|
TREAT FRACTURE OF RADIUS
|
Facility
|
OP
|
$1,948.00
|
|
|
Service Code
|
CPT 25526
|
| Hospital Charge Code |
6125526
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$531.80 |
| 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 |
$1,168.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,168.80
|
| 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 |
$1,558.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,753.20
|
| 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 |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,772.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,363.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,753.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,850.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,461.00
|
| 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 |
$1,811.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$779.20
|
| 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 |
$531.80
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$1,364.00
|
|
|
Service Code
|
CPT 25515
|
| Hospital Charge Code |
6125515
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$372.37 |
| Max. Negotiated Rate |
$1,295.80 |
| 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 |
$954.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,227.60
|
| Rate for Payer: Multiplan All |
$1,241.24
|
| Rate for Payer: OMNI Networks Commercial |
$954.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,227.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,295.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,023.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,268.52
|
| Rate for Payer: Zelis Auto |
$545.60
|
| Rate for Payer: Zelis Worker's Compensation |
$372.37
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$2,335.74
|
|
|
Service Code
|
CPT 25525
|
| Hospital Charge Code |
6125525
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$637.66 |
| Max. Negotiated Rate |
$2,218.95 |
| 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 |
$1,635.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,102.17
|
| Rate for Payer: Multiplan All |
$2,125.52
|
| Rate for Payer: OMNI Networks Commercial |
$1,635.02
|
| Rate for Payer: One Health Plan PPO/POS |
$2,102.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,218.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,751.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,172.24
|
| Rate for Payer: Zelis Auto |
$934.30
|
| Rate for Payer: Zelis Worker's Compensation |
$637.66
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
6125530
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$161.34 |
| Max. Negotiated Rate |
$561.45 |
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cigna Commercial |
$502.35
|
| Rate for Payer: First Health Commercial |
$531.90
|
| Rate for Payer: First Health Workers Compensation |
$228.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$531.90
|
| Rate for Payer: GEHA Commercial |
$413.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$531.90
|
| Rate for Payer: Multiplan All |
$537.81
|
| Rate for Payer: OMNI Networks Commercial |
$413.70
|
| Rate for Payer: One Health Plan PPO/POS |
$531.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$561.45
|
| Rate for Payer: Three Rivers Provider Network All |
$443.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$549.63
|
| Rate for Payer: Zelis Auto |
$236.40
|
| Rate for Payer: Zelis Worker's Compensation |
$161.34
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
OP
|
$912.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
6125535
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$866.40 |
| 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 |
$547.20
|
| 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 |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$775.20
|
| Rate for Payer: First Health Commercial |
$820.80
|
| Rate for Payer: First Health Workers Compensation |
$352.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$820.80
|
| Rate for Payer: GEHA Commercial |
$729.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$820.80
|
| 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 |
$829.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$638.40
|
| Rate for Payer: One Health Plan PPO/POS |
$820.80
|
| 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 |
$866.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$684.00
|
| 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 |
$848.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$364.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$248.98
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
OP
|
$1,267.00
|
|
|
Service Code
|
CPT 25545
|
| Hospital Charge Code |
6125545
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$345.89 |
| 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 |
$760.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$760.20
|
| Rate for Payer: Cash Price |
$760.20
|
| Rate for Payer: Cigna Commercial |
$1,076.95
|
| Rate for Payer: First Health Commercial |
$1,140.30
|
| Rate for Payer: First Health Workers Compensation |
$489.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,140.30
|
| Rate for Payer: GEHA Commercial |
$1,013.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,140.30
|
| 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 |
$1,152.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$886.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,140.30
|
| 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 |
$1,203.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$950.25
|
| 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 |
$1,178.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$506.80
|
| 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 |
$345.89
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
IP
|
$1,267.00
|
|
|
Service Code
|
CPT 25545
|
| Hospital Charge Code |
6125545
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$345.89 |
| Max. Negotiated Rate |
$1,203.65 |
| Rate for Payer: Cash Price |
$760.20
|
| Rate for Payer: Cigna Commercial |
$1,076.95
|
| Rate for Payer: First Health Commercial |
$1,140.30
|
| Rate for Payer: First Health Workers Compensation |
$489.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,140.30
|
| Rate for Payer: GEHA Commercial |
$886.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,140.30
|
| Rate for Payer: Multiplan All |
$1,152.97
|
| Rate for Payer: OMNI Networks Commercial |
$886.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,140.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,203.65
|
| Rate for Payer: Three Rivers Provider Network All |
$950.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,178.31
|
| Rate for Payer: Zelis Auto |
$506.80
|
| Rate for Payer: Zelis Worker's Compensation |
$345.89
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
IP
|
$912.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
6125535
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$248.98 |
| Max. Negotiated Rate |
$866.40 |
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$775.20
|
| Rate for Payer: First Health Commercial |
$820.80
|
| Rate for Payer: First Health Workers Compensation |
$352.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$820.80
|
| Rate for Payer: GEHA Commercial |
$638.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$820.80
|
| Rate for Payer: Multiplan All |
$829.92
|
| Rate for Payer: OMNI Networks Commercial |
$638.40
|
| Rate for Payer: One Health Plan PPO/POS |
$820.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$866.40
|
| Rate for Payer: Three Rivers Provider Network All |
$684.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$848.16
|
| Rate for Payer: Zelis Auto |
$364.80
|
| Rate for Payer: Zelis Worker's Compensation |
$248.98
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
6125530
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$561.45 |
| 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 |
$354.60
|
| 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 |
$354.60
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cigna Commercial |
$502.35
|
| Rate for Payer: First Health Commercial |
$531.90
|
| Rate for Payer: First Health Workers Compensation |
$228.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$531.90
|
| Rate for Payer: GEHA Commercial |
$472.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$531.90
|
| 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 |
$537.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$413.70
|
| Rate for Payer: One Health Plan PPO/POS |
$531.90
|
| 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 |
$561.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$443.25
|
| 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 |
$549.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$236.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$161.34
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Facility
|
OP
|
$1,370.00
|
|
|
Service Code
|
CPT 25574
|
| Hospital Charge Code |
6125574
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$374.01 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$822.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,244.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$822.00
|
| Rate for Payer: Cash Price |
$822.00
|
| Rate for Payer: Cigna Commercial |
$1,164.50
|
| Rate for Payer: First Health Commercial |
$1,233.00
|
| Rate for Payer: First Health Workers Compensation |
$528.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,233.00
|
| Rate for Payer: GEHA Commercial |
$1,096.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,233.00
|
| 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 |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,246.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$959.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,233.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,178.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,351.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,301.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,027.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,274.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$548.00
|
| 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 |
$374.01
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
6125560
|
|
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 RADIUS & ULNA
|
Facility
|
OP
|
$949.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
6125565
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$259.08 |
| 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 |
$569.40
|
| 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 |
$569.40
|
| Rate for Payer: Cash Price |
$569.40
|
| Rate for Payer: Cigna Commercial |
$806.65
|
| Rate for Payer: First Health Commercial |
$854.10
|
| Rate for Payer: First Health Workers Compensation |
$366.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$854.10
|
| Rate for Payer: GEHA Commercial |
$759.20
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$854.10
|
| 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 |
$391.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$863.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$664.30
|
| Rate for Payer: One Health Plan PPO/POS |
$854.10
|
| 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 |
$901.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$711.75
|
| 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 |
$882.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$379.60
|
| 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 |
$259.08
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Facility
|
IP
|
$1,370.00
|
|
|
Service Code
|
CPT 25574
|
| Hospital Charge Code |
6125574
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$374.01 |
| Max. Negotiated Rate |
$1,301.50 |
| Rate for Payer: Cash Price |
$822.00
|
| Rate for Payer: Cigna Commercial |
$1,164.50
|
| Rate for Payer: First Health Commercial |
$1,233.00
|
| Rate for Payer: First Health Workers Compensation |
$528.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,233.00
|
| Rate for Payer: GEHA Commercial |
$959.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,233.00
|
| Rate for Payer: Multiplan All |
$1,246.70
|
| Rate for Payer: OMNI Networks Commercial |
$959.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,233.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,301.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,027.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,274.10
|
| Rate for Payer: Zelis Auto |
$548.00
|
| Rate for Payer: Zelis Worker's Compensation |
$374.01
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Facility
|
IP
|
$625.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
6125560
|
|
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 RADIUS & ULNA
|
Facility
|
IP
|
$3,035.00
|
|
| Hospital Charge Code |
8125565
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$828.55 |
| Max. Negotiated Rate |
$2,883.25 |
| Rate for Payer: Cash Price |
$1,821.00
|
| Rate for Payer: Cigna Commercial |
$2,579.75
|
| Rate for Payer: First Health Commercial |
$2,731.50
|
| Rate for Payer: First Health Workers Compensation |
$1,171.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,731.50
|
| Rate for Payer: GEHA Commercial |
$2,124.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,731.50
|
| Rate for Payer: Multiplan All |
$2,761.85
|
| Rate for Payer: OMNI Networks Commercial |
$2,124.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,731.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,883.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,276.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,822.55
|
| Rate for Payer: Zelis Auto |
$1,214.00
|
| Rate for Payer: Zelis Worker's Compensation |
$828.55
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Facility
|
OP
|
$3,035.00
|
|
| Hospital Charge Code |
8125565
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$758.75 |
| Max. Negotiated Rate |
$2,883.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,821.00
|
| Rate for Payer: Cash Price |
$1,821.00
|
| Rate for Payer: Cigna Commercial |
$2,579.75
|
| Rate for Payer: First Health Commercial |
$2,731.50
|
| Rate for Payer: First Health Workers Compensation |
$1,171.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,731.50
|
| Rate for Payer: GEHA Commercial |
$2,428.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,731.50
|
| Rate for Payer: Humana ChoiceCare |
$789.10
|
| Rate for Payer: Multiplan All |
$2,761.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,821.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,124.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,731.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,883.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,276.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,670.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$758.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,822.55
|
| Rate for Payer: Zelis Auto |
$1,214.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,517.50
|
| Rate for Payer: Zelis Worker's Compensation |
$828.55
|
|
|
TREAT FRACTURE RADIUS & ULNA
|
Facility
|
IP
|
$949.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
6125565
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$259.08 |
| Max. Negotiated Rate |
$901.55 |
| Rate for Payer: Cash Price |
$569.40
|
| Rate for Payer: Cigna Commercial |
$806.65
|
| Rate for Payer: First Health Commercial |
$854.10
|
| Rate for Payer: First Health Workers Compensation |
$366.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$854.10
|
| Rate for Payer: GEHA Commercial |
$664.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$854.10
|
| Rate for Payer: Multiplan All |
$863.59
|
| Rate for Payer: OMNI Networks Commercial |
$664.30
|
| Rate for Payer: One Health Plan PPO/POS |
$854.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$901.55
|
| Rate for Payer: Three Rivers Provider Network All |
$711.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$882.57
|
| Rate for Payer: Zelis Auto |
$379.60
|
| Rate for Payer: Zelis Worker's Compensation |
$259.08
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
6125600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$209.66 |
| Max. Negotiated Rate |
$729.60 |
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$652.80
|
| Rate for Payer: First Health Commercial |
$691.20
|
| Rate for Payer: First Health Workers Compensation |
$296.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$691.20
|
| Rate for Payer: GEHA Commercial |
$537.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$691.20
|
| Rate for Payer: Multiplan All |
$698.88
|
| Rate for Payer: OMNI Networks Commercial |
$537.60
|
| Rate for Payer: One Health Plan PPO/POS |
$691.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$729.60
|
| Rate for Payer: Three Rivers Provider Network All |
$576.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$714.24
|
| Rate for Payer: Zelis Auto |
$307.20
|
| Rate for Payer: Zelis Worker's Compensation |
$209.66
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
6125600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$729.60 |
| 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 |
$460.80
|
| 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 |
$460.80
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna Commercial |
$652.80
|
| Rate for Payer: First Health Commercial |
$691.20
|
| Rate for Payer: First Health Workers Compensation |
$296.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$691.20
|
| Rate for Payer: GEHA Commercial |
$614.40
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$691.20
|
| 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 |
$698.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$537.60
|
| Rate for Payer: One Health Plan PPO/POS |
$691.20
|
| 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 |
$729.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$576.00
|
| 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 |
$714.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$307.20
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$209.66
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
OP
|
$1,843.00
|
|
|
Service Code
|
CPT 25575
|
| Hospital Charge Code |
6125575
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$503.14 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,105.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,244.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,105.80
|
| Rate for Payer: Cash Price |
$1,105.80
|
| Rate for Payer: Cigna Commercial |
$1,566.55
|
| Rate for Payer: First Health Commercial |
$1,658.70
|
| Rate for Payer: First Health Workers Compensation |
$711.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,658.70
|
| Rate for Payer: GEHA Commercial |
$1,474.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,658.70
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,677.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,290.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,658.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,178.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,351.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,750.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,382.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,713.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$737.20
|
| 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 |
$503.14
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
IP
|
$1,843.00
|
|
|
Service Code
|
CPT 25575
|
| Hospital Charge Code |
6125575
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$503.14 |
| Max. Negotiated Rate |
$1,750.85 |
| Rate for Payer: Cash Price |
$1,105.80
|
| Rate for Payer: Cigna Commercial |
$1,566.55
|
| Rate for Payer: First Health Commercial |
$1,658.70
|
| Rate for Payer: First Health Workers Compensation |
$711.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,658.70
|
| Rate for Payer: GEHA Commercial |
$1,290.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,658.70
|
| Rate for Payer: Multiplan All |
$1,677.13
|
| Rate for Payer: OMNI Networks Commercial |
$1,290.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,658.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,750.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,382.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,713.99
|
| Rate for Payer: Zelis Auto |
$737.20
|
| Rate for Payer: Zelis Worker's Compensation |
$503.14
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
OP
|
$1,036.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
6125605
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$282.83 |
| 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 |
$621.60
|
| 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 |
$621.60
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Cigna Commercial |
$880.60
|
| Rate for Payer: First Health Commercial |
$932.40
|
| Rate for Payer: First Health Workers Compensation |
$400.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$932.40
|
| Rate for Payer: GEHA Commercial |
$828.80
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$932.40
|
| 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 |
$942.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$725.20
|
| Rate for Payer: One Health Plan PPO/POS |
$932.40
|
| 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 |
$984.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$777.00
|
| 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 |
$963.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$414.40
|
| 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 |
$282.83
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
IP
|
$1,036.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
6125605
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$282.83 |
| Max. Negotiated Rate |
$984.20 |
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Cigna Commercial |
$880.60
|
| Rate for Payer: First Health Commercial |
$932.40
|
| Rate for Payer: First Health Workers Compensation |
$400.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$932.40
|
| Rate for Payer: GEHA Commercial |
$725.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$932.40
|
| Rate for Payer: Multiplan All |
$942.76
|
| Rate for Payer: OMNI Networks Commercial |
$725.20
|
| Rate for Payer: One Health Plan PPO/POS |
$932.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$984.20
|
| Rate for Payer: Three Rivers Provider Network All |
$777.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$963.48
|
| Rate for Payer: Zelis Auto |
$414.40
|
| Rate for Payer: Zelis Worker's Compensation |
$282.83
|
|
|
TREAT FRACTURE ULNAR STYLOID
|
Facility
|
OP
|
$1,270.00
|
|
|
Service Code
|
CPT 25652
|
| Hospital Charge Code |
6125652
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$346.71 |
| 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 |
$762.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$762.00
|
| Rate for Payer: Cash Price |
$762.00
|
| Rate for Payer: Cigna Commercial |
$1,079.50
|
| Rate for Payer: First Health Commercial |
$1,143.00
|
| Rate for Payer: First Health Workers Compensation |
$490.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,143.00
|
| Rate for Payer: GEHA Commercial |
$1,016.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,143.00
|
| 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 |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,155.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$889.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,143.00
|
| 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 |
$1,206.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$952.50
|
| 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 |
$1,181.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$508.00
|
| 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 |
$346.71
|
|
|
TREAT FRACTURE ULNAR STYLOID
|
Facility
|
IP
|
$1,270.00
|
|
|
Service Code
|
CPT 25652
|
| Hospital Charge Code |
6125652
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$346.71 |
| Max. Negotiated Rate |
$1,206.50 |
| Rate for Payer: Cash Price |
$762.00
|
| Rate for Payer: Cigna Commercial |
$1,079.50
|
| Rate for Payer: First Health Commercial |
$1,143.00
|
| Rate for Payer: First Health Workers Compensation |
$490.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,143.00
|
| Rate for Payer: GEHA Commercial |
$889.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,143.00
|
| Rate for Payer: Multiplan All |
$1,155.70
|
| Rate for Payer: OMNI Networks Commercial |
$889.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,143.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,206.50
|
| Rate for Payer: Three Rivers Provider Network All |
$952.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,181.10
|
| Rate for Payer: Zelis Auto |
$508.00
|
| Rate for Payer: Zelis Worker's Compensation |
$346.71
|
|
