|
TREAT FOOT DISLOCATION
|
Facility
|
IP
|
$1,005.00
|
|
|
Service Code
|
CPT 28606
|
| Hospital Charge Code |
6128606
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$274.37 |
| Max. Negotiated Rate |
$954.75 |
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cigna Commercial |
$854.25
|
| Rate for Payer: First Health Commercial |
$904.50
|
| Rate for Payer: First Health Workers Compensation |
$388.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$904.50
|
| Rate for Payer: GEHA Commercial |
$703.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$904.50
|
| Rate for Payer: Multiplan All |
$914.55
|
| Rate for Payer: OMNI Networks Commercial |
$703.50
|
| Rate for Payer: One Health Plan PPO/POS |
$904.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$954.75
|
| Rate for Payer: Three Rivers Provider Network All |
$753.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$934.65
|
| Rate for Payer: Zelis Auto |
$402.00
|
| Rate for Payer: Zelis Worker's Compensation |
$274.37
|
|
|
TREAT FOOT DISLOCATION
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
CPT 28570
|
| Hospital Charge Code |
6128570
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$154.79 |
| Max. Negotiated Rate |
$538.65 |
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cigna Commercial |
$481.95
|
| Rate for Payer: First Health Commercial |
$510.30
|
| Rate for Payer: First Health Workers Compensation |
$218.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$510.30
|
| Rate for Payer: GEHA Commercial |
$396.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$510.30
|
| Rate for Payer: Multiplan All |
$515.97
|
| Rate for Payer: OMNI Networks Commercial |
$396.90
|
| Rate for Payer: One Health Plan PPO/POS |
$510.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$538.65
|
| Rate for Payer: Three Rivers Provider Network All |
$425.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$527.31
|
| Rate for Payer: Zelis Auto |
$226.80
|
| Rate for Payer: Zelis Worker's Compensation |
$154.79
|
|
|
TREAT FOOT DISLOCATION
|
Facility
|
OP
|
$833.00
|
|
|
Service Code
|
CPT 28575
|
| Hospital Charge Code |
6128575
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$227.41 |
| Max. Negotiated Rate |
$6,161.78 |
| 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 |
$499.80
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$499.80
|
| Rate for Payer: Cash Price |
$499.80
|
| Rate for Payer: Cigna Commercial |
$708.05
|
| Rate for Payer: First Health Commercial |
$749.70
|
| Rate for Payer: First Health Workers Compensation |
$321.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$749.70
|
| Rate for Payer: GEHA Commercial |
$666.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$749.70
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,503.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$758.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$583.10
|
| Rate for Payer: One Health Plan PPO/POS |
$749.70
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$791.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$624.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,503.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$774.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$333.20
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$227.41
|
|
|
TREAT FOOT DISLOCATION
|
Facility
|
IP
|
$829.00
|
|
|
Service Code
|
CPT 28546
|
| Hospital Charge Code |
6128546
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$226.32 |
| Max. Negotiated Rate |
$787.55 |
| Rate for Payer: Cash Price |
$497.40
|
| Rate for Payer: Cigna Commercial |
$704.65
|
| Rate for Payer: First Health Commercial |
$746.10
|
| Rate for Payer: First Health Workers Compensation |
$320.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$746.10
|
| Rate for Payer: GEHA Commercial |
$580.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$746.10
|
| Rate for Payer: Multiplan All |
$754.39
|
| Rate for Payer: OMNI Networks Commercial |
$580.30
|
| Rate for Payer: One Health Plan PPO/POS |
$746.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$787.55
|
| Rate for Payer: Three Rivers Provider Network All |
$621.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$770.97
|
| Rate for Payer: Zelis Auto |
$331.60
|
| Rate for Payer: Zelis Worker's Compensation |
$226.32
|
|
|
TREAT FOOT DISLOCATION
|
Facility
|
OP
|
$1,005.00
|
|
|
Service Code
|
CPT 28606
|
| Hospital Charge Code |
6128606
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$274.37 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$603.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,070.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cigna Commercial |
$854.25
|
| Rate for Payer: First Health Commercial |
$904.50
|
| Rate for Payer: First Health Workers Compensation |
$388.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$904.50
|
| Rate for Payer: GEHA Commercial |
$804.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$904.50
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$914.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$703.50
|
| Rate for Payer: One Health Plan PPO/POS |
$904.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,438.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,112.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$954.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$753.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$934.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$402.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$274.37
|
|
|
TREAT FOOT DISLOCATION
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
CPT 28605
|
| Hospital Charge Code |
6128605
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$700.15 |
| 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 |
$442.20
|
| 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 |
$227.78
|
| Rate for Payer: Cash Price |
$442.20
|
| Rate for Payer: Cash Price |
$442.20
|
| Rate for Payer: Cigna Commercial |
$626.45
|
| Rate for Payer: First Health Commercial |
$663.30
|
| Rate for Payer: First Health Workers Compensation |
$284.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$663.30
|
| Rate for Payer: GEHA Commercial |
$589.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$663.30
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$670.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$515.90
|
| Rate for Payer: One Health Plan PPO/POS |
$663.30
|
| 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 |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$700.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$552.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$685.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$294.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$201.20
|
|
|
TREAT FOOT DISLOCATION
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
CPT 28605
|
| Hospital Charge Code |
6128605
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$201.20 |
| Max. Negotiated Rate |
$700.15 |
| Rate for Payer: Cash Price |
$442.20
|
| Rate for Payer: Cigna Commercial |
$626.45
|
| Rate for Payer: First Health Commercial |
$663.30
|
| Rate for Payer: First Health Workers Compensation |
$284.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$663.30
|
| Rate for Payer: GEHA Commercial |
$515.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$663.30
|
| Rate for Payer: Multiplan All |
$670.67
|
| Rate for Payer: OMNI Networks Commercial |
$515.90
|
| Rate for Payer: One Health Plan PPO/POS |
$663.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$700.15
|
| Rate for Payer: Three Rivers Provider Network All |
$552.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$685.41
|
| Rate for Payer: Zelis Auto |
$294.80
|
| Rate for Payer: Zelis Worker's Compensation |
$201.20
|
|
|
TREAT FOOT DISLOCATION
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
CPT 28570
|
| Hospital Charge Code |
6128570
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$154.79 |
| Max. Negotiated Rate |
$538.65 |
| 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 |
$340.20
|
| 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 |
$227.78
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cigna Commercial |
$481.95
|
| Rate for Payer: First Health Commercial |
$510.30
|
| Rate for Payer: First Health Workers Compensation |
$218.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$510.30
|
| Rate for Payer: GEHA Commercial |
$453.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$510.30
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$391.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$515.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$396.90
|
| Rate for Payer: One Health Plan PPO/POS |
$510.30
|
| 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 |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$538.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$425.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$391.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$527.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$226.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$154.79
|
|
|
TREAT FOOT DISLOCATION
|
Facility
|
OP
|
$651.00
|
|
|
Service Code
|
CPT 28545
|
| Hospital Charge Code |
6128545
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$177.72 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$390.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,070.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cigna Commercial |
$553.35
|
| Rate for Payer: First Health Commercial |
$585.90
|
| Rate for Payer: First Health Workers Compensation |
$251.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$585.90
|
| Rate for Payer: GEHA Commercial |
$520.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$585.90
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$592.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$455.70
|
| Rate for Payer: One Health Plan PPO/POS |
$585.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,438.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,112.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$618.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$488.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$605.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$260.40
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$177.72
|
|
|
TREAT FOOT DISLOCATION
|
Facility
|
IP
|
$651.00
|
|
|
Service Code
|
CPT 28545
|
| Hospital Charge Code |
6128545
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$177.72 |
| Max. Negotiated Rate |
$618.45 |
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cigna Commercial |
$553.35
|
| Rate for Payer: First Health Commercial |
$585.90
|
| Rate for Payer: First Health Workers Compensation |
$251.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$585.90
|
| Rate for Payer: GEHA Commercial |
$455.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$585.90
|
| Rate for Payer: Multiplan All |
$592.41
|
| Rate for Payer: OMNI Networks Commercial |
$455.70
|
| Rate for Payer: One Health Plan PPO/POS |
$585.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$618.45
|
| Rate for Payer: Three Rivers Provider Network All |
$488.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$605.43
|
| Rate for Payer: Zelis Auto |
$260.40
|
| Rate for Payer: Zelis Worker's Compensation |
$177.72
|
|
|
TREAT FOOT DISLOCATION
|
Facility
|
OP
|
$990.00
|
|
|
Service Code
|
CPT 28576
|
| Hospital Charge Code |
6128576
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$270.27 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$594.00
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna Commercial |
$841.50
|
| Rate for Payer: First Health Commercial |
$891.00
|
| Rate for Payer: First Health Workers Compensation |
$382.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$891.00
|
| Rate for Payer: GEHA Commercial |
$792.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$891.00
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$900.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$693.00
|
| Rate for Payer: One Health Plan PPO/POS |
$891.00
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$940.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$742.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$920.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$396.00
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$270.27
|
|
|
TREAT FOOT DISLOCATION
|
Facility
|
IP
|
$990.00
|
|
|
Service Code
|
CPT 28576
|
| Hospital Charge Code |
6128576
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$270.27 |
| Max. Negotiated Rate |
$940.50 |
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna Commercial |
$841.50
|
| Rate for Payer: First Health Commercial |
$891.00
|
| Rate for Payer: First Health Workers Compensation |
$382.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$891.00
|
| Rate for Payer: GEHA Commercial |
$693.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$891.00
|
| Rate for Payer: Multiplan All |
$900.90
|
| Rate for Payer: OMNI Networks Commercial |
$693.00
|
| Rate for Payer: One Health Plan PPO/POS |
$891.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$940.50
|
| Rate for Payer: Three Rivers Provider Network All |
$742.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$920.70
|
| Rate for Payer: Zelis Auto |
$396.00
|
| Rate for Payer: Zelis Worker's Compensation |
$270.27
|
|
|
TREAT FOOT DISLOCATION
|
Facility
|
IP
|
$833.00
|
|
|
Service Code
|
CPT 28575
|
| Hospital Charge Code |
6128575
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$227.41 |
| Max. Negotiated Rate |
$791.35 |
| Rate for Payer: Cash Price |
$499.80
|
| Rate for Payer: Cigna Commercial |
$708.05
|
| Rate for Payer: First Health Commercial |
$749.70
|
| Rate for Payer: First Health Workers Compensation |
$321.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$749.70
|
| Rate for Payer: GEHA Commercial |
$583.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$749.70
|
| Rate for Payer: Multiplan All |
$758.03
|
| Rate for Payer: OMNI Networks Commercial |
$583.10
|
| Rate for Payer: One Health Plan PPO/POS |
$749.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$791.35
|
| Rate for Payer: Three Rivers Provider Network All |
$624.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$774.69
|
| Rate for Payer: Zelis Auto |
$333.20
|
| Rate for Payer: Zelis Worker's Compensation |
$227.41
|
|
|
TREAT FOOT DISLOCATION
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT 28600
|
| Hospital Charge Code |
6128600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$536.75 |
| 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 |
$339.00
|
| 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 |
$227.78
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cigna Commercial |
$480.25
|
| Rate for Payer: First Health Commercial |
$508.50
|
| Rate for Payer: First Health Workers Compensation |
$218.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$508.50
|
| Rate for Payer: GEHA Commercial |
$452.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$508.50
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$514.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$395.50
|
| Rate for Payer: One Health Plan PPO/POS |
$508.50
|
| 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 |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$536.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$423.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$525.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$226.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$154.25
|
|
|
TREAT FOOT DISLOCATION
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 28600
|
| Hospital Charge Code |
6128600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$154.25 |
| Max. Negotiated Rate |
$536.75 |
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cigna Commercial |
$480.25
|
| Rate for Payer: First Health Commercial |
$508.50
|
| Rate for Payer: First Health Workers Compensation |
$218.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$508.50
|
| Rate for Payer: GEHA Commercial |
$395.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$508.50
|
| Rate for Payer: Multiplan All |
$514.15
|
| Rate for Payer: OMNI Networks Commercial |
$395.50
|
| Rate for Payer: One Health Plan PPO/POS |
$508.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$536.75
|
| Rate for Payer: Three Rivers Provider Network All |
$423.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$525.45
|
| Rate for Payer: Zelis Auto |
$226.00
|
| Rate for Payer: Zelis Worker's Compensation |
$154.25
|
|
|
TREAT FOOT DISLOCATION
|
Facility
|
OP
|
$829.00
|
|
|
Service Code
|
CPT 28546
|
| Hospital Charge Code |
6128546
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$226.32 |
| Max. Negotiated Rate |
$3,039.30 |
| 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 |
$497.40
|
| 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 |
$1,519.65
|
| Rate for Payer: Cash Price |
$497.40
|
| Rate for Payer: Cash Price |
$497.40
|
| Rate for Payer: Cigna Commercial |
$704.65
|
| Rate for Payer: First Health Commercial |
$746.10
|
| Rate for Payer: First Health Workers Compensation |
$320.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$746.10
|
| Rate for Payer: GEHA Commercial |
$663.20
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$746.10
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$754.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$580.30
|
| Rate for Payer: One Health Plan PPO/POS |
$746.10
|
| 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 |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$787.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$621.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$770.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$331.60
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$226.32
|
|
|
TREAT FOREARM BONE LESION
|
Facility
|
OP
|
$1,178.00
|
|
|
Service Code
|
CPT 25035
|
| Hospital Charge Code |
6125035
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$321.59 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$706.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$706.80
|
| Rate for Payer: Cash Price |
$706.80
|
| Rate for Payer: Cigna Commercial |
$1,001.30
|
| Rate for Payer: First Health Commercial |
$1,060.20
|
| Rate for Payer: First Health Workers Compensation |
$454.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,060.20
|
| Rate for Payer: GEHA Commercial |
$942.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,060.20
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,071.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$824.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,060.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,119.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$883.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,095.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$471.20
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$321.59
|
|
|
TREAT FOREARM BONE LESION
|
Facility
|
IP
|
$1,178.00
|
|
|
Service Code
|
CPT 25035
|
| Hospital Charge Code |
6125035
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$321.59 |
| Max. Negotiated Rate |
$1,119.10 |
| Rate for Payer: Cash Price |
$706.80
|
| Rate for Payer: Cigna Commercial |
$1,001.30
|
| Rate for Payer: First Health Commercial |
$1,060.20
|
| Rate for Payer: First Health Workers Compensation |
$454.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,060.20
|
| Rate for Payer: GEHA Commercial |
$824.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,060.20
|
| Rate for Payer: Multiplan All |
$1,071.98
|
| Rate for Payer: OMNI Networks Commercial |
$824.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,060.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,119.10
|
| Rate for Payer: Three Rivers Provider Network All |
$883.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,095.54
|
| Rate for Payer: Zelis Auto |
$471.20
|
| Rate for Payer: Zelis Worker's Compensation |
$321.59
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$1,948.00
|
|
|
Service Code
|
CPT 25526
|
| Hospital Charge Code |
6125526
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$531.80 |
| Max. Negotiated Rate |
$1,850.60 |
| Rate for Payer: Cash Price |
$1,168.80
|
| Rate for Payer: Cigna Commercial |
$1,655.80
|
| Rate for Payer: First Health Commercial |
$1,753.20
|
| Rate for Payer: First Health Workers Compensation |
$752.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,753.20
|
| Rate for Payer: GEHA Commercial |
$1,363.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,753.20
|
| Rate for Payer: Multiplan All |
$1,772.68
|
| Rate for Payer: OMNI Networks Commercial |
$1,363.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,753.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,850.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,461.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,811.64
|
| Rate for Payer: Zelis Auto |
$779.20
|
| Rate for Payer: Zelis Worker's Compensation |
$531.80
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
6125500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$593.75 |
| 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 |
$375.00
|
| 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 |
$227.78
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$531.25
|
| Rate for Payer: First Health Commercial |
$562.50
|
| Rate for Payer: First Health Workers Compensation |
$241.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$562.50
|
| Rate for Payer: GEHA Commercial |
$500.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$562.50
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$568.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$437.50
|
| Rate for Payer: One Health Plan PPO/POS |
$562.50
|
| 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 |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$593.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$468.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$581.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$250.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$170.62
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$625.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
6125500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$170.62 |
| Max. Negotiated Rate |
$593.75 |
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$531.25
|
| Rate for Payer: First Health Commercial |
$562.50
|
| Rate for Payer: First Health Workers Compensation |
$241.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$562.50
|
| Rate for Payer: GEHA Commercial |
$437.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$562.50
|
| Rate for Payer: Multiplan All |
$568.75
|
| Rate for Payer: OMNI Networks Commercial |
$437.50
|
| Rate for Payer: One Health Plan PPO/POS |
$562.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$593.75
|
| Rate for Payer: Three Rivers Provider Network All |
$468.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$581.25
|
| Rate for Payer: Zelis Auto |
$250.00
|
| Rate for Payer: Zelis Worker's Compensation |
$170.62
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
OP
|
$2,335.74
|
|
|
Service Code
|
CPT 25525
|
| Hospital Charge Code |
6125525
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$637.66 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,401.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,401.44
|
| Rate for Payer: Cash Price |
$1,401.44
|
| Rate for Payer: Cigna Commercial |
$1,985.38
|
| Rate for Payer: First Health Commercial |
$2,102.17
|
| Rate for Payer: First Health Workers Compensation |
$901.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,102.17
|
| Rate for Payer: GEHA Commercial |
$1,868.59
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,102.17
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$2,125.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,635.02
|
| Rate for Payer: One Health Plan PPO/POS |
$2,102.17
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,218.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,751.81
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,172.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$934.30
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$637.66
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
6125520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$293.20 |
| Max. Negotiated Rate |
$3,039.30 |
| 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 |
$644.40
|
| 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 |
$1,519.65
|
| Rate for Payer: Cash Price |
$644.40
|
| Rate for Payer: Cash Price |
$644.40
|
| Rate for Payer: Cigna Commercial |
$912.90
|
| Rate for Payer: First Health Commercial |
$966.60
|
| Rate for Payer: First Health Workers Compensation |
$414.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$966.60
|
| Rate for Payer: GEHA Commercial |
$859.20
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$966.60
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$391.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$977.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$751.80
|
| Rate for Payer: One Health Plan PPO/POS |
$966.60
|
| 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 |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,020.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$805.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$391.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$998.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$429.60
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$293.20
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
6125520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$293.20 |
| Max. Negotiated Rate |
$1,020.30 |
| Rate for Payer: Cash Price |
$644.40
|
| Rate for Payer: Cigna Commercial |
$912.90
|
| Rate for Payer: First Health Commercial |
$966.60
|
| Rate for Payer: First Health Workers Compensation |
$414.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$966.60
|
| Rate for Payer: GEHA Commercial |
$751.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$966.60
|
| Rate for Payer: Multiplan All |
$977.34
|
| Rate for Payer: OMNI Networks Commercial |
$751.80
|
| Rate for Payer: One Health Plan PPO/POS |
$966.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,020.30
|
| Rate for Payer: Three Rivers Provider Network All |
$805.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$998.82
|
| Rate for Payer: Zelis Auto |
$429.60
|
| Rate for Payer: Zelis Worker's Compensation |
$293.20
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
OP
|
$1,364.00
|
|
|
Service Code
|
CPT 25515
|
| Hospital Charge Code |
6125515
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$372.37 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$818.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cigna Commercial |
$1,159.40
|
| Rate for Payer: First Health Commercial |
$1,227.60
|
| Rate for Payer: First Health Workers Compensation |
$526.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,227.60
|
| Rate for Payer: GEHA Commercial |
$1,091.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,227.60
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,241.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$954.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,227.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,295.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,023.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,268.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$545.60
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$372.37
|
|
