|
TREAT EACH ADD SPINE FX
|
Facility
|
OP
|
$757.00
|
|
|
Service Code
|
CPT 22328
|
| Hospital Charge Code |
6122328
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$189.25 |
| Max. Negotiated Rate |
$719.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$454.20
|
| 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 |
$605.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$681.30
|
| Rate for Payer: Humana ChoiceCare |
$196.82
|
| Rate for Payer: Multiplan All |
$688.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$454.20
|
| 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: TriWest Veterans Administration/VAPC3 |
$666.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$189.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$704.01
|
| Rate for Payer: Zelis Auto |
$302.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$378.50
|
| Rate for Payer: Zelis Worker's Compensation |
$206.66
|
|
|
TREAT ELBOW DISLOCATION
|
Facility
|
IP
|
$1,459.00
|
|
|
Service Code
|
CPT 24615
|
| Hospital Charge Code |
6124615
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$398.31 |
| Max. Negotiated Rate |
$1,386.05 |
| Rate for Payer: Cash Price |
$875.40
|
| Rate for Payer: Cigna Commercial |
$1,240.15
|
| Rate for Payer: First Health Commercial |
$1,313.10
|
| Rate for Payer: First Health Workers Compensation |
$563.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,313.10
|
| Rate for Payer: GEHA Commercial |
$1,021.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,313.10
|
| Rate for Payer: Multiplan All |
$1,327.69
|
| Rate for Payer: OMNI Networks Commercial |
$1,021.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,313.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,386.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,094.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,356.87
|
| Rate for Payer: Zelis Auto |
$583.60
|
| Rate for Payer: Zelis Worker's Compensation |
$398.31
|
|
|
TREAT ELBOW DISLOCATION
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
CPT 24600
|
| Hospital Charge Code |
6124600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$798.00 |
| 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 |
$504.00
|
| 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 |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cigna Commercial |
$714.00
|
| Rate for Payer: First Health Commercial |
$756.00
|
| Rate for Payer: First Health Workers Compensation |
$324.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$756.00
|
| Rate for Payer: GEHA Commercial |
$672.00
|
| Rate for Payer: GEHA Medicare |
$232.44
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$756.00
|
| 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 |
$764.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$395.15
|
| Rate for Payer: OMNI Networks Commercial |
$588.00
|
| Rate for Payer: One Health Plan PPO/POS |
$756.00
|
| 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 |
$798.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$464.88
|
| Rate for Payer: Three Rivers Provider Network All |
$630.00
|
| 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 |
$781.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$232.44
|
| Rate for Payer: Zelis Auto |
$336.00
|
| Rate for Payer: Zelis Medicare |
$197.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$278.93
|
| Rate for Payer: Zelis Worker's Compensation |
$229.32
|
|
|
TREAT ELBOW DISLOCATION
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
CPT 24600
|
| Hospital Charge Code |
6124600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$229.32 |
| Max. Negotiated Rate |
$798.00 |
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cigna Commercial |
$714.00
|
| Rate for Payer: First Health Commercial |
$756.00
|
| Rate for Payer: First Health Workers Compensation |
$324.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$756.00
|
| Rate for Payer: GEHA Commercial |
$588.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$756.00
|
| Rate for Payer: Multiplan All |
$764.40
|
| Rate for Payer: OMNI Networks Commercial |
$588.00
|
| Rate for Payer: One Health Plan PPO/POS |
$756.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$798.00
|
| Rate for Payer: Three Rivers Provider Network All |
$630.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$781.20
|
| Rate for Payer: Zelis Auto |
$336.00
|
| Rate for Payer: Zelis Worker's Compensation |
$229.32
|
|
|
TREAT ELBOW DISLOCATION
|
Facility
|
OP
|
$1,459.00
|
|
|
Service Code
|
CPT 24615
|
| Hospital Charge Code |
6124615
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$398.31 |
| 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 |
$875.40
|
| 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 |
$875.40
|
| Rate for Payer: Cash Price |
$875.40
|
| Rate for Payer: Cigna Commercial |
$1,240.15
|
| Rate for Payer: First Health Commercial |
$1,313.10
|
| Rate for Payer: First Health Workers Compensation |
$563.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,313.10
|
| Rate for Payer: GEHA Commercial |
$1,167.20
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,313.10
|
| 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 |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,327.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,021.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,313.10
|
| 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 |
$1,386.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,094.25
|
| 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 |
$1,356.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$583.60
|
| 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 |
$398.31
|
|
|
TREAT ELBOW FRACTURE
|
Facility
|
OP
|
$2,229.00
|
|
|
Service Code
|
CPT 24586
|
| Hospital Charge Code |
6124586
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$608.52 |
| Max. Negotiated Rate |
$24,935.38 |
| 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 |
$1,337.40
|
| 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 |
$12,467.69
|
| Rate for Payer: Cash Price |
$1,337.40
|
| Rate for Payer: Cash Price |
$1,337.40
|
| Rate for Payer: Cigna Commercial |
$1,894.65
|
| Rate for Payer: First Health Commercial |
$2,006.10
|
| Rate for Payer: First Health Workers Compensation |
$860.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,006.10
|
| Rate for Payer: GEHA Commercial |
$1,783.20
|
| Rate for Payer: GEHA Medicare |
$12,467.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,006.10
|
| 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 |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,467.69
|
| Rate for Payer: Multiplan All |
$2,028.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21,195.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,560.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,006.10
|
| 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 |
$12,467.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,117.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,935.38
|
| Rate for Payer: Three Rivers Provider Network All |
$1,671.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,218.34
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,467.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,072.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,467.69
|
| Rate for Payer: Zelis Auto |
$891.60
|
| 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 |
$608.52
|
|
|
TREAT ELBOW FRACTURE
|
Facility
|
OP
|
$1,117.00
|
|
|
Service Code
|
CPT 24620
|
| Hospital Charge Code |
6124620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$304.94 |
| Max. Negotiated Rate |
$3,101.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,860.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$670.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,860.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,473.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,550.77
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$949.45
|
| Rate for Payer: First Health Commercial |
$1,005.30
|
| Rate for Payer: First Health Workers Compensation |
$431.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,005.30
|
| Rate for Payer: GEHA Commercial |
$893.60
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,005.30
|
| 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 |
$1,503.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$1,016.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$781.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,005.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,736.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,503.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,061.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$837.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,503.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,038.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$446.80
|
| 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 |
$304.94
|
|
|
TREAT ELBOW FRACTURE
|
Facility
|
OP
|
$1,372.00
|
|
|
Service Code
|
CPT 24635
|
| Hospital Charge Code |
6124635
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$374.56 |
| 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 |
$823.20
|
| 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 |
$823.20
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cigna Commercial |
$1,166.20
|
| Rate for Payer: First Health Commercial |
$1,234.80
|
| Rate for Payer: First Health Workers Compensation |
$529.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,234.80
|
| Rate for Payer: GEHA Commercial |
$1,097.60
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,234.80
|
| 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 |
$1,248.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$960.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,234.80
|
| 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 |
$1,303.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,029.00
|
| 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 |
$1,275.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$548.80
|
| 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 |
$374.56
|
|
|
TREAT ELBOW FRACTURE
|
Facility
|
IP
|
$2,223.00
|
|
|
Service Code
|
CPT 24587
|
| Hospital Charge Code |
6124587
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$606.88 |
| Max. Negotiated Rate |
$2,111.85 |
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cigna Commercial |
$1,889.55
|
| Rate for Payer: First Health Commercial |
$2,000.70
|
| Rate for Payer: First Health Workers Compensation |
$858.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,000.70
|
| Rate for Payer: GEHA Commercial |
$1,556.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,000.70
|
| Rate for Payer: Multiplan All |
$2,022.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,556.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,000.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,111.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,667.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,067.39
|
| Rate for Payer: Zelis Auto |
$889.20
|
| Rate for Payer: Zelis Worker's Compensation |
$606.88
|
|
|
TREAT ELBOW FRACTURE
|
Facility
|
IP
|
$1,117.00
|
|
|
Service Code
|
CPT 24620
|
| Hospital Charge Code |
6124620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$304.94 |
| Max. Negotiated Rate |
$1,061.15 |
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$949.45
|
| Rate for Payer: First Health Commercial |
$1,005.30
|
| Rate for Payer: First Health Workers Compensation |
$431.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,005.30
|
| Rate for Payer: GEHA Commercial |
$781.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,005.30
|
| Rate for Payer: Multiplan All |
$1,016.47
|
| Rate for Payer: OMNI Networks Commercial |
$781.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,005.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,061.15
|
| Rate for Payer: Three Rivers Provider Network All |
$837.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,038.81
|
| Rate for Payer: Zelis Auto |
$446.80
|
| Rate for Payer: Zelis Worker's Compensation |
$304.94
|
|
|
TREAT ELBOW FRACTURE
|
Facility
|
IP
|
$2,229.00
|
|
|
Service Code
|
CPT 24586
|
| Hospital Charge Code |
6124586
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$608.52 |
| Max. Negotiated Rate |
$2,117.55 |
| Rate for Payer: Cash Price |
$1,337.40
|
| Rate for Payer: Cigna Commercial |
$1,894.65
|
| Rate for Payer: First Health Commercial |
$2,006.10
|
| Rate for Payer: First Health Workers Compensation |
$860.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,006.10
|
| Rate for Payer: GEHA Commercial |
$1,560.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,006.10
|
| Rate for Payer: Multiplan All |
$2,028.39
|
| Rate for Payer: OMNI Networks Commercial |
$1,560.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,006.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,117.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,671.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,072.97
|
| Rate for Payer: Zelis Auto |
$891.60
|
| Rate for Payer: Zelis Worker's Compensation |
$608.52
|
|
|
TREAT ELBOW FRACTURE
|
Facility
|
IP
|
$1,372.00
|
|
|
Service Code
|
CPT 24635
|
| Hospital Charge Code |
6124635
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$374.56 |
| Max. Negotiated Rate |
$1,303.40 |
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cigna Commercial |
$1,166.20
|
| Rate for Payer: First Health Commercial |
$1,234.80
|
| Rate for Payer: First Health Workers Compensation |
$529.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,234.80
|
| Rate for Payer: GEHA Commercial |
$960.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,234.80
|
| Rate for Payer: Multiplan All |
$1,248.52
|
| Rate for Payer: OMNI Networks Commercial |
$960.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,234.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,303.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,029.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,275.96
|
| Rate for Payer: Zelis Auto |
$548.80
|
| Rate for Payer: Zelis Worker's Compensation |
$374.56
|
|
|
TREAT ELBOW FRACTURE
|
Facility
|
OP
|
$2,223.00
|
|
|
Service Code
|
CPT 24587
|
| Hospital Charge Code |
6124587
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$606.88 |
| Max. Negotiated Rate |
$24,935.38 |
| 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 |
$1,333.80
|
| 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 |
$12,467.69
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cigna Commercial |
$1,889.55
|
| Rate for Payer: First Health Commercial |
$2,000.70
|
| Rate for Payer: First Health Workers Compensation |
$858.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,000.70
|
| Rate for Payer: GEHA Commercial |
$1,778.40
|
| Rate for Payer: GEHA Medicare |
$12,467.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,000.70
|
| 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 |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,467.69
|
| Rate for Payer: Multiplan All |
$2,022.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21,195.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,556.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,000.70
|
| 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 |
$12,467.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,111.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,935.38
|
| Rate for Payer: Three Rivers Provider Network All |
$1,667.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,218.34
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,467.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,067.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,467.69
|
| Rate for Payer: Zelis Auto |
$889.20
|
| 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 |
$606.88
|
|
|
TREAT EYELID LESION
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT 67850
|
| Hospital Charge Code |
6167850
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$111.66 |
| Max. Negotiated Rate |
$1,877.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$772.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$245.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$772.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$612.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$938.50
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$347.65
|
| Rate for Payer: First Health Commercial |
$368.10
|
| Rate for Payer: First Health Workers Compensation |
$157.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$368.10
|
| Rate for Payer: GEHA Commercial |
$327.20
|
| Rate for Payer: GEHA Medicare |
$938.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$368.10
|
| Rate for Payer: Humana ChoiceCare |
$1,032.35
|
| Rate for Payer: Humana Medicare Advantage |
$938.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,576.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$624.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$938.50
|
| Rate for Payer: Multiplan All |
$372.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,595.45
|
| Rate for Payer: OMNI Networks Commercial |
$286.30
|
| Rate for Payer: One Health Plan PPO/POS |
$368.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$721.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$624.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$938.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$388.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,877.00
|
| Rate for Payer: Three Rivers Provider Network All |
$306.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$919.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$624.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$938.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$380.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$938.50
|
| Rate for Payer: Zelis Auto |
$163.60
|
| Rate for Payer: Zelis Medicare |
$797.73
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,126.20
|
| Rate for Payer: Zelis Worker's Compensation |
$111.66
|
|
|
TREAT EYELID LESION
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
CPT 67850
|
| Hospital Charge Code |
6167850
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$111.66 |
| Max. Negotiated Rate |
$388.55 |
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$347.65
|
| Rate for Payer: First Health Commercial |
$368.10
|
| Rate for Payer: First Health Workers Compensation |
$157.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$368.10
|
| Rate for Payer: GEHA Commercial |
$286.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$368.10
|
| Rate for Payer: Multiplan All |
$372.19
|
| Rate for Payer: OMNI Networks Commercial |
$286.30
|
| Rate for Payer: One Health Plan PPO/POS |
$368.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$388.55
|
| Rate for Payer: Three Rivers Provider Network All |
$306.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$380.37
|
| Rate for Payer: Zelis Auto |
$163.60
|
| Rate for Payer: Zelis Worker's Compensation |
$111.66
|
|
|
TREAT FINGER DISLOCATION
|
Facility
|
OP
|
$867.00
|
|
|
Service Code
|
CPT 26775
|
| Hospital Charge Code |
6126775
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$218.74 |
| Max. Negotiated Rate |
$1,546.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$520.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,224.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$257.34
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cigna Commercial |
$736.95
|
| Rate for Payer: First Health Commercial |
$780.30
|
| Rate for Payer: First Health Workers Compensation |
$334.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$780.30
|
| Rate for Payer: GEHA Commercial |
$693.60
|
| Rate for Payer: GEHA Medicare |
$257.34
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$780.30
|
| Rate for Payer: Humana ChoiceCare |
$283.07
|
| Rate for Payer: Humana Medicare Advantage |
$257.34
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$432.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,249.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$257.34
|
| Rate for Payer: Multiplan All |
$788.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$437.48
|
| Rate for Payer: OMNI Networks Commercial |
$606.90
|
| Rate for Payer: One Health Plan PPO/POS |
$780.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,443.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,249.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$257.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$823.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$514.68
|
| Rate for Payer: Three Rivers Provider Network All |
$650.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$252.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,249.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.34
|
| Rate for Payer: United Payors & United Providers UP&UP |
$806.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$257.34
|
| Rate for Payer: Zelis Auto |
$346.80
|
| Rate for Payer: Zelis Medicare |
$218.74
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$308.81
|
| Rate for Payer: Zelis Worker's Compensation |
$236.69
|
|
|
TREAT FINGER DISLOCATION
|
Facility
|
OP
|
$1,107.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
6126785
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$302.21 |
| 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 |
$664.20
|
| 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 |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$940.95
|
| Rate for Payer: First Health Commercial |
$996.30
|
| Rate for Payer: First Health Workers Compensation |
$427.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$996.30
|
| Rate for Payer: GEHA Commercial |
$885.60
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$996.30
|
| 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 |
$1,007.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$774.90
|
| Rate for Payer: One Health Plan PPO/POS |
$996.30
|
| 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 |
$1,051.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$830.25
|
| 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 |
$1,029.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$442.80
|
| 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 |
$302.21
|
|
|
TREAT FINGER DISLOCATION
|
Facility
|
IP
|
$1,107.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
6126785
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$302.21 |
| Max. Negotiated Rate |
$1,051.65 |
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$940.95
|
| Rate for Payer: First Health Commercial |
$996.30
|
| Rate for Payer: First Health Workers Compensation |
$427.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$996.30
|
| Rate for Payer: GEHA Commercial |
$774.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$996.30
|
| Rate for Payer: Multiplan All |
$1,007.37
|
| Rate for Payer: OMNI Networks Commercial |
$774.90
|
| Rate for Payer: One Health Plan PPO/POS |
$996.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,051.65
|
| Rate for Payer: Three Rivers Provider Network All |
$830.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,029.51
|
| Rate for Payer: Zelis Auto |
$442.80
|
| Rate for Payer: Zelis Worker's Compensation |
$302.21
|
|
|
TREAT FINGER DISLOCATION
|
Facility
|
IP
|
$867.00
|
|
|
Service Code
|
CPT 26775
|
| Hospital Charge Code |
6126775
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.69 |
| Max. Negotiated Rate |
$823.65 |
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cigna Commercial |
$736.95
|
| Rate for Payer: First Health Commercial |
$780.30
|
| Rate for Payer: First Health Workers Compensation |
$334.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$780.30
|
| Rate for Payer: GEHA Commercial |
$606.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$780.30
|
| Rate for Payer: Multiplan All |
$788.97
|
| Rate for Payer: OMNI Networks Commercial |
$606.90
|
| Rate for Payer: One Health Plan PPO/POS |
$780.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$823.65
|
| Rate for Payer: Three Rivers Provider Network All |
$650.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$806.31
|
| Rate for Payer: Zelis Auto |
$346.80
|
| Rate for Payer: Zelis Worker's Compensation |
$236.69
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
6126742
|
|
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 |
$504.00
|
| 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 |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cigna Commercial |
$714.00
|
| Rate for Payer: First Health Commercial |
$756.00
|
| Rate for Payer: First Health Workers Compensation |
$324.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$756.00
|
| Rate for Payer: GEHA Commercial |
$672.00
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$756.00
|
| 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 |
$764.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$588.00
|
| Rate for Payer: One Health Plan PPO/POS |
$756.00
|
| 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 |
$798.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$630.00
|
| 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 |
$781.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$336.00
|
| 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 |
$229.32
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
IP
|
$1,509.00
|
|
|
Service Code
|
CPT 26746
|
| Hospital Charge Code |
6126746
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$411.96 |
| Max. Negotiated Rate |
$1,433.55 |
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Cigna Commercial |
$1,282.65
|
| Rate for Payer: First Health Commercial |
$1,358.10
|
| Rate for Payer: First Health Workers Compensation |
$582.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,358.10
|
| Rate for Payer: GEHA Commercial |
$1,056.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,358.10
|
| Rate for Payer: Multiplan All |
$1,373.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,056.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,358.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,433.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,131.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,403.37
|
| Rate for Payer: Zelis Auto |
$603.60
|
| Rate for Payer: Zelis Worker's Compensation |
$411.96
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
6126742
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$229.32 |
| Max. Negotiated Rate |
$798.00 |
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cigna Commercial |
$714.00
|
| Rate for Payer: First Health Commercial |
$756.00
|
| Rate for Payer: First Health Workers Compensation |
$324.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$756.00
|
| Rate for Payer: GEHA Commercial |
$588.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$756.00
|
| Rate for Payer: Multiplan All |
$764.40
|
| Rate for Payer: OMNI Networks Commercial |
$588.00
|
| Rate for Payer: One Health Plan PPO/POS |
$756.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$798.00
|
| Rate for Payer: Three Rivers Provider Network All |
$630.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$781.20
|
| Rate for Payer: Zelis Auto |
$336.00
|
| Rate for Payer: Zelis Worker's Compensation |
$229.32
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
OP
|
$1,509.00
|
|
|
Service Code
|
CPT 26746
|
| Hospital Charge Code |
6126746
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$411.96 |
| 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 |
$905.40
|
| 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 |
$3,143.96
|
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Cigna Commercial |
$1,282.65
|
| Rate for Payer: First Health Commercial |
$1,358.10
|
| Rate for Payer: First Health Workers Compensation |
$582.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,358.10
|
| Rate for Payer: GEHA Commercial |
$1,207.20
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,358.10
|
| 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 |
$1,373.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$1,056.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,358.10
|
| 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 |
$1,433.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,131.75
|
| 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 |
$1,403.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$603.60
|
| 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 |
$411.96
|
|
|
TREAT FOOT BONE LESION
|
Facility
|
IP
|
$1,183.00
|
|
|
Service Code
|
CPT 28005
|
| Hospital Charge Code |
6128005
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$322.96 |
| Max. Negotiated Rate |
$1,123.85 |
| Rate for Payer: Cash Price |
$709.80
|
| Rate for Payer: Cigna Commercial |
$1,005.55
|
| Rate for Payer: First Health Commercial |
$1,064.70
|
| Rate for Payer: First Health Workers Compensation |
$456.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,064.70
|
| Rate for Payer: GEHA Commercial |
$828.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,064.70
|
| Rate for Payer: Multiplan All |
$1,076.53
|
| Rate for Payer: OMNI Networks Commercial |
$828.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,064.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,123.85
|
| Rate for Payer: Three Rivers Provider Network All |
$887.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,100.19
|
| Rate for Payer: Zelis Auto |
$473.20
|
| Rate for Payer: Zelis Worker's Compensation |
$322.96
|
|
|
TREAT FOOT BONE LESION
|
Facility
|
OP
|
$1,183.00
|
|
|
Service Code
|
CPT 28005
|
| Hospital Charge Code |
6128005
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$322.96 |
| Max. Negotiated Rate |
$6,287.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$709.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,143.96
|
| Rate for Payer: Cash Price |
$709.80
|
| Rate for Payer: Cash Price |
$709.80
|
| Rate for Payer: Cigna Commercial |
$1,005.55
|
| Rate for Payer: First Health Commercial |
$1,064.70
|
| Rate for Payer: First Health Workers Compensation |
$456.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,064.70
|
| Rate for Payer: GEHA Commercial |
$946.40
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,064.70
|
| 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 |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$1,076.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$828.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,064.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,123.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$887.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,100.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$473.20
|
| 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 |
$322.96
|
|
