|
OPEN BOWEL TO SKIN
|
Facility
|
IP
|
$1,769.00
|
|
|
Service Code
|
CPT 44300
|
| Hospital Charge Code |
6144300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$482.94 |
| Max. Negotiated Rate |
$1,680.55 |
| Rate for Payer: Cash Price |
$1,061.40
|
| Rate for Payer: Cigna Commercial |
$1,503.65
|
| Rate for Payer: First Health Commercial |
$1,592.10
|
| Rate for Payer: First Health Workers Compensation |
$683.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,592.10
|
| Rate for Payer: GEHA Commercial |
$1,238.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,592.10
|
| Rate for Payer: Multiplan All |
$1,609.79
|
| Rate for Payer: OMNI Networks Commercial |
$1,238.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,592.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,680.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,326.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,645.17
|
| Rate for Payer: Zelis Auto |
$707.60
|
| Rate for Payer: Zelis Worker's Compensation |
$482.94
|
|
|
OPEN CHEST HEART MASSAGE
|
Facility
|
IP
|
$1,658.00
|
|
|
Service Code
|
CPT 32160
|
| Hospital Charge Code |
6132160
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$452.63 |
| Max. Negotiated Rate |
$1,575.10 |
| Rate for Payer: Cash Price |
$994.80
|
| Rate for Payer: Cigna Commercial |
$1,409.30
|
| Rate for Payer: First Health Commercial |
$1,492.20
|
| Rate for Payer: First Health Workers Compensation |
$640.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,492.20
|
| Rate for Payer: GEHA Commercial |
$1,160.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,492.20
|
| Rate for Payer: Multiplan All |
$1,508.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,160.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,492.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,575.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,243.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,541.94
|
| Rate for Payer: Zelis Auto |
$663.20
|
| Rate for Payer: Zelis Worker's Compensation |
$452.63
|
|
|
OPEN CHEST HEART MASSAGE
|
Facility
|
OP
|
$1,658.00
|
|
|
Service Code
|
CPT 32160
|
| Hospital Charge Code |
6132160
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$414.50 |
| Max. Negotiated Rate |
$1,575.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$994.80
|
| Rate for Payer: Cash Price |
$994.80
|
| Rate for Payer: Cigna Commercial |
$1,409.30
|
| Rate for Payer: First Health Commercial |
$1,492.20
|
| Rate for Payer: First Health Workers Compensation |
$640.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,492.20
|
| Rate for Payer: GEHA Commercial |
$1,326.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,492.20
|
| Rate for Payer: Humana ChoiceCare |
$431.08
|
| Rate for Payer: Multiplan All |
$1,508.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$994.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,160.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,492.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,575.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,243.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,459.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$414.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,541.94
|
| Rate for Payer: Zelis Auto |
$663.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$829.00
|
| Rate for Payer: Zelis Worker's Compensation |
$452.63
|
|
|
OPEN DRAINAGE LIVER LESION
|
Facility
|
OP
|
$2,524.00
|
|
|
Service Code
|
CPT 47010
|
| Hospital Charge Code |
6147010
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$631.00 |
| Max. Negotiated Rate |
$2,397.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,514.40
|
| Rate for Payer: Cash Price |
$1,514.40
|
| Rate for Payer: Cigna Commercial |
$2,145.40
|
| Rate for Payer: First Health Commercial |
$2,271.60
|
| Rate for Payer: First Health Workers Compensation |
$974.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,271.60
|
| Rate for Payer: GEHA Commercial |
$2,019.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,271.60
|
| Rate for Payer: Humana ChoiceCare |
$656.24
|
| Rate for Payer: Multiplan All |
$2,296.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,514.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,766.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,271.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,397.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,893.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,221.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$631.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,347.32
|
| Rate for Payer: Zelis Auto |
$1,009.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,262.00
|
| Rate for Payer: Zelis Worker's Compensation |
$689.05
|
|
|
OPEN DRAINAGE LIVER LESION
|
Facility
|
IP
|
$2,524.00
|
|
|
Service Code
|
CPT 47010
|
| Hospital Charge Code |
6147010
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$689.05 |
| Max. Negotiated Rate |
$2,397.80 |
| Rate for Payer: Cash Price |
$1,514.40
|
| Rate for Payer: Cigna Commercial |
$2,145.40
|
| Rate for Payer: First Health Commercial |
$2,271.60
|
| Rate for Payer: First Health Workers Compensation |
$974.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,271.60
|
| Rate for Payer: GEHA Commercial |
$1,766.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,271.60
|
| Rate for Payer: Multiplan All |
$2,296.84
|
| Rate for Payer: OMNI Networks Commercial |
$1,766.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,271.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,397.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,893.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,347.32
|
| Rate for Payer: Zelis Auto |
$1,009.60
|
| Rate for Payer: Zelis Worker's Compensation |
$689.05
|
|
|
OPEN NASOETHMOID FX W/ FIXJ
|
Facility
|
OP
|
$1,552.00
|
|
|
Service Code
|
CPT 21339
|
| Hospital Charge Code |
6121339
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$423.70 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$931.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Cigna Commercial |
$1,319.20
|
| Rate for Payer: First Health Commercial |
$1,396.80
|
| Rate for Payer: First Health Workers Compensation |
$599.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,396.80
|
| Rate for Payer: GEHA Commercial |
$1,241.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,396.80
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,412.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,086.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,396.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,474.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,164.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,443.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$620.80
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$423.70
|
|
|
OPEN NASOETHMOID FX W/ FIXJ
|
Facility
|
IP
|
$1,552.00
|
|
|
Service Code
|
CPT 21339
|
| Hospital Charge Code |
6121339
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$423.70 |
| Max. Negotiated Rate |
$1,474.40 |
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Cigna Commercial |
$1,319.20
|
| Rate for Payer: First Health Commercial |
$1,396.80
|
| Rate for Payer: First Health Workers Compensation |
$599.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,396.80
|
| Rate for Payer: GEHA Commercial |
$1,086.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,396.80
|
| Rate for Payer: Multiplan All |
$1,412.32
|
| Rate for Payer: OMNI Networks Commercial |
$1,086.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,396.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,474.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,164.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,443.36
|
| Rate for Payer: Zelis Auto |
$620.80
|
| Rate for Payer: Zelis Worker's Compensation |
$423.70
|
|
|
OPEN NASOETHMOID FX W/O FIXJ
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
CPT 21338
|
| Hospital Charge Code |
6121338
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$395.85 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$870.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$870.00
|
| Rate for Payer: Cash Price |
$870.00
|
| Rate for Payer: Cigna Commercial |
$1,232.50
|
| Rate for Payer: First Health Commercial |
$1,305.00
|
| Rate for Payer: First Health Workers Compensation |
$559.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,305.00
|
| Rate for Payer: GEHA Commercial |
$1,160.00
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,305.00
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,319.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,015.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,305.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,377.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,087.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,348.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$580.00
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$395.85
|
|
|
OPEN NASOETHMOID FX W/O FIXJ
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
CPT 21338
|
| Hospital Charge Code |
6121338
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$395.85 |
| Max. Negotiated Rate |
$1,377.50 |
| Rate for Payer: Cash Price |
$870.00
|
| Rate for Payer: Cigna Commercial |
$1,232.50
|
| Rate for Payer: First Health Commercial |
$1,305.00
|
| Rate for Payer: First Health Workers Compensation |
$559.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,305.00
|
| Rate for Payer: GEHA Commercial |
$1,015.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,305.00
|
| Rate for Payer: Multiplan All |
$1,319.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,015.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,305.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,377.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,087.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,348.50
|
| Rate for Payer: Zelis Auto |
$580.00
|
| Rate for Payer: Zelis Worker's Compensation |
$395.85
|
|
|
OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC;
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 23550
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,641.90 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| 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 |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| 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 |
$6,172.77
|
|
|
OPEN TREATMENT OF BIMALLEOLAR ANKLE FRACTURE (EG, LATERAL AND MEDIAL MALLEOLI, OR LATERAL AND POSTERIOR MALLEOLI, OR MEDIAL AND POSTERIOR MALLEOLI), INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 27814
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,641.90 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| 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 |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| 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 |
$6,172.77
|
|
|
OPEN TREATMENT OF CLAVICULAR FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 23515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,244.47 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,244.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| 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 |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,178.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,351.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| 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 |
$6,172.77
|
|
|
OPEN TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS), INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 27792
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,641.90 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| 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 |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| 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 |
$6,172.77
|
|
|
OPEN TREATMENT OF DISTAL RADIAL EXTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATION, WITH INTERNAL FIXATION
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 25607
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,244.47 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,244.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| 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 |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,178.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,351.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| 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 |
$6,172.77
|
|
|
OPEN TREATMENT OF DISTAL RADIAL INTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATION; WITH INTERNAL FIXATION OF 2 FRAGMENTS
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 25608
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,244.47 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,244.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| 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 |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,178.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,351.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| 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 |
$6,172.77
|
|
|
OPEN TREATMENT OF DISTAL RADIAL INTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATION; WITH INTERNAL FIXATION OF 3 OR MORE FRAGMENTS
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 25609
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,244.47 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,244.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| 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 |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,178.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,351.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| 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 |
$6,172.77
|
|
|
OPEN TREATMENT OF DISTAL TIBIOFIBULAR JOINT (SYNDESMOSIS) DISRUPTION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 27829
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,641.90 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| 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 |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| 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 |
$6,172.77
|
|
|
OPEN TREATMENT OF FRACTURE, GREAT TOE, PHALANX OR PHALANGES, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 28505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,070.11 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,070.11
|
| 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 |
$2,112.27
|
| 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 |
$2,438.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,112.27
|
| 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 |
$2,112.27
|
| 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
|
|
|
OPEN TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, EACH
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 28525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,070.11 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,070.11
|
| 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 |
$2,112.27
|
| 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 |
$2,438.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,112.27
|
| 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 |
$2,112.27
|
| 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
|
|
|
OPEN TREATMENT OF HUMERAL SHAFT FRACTURE WITH PLATE/SCREWS, WITH OR WITHOUT CERCLAGE
|
Facility
|
OP
|
$24,435.12
|
|
|
Service Code
|
CPT 24515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,244.47 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,244.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: First Health Workers Compensation |
$15,724.00
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| 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 |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,178.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,351.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| 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 |
$11,117.98
|
|
|
OPEN TREATMENT OF HUMERAL SUPRACONDYLAR OR TRANSCONDYLAR FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED; WITHOUT INTERCONDYLAR EXTENSION
|
Facility
|
OP
|
$24,435.12
|
|
|
Service Code
|
CPT 24545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,244.47 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,244.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: First Health Workers Compensation |
$15,724.00
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| 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 |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,178.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,351.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| 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 |
$11,117.98
|
|
|
OPEN TREATMENT OF MEDIAL MALLEOLUS FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 27766
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,641.90 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| 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 |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| 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 |
$6,172.77
|
|
|
OPEN TREATMENT OF METACARPAL FRACTURE, SINGLE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, EACH BONE
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 26615
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,618.76 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| 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 |
$3,716.07
|
| 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 |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| 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 |
$3,716.07
|
| 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
|
|
|
OPEN TREATMENT OF METATARSAL FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, EACH
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 28485
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,641.90 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| 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 |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| 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 |
$6,172.77
|
|
|
OPEN TREATMENT OF PATELLAR FRACTURE, WITH INTERNAL FIXATION AND/OR PARTIAL OR COMPLETE PATELLECTOMY AND SOFT TISSUE REPAIR
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 27524
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,641.90 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| 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 |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| 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 |
$6,172.77
|
|
