|
TREAT CLAVICLE DISLOCATION
|
Facility
|
IP
|
$1,264.00
|
|
|
Service Code
|
CPT 23532
|
| Hospital Charge Code |
6123532
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$345.07 |
| Max. Negotiated Rate |
$1,200.80 |
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Cigna Commercial |
$1,074.40
|
| Rate for Payer: First Health Commercial |
$1,137.60
|
| Rate for Payer: First Health Workers Compensation |
$488.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,137.60
|
| Rate for Payer: GEHA Commercial |
$884.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,137.60
|
| Rate for Payer: Multiplan All |
$1,150.24
|
| Rate for Payer: OMNI Networks Commercial |
$884.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,137.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,200.80
|
| Rate for Payer: Three Rivers Provider Network All |
$948.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,175.52
|
| Rate for Payer: Zelis Auto |
$505.60
|
| Rate for Payer: Zelis Worker's Compensation |
$345.07
|
|
|
TREAT CLAVICLE DISLOCATION
|
Facility
|
IP
|
$1,126.00
|
|
|
Service Code
|
CPT 23530
|
| Hospital Charge Code |
6123530
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$307.40 |
| Max. Negotiated Rate |
$1,069.70 |
| Rate for Payer: Cash Price |
$675.60
|
| Rate for Payer: Cigna Commercial |
$957.10
|
| Rate for Payer: First Health Commercial |
$1,013.40
|
| Rate for Payer: First Health Workers Compensation |
$434.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,013.40
|
| Rate for Payer: GEHA Commercial |
$788.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,013.40
|
| Rate for Payer: Multiplan All |
$1,024.66
|
| Rate for Payer: OMNI Networks Commercial |
$788.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,013.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,069.70
|
| Rate for Payer: Three Rivers Provider Network All |
$844.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,047.18
|
| Rate for Payer: Zelis Auto |
$450.40
|
| Rate for Payer: Zelis Worker's Compensation |
$307.40
|
|
|
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
|
OP
|
$1,126.00
|
|
|
Service Code
|
CPT 23530
|
| Hospital Charge Code |
6123530
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$307.40 |
| 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 |
$675.60
|
| 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 |
$675.60
|
| Rate for Payer: Cash Price |
$675.60
|
| Rate for Payer: Cigna Commercial |
$957.10
|
| Rate for Payer: First Health Commercial |
$1,013.40
|
| Rate for Payer: First Health Workers Compensation |
$434.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,013.40
|
| Rate for Payer: GEHA Commercial |
$900.80
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,013.40
|
| 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 |
$1,024.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$788.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,013.40
|
| 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 |
$1,069.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$844.50
|
| 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 |
$1,047.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$450.40
|
| 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 |
$307.40
|
|
|
TREAT CLAVICLE DISLOCATION
|
Facility
|
OP
|
$1,264.00
|
|
|
Service Code
|
CPT 23532
|
| Hospital Charge Code |
6123532
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$345.07 |
| Max. Negotiated Rate |
$13,844.26 |
| 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 |
$758.40
|
| 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 |
$6,922.13
|
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Cigna Commercial |
$1,074.40
|
| Rate for Payer: First Health Commercial |
$1,137.60
|
| Rate for Payer: First Health Workers Compensation |
$488.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,137.60
|
| Rate for Payer: GEHA Commercial |
$1,011.20
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,137.60
|
| 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 |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,150.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$884.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,137.60
|
| 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 |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,200.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$948.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,175.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$505.60
|
| 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 |
$345.07
|
|
|
TREAT CLAVICLE DISLOCATION
|
Facility
|
OP
|
$873.00
|
|
|
Service Code
|
CPT 23525
|
| Hospital Charge Code |
6123525
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$197.57 |
| Max. Negotiated Rate |
$829.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$484.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$523.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$484.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$384.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$232.44
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cigna Commercial |
$742.05
|
| Rate for Payer: First Health Commercial |
$785.70
|
| Rate for Payer: First Health Workers Compensation |
$337.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$785.70
|
| Rate for Payer: GEHA Commercial |
$698.40
|
| Rate for Payer: GEHA Medicare |
$232.44
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$785.70
|
| Rate for Payer: Humana ChoiceCare |
$255.68
|
| Rate for Payer: Humana Medicare Advantage |
$232.44
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$390.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$391.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$232.44
|
| Rate for Payer: Multiplan All |
$794.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$395.15
|
| Rate for Payer: OMNI Networks Commercial |
$611.10
|
| Rate for Payer: One Health Plan PPO/POS |
$785.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$452.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$391.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$232.44
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$829.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$464.88
|
| Rate for Payer: Three Rivers Provider Network All |
$654.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$227.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$391.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$232.44
|
| Rate for Payer: United Payors & United Providers UP&UP |
$811.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$232.44
|
| Rate for Payer: Zelis Auto |
$349.20
|
| Rate for Payer: Zelis Medicare |
$197.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$278.93
|
| Rate for Payer: Zelis Worker's Compensation |
$238.33
|
|
|
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
|
OP
|
$568.00
|
|
|
Service Code
|
CPT 23520
|
| Hospital Charge Code |
6123520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$155.06 |
| Max. Negotiated Rate |
$3,101.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$484.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$340.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$484.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$384.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,550.77
|
| Rate for Payer: Cash Price |
$340.80
|
| 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 |
$454.40
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$511.20
|
| Rate for Payer: Humana ChoiceCare |
$1,705.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,550.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,605.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$391.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$516.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$397.60
|
| Rate for Payer: One Health Plan PPO/POS |
$511.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$452.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$391.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$539.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$426.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$391.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$528.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$227.20
|
| Rate for Payer: Zelis Medicare |
$1,318.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,860.92
|
| Rate for Payer: Zelis Worker's Compensation |
$155.06
|
|
|
TREAT CLAVICLE DISLOCATION
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
6123540
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$540.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$341.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$232.44
|
| Rate for Payer: Cash Price |
$341.40
|
| 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 |
$455.20
|
| Rate for Payer: GEHA Medicare |
$232.44
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$512.10
|
| Rate for Payer: Humana ChoiceCare |
$255.68
|
| Rate for Payer: Humana Medicare Advantage |
$232.44
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$390.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$232.44
|
| Rate for Payer: Multiplan All |
$517.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$395.15
|
| Rate for Payer: OMNI Networks Commercial |
$398.30
|
| Rate for Payer: One Health Plan PPO/POS |
$512.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$232.44
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$540.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$464.88
|
| Rate for Payer: Three Rivers Provider Network All |
$426.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$227.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$232.44
|
| Rate for Payer: United Payors & United Providers UP&UP |
$529.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$232.44
|
| Rate for Payer: Zelis Auto |
$227.60
|
| Rate for Payer: Zelis Medicare |
$197.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$278.93
|
| Rate for Payer: Zelis Worker's Compensation |
$155.34
|
|
|
TREAT CLAVICLE FRACTURE
|
Facility
|
OP
|
$1,473.00
|
|
|
Service Code
|
CPT 23515
|
| Hospital Charge Code |
6123515
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$402.13 |
| Max. Negotiated Rate |
$13,844.26 |
| 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 Community HMO |
$883.80
|
| 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 |
$6,922.13
|
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Cigna Commercial |
$1,252.05
|
| Rate for Payer: First Health Commercial |
$1,325.70
|
| Rate for Payer: First Health Workers Compensation |
$568.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,325.70
|
| Rate for Payer: GEHA Commercial |
$1,178.40
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,325.70
|
| 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 |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,340.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,031.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,325.70
|
| 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 |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,399.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,104.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,369.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$589.20
|
| 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 |
$402.13
|
|
|
TREAT CLAVICLE FRACTURE
|
Facility
|
IP
|
$1,473.00
|
|
|
Service Code
|
CPT 23515
|
| Hospital Charge Code |
6123515
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$402.13 |
| Max. Negotiated Rate |
$1,399.35 |
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Cigna Commercial |
$1,252.05
|
| Rate for Payer: First Health Commercial |
$1,325.70
|
| Rate for Payer: First Health Workers Compensation |
$568.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,325.70
|
| Rate for Payer: GEHA Commercial |
$1,031.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,325.70
|
| Rate for Payer: Multiplan All |
$1,340.43
|
| Rate for Payer: OMNI Networks Commercial |
$1,031.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,325.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,399.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,104.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,369.89
|
| Rate for Payer: Zelis Auto |
$589.20
|
| Rate for Payer: Zelis Worker's Compensation |
$402.13
|
|
|
TREAT CLAVICLE FRACTURE
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
6123500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$151.24 |
| Max. Negotiated Rate |
$526.30 |
| Rate for Payer: Cash Price |
$332.40
|
| Rate for Payer: Cigna Commercial |
$470.90
|
| Rate for Payer: First Health Commercial |
$498.60
|
| Rate for Payer: First Health Workers Compensation |
$213.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$498.60
|
| Rate for Payer: GEHA Commercial |
$387.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$498.60
|
| Rate for Payer: Multiplan All |
$504.14
|
| Rate for Payer: OMNI Networks Commercial |
$387.80
|
| Rate for Payer: One Health Plan PPO/POS |
$498.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$526.30
|
| Rate for Payer: Three Rivers Provider Network All |
$415.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$515.22
|
| Rate for Payer: Zelis Auto |
$221.60
|
| Rate for Payer: Zelis Worker's Compensation |
$151.24
|
|
|
TREAT CLAVICLE FRACTURE
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
6123500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$526.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$332.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$232.44
|
| Rate for Payer: Cash Price |
$332.40
|
| Rate for Payer: Cash Price |
$332.40
|
| Rate for Payer: Cigna Commercial |
$470.90
|
| Rate for Payer: First Health Commercial |
$498.60
|
| Rate for Payer: First Health Workers Compensation |
$213.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$498.60
|
| Rate for Payer: GEHA Commercial |
$443.20
|
| Rate for Payer: GEHA Medicare |
$232.44
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$498.60
|
| Rate for Payer: Humana ChoiceCare |
$255.68
|
| Rate for Payer: Humana Medicare Advantage |
$232.44
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$390.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$232.44
|
| Rate for Payer: Multiplan All |
$504.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$395.15
|
| Rate for Payer: OMNI Networks Commercial |
$387.80
|
| Rate for Payer: One Health Plan PPO/POS |
$498.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$232.44
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$526.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$464.88
|
| Rate for Payer: Three Rivers Provider Network All |
$415.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$227.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$232.44
|
| Rate for Payer: United Payors & United Providers UP&UP |
$515.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$232.44
|
| Rate for Payer: Zelis Auto |
$221.60
|
| Rate for Payer: Zelis Medicare |
$197.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$278.93
|
| Rate for Payer: Zelis Worker's Compensation |
$151.24
|
|
|
TREAT CRANIOFACIAL FRACTURE
|
Facility
|
IP
|
$2,607.00
|
|
|
Service Code
|
CPT 21435
|
| Hospital Charge Code |
6121435
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$711.71 |
| Max. Negotiated Rate |
$2,476.65 |
| Rate for Payer: Cash Price |
$1,564.20
|
| Rate for Payer: Cigna Commercial |
$2,215.95
|
| Rate for Payer: First Health Commercial |
$2,346.30
|
| Rate for Payer: First Health Workers Compensation |
$1,006.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,346.30
|
| Rate for Payer: GEHA Commercial |
$1,824.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,346.30
|
| Rate for Payer: Multiplan All |
$2,372.37
|
| Rate for Payer: OMNI Networks Commercial |
$1,824.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,346.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,476.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,955.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,424.51
|
| Rate for Payer: Zelis Auto |
$1,042.80
|
| Rate for Payer: Zelis Worker's Compensation |
$711.71
|
|
|
TREAT CRANIOFACIAL FRACTURE
|
Facility
|
OP
|
$2,607.00
|
|
|
Service Code
|
CPT 21435
|
| Hospital Charge Code |
6121435
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$651.75 |
| Max. Negotiated Rate |
$2,476.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,564.20
|
| Rate for Payer: Cash Price |
$1,564.20
|
| Rate for Payer: Cigna Commercial |
$2,215.95
|
| Rate for Payer: First Health Commercial |
$2,346.30
|
| Rate for Payer: First Health Workers Compensation |
$1,006.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,346.30
|
| Rate for Payer: GEHA Commercial |
$2,085.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,346.30
|
| Rate for Payer: Humana ChoiceCare |
$677.82
|
| Rate for Payer: Multiplan All |
$2,372.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,564.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,824.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,346.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,476.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,955.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,294.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$651.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,424.51
|
| Rate for Payer: Zelis Auto |
$1,042.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,303.50
|
| Rate for Payer: Zelis Worker's Compensation |
$711.71
|
|
|
TREAT DISLOCATION/FRACTURE
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT 23665
|
| Hospital Charge Code |
6123665
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$272.18 |
| Max. Negotiated Rate |
$947.15 |
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: First Health Workers Compensation |
$384.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$697.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: Zelis Auto |
$398.80
|
| Rate for Payer: Zelis Worker's Compensation |
$272.18
|
|
|
TREAT DISLOCATION/FRACTURE
|
Facility
|
OP
|
$1,017.00
|
|
|
Service Code
|
CPT 23675
|
| Hospital Charge Code |
6123675
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$3,101.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$610.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,550.77
|
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Cigna Commercial |
$864.45
|
| Rate for Payer: First Health Commercial |
$915.30
|
| Rate for Payer: First Health Workers Compensation |
$392.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$915.30
|
| Rate for Payer: GEHA Commercial |
$813.60
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$915.30
|
| Rate for Payer: Humana ChoiceCare |
$1,705.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,550.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,605.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$925.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$711.90
|
| Rate for Payer: One Health Plan PPO/POS |
$915.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$966.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$762.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$945.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$406.80
|
| Rate for Payer: Zelis Medicare |
$1,318.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,860.92
|
| Rate for Payer: Zelis Worker's Compensation |
$277.64
|
|
|
TREAT DISLOCATION/FRACTURE
|
Facility
|
IP
|
$1,906.00
|
|
|
Service Code
|
CPT 23680
|
| Hospital Charge Code |
6123680
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$520.34 |
| Max. Negotiated Rate |
$1,810.70 |
| Rate for Payer: Cash Price |
$1,143.60
|
| Rate for Payer: Cigna Commercial |
$1,620.10
|
| Rate for Payer: First Health Commercial |
$1,715.40
|
| Rate for Payer: First Health Workers Compensation |
$735.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,715.40
|
| Rate for Payer: GEHA Commercial |
$1,334.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,715.40
|
| Rate for Payer: Multiplan All |
$1,734.46
|
| Rate for Payer: OMNI Networks Commercial |
$1,334.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,715.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,810.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,429.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,772.58
|
| Rate for Payer: Zelis Auto |
$762.40
|
| Rate for Payer: Zelis Worker's Compensation |
$520.34
|
|
|
TREAT DISLOCATION/FRACTURE
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT 23665
|
| Hospital Charge Code |
6123665
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$272.18 |
| Max. Negotiated Rate |
$3,101.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$484.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$598.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$484.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$384.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,550.77
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Cigna Commercial |
$847.45
|
| Rate for Payer: First Health Commercial |
$897.30
|
| Rate for Payer: First Health Workers Compensation |
$384.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$897.30
|
| Rate for Payer: GEHA Commercial |
$797.60
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$897.30
|
| Rate for Payer: Humana ChoiceCare |
$1,705.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,550.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,605.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$391.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$907.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$697.90
|
| Rate for Payer: One Health Plan PPO/POS |
$897.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$452.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$391.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$947.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$747.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$391.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$927.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$398.80
|
| Rate for Payer: Zelis Medicare |
$1,318.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,860.92
|
| Rate for Payer: Zelis Worker's Compensation |
$272.18
|
|
|
TREAT DISLOCATION/FRACTURE
|
Facility
|
IP
|
$1,017.00
|
|
|
Service Code
|
CPT 23675
|
| Hospital Charge Code |
6123675
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$277.64 |
| Max. Negotiated Rate |
$966.15 |
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Cigna Commercial |
$864.45
|
| Rate for Payer: First Health Commercial |
$915.30
|
| Rate for Payer: First Health Workers Compensation |
$392.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$915.30
|
| Rate for Payer: GEHA Commercial |
$711.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$915.30
|
| Rate for Payer: Multiplan All |
$925.47
|
| Rate for Payer: OMNI Networks Commercial |
$711.90
|
| Rate for Payer: One Health Plan PPO/POS |
$915.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$966.15
|
| Rate for Payer: Three Rivers Provider Network All |
$762.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$945.81
|
| Rate for Payer: Zelis Auto |
$406.80
|
| Rate for Payer: Zelis Worker's Compensation |
$277.64
|
|
|
TREAT DISLOCATION/FRACTURE
|
Facility
|
OP
|
$1,906.00
|
|
|
Service Code
|
CPT 23680
|
| Hospital Charge Code |
6123680
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$520.34 |
| Max. Negotiated Rate |
$24,935.38 |
| 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 |
$1,143.60
|
| 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 |
$12,467.69
|
| Rate for Payer: Cash Price |
$1,143.60
|
| Rate for Payer: Cash Price |
$1,143.60
|
| Rate for Payer: Cigna Commercial |
$1,620.10
|
| Rate for Payer: First Health Commercial |
$1,715.40
|
| Rate for Payer: First Health Workers Compensation |
$735.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,715.40
|
| Rate for Payer: GEHA Commercial |
$1,524.80
|
| Rate for Payer: GEHA Medicare |
$12,467.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,715.40
|
| Rate for Payer: Humana ChoiceCare |
$13,714.46
|
| Rate for Payer: Humana Medicare Advantage |
$12,467.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,945.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,467.69
|
| Rate for Payer: Multiplan All |
$1,734.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21,195.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,334.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,715.40
|
| 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 |
$12,467.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,810.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,935.38
|
| Rate for Payer: Three Rivers Provider Network All |
$1,429.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,218.34
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,467.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,772.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,467.69
|
| Rate for Payer: Zelis Auto |
$762.40
|
| Rate for Payer: Zelis Medicare |
$10,597.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,961.23
|
| Rate for Payer: Zelis Worker's Compensation |
$520.34
|
|
|
TREAT DISLOCATION/FRACTURE
|
Facility
|
OP
|
$1,798.00
|
|
|
Service Code
|
CPT 23670
|
| Hospital Charge Code |
6123670
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$490.85 |
| Max. Negotiated Rate |
$13,844.26 |
| 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 Community HMO |
$1,078.80
|
| 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 |
$6,922.13
|
| Rate for Payer: Cash Price |
$1,078.80
|
| Rate for Payer: Cash Price |
$1,078.80
|
| Rate for Payer: Cigna Commercial |
$1,528.30
|
| Rate for Payer: First Health Commercial |
$1,618.20
|
| Rate for Payer: First Health Workers Compensation |
$694.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,618.20
|
| Rate for Payer: GEHA Commercial |
$1,438.40
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,618.20
|
| 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 |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,636.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,258.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,618.20
|
| 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 |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,708.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,348.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,672.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$719.20
|
| 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 |
$490.85
|
|
|
TREAT DISLOCATION/FRACTURE
|
Facility
|
IP
|
$1,798.00
|
|
|
Service Code
|
CPT 23670
|
| Hospital Charge Code |
6123670
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$490.85 |
| Max. Negotiated Rate |
$1,708.10 |
| Rate for Payer: Cash Price |
$1,078.80
|
| Rate for Payer: Cigna Commercial |
$1,528.30
|
| Rate for Payer: First Health Commercial |
$1,618.20
|
| Rate for Payer: First Health Workers Compensation |
$694.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,618.20
|
| Rate for Payer: GEHA Commercial |
$1,258.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,618.20
|
| Rate for Payer: Multiplan All |
$1,636.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,258.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,618.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,708.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,348.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,672.14
|
| Rate for Payer: Zelis Auto |
$719.20
|
| Rate for Payer: Zelis Worker's Compensation |
$490.85
|
|
|
TREAT EACH ADD SPINE FX
|
Facility
|
IP
|
$757.00
|
|
|
Service Code
|
CPT 22328
|
| Hospital Charge Code |
6122328
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$206.66 |
| Max. Negotiated Rate |
$719.15 |
| Rate for Payer: Cash Price |
$454.20
|
| Rate for Payer: Cigna Commercial |
$643.45
|
| Rate for Payer: First Health Commercial |
$681.30
|
| Rate for Payer: First Health Workers Compensation |
$292.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$681.30
|
| Rate for Payer: GEHA Commercial |
$529.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$681.30
|
| Rate for Payer: Multiplan All |
$688.87
|
| Rate for Payer: OMNI Networks Commercial |
$529.90
|
| Rate for Payer: One Health Plan PPO/POS |
$681.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$719.15
|
| Rate for Payer: Three Rivers Provider Network All |
$567.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$704.01
|
| Rate for Payer: Zelis Auto |
$302.80
|
| Rate for Payer: Zelis Worker's Compensation |
$206.66
|
|
