|
TRAY CVC TRIPLE-LUMEN COOK MEDICAL
|
Facility
|
IP
|
$738.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
7002759
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$201.47 |
| Max. Negotiated Rate |
$701.10 |
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cigna Commercial |
$627.30
|
| Rate for Payer: First Health Commercial |
$664.20
|
| Rate for Payer: First Health Workers Compensation |
$284.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$664.20
|
| Rate for Payer: GEHA Commercial |
$516.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$664.20
|
| Rate for Payer: Multiplan All |
$671.58
|
| Rate for Payer: OMNI Networks Commercial |
$516.60
|
| Rate for Payer: One Health Plan PPO/POS |
$664.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$701.10
|
| Rate for Payer: Three Rivers Provider Network All |
$553.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$686.34
|
| Rate for Payer: Zelis Auto |
$295.20
|
| Rate for Payer: Zelis Worker's Compensation |
$201.47
|
|
|
TRAY CVP TRIPLE-LUMEN ARROW
|
Facility
|
OP
|
$655.00
|
|
| Hospital Charge Code |
7000021
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$163.75 |
| Max. Negotiated Rate |
$622.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$393.00
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cigna Commercial |
$556.75
|
| Rate for Payer: First Health Commercial |
$589.50
|
| Rate for Payer: First Health Workers Compensation |
$252.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$589.50
|
| Rate for Payer: GEHA Commercial |
$524.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$589.50
|
| Rate for Payer: Humana ChoiceCare |
$170.30
|
| Rate for Payer: Multiplan All |
$596.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$393.00
|
| Rate for Payer: OMNI Networks Commercial |
$458.50
|
| Rate for Payer: One Health Plan PPO/POS |
$589.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$622.25
|
| Rate for Payer: Three Rivers Provider Network All |
$491.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$576.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$163.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$609.15
|
| Rate for Payer: Zelis Auto |
$262.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$327.50
|
| Rate for Payer: Zelis Worker's Compensation |
$178.81
|
|
|
TRAY CVP TRIPLE-LUMEN ARROW
|
Facility
|
IP
|
$655.00
|
|
| Hospital Charge Code |
7000021
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$178.81 |
| Max. Negotiated Rate |
$622.25 |
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cigna Commercial |
$556.75
|
| Rate for Payer: First Health Commercial |
$589.50
|
| Rate for Payer: First Health Workers Compensation |
$252.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$589.50
|
| Rate for Payer: GEHA Commercial |
$458.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$589.50
|
| Rate for Payer: Multiplan All |
$596.05
|
| Rate for Payer: OMNI Networks Commercial |
$458.50
|
| Rate for Payer: One Health Plan PPO/POS |
$589.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$622.25
|
| Rate for Payer: Three Rivers Provider Network All |
$491.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$609.15
|
| Rate for Payer: Zelis Auto |
$262.00
|
| Rate for Payer: Zelis Worker's Compensation |
$178.81
|
|
|
TRAZODONE 150MG TAB
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
NDC 50268077115
|
| Hospital Charge Code |
3301878
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$41.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$37.40
|
| Rate for Payer: First Health Commercial |
$39.60
|
| Rate for Payer: First Health Workers Compensation |
$16.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$39.60
|
| Rate for Payer: GEHA Commercial |
$35.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$39.60
|
| Rate for Payer: Humana ChoiceCare |
$11.44
|
| Rate for Payer: Multiplan All |
$40.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$26.40
|
| Rate for Payer: OMNI Networks Commercial |
$30.80
|
| Rate for Payer: One Health Plan PPO/POS |
$39.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$41.80
|
| Rate for Payer: Three Rivers Provider Network All |
$33.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$38.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$40.92
|
| Rate for Payer: Zelis Auto |
$17.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.00
|
| Rate for Payer: Zelis Worker's Compensation |
$12.01
|
|
|
TRAZODONE 150MG TAB
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
NDC 50268077115
|
| Hospital Charge Code |
3301878
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$41.80 |
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$37.40
|
| Rate for Payer: First Health Commercial |
$39.60
|
| Rate for Payer: First Health Workers Compensation |
$16.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$39.60
|
| Rate for Payer: GEHA Commercial |
$30.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$39.60
|
| Rate for Payer: Multiplan All |
$40.04
|
| Rate for Payer: OMNI Networks Commercial |
$30.80
|
| Rate for Payer: One Health Plan PPO/POS |
$39.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$41.80
|
| Rate for Payer: Three Rivers Provider Network All |
$33.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$40.92
|
| Rate for Payer: Zelis Auto |
$17.60
|
| Rate for Payer: Zelis Worker's Compensation |
$12.01
|
|
|
TraZODone HCL 50MG TAB
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 00904686861
|
| Hospital Charge Code |
3300915
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna Commercial |
$5.95
|
| Rate for Payer: First Health Commercial |
$6.30
|
| Rate for Payer: First Health Workers Compensation |
$2.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6.30
|
| Rate for Payer: GEHA Commercial |
$4.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6.30
|
| Rate for Payer: Multiplan All |
$6.37
|
| Rate for Payer: OMNI Networks Commercial |
$4.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6.65
|
| Rate for Payer: Three Rivers Provider Network All |
$5.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6.51
|
| Rate for Payer: Zelis Auto |
$2.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1.91
|
|
|
TraZODone HCL 50MG TAB
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
NDC 00904686861
|
| Hospital Charge Code |
3300915
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4.20
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna Commercial |
$5.95
|
| Rate for Payer: First Health Commercial |
$6.30
|
| Rate for Payer: First Health Workers Compensation |
$2.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6.30
|
| Rate for Payer: GEHA Commercial |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6.30
|
| Rate for Payer: Humana ChoiceCare |
$1.82
|
| Rate for Payer: Multiplan All |
$6.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.20
|
| Rate for Payer: OMNI Networks Commercial |
$4.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6.65
|
| Rate for Payer: Three Rivers Provider Network All |
$5.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6.51
|
| Rate for Payer: Zelis Auto |
$2.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1.91
|
|
|
TREAT ANKLE DISLOCATION
|
Facility
|
IP
|
$1,668.00
|
|
|
Service Code
|
CPT 27848
|
| Hospital Charge Code |
6127848
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$455.36 |
| Max. Negotiated Rate |
$1,584.60 |
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cigna Commercial |
$1,417.80
|
| Rate for Payer: First Health Commercial |
$1,501.20
|
| Rate for Payer: First Health Workers Compensation |
$644.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,501.20
|
| Rate for Payer: GEHA Commercial |
$1,167.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,501.20
|
| Rate for Payer: Multiplan All |
$1,517.88
|
| Rate for Payer: OMNI Networks Commercial |
$1,167.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,501.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,584.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,251.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,551.24
|
| Rate for Payer: Zelis Auto |
$667.20
|
| Rate for Payer: Zelis Worker's Compensation |
$455.36
|
|
|
TREAT ANKLE DISLOCATION
|
Facility
|
OP
|
$1,489.00
|
|
|
Service Code
|
CPT 27846
|
| Hospital Charge Code |
6127846
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$406.50 |
| Max. Negotiated Rate |
$13,844.26 |
| 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 Community HMO |
$893.40
|
| 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 |
$6,922.13
|
| Rate for Payer: Cash Price |
$893.40
|
| Rate for Payer: Cash Price |
$893.40
|
| Rate for Payer: Cigna Commercial |
$1,265.65
|
| Rate for Payer: First Health Commercial |
$1,340.10
|
| Rate for Payer: First Health Workers Compensation |
$574.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,340.10
|
| Rate for Payer: GEHA Commercial |
$1,191.20
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,340.10
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,354.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,042.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,340.10
|
| 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 |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,414.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,116.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,384.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$595.60
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$406.50
|
|
|
TREAT ANKLE DISLOCATION
|
Facility
|
IP
|
$1,489.00
|
|
|
Service Code
|
CPT 27846
|
| Hospital Charge Code |
6127846
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$406.50 |
| Max. Negotiated Rate |
$1,414.55 |
| Rate for Payer: Cash Price |
$893.40
|
| Rate for Payer: Cigna Commercial |
$1,265.65
|
| Rate for Payer: First Health Commercial |
$1,340.10
|
| Rate for Payer: First Health Workers Compensation |
$574.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,340.10
|
| Rate for Payer: GEHA Commercial |
$1,042.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,340.10
|
| Rate for Payer: Multiplan All |
$1,354.99
|
| Rate for Payer: OMNI Networks Commercial |
$1,042.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,340.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,414.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,116.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,384.77
|
| Rate for Payer: Zelis Auto |
$595.60
|
| Rate for Payer: Zelis Worker's Compensation |
$406.50
|
|
|
TREAT ANKLE DISLOCATION
|
Facility
|
OP
|
$1,668.00
|
|
|
Service Code
|
CPT 27848
|
| Hospital Charge Code |
6127848
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$455.36 |
| Max. Negotiated Rate |
$13,844.26 |
| 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 Community HMO |
$1,000.80
|
| 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 |
$6,922.13
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cigna Commercial |
$1,417.80
|
| Rate for Payer: First Health Commercial |
$1,501.20
|
| Rate for Payer: First Health Workers Compensation |
$644.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,501.20
|
| Rate for Payer: GEHA Commercial |
$1,334.40
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,501.20
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,517.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,167.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,501.20
|
| 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 |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,584.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,251.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,551.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$667.20
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$455.36
|
|
|
TREAT ANKLE FRACTURE
|
Facility
|
OP
|
$2,185.00
|
|
|
Service Code
|
CPT 28445
|
| Hospital Charge Code |
6128445
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$596.50 |
| Max. Negotiated Rate |
$13,844.26 |
| 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 Community HMO |
$1,311.00
|
| 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 |
$6,922.13
|
| Rate for Payer: Cash Price |
$1,311.00
|
| Rate for Payer: Cash Price |
$1,311.00
|
| Rate for Payer: Cigna Commercial |
$1,857.25
|
| Rate for Payer: First Health Commercial |
$1,966.50
|
| Rate for Payer: First Health Workers Compensation |
$843.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,966.50
|
| Rate for Payer: GEHA Commercial |
$1,748.00
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,966.50
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,988.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,529.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,966.50
|
| 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 |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,075.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,638.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,032.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$874.00
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$596.50
|
|
|
TREAT ANKLE FRACTURE
|
Facility
|
IP
|
$2,185.00
|
|
|
Service Code
|
CPT 28445
|
| Hospital Charge Code |
6128445
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$596.50 |
| Max. Negotiated Rate |
$2,075.75 |
| Rate for Payer: Cash Price |
$1,311.00
|
| Rate for Payer: Cigna Commercial |
$1,857.25
|
| Rate for Payer: First Health Commercial |
$1,966.50
|
| Rate for Payer: First Health Workers Compensation |
$843.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,966.50
|
| Rate for Payer: GEHA Commercial |
$1,529.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,966.50
|
| Rate for Payer: Multiplan All |
$1,988.35
|
| Rate for Payer: OMNI Networks Commercial |
$1,529.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,966.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,075.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,638.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,032.05
|
| Rate for Payer: Zelis Auto |
$874.00
|
| Rate for Payer: Zelis Worker's Compensation |
$596.50
|
|
|
TREAT BIG TOE FRACTURE
|
Facility
|
IP
|
$1,810.92
|
|
|
Service Code
|
CPT 28505
|
| Hospital Charge Code |
6128505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$494.38 |
| Max. Negotiated Rate |
$1,720.37 |
| Rate for Payer: Cash Price |
$1,086.55
|
| Rate for Payer: Cigna Commercial |
$1,539.28
|
| Rate for Payer: First Health Commercial |
$1,629.83
|
| Rate for Payer: First Health Workers Compensation |
$699.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,629.83
|
| Rate for Payer: GEHA Commercial |
$1,267.64
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,629.83
|
| Rate for Payer: Multiplan All |
$1,647.94
|
| Rate for Payer: OMNI Networks Commercial |
$1,267.64
|
| Rate for Payer: One Health Plan PPO/POS |
$1,629.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,720.37
|
| Rate for Payer: Three Rivers Provider Network All |
$1,358.19
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,684.16
|
| Rate for Payer: Zelis Auto |
$724.37
|
| Rate for Payer: Zelis Worker's Compensation |
$494.38
|
|
|
TREAT BIG TOE FRACTURE
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
CPT 28496
|
| Hospital Charge Code |
6128496
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$160.52 |
| Max. Negotiated Rate |
$558.60 |
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cigna Commercial |
$499.80
|
| Rate for Payer: First Health Commercial |
$529.20
|
| Rate for Payer: First Health Workers Compensation |
$227.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$529.20
|
| Rate for Payer: GEHA Commercial |
$411.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$529.20
|
| Rate for Payer: Multiplan All |
$535.08
|
| Rate for Payer: OMNI Networks Commercial |
$411.60
|
| Rate for Payer: One Health Plan PPO/POS |
$529.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$558.60
|
| Rate for Payer: Three Rivers Provider Network All |
$441.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$546.84
|
| Rate for Payer: Zelis Auto |
$235.20
|
| Rate for Payer: Zelis Worker's Compensation |
$160.52
|
|
|
TREAT BIG TOE FRACTURE
|
Facility
|
OP
|
$1,810.92
|
|
|
Service Code
|
CPT 28505
|
| Hospital Charge Code |
6128505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$494.38 |
| Max. Negotiated Rate |
$6,287.92 |
| 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 Community HMO |
$1,086.55
|
| 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 |
$3,143.96
|
| Rate for Payer: Cash Price |
$1,086.55
|
| Rate for Payer: Cash Price |
$1,086.55
|
| Rate for Payer: Cigna Commercial |
$1,539.28
|
| Rate for Payer: First Health Commercial |
$1,629.83
|
| Rate for Payer: First Health Workers Compensation |
$699.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,629.83
|
| Rate for Payer: GEHA Commercial |
$1,448.74
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,629.83
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$1,647.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$1,267.64
|
| Rate for Payer: One Health Plan PPO/POS |
$1,629.83
|
| 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 |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,720.37
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,358.19
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,684.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$724.37
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$494.38
|
|
|
TREAT BIG TOE FRACTURE
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
CPT 28496
|
| Hospital Charge Code |
6128496
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$160.52 |
| Max. Negotiated Rate |
$6,287.92 |
| 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 Community HMO |
$352.80
|
| 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 |
$3,143.96
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cigna Commercial |
$499.80
|
| Rate for Payer: First Health Commercial |
$529.20
|
| Rate for Payer: First Health Workers Compensation |
$227.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$529.20
|
| Rate for Payer: GEHA Commercial |
$470.40
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$529.20
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$535.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$411.60
|
| Rate for Payer: One Health Plan PPO/POS |
$529.20
|
| 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 |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$558.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$441.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$546.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$235.20
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$160.52
|
|
|
TREAT CHEST LINING
|
Facility
|
IP
|
$1,671.00
|
|
|
Service Code
|
CPT 32215
|
| Hospital Charge Code |
6132215
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$456.18 |
| Max. Negotiated Rate |
$1,587.45 |
| Rate for Payer: Cash Price |
$1,002.60
|
| Rate for Payer: Cigna Commercial |
$1,420.35
|
| Rate for Payer: First Health Commercial |
$1,503.90
|
| Rate for Payer: First Health Workers Compensation |
$645.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,503.90
|
| Rate for Payer: GEHA Commercial |
$1,169.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,503.90
|
| Rate for Payer: Multiplan All |
$1,520.61
|
| Rate for Payer: OMNI Networks Commercial |
$1,169.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,503.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,587.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,253.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,554.03
|
| Rate for Payer: Zelis Auto |
$668.40
|
| Rate for Payer: Zelis Worker's Compensation |
$456.18
|
|
|
TREAT CHEST LINING
|
Facility
|
OP
|
$1,671.00
|
|
|
Service Code
|
CPT 32215
|
| Hospital Charge Code |
6132215
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$417.75 |
| Max. Negotiated Rate |
$1,587.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,002.60
|
| Rate for Payer: Cash Price |
$1,002.60
|
| Rate for Payer: Cigna Commercial |
$1,420.35
|
| Rate for Payer: First Health Commercial |
$1,503.90
|
| Rate for Payer: First Health Workers Compensation |
$645.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,503.90
|
| Rate for Payer: GEHA Commercial |
$1,336.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,503.90
|
| Rate for Payer: Humana ChoiceCare |
$434.46
|
| Rate for Payer: Multiplan All |
$1,520.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,002.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,169.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,503.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,587.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,253.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,470.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$417.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,554.03
|
| Rate for Payer: Zelis Auto |
$668.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$835.50
|
| Rate for Payer: Zelis Worker's Compensation |
$456.18
|
|
|
TREAT CLAVICLE DISLOCATION
|
Facility
|
OP
|
$1,339.00
|
|
|
Service Code
|
CPT 23552
|
| Hospital Charge Code |
6123552
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$365.55 |
| Max. Negotiated Rate |
$13,844.26 |
| 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 Community HMO |
$803.40
|
| 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 |
$6,922.13
|
| Rate for Payer: Cash Price |
$803.40
|
| Rate for Payer: Cash Price |
$803.40
|
| Rate for Payer: Cigna Commercial |
$1,138.15
|
| Rate for Payer: First Health Commercial |
$1,205.10
|
| Rate for Payer: First Health Workers Compensation |
$516.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,205.10
|
| Rate for Payer: GEHA Commercial |
$1,071.20
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,205.10
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,218.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$937.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,205.10
|
| 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 |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,272.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,004.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,245.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$535.60
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$365.55
|
|
|
TREAT CLAVICLE DISLOCATION
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
6123540
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$155.34 |
| Max. Negotiated Rate |
$540.55 |
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$483.65
|
| Rate for Payer: First Health Commercial |
$512.10
|
| Rate for Payer: First Health Workers Compensation |
$219.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$512.10
|
| Rate for Payer: GEHA Commercial |
$398.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$512.10
|
| Rate for Payer: Multiplan All |
$517.79
|
| Rate for Payer: OMNI Networks Commercial |
$398.30
|
| Rate for Payer: One Health Plan PPO/POS |
$512.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$540.55
|
| Rate for Payer: Three Rivers Provider Network All |
$426.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$529.17
|
| Rate for Payer: Zelis Auto |
$227.60
|
| Rate for Payer: Zelis Worker's Compensation |
$155.34
|
|
|
TREAT CLAVICLE DISLOCATION
|
Facility
|
IP
|
$568.00
|
|
|
Service Code
|
CPT 23520
|
| Hospital Charge Code |
6123520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$155.06 |
| Max. Negotiated Rate |
$539.60 |
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cigna Commercial |
$482.80
|
| Rate for Payer: First Health Commercial |
$511.20
|
| Rate for Payer: First Health Workers Compensation |
$219.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$511.20
|
| Rate for Payer: GEHA Commercial |
$397.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$511.20
|
| Rate for Payer: Multiplan All |
$516.88
|
| Rate for Payer: OMNI Networks Commercial |
$397.60
|
| Rate for Payer: One Health Plan PPO/POS |
$511.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$539.60
|
| Rate for Payer: Three Rivers Provider Network All |
$426.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$528.24
|
| Rate for Payer: Zelis Auto |
$227.20
|
| Rate for Payer: Zelis Worker's Compensation |
$155.06
|
|
|
TREAT CLAVICLE DISLOCATION
|
Facility
|
OP
|
$1,151.00
|
|
|
Service Code
|
CPT 23550
|
| Hospital Charge Code |
6123550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$314.22 |
| Max. Negotiated Rate |
$13,844.26 |
| 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 Community HMO |
$690.60
|
| 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 |
$6,922.13
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$978.35
|
| Rate for Payer: First Health Commercial |
$1,035.90
|
| Rate for Payer: First Health Workers Compensation |
$444.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,035.90
|
| Rate for Payer: GEHA Commercial |
$920.80
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,035.90
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,047.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$805.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,035.90
|
| 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 |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,093.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$863.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,070.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$460.40
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$314.22
|
|
|
TREAT CLAVICLE DISLOCATION
|
Facility
|
IP
|
$1,151.00
|
|
|
Service Code
|
CPT 23550
|
| Hospital Charge Code |
6123550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$314.22 |
| Max. Negotiated Rate |
$1,093.45 |
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$978.35
|
| Rate for Payer: First Health Commercial |
$1,035.90
|
| Rate for Payer: First Health Workers Compensation |
$444.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,035.90
|
| Rate for Payer: GEHA Commercial |
$805.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,035.90
|
| Rate for Payer: Multiplan All |
$1,047.41
|
| Rate for Payer: OMNI Networks Commercial |
$805.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,035.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,093.45
|
| Rate for Payer: Three Rivers Provider Network All |
$863.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,070.43
|
| Rate for Payer: Zelis Auto |
$460.40
|
| Rate for Payer: Zelis Worker's Compensation |
$314.22
|
|
|
TREAT CLAVICLE DISLOCATION
|
Facility
|
IP
|
$1,339.00
|
|
|
Service Code
|
CPT 23552
|
| Hospital Charge Code |
6123552
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$365.55 |
| Max. Negotiated Rate |
$1,272.05 |
| Rate for Payer: Cash Price |
$803.40
|
| Rate for Payer: Cigna Commercial |
$1,138.15
|
| Rate for Payer: First Health Commercial |
$1,205.10
|
| Rate for Payer: First Health Workers Compensation |
$516.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,205.10
|
| Rate for Payer: GEHA Commercial |
$937.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,205.10
|
| Rate for Payer: Multiplan All |
$1,218.49
|
| Rate for Payer: OMNI Networks Commercial |
$937.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,205.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,272.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,004.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,245.27
|
| Rate for Payer: Zelis Auto |
$535.60
|
| Rate for Payer: Zelis Worker's Compensation |
$365.55
|
|
