rate for Payer: GEHA Commercial |
$1,320.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,485.90
|
| Rate for Payer: Humana ChoiceCare |
$429.26
|
| Rate for Payer: Multiplan All |
$1,502.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$990.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,155.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,485.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,568.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,238.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,452.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$412.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,535.43
|
| Rate for Payer: Zelis Auto |
$660.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$825.50
|
| Rate for Payer: Zelis Worker's Compensation |
$450.72
|
|
|
AMPUTATION AT SHOULDER JOINT
|
Facility
|
IP
|
$2,316.00
|
|
|
Service Code
|
CPT 23920
|
| Hospital Charge Code |
6123920
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$632.27 |
| Max. Negotiated Rate |
$2,200.20 |
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cigna Commercial |
$1,968.60
|
| Rate for Payer: First Health Commercial |
$2,084.40
|
| Rate for Payer: First Health Workers Compensation |
$894.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,084.40
|
| Rate for Payer: GEHA Commercial |
$1,621.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,084.40
|
| Rate for Payer: Multiplan All |
$2,107.56
|
| Rate for Payer: OMNI Networks Commercial |
$1,621.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,084.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,200.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,737.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,153.88
|
| Rate for Payer: Zelis Auto |
$926.40
|
| Rate for Payer: Zelis Worker's Compensation |
$632.27
|
|
|
AMPUTATION AT SHOULDER JOINT
|
Facility
|
OP
|
$2,316.00
|
|
|
Service Code
|
CPT 23920
|
| Hospital Charge Code |
6123920
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$579.00 |
| Max. Negotiated Rate |
$2,200.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,389.60
|
| Rate for Payer: Cash Price |
$1,389.60
|
| Rate for Payer: Cigna Commercial |
$1,968.60
|
| Rate for Payer: First Health Commercial |
$2,084.40
|
| Rate for Payer: First Health Workers Compensation |
$894.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,084.40
|
| Rate for Payer: GEHA Commercial |
$1,852.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,084.40
|
| Rate for Payer: Humana ChoiceCare |
$602.16
|
| Rate for Payer: Multiplan All |
$2,107.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,389.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,621.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,084.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,200.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,737.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,038.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$579.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,153.88
|
| Rate for Payer: Zelis Auto |
$926.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,158.00
|
| Rate for Payer: Zelis Worker's Compensation |
$632.27
|
|
|
AMPUTATION FOLLOW-UP SURGERY
|
Facility
|
OP
|
$952.00
|
|
|
Service Code
|
CPT 23921
|
| Hospital Charge Code |
6123921
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$259.90 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$571.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,285.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$809.20
|
| Rate for Payer: First Health Commercial |
$856.80
|
| Rate for Payer: First Health Workers Compensation |
$367.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$856.80
|
| Rate for Payer: GEHA Commercial |
$761.60
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$856.80
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,312.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$866.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$666.40
|
| Rate for Payer: One Health Plan PPO/POS |
$856.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,515.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,312.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$904.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$714.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,312.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$885.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$380.80
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$259.90
|
|
|
AMPUTATION FOLLOW-UP SURGERY
|
Facility
|
OP
|
$1,192.00
|
|
|
Service Code
|
CPT 25907
|
| Hospital Charge Code |
6125907
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$325.42 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$715.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Cigna Commercial |
$1,013.20
|
| Rate for Payer: First Health Commercial |
$1,072.80
|
| Rate for Payer: First Health Workers Compensation |
$460.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,072.80
|
| Rate for Payer: GEHA Commercial |
$953.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,072.80
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,084.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$834.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,072.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,132.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$894.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,108.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$476.80
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$325.42
|
|
|
AMPUTATION FOLLOW-UP SURGERY
|
Facility
|
IP
|
$2,107.68
|
|
|
Service Code
|
CPT 27596
|
| Hospital Charge Code |
6127596
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$575.40 |
| Max. Negotiated Rate |
$2,002.30 |
| Rate for Payer: Cash Price |
$1,264.61
|
| Rate for Payer: Cigna Commercial |
$1,791.53
|
| Rate for Payer: First Health Commercial |
$1,896.91
|
| Rate for Payer: First Health Workers Compensation |
$813.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,896.91
|
| Rate for Payer: GEHA Commercial |
$1,475.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,896.91
|
| Rate for Payer: Multiplan All |
$1,917.99
|
| Rate for Payer: OMNI Networks Commercial |
$1,475.38
|
| Rate for Payer: One Health Plan PPO/POS |
$1,896.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,002.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,580.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,960.14
|
| Rate for Payer: Zelis Auto |
$843.07
|
| Rate for Payer: Zelis Worker's Compensation |
$575.40
|
|
|
AMPUTATION FOLLOW-UP SURGERY
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
CPT 27594
|
| Hospital Charge Code |
6127594
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$288.29 |
| Max. Negotiated Rate |
$1,003.20 |
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$897.60
|
| Rate for Payer: First Health Commercial |
$950.40
|
| Rate for Payer: First Health Workers Compensation |
$407.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$950.40
|
| Rate for Payer: GEHA Commercial |
$739.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$950.40
|
| Rate for Payer: Multiplan All |
$960.96
|
| Rate for Payer: OMNI Networks Commercial |
$739.20
|
| Rate for Payer: One Health Plan PPO/POS |
$950.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,003.20
|
| Rate for Payer: Three Rivers Provider Network All |
$792.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$982.08
|
| Rate for Payer: Zelis Auto |
$422.40
|
| Rate for Payer: Zelis Worker's Compensation |
$288.29
|
|
|
AMPUTATION FOLLOW-UP SURGERY
|
Facility
|
IP
|
$1,192.00
|
|
|
Service Code
|
CPT 25907
|
| Hospital Charge Code |
6125907
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$325.42 |
| Max. Negotiated Rate |
$1,132.40 |
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Cigna Commercial |
$1,013.20
|
| Rate for Payer: First Health Commercial |
$1,072.80
|
| Rate for Payer: First Health Workers Compensation |
$460.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,072.80
|
| Rate for Payer: GEHA Commercial |
$834.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,072.80
|
| Rate for Payer: Multiplan All |
$1,084.72
|
| Rate for Payer: OMNI Networks Commercial |
$834.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,072.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,132.40
|
| Rate for Payer: Three Rivers Provider Network All |
$894.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,108.56
|
| Rate for Payer: Zelis Auto |
$476.80
|
| Rate for Payer: Zelis Worker's Compensation |
$325.42
|
|
|
AMPUTATION FOLLOW-UP SURGERY
|
Facility
|
IP
|
$1,381.00
|
|
|
Service Code
|
CPT 27886
|
| Hospital Charge Code |
6127886
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$377.01 |
| Max. Negotiated Rate |
$1,311.95 |
| Rate for Payer: Cash Price |
$828.60
|
| Rate for Payer: Cigna Commercial |
$1,173.85
|
| Rate for Payer: First Health Commercial |
$1,242.90
|
| Rate for Payer: First Health Workers Compensation |
$533.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,242.90
|
| Rate for Payer: GEHA Commercial |
$966.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,242.90
|
| Rate for Payer: Multiplan All |
$1,256.71
|
| Rate for Payer: OMNI Networks Commercial |
$966.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,242.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,311.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,035.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,284.33
|
| Rate for Payer: Zelis Auto |
$552.40
|
| Rate for Payer: Zelis Worker's Compensation |
$377.01
|
|
|
AMPUTATION FOLLOW-UP SURGERY
|
Facility
|
OP
|
$1,208.00
|
|
|
Service Code
|
CPT 25929
|
| Hospital Charge Code |
6125929
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$329.78 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$724.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,285.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cigna Commercial |
$1,026.80
|
| Rate for Payer: First Health Commercial |
$1,087.20
|
| Rate for Payer: First Health Workers Compensation |
$466.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,087.20
|
| Rate for Payer: GEHA Commercial |
$966.40
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,087.20
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,312.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$1,099.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$845.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,087.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,515.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,312.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,147.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$906.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,312.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,123.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$483.20
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$329.78
|
|
|
AMPUTATION FOLLOW-UP SURGERY
|
Facility
|
OP
|
$1,210.00
|
|
|
Service Code
|
CPT 27884
|
| Hospital Charge Code |
6127884
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$330.33 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$726.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Cigna Commercial |
$1,028.50
|
| Rate for Payer: First Health Commercial |
$1,089.00
|
| Rate for Payer: First Health Workers Compensation |
$467.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,089.00
|
| Rate for Payer: GEHA Commercial |
$968.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,089.00
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,101.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$847.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,089.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,149.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$907.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,125.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$484.00
|
| 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 |
$330.33
|
|
|
AMPUTATION FOLLOW-UP SURGERY
|
Facility
|
OP
|
$1,056.00
|
|
|
Service Code
|
CPT 27594
|
| Hospital Charge Code |
6127594
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$288.29 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$633.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$897.60
|
| Rate for Payer: First Health Commercial |
$950.40
|
| Rate for Payer: First Health Workers Compensation |
$407.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$950.40
|
| Rate for Payer: GEHA Commercial |
$844.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$950.40
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$960.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$739.20
|
| Rate for Payer: One Health Plan PPO/POS |
$950.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,003.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$792.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$982.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$422.40
|
| 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 |
$288.29
|
|
|
AMPUTATION FOLLOW-UP SURGERY
|
Facility
|
IP
|
$1,210.00
|
|
|
Service Code
|
CPT 27884
|
| Hospital Charge Code |
6127884
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$330.33 |
| Max. Negotiated Rate |
$1,149.50 |
| Rate for Payer: Cash Price |
$726.00
|
| Rate for Payer: Cigna Commercial |
$1,028.50
|
| Rate for Payer: First Health Commercial |
$1,089.00
|
| Rate for Payer: First Health Workers Compensation |
$467.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,089.00
|
| Rate for Payer: GEHA Commercial |
$847.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,089.00
|
| Rate for Payer: Multiplan All |
$1,101.10
|
| Rate for Payer: OMNI Networks Commercial |
$847.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,089.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,149.50
|
| Rate for Payer: Three Rivers Provider Network All |
$907.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,125.30
|
| Rate for Payer: Zelis Auto |
$484.00
|
| Rate for Payer: Zelis Worker's Compensation |
$330.33
|
|
|
AMPUTATION FOLLOW-UP SURGERY
|
Facility
|
OP
|
$1,123.00
|
|
|
Service Code
|
CPT 24925
|
| Hospital Charge Code |
6124925
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$306.58 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$673.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$673.80
|
| Rate for Payer: Cash Price |
$673.80
|
| Rate for Payer: Cigna Commercial |
$954.55
|
| Rate for Payer: First Health Commercial |
$1,010.70
|
| Rate for Payer: First Health Workers Compensation |
$433.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,010.70
|
| Rate for Payer: GEHA Commercial |
$898.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,010.70
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,021.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$786.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,010.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,066.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$842.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,044.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$449.20
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$306.58
|
|
|
AMPUTATION FOLLOW-UP SURGERY
|
Facility
|
IP
|
$1,247.00
|
|
|
Service Code
|
CPT 25924
|
| Hospital Charge Code |
6125924
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$340.43 |
| Max. Negotiated Rate |
$1,184.65 |
| Rate for Payer: Cash Price |
$748.20
|
| Rate for Payer: Cigna Commercial |
$1,059.95
|
| Rate for Payer: First Health Commercial |
$1,122.30
|
| Rate for Payer: First Health Workers Compensation |
$481.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,122.30
|
| Rate for Payer: GEHA Commercial |
$872.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,122.30
|
| Rate for Payer: Multiplan All |
$1,134.77
|
| Rate for Payer: OMNI Networks Commercial |
$872.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,122.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,184.65
|
| Rate for Payer: Three Rivers Provider Network All |
$935.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,159.71
|
| Rate for Payer: Zelis Auto |
$498.80
|
| Rate for Payer: Zelis Worker's Compensation |
$340.43
|
|
|
AMPUTATION FOLLOW-UP SURGERY
|
Facility
|
OP
|
$1,381.00
|
|
|
Service Code
|
CPT 27886
|
| Hospital Charge Code |
6127886
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$345.25 |
| Max. Negotiated Rate |
$1,311.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$828.60
|
| Rate for Payer: Cash Price |
$828.60
|
| Rate for Payer: Cigna Commercial |
$1,173.85
|
| Rate for Payer: First Health Commercial |
$1,242.90
|
| Rate for Payer: First Health Workers Compensation |
$533.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,242.90
|
| Rate for Payer: GEHA Commercial |
$1,104.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,242.90
|
| Rate for Payer: Humana ChoiceCare |
$359.06
|
| Rate for Payer: Multiplan All |
$1,256.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$828.60
|
| Rate for Payer: OMNI Networks Commercial |
$966.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,242.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,311.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,035.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,215.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$345.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,284.33
|
| Rate for Payer: Zelis Auto |
$552.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$690.50
|
| Rate for Payer: Zelis Worker's Compensation |
$377.01
|
|
|
AMPUTATION FOLLOW-UP SURGERY
|
Facility
|
IP
|
$1,403.00
|
|
|
Service Code
|
CPT 25909
|
| Hospital Charge Code |
6125909
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$383.02 |
| Max. Negotiated Rate |
$1,332.85 |
| Rate for Payer: Cash Price |
$841.80
|
| Rate for Payer: Cigna Commercial |
$1,192.55
|
| Rate for Payer: First Health Commercial |
$1,262.70
|
| Rate for Payer: First Health Workers Compensation |
$541.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,262.70
|
| Rate for Payer: GEHA Commercial |
$982.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,262.70
|
| Rate for Payer: Multiplan All |
$1,276.73
|
| Rate for Payer: OMNI Networks Commercial |
$982.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,262.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,332.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,052.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,304.79
|
| Rate for Payer: Zelis Auto |
$561.20
|
| Rate for Payer: Zelis Worker's Compensation |
$383.02
|
|
|
AMPUTATION FOLLOW-UP SURGERY
|
Facility
|
OP
|
$1,403.00
|
|
|
Service Code
|
CPT 25909
|
| Hospital Charge Code |
6125909
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$383.02 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,322.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$841.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,322.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,840.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$841.80
|
| Rate for Payer: Cash Price |
$841.80
|
| Rate for Payer: Cigna Commercial |
$1,192.55
|
| Rate for Payer: First Health Commercial |
$1,262.70
|
| Rate for Payer: First Health Workers Compensation |
$541.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,262.70
|
| Rate for Payer: GEHA Commercial |
$1,122.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,262.70
|
| 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 |
$1,877.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,276.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$982.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,262.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,168.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,877.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,332.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,052.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,877.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,304.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$561.20
|
| 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 |
$383.02
|
|
|
AMPUTATION FOLLOW-UP SURGERY
|
Facility
|
IP
|
$1,208.00
|
|
|
Service Code
|
CPT 25929
|
| Hospital Charge Code |
6125929
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$329.78 |
| Max. Negotiated Rate |
$1,147.60 |
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cigna Commercial |
$1,026.80
|
| Rate for Payer: First Health Commercial |
$1,087.20
|
| Rate for Payer: First Health Workers Compensation |
$466.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,087.20
|
| Rate for Payer: GEHA Commercial |
$845.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,087.20
|
| Rate for Payer: Multiplan All |
$1,099.28
|
| Rate for Payer: OMNI Networks Commercial |
$845.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,087.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,147.60
|
| Rate for Payer: Three Rivers Provider Network All |
$906.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,123.44
|
| Rate for Payer: Zelis Auto |
$483.20
|
| Rate for Payer: Zelis Worker's Compensation |
$329.78
|
|
|
AMPUTATION FOLLOW-UP SURGERY
|
Facility
|
IP
|
$952.00
|
|
|
Service Code
|
CPT 23921
|
| Hospital Charge Code |
6123921
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$259.90 |
| Max. Negotiated Rate |
$904.40 |
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$809.20
|
| Rate for Payer: First Health Commercial |
$856.80
|
| Rate for Payer: First Health Workers Compensation |
$367.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$856.80
|
| Rate for Payer: GEHA Commercial |
$666.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$856.80
|
| Rate for Payer: Multiplan All |
$866.32
|
| Rate for Payer: OMNI Networks Commercial |
$666.40
|
| Rate for Payer: One Health Plan PPO/POS |
$856.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$904.40
|
| Rate for Payer: Three Rivers Provider Network All |
$714.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$885.36
|
| Rate for Payer: Zelis Auto |
$380.80
|
| Rate for Payer: Zelis Worker's Compensation |
$259.90
|
|
|
AMPUTATION FOLLOW-UP SURGERY
|
Facility
|
IP
|
$1,123.00
|
|
|
Service Code
|
CPT 24925
|
| Hospital Charge Code |
6124925
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$306.58 |
| Max. Negotiated Rate |
$1,066.85 |
| Rate for Payer: Cash Price |
$673.80
|
| Rate for Payer: Cigna Commercial |
$954.55
|
| Rate for Payer: First Health Commercial |
$1,010.70
|
| Rate for Payer: First Health Workers Compensation |
$433.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,010.70
|
| Rate for Payer: GEHA Commercial |
$786.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,010.70
|
| Rate for Payer: Multiplan All |
$1,021.93
|
| Rate for Payer: OMNI Networks Commercial |
$786.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,010.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,066.85
|
| Rate for Payer: Three Rivers Provider Network All |
$842.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,044.39
|
| Rate for Payer: Zelis Auto |
$449.20
|
| Rate for Payer: Zelis Worker's Compensation |
$306.58
|
|
|
AMPUTATION FOLLOW-UP SURGERY
|
Facility
|
OP
|
$2,107.68
|
|
|
Service Code
|
CPT 27596
|
| Hospital Charge Code |
6127596
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$526.92 |
| Max. Negotiated Rate |
$2,002.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,264.61
|
| Rate for Payer: Cash Price |
$1,264.61
|
| Rate for Payer: Cigna Commercial |
$1,791.53
|
| Rate for Payer: First Health Commercial |
$1,896.91
|
| Rate for Payer: First Health Workers Compensation |
$813.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,896.91
|
| Rate for Payer: GEHA Commercial |
$1,686.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,896.91
|
| Rate for Payer: Humana ChoiceCare |
$548.00
|
| Rate for Payer: Multiplan All |
$1,917.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,264.61
|
| Rate for Payer: OMNI Networks Commercial |
$1,475.38
|
| Rate for Payer: One Health Plan PPO/POS |
$1,896.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,002.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,580.76
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,854.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$526.92
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,960.14
|
| Rate for Payer: Zelis Auto |
$843.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,053.84
|
| Rate for Payer: Zelis Worker's Compensation |
$575.40
|
|
|
AMPUTATION FOLLOW-UP SURGERY
|
Facility
|
OP
|
$1,580.00
|
|
|
Service Code
|
CPT 24930
|
| Hospital Charge Code |
6124930
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$395.00 |
| Max. Negotiated Rate |
$1,501.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$948.00
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,343.00
|
| Rate for Payer: First Health Commercial |
$1,422.00
|
| Rate for Payer: First Health Workers Compensation |
$610.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,422.00
|
| Rate for Payer: GEHA Commercial |
$1,264.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,422.00
|
| Rate for Payer: Humana ChoiceCare |
$410.80
|
| Rate for Payer: Multiplan All |
$1,437.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$948.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,106.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,422.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,501.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,185.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,390.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$395.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,469.40
|
| Rate for Payer: Zelis Auto |
$632.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$790.00
|
| Rate for Payer: Zelis Worker's Compensation |
$431.34
|
|
|
AMPUTATION FOLLOW-UP SURGERY
|
Facility
|
IP
|
$1,352.00
|
|
|
Service Code
|
CPT 25931
|
| Hospital Charge Code |
6125931
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$369.10 |
| Max. Negotiated Rate |
$1,284.40 |
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Cigna Commercial |
$1,149.20
|
| Rate for Payer: First Health Commercial |
$1,216.80
|
| Rate for Payer: First Health Workers Compensation |
$522.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,216.80
|
| Rate for Payer: GEHA Commercial |
$946.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,216.80
|
| Rate for Payer: Multiplan All |
$1,230.32
|
| Rate for Payer: OMNI Networks Commercial |
$946.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,216.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,284.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,014.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,257.36
|
| Rate for Payer: Zelis Auto |
$540.80
|
| Rate for Payer: Zelis Worker's Compensation |
$369.10
|
|
|
AMPUTATION FOLLOW-UP SURGERY
|
Facility
|
OP
|
$1,352.00
|
|
|
Service Code
|
CPT 25931
|
| Hospital Charge Code |
6125931
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$369.10 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$811.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Cigna Commercial |
$1,149.20
|
| Rate for Payer: First Health Commercial |
$1,216.80
|
| Rate for Payer: First Health Workers Compensation |
$522.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,216.80
|
| Rate for Payer: GEHA Commercial |
$1,081.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,216.80
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,230.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$946.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,216.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,284.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,014.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,257.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$540.80
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$369.10
|
|
