|
AMPUTATION FOLLOW-UP SURGERY
|
Facility
|
IP
|
$1,580.00
|
|
|
Service Code
|
CPT 24930
|
| Hospital Charge Code |
6124930
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$431.34 |
| Max. Negotiated Rate |
$1,501.00 |
| 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 |
$1,106.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,422.00
|
| Rate for Payer: Multiplan All |
$1,437.80
|
| 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: United Payors & United Providers UP&UP |
$1,469.40
|
| Rate for Payer: Zelis Auto |
$632.00
|
| Rate for Payer: Zelis Worker's Compensation |
$431.34
|
|
|
AMPUTATION FOLLOW-UP SURGERY
|
Facility
|
OP
|
$1,247.00
|
|
|
Service Code
|
CPT 25924
|
| Hospital Charge Code |
6125924
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$311.75 |
| Max. Negotiated Rate |
$1,184.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$748.20
|
| 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 |
$997.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,122.30
|
| Rate for Payer: Humana ChoiceCare |
$324.22
|
| Rate for Payer: Multiplan All |
$1,134.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$748.20
|
| 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: TriWest Veterans Administration/VAPC3 |
$1,097.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$311.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,159.71
|
| Rate for Payer: Zelis Auto |
$498.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$623.50
|
| Rate for Payer: Zelis Worker's Compensation |
$340.43
|
|
|
AMPUTATION, METATARSAL, WITH TOE, SINGLE
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 28810
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,749.66 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$2,803.61
|
|
|
AMPUTATION OF ARM & GIRDLE
|
Facility
|
IP
|
$2,869.00
|
|
|
Service Code
|
CPT 23900
|
| Hospital Charge Code |
6123900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$783.24 |
| Max. Negotiated Rate |
$2,725.55 |
| Rate for Payer: Cash Price |
$1,721.40
|
| Rate for Payer: Cigna Commercial |
$2,438.65
|
| Rate for Payer: First Health Commercial |
$2,582.10
|
| Rate for Payer: First Health Workers Compensation |
$1,107.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,582.10
|
| Rate for Payer: GEHA Commercial |
$2,008.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,582.10
|
| Rate for Payer: Multiplan All |
$2,610.79
|
| Rate for Payer: OMNI Networks Commercial |
$2,008.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,582.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,725.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,151.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,668.17
|
| Rate for Payer: Zelis Auto |
$1,147.60
|
| Rate for Payer: Zelis Worker's Compensation |
$783.24
|
|
|
AMPUTATION OF ARM & GIRDLE
|
Facility
|
OP
|
$2,869.00
|
|
|
Service Code
|
CPT 23900
|
| Hospital Charge Code |
6123900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$717.25 |
| Max. Negotiated Rate |
$2,725.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,721.40
|
| Rate for Payer: Cash Price |
$1,721.40
|
| Rate for Payer: Cigna Commercial |
$2,438.65
|
| Rate for Payer: First Health Commercial |
$2,582.10
|
| Rate for Payer: First Health Workers Compensation |
$1,107.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,582.10
|
| Rate for Payer: GEHA Commercial |
$2,295.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,582.10
|
| Rate for Payer: Humana ChoiceCare |
$745.94
|
| Rate for Payer: Multiplan All |
$2,610.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,721.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,008.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,582.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,725.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,151.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,524.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$717.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,668.17
|
| Rate for Payer: Zelis Auto |
$1,147.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,434.50
|
| Rate for Payer: Zelis Worker's Compensation |
$783.24
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
OP
|
$1,286.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
6126951
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$351.08 |
| 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 |
$771.60
|
| 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 |
$771.60
|
| Rate for Payer: Cash Price |
$771.60
|
| Rate for Payer: Cigna Commercial |
$1,093.10
|
| Rate for Payer: First Health Commercial |
$1,157.40
|
| Rate for Payer: First Health Workers Compensation |
$496.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,157.40
|
| Rate for Payer: GEHA Commercial |
$1,028.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,157.40
|
| 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 |
$1,170.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$900.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,157.40
|
| 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 |
$1,221.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$964.50
|
| 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 |
$1,195.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$514.40
|
| 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 |
$351.08
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
IP
|
$1,273.00
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
6126952
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$347.53 |
| Max. Negotiated Rate |
$1,209.35 |
| Rate for Payer: Cash Price |
$763.80
|
| Rate for Payer: Cigna Commercial |
$1,082.05
|
| Rate for Payer: First Health Commercial |
$1,145.70
|
| Rate for Payer: First Health Workers Compensation |
$491.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,145.70
|
| Rate for Payer: GEHA Commercial |
$891.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,145.70
|
| Rate for Payer: Multiplan All |
$1,158.43
|
| Rate for Payer: OMNI Networks Commercial |
$891.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,145.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,209.35
|
| Rate for Payer: Three Rivers Provider Network All |
$954.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,183.89
|
| Rate for Payer: Zelis Auto |
$509.20
|
| Rate for Payer: Zelis Worker's Compensation |
$347.53
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
OP
|
$1,273.00
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
6126952
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$347.53 |
| 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 |
$763.80
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$763.80
|
| Rate for Payer: Cash Price |
$763.80
|
| Rate for Payer: Cigna Commercial |
$1,082.05
|
| Rate for Payer: First Health Commercial |
$1,145.70
|
| Rate for Payer: First Health Workers Compensation |
$491.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,145.70
|
| Rate for Payer: GEHA Commercial |
$1,018.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,145.70
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,158.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$891.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,145.70
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,209.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$954.75
|
| 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 |
$1,183.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$509.20
|
| 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 |
$347.53
|
|
|
AMPUTATION OF FINGER/THUMB
|
Facility
|
IP
|
$1,286.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
6126951
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$351.08 |
| Max. Negotiated Rate |
$1,221.70 |
| Rate for Payer: Cash Price |
$771.60
|
| Rate for Payer: Cigna Commercial |
$1,093.10
|
| Rate for Payer: First Health Commercial |
$1,157.40
|
| Rate for Payer: First Health Workers Compensation |
$496.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,157.40
|
| Rate for Payer: GEHA Commercial |
$900.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,157.40
|
| Rate for Payer: Multiplan All |
$1,170.26
|
| Rate for Payer: OMNI Networks Commercial |
$900.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,157.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,221.70
|
| Rate for Payer: Three Rivers Provider Network All |
$964.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,195.98
|
| Rate for Payer: Zelis Auto |
$514.40
|
| Rate for Payer: Zelis Worker's Compensation |
$351.08
|
|
|
AMPUTATION OF FOOT AT ANKLE
|
Facility
|
IP
|
$1,420.00
|
|
|
Service Code
|
CPT 27888
|
| Hospital Charge Code |
6127888
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$387.66 |
| Max. Negotiated Rate |
$1,349.00 |
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Cigna Commercial |
$1,207.00
|
| Rate for Payer: First Health Commercial |
$1,278.00
|
| Rate for Payer: First Health Workers Compensation |
$548.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,278.00
|
| Rate for Payer: GEHA Commercial |
$994.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,278.00
|
| Rate for Payer: Multiplan All |
$1,292.20
|
| Rate for Payer: OMNI Networks Commercial |
$994.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,278.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,349.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,065.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,320.60
|
| Rate for Payer: Zelis Auto |
$568.00
|
| Rate for Payer: Zelis Worker's Compensation |
$387.66
|
|
|
AMPUTATION OF FOOT AT ANKLE
|
Facility
|
IP
|
$1,375.00
|
|
|
Service Code
|
CPT 27889
|
| Hospital Charge Code |
6127889
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$375.38 |
| Max. Negotiated Rate |
$1,306.25 |
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,168.75
|
| Rate for Payer: First Health Commercial |
$1,237.50
|
| Rate for Payer: First Health Workers Compensation |
$530.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,237.50
|
| Rate for Payer: GEHA Commercial |
$962.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,237.50
|
| Rate for Payer: Multiplan All |
$1,251.25
|
| Rate for Payer: OMNI Networks Commercial |
$962.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,237.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,306.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,031.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,278.75
|
| Rate for Payer: Zelis Auto |
$550.00
|
| Rate for Payer: Zelis Worker's Compensation |
$375.38
|
|
|
AMPUTATION OF FOOT AT ANKLE
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
CPT 27888
|
| Hospital Charge Code |
6127888
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$355.00 |
| Max. Negotiated Rate |
$1,349.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$852.00
|
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Cigna Commercial |
$1,207.00
|
| Rate for Payer: First Health Commercial |
$1,278.00
|
| Rate for Payer: First Health Workers Compensation |
$548.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,278.00
|
| Rate for Payer: GEHA Commercial |
$1,136.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,278.00
|
| Rate for Payer: Humana ChoiceCare |
$369.20
|
| Rate for Payer: Multiplan All |
$1,292.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$852.00
|
| Rate for Payer: OMNI Networks Commercial |
$994.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,278.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,349.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,065.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,249.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$355.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,320.60
|
| Rate for Payer: Zelis Auto |
$568.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$710.00
|
| Rate for Payer: Zelis Worker's Compensation |
$387.66
|
|
|
AMPUTATION OF FOOT AT ANKLE
|
Facility
|
OP
|
$1,375.00
|
|
|
Service Code
|
CPT 27889
|
| Hospital Charge Code |
6127889
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$375.38 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$825.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,168.75
|
| Rate for Payer: First Health Commercial |
$1,237.50
|
| Rate for Payer: First Health Workers Compensation |
$530.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,237.50
|
| Rate for Payer: GEHA Commercial |
$1,100.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,237.50
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,251.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$962.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,237.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,306.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,031.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,278.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$550.00
|
| 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 |
$375.38
|
|
|
AMPUTATION OF FOREARM
|
Facility
|
OP
|
$1,341.00
|
|
|
Service Code
|
CPT 25905
|
| Hospital Charge Code |
6125905
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$335.25 |
| Max. Negotiated Rate |
$1,273.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$804.60
|
| Rate for Payer: Cash Price |
$804.60
|
| Rate for Payer: Cigna Commercial |
$1,139.85
|
| Rate for Payer: First Health Commercial |
$1,206.90
|
| Rate for Payer: First Health Workers Compensation |
$517.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,206.90
|
| Rate for Payer: GEHA Commercial |
$1,072.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,206.90
|
| Rate for Payer: Humana ChoiceCare |
$348.66
|
| Rate for Payer: Multiplan All |
$1,220.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$804.60
|
| Rate for Payer: OMNI Networks Commercial |
$938.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,206.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,273.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,005.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,180.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$335.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,247.13
|
| Rate for Payer: Zelis Auto |
$536.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$670.50
|
| Rate for Payer: Zelis Worker's Compensation |
$366.09
|
|
|
AMPUTATION OF FOREARM
|
Facility
|
IP
|
$1,447.00
|
|
|
Service Code
|
CPT 25900
|
| Hospital Charge Code |
6125900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$395.03 |
| Max. Negotiated Rate |
$1,374.65 |
| Rate for Payer: Cash Price |
$868.20
|
| Rate for Payer: Cigna Commercial |
$1,229.95
|
| Rate for Payer: First Health Commercial |
$1,302.30
|
| Rate for Payer: First Health Workers Compensation |
$558.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,302.30
|
| Rate for Payer: GEHA Commercial |
$1,012.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,302.30
|
| Rate for Payer: Multiplan All |
$1,316.77
|
| Rate for Payer: OMNI Networks Commercial |
$1,012.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,302.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,374.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,085.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,345.71
|
| Rate for Payer: Zelis Auto |
$578.80
|
| Rate for Payer: Zelis Worker's Compensation |
$395.03
|
|
|
AMPUTATION OF FOREARM
|
Facility
|
IP
|
$1,341.00
|
|
|
Service Code
|
CPT 25905
|
| Hospital Charge Code |
6125905
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$366.09 |
| Max. Negotiated Rate |
$1,273.95 |
| Rate for Payer: Cash Price |
$804.60
|
| Rate for Payer: Cigna Commercial |
$1,139.85
|
| Rate for Payer: First Health Commercial |
$1,206.90
|
| Rate for Payer: First Health Workers Compensation |
$517.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,206.90
|
| Rate for Payer: GEHA Commercial |
$938.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,206.90
|
| Rate for Payer: Multiplan All |
$1,220.31
|
| Rate for Payer: OMNI Networks Commercial |
$938.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,206.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,273.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,005.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,247.13
|
| Rate for Payer: Zelis Auto |
$536.40
|
| Rate for Payer: Zelis Worker's Compensation |
$366.09
|
|
|
AMPUTATION OF FOREARM
|
Facility
|
OP
|
$1,447.00
|
|
|
Service Code
|
CPT 25900
|
| Hospital Charge Code |
6125900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$361.75 |
| Max. Negotiated Rate |
$1,374.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$868.20
|
| Rate for Payer: Cash Price |
$868.20
|
| Rate for Payer: Cigna Commercial |
$1,229.95
|
| Rate for Payer: First Health Commercial |
$1,302.30
|
| Rate for Payer: First Health Workers Compensation |
$558.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,302.30
|
| Rate for Payer: GEHA Commercial |
$1,157.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,302.30
|
| Rate for Payer: Humana ChoiceCare |
$376.22
|
| Rate for Payer: Multiplan All |
$1,316.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$868.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,012.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,302.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,374.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,085.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,273.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$361.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,345.71
|
| Rate for Payer: Zelis Auto |
$578.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$723.50
|
| Rate for Payer: Zelis Worker's Compensation |
$395.03
|
|
|
AMPUTATION OF FOREARM
|
Facility
|
IP
|
$2,428.00
|
|
|
Service Code
|
CPT 25915
|
| Hospital Charge Code |
6125915
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$662.84 |
| Max. Negotiated Rate |
$2,306.60 |
| Rate for Payer: Cash Price |
$1,456.80
|
| Rate for Payer: Cigna Commercial |
$2,063.80
|
| Rate for Payer: First Health Commercial |
$2,185.20
|
| Rate for Payer: First Health Workers Compensation |
$937.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,185.20
|
| Rate for Payer: GEHA Commercial |
$1,699.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,185.20
|
| Rate for Payer: Multiplan All |
$2,209.48
|
| Rate for Payer: OMNI Networks Commercial |
$1,699.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,185.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,306.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,821.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,258.04
|
| Rate for Payer: Zelis Auto |
$971.20
|
| Rate for Payer: Zelis Worker's Compensation |
$662.84
|
|
|
AMPUTATION OF FOREARM
|
Facility
|
OP
|
$2,428.00
|
|
|
Service Code
|
CPT 25915
|
| Hospital Charge Code |
6125915
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$607.00 |
| Max. Negotiated Rate |
$2,306.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,456.80
|
| Rate for Payer: Cash Price |
$1,456.80
|
| Rate for Payer: Cigna Commercial |
$2,063.80
|
| Rate for Payer: First Health Commercial |
$2,185.20
|
| Rate for Payer: First Health Workers Compensation |
$937.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,185.20
|
| Rate for Payer: GEHA Commercial |
$1,942.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,185.20
|
| Rate for Payer: Humana ChoiceCare |
$631.28
|
| Rate for Payer: Multiplan All |
$2,209.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,456.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,699.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,185.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,306.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,821.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,136.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$607.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,258.04
|
| Rate for Payer: Zelis Auto |
$971.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,214.00
|
| Rate for Payer: Zelis Worker's Compensation |
$662.84
|
|
|
AMPUTATION OF HAND
|
Facility
|
OP
|
$1,641.00
|
|
|
Service Code
|
CPT 25927
|
| Hospital Charge Code |
6125927
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$410.25 |
| Max. Negotiated Rate |
$1,558.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$984.60
|
| Rate for Payer: Cash Price |
$984.60
|
| Rate for Payer: Cigna Commercial |
$1,394.85
|
| Rate for Payer: First Health Commercial |
$1,476.90
|
| Rate for Payer: First Health Workers Compensation |
$633.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,476.90
|
| Rate for Payer: GEHA Commercial |
$1,312.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,476.90
|
| Rate for Payer: Humana ChoiceCare |
$426.66
|
| Rate for Payer: Multiplan All |
$1,493.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$984.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,148.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,476.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,558.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,230.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,444.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$410.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,526.13
|
| Rate for Payer: Zelis Auto |
$656.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$820.50
|
| Rate for Payer: Zelis Worker's Compensation |
$447.99
|
|
|
AMPUTATION OF HAND
|
Facility
|
IP
|
$1,641.00
|
|
|
Service Code
|
CPT 25927
|
| Hospital Charge Code |
6125927
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$447.99 |
| Max. Negotiated Rate |
$1,558.95 |
| Rate for Payer: Cash Price |
$984.60
|
| Rate for Payer: Cigna Commercial |
$1,394.85
|
| Rate for Payer: First Health Commercial |
$1,476.90
|
| Rate for Payer: First Health Workers Compensation |
$633.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,476.90
|
| Rate for Payer: GEHA Commercial |
$1,148.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,476.90
|
| Rate for Payer: Multiplan All |
$1,493.31
|
| Rate for Payer: OMNI Networks Commercial |
$1,148.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,476.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,558.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,230.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,526.13
|
| Rate for Payer: Zelis Auto |
$656.40
|
| Rate for Payer: Zelis Worker's Compensation |
$447.99
|
|
|
AMPUTATION OF LEG AT HIP
|
Facility
|
OP
|
$2,616.00
|
|
|
Service Code
|
CPT 27295
|
| Hospital Charge Code |
6127295
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$654.00 |
| Max. Negotiated Rate |
$2,485.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,569.60
|
| Rate for Payer: Cash Price |
$1,569.60
|
| Rate for Payer: Cigna Commercial |
$2,223.60
|
| Rate for Payer: First Health Commercial |
$2,354.40
|
| Rate for Payer: First Health Workers Compensation |
$1,010.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,354.40
|
| Rate for Payer: GEHA Commercial |
$2,092.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,354.40
|
| Rate for Payer: Humana ChoiceCare |
$680.16
|
| Rate for Payer: Multiplan All |
$2,380.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,569.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,831.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,354.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,485.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,962.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,302.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$654.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,432.88
|
| Rate for Payer: Zelis Auto |
$1,046.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,308.00
|
| Rate for Payer: Zelis Worker's Compensation |
$714.17
|
|
|
AMPUTATION OF LEG AT HIP
|
Facility
|
IP
|
$2,616.00
|
|
|
Service Code
|
CPT 27295
|
| Hospital Charge Code |
6127295
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$714.17 |
| Max. Negotiated Rate |
$2,485.20 |
| Rate for Payer: Cash Price |
$1,569.60
|
| Rate for Payer: Cigna Commercial |
$2,223.60
|
| Rate for Payer: First Health Commercial |
$2,354.40
|
| Rate for Payer: First Health Workers Compensation |
$1,010.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,354.40
|
| Rate for Payer: GEHA Commercial |
$1,831.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,354.40
|
| Rate for Payer: Multiplan All |
$2,380.56
|
| Rate for Payer: OMNI Networks Commercial |
$1,831.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,354.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,485.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,962.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,432.88
|
| Rate for Payer: Zelis Auto |
$1,046.40
|
| Rate for Payer: Zelis Worker's Compensation |
$714.17
|
|
|
AMPUTATION OF LEG AT HIP
|
Facility
|
OP
|
$3,337.00
|
|
|
Service Code
|
CPT 27290
|
| Hospital Charge Code |
6127290
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$834.25 |
| Max. Negotiated Rate |
$3,170.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,002.20
|
| Rate for Payer: Cash Price |
$2,002.20
|
| Rate for Payer: Cigna Commercial |
$2,836.45
|
| Rate for Payer: First Health Commercial |
$3,003.30
|
| Rate for Payer: First Health Workers Compensation |
$1,288.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,003.30
|
| Rate for Payer: GEHA Commercial |
$2,669.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,003.30
|
| Rate for Payer: Humana ChoiceCare |
$867.62
|
| Rate for Payer: Multiplan All |
$3,036.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,002.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,335.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,003.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,170.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,502.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,936.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$834.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,103.41
|
| Rate for Payer: Zelis Auto |
$1,334.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,668.50
|
| Rate for Payer: Zelis Worker's Compensation |
$911.00
|
|
|
AMPUTATION OF LEG AT HIP
|
Facility
|
IP
|
$3,337.00
|
|
|
Service Code
|
CPT 27290
|
| Hospital Charge Code |
6127290
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$911.00 |
| Max. Negotiated Rate |
$3,170.15 |
| Rate for Payer: Cash Price |
$2,002.20
|
| Rate for Payer: Cigna Commercial |
$2,836.45
|
| Rate for Payer: First Health Commercial |
$3,003.30
|
| Rate for Payer: First Health Workers Compensation |
$1,288.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,003.30
|
| Rate for Payer: GEHA Commercial |
$2,335.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,003.30
|
| Rate for Payer: Multiplan All |
$3,036.67
|
| Rate for Payer: OMNI Networks Commercial |
$2,335.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,003.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,170.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,502.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,103.41
|
| Rate for Payer: Zelis Auto |
$1,334.80
|
| Rate for Payer: Zelis Worker's Compensation |
$911.00
|
|
