|
TREAT FX DISTAL RADIAL
|
Facility
|
OP
|
$1,348.00
|
|
|
Service Code
|
CPT 25606
|
| Hospital Charge Code |
6125606
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$368.00 |
| 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 |
$808.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,070.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cigna Commercial |
$1,145.80
|
| Rate for Payer: First Health Commercial |
$1,213.20
|
| Rate for Payer: First Health Workers Compensation |
$520.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,213.20
|
| Rate for Payer: GEHA Commercial |
$1,078.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,213.20
|
| 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 |
$1,226.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$943.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,213.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,438.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,112.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,280.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,011.00
|
| 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 |
$1,253.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$539.20
|
| 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 |
$368.00
|
|
|
TREAT FX DISTAL RADIAL
|
Facility
|
IP
|
$1,348.00
|
|
|
Service Code
|
CPT 25606
|
| Hospital Charge Code |
6125606
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$368.00 |
| Max. Negotiated Rate |
$1,280.60 |
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cigna Commercial |
$1,145.80
|
| Rate for Payer: First Health Commercial |
$1,213.20
|
| Rate for Payer: First Health Workers Compensation |
$520.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,213.20
|
| Rate for Payer: GEHA Commercial |
$943.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,213.20
|
| Rate for Payer: Multiplan All |
$1,226.68
|
| Rate for Payer: OMNI Networks Commercial |
$943.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,213.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,280.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,011.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,253.64
|
| Rate for Payer: Zelis Auto |
$539.20
|
| Rate for Payer: Zelis Worker's Compensation |
$368.00
|
|
|
TREAT FX RAD EXTRA-ARTICUL
|
Facility
|
OP
|
$1,497.00
|
|
|
Service Code
|
CPT 25607
|
| Hospital Charge Code |
6125607
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$408.68 |
| 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 |
$898.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,244.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$898.20
|
| Rate for Payer: Cash Price |
$898.20
|
| Rate for Payer: Cigna Commercial |
$1,272.45
|
| Rate for Payer: First Health Commercial |
$1,347.30
|
| Rate for Payer: First Health Workers Compensation |
$577.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,347.30
|
| Rate for Payer: GEHA Commercial |
$1,197.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,347.30
|
| 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 |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,362.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,047.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,347.30
|
| 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 |
$1,422.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,122.75
|
| 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 |
$1,392.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$598.80
|
| 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 |
$408.68
|
|
|
TREAT FX RAD EXTRA-ARTICUL
|
Facility
|
IP
|
$1,497.00
|
|
|
Service Code
|
CPT 25607
|
| Hospital Charge Code |
6125607
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$408.68 |
| Max. Negotiated Rate |
$1,422.15 |
| Rate for Payer: Cash Price |
$898.20
|
| Rate for Payer: Cigna Commercial |
$1,272.45
|
| Rate for Payer: First Health Commercial |
$1,347.30
|
| Rate for Payer: First Health Workers Compensation |
$577.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,347.30
|
| Rate for Payer: GEHA Commercial |
$1,047.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,347.30
|
| Rate for Payer: Multiplan All |
$1,362.27
|
| Rate for Payer: OMNI Networks Commercial |
$1,047.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,347.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,422.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,122.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,392.21
|
| Rate for Payer: Zelis Auto |
$598.80
|
| Rate for Payer: Zelis Worker's Compensation |
$408.68
|
|
|
TREAT FX RADIAL 3+ FRAG
|
Facility
|
IP
|
$2,141.00
|
|
|
Service Code
|
CPT 25609
|
| Hospital Charge Code |
6125609
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$584.49 |
| Max. Negotiated Rate |
$2,033.95 |
| Rate for Payer: Cash Price |
$1,284.60
|
| Rate for Payer: Cigna Commercial |
$1,819.85
|
| Rate for Payer: First Health Commercial |
$1,926.90
|
| Rate for Payer: First Health Workers Compensation |
$826.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,926.90
|
| Rate for Payer: GEHA Commercial |
$1,498.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,926.90
|
| Rate for Payer: Multiplan All |
$1,948.31
|
| Rate for Payer: OMNI Networks Commercial |
$1,498.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,926.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,033.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,605.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,991.13
|
| Rate for Payer: Zelis Auto |
$856.40
|
| Rate for Payer: Zelis Worker's Compensation |
$584.49
|
|
|
TREAT FX RADIAL 3+ FRAG
|
Facility
|
OP
|
$2,141.00
|
|
|
Service Code
|
CPT 25609
|
| Hospital Charge Code |
6125609
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$584.49 |
| 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 |
$1,284.60
|
| 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 |
$1,284.60
|
| Rate for Payer: Cash Price |
$1,284.60
|
| Rate for Payer: Cigna Commercial |
$1,819.85
|
| Rate for Payer: First Health Commercial |
$1,926.90
|
| Rate for Payer: First Health Workers Compensation |
$826.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,926.90
|
| Rate for Payer: GEHA Commercial |
$1,712.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,926.90
|
| 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 |
$1,948.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,498.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,926.90
|
| 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 |
$2,033.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,605.75
|
| 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 |
$1,991.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$856.40
|
| 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 |
$584.49
|
|
|
TREAT FX RAD INTRA-ARTICUL
|
Facility
|
OP
|
$1,682.00
|
|
|
Service Code
|
CPT 25608
|
| Hospital Charge Code |
6125608
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$459.19 |
| 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 |
$1,009.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,244.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,009.20
|
| Rate for Payer: Cash Price |
$1,009.20
|
| Rate for Payer: Cigna Commercial |
$1,429.70
|
| Rate for Payer: First Health Commercial |
$1,513.80
|
| Rate for Payer: First Health Workers Compensation |
$649.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,513.80
|
| Rate for Payer: GEHA Commercial |
$1,345.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,513.80
|
| 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 |
$1,530.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,177.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,513.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,178.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,351.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,597.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,261.50
|
| 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 |
$1,564.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$672.80
|
| 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 |
$459.19
|
|
|
TREAT FX RAD INTRA-ARTICUL
|
Facility
|
IP
|
$1,682.00
|
|
|
Service Code
|
CPT 25608
|
| Hospital Charge Code |
6125608
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$459.19 |
| Max. Negotiated Rate |
$1,597.90 |
| Rate for Payer: Cash Price |
$1,009.20
|
| Rate for Payer: Cigna Commercial |
$1,429.70
|
| Rate for Payer: First Health Commercial |
$1,513.80
|
| Rate for Payer: First Health Workers Compensation |
$649.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,513.80
|
| Rate for Payer: GEHA Commercial |
$1,177.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,513.80
|
| Rate for Payer: Multiplan All |
$1,530.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,177.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,513.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,597.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,261.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,564.26
|
| Rate for Payer: Zelis Auto |
$672.80
|
| Rate for Payer: Zelis Worker's Compensation |
$459.19
|
|
|
TREAT/GRAFT HEEL FRACTURE
|
Facility
|
OP
|
$2,583.00
|
|
|
Service Code
|
CPT 28420
|
| Hospital Charge Code |
6128420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$705.16 |
| Max. Negotiated Rate |
$24,435.12 |
| 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 |
$1,549.80
|
| 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 |
$12,217.56
|
| Rate for Payer: Cash Price |
$1,549.80
|
| Rate for Payer: Cash Price |
$1,549.80
|
| Rate for Payer: Cigna Commercial |
$2,195.55
|
| Rate for Payer: First Health Commercial |
$2,324.70
|
| Rate for Payer: First Health Workers Compensation |
$997.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,324.70
|
| Rate for Payer: GEHA Commercial |
$2,066.40
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,324.70
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$2,350.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,808.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,324.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,453.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,937.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,402.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$1,033.20
|
| Rate for Payer: Zelis Medicare |
$10,384.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,661.07
|
| Rate for Payer: Zelis Worker's Compensation |
$705.16
|
|
|
TREAT/GRAFT HEEL FRACTURE
|
Facility
|
IP
|
$2,583.00
|
|
|
Service Code
|
CPT 28420
|
| Hospital Charge Code |
6128420
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$705.16 |
| Max. Negotiated Rate |
$2,453.85 |
| Rate for Payer: Cash Price |
$1,549.80
|
| Rate for Payer: Cigna Commercial |
$2,195.55
|
| Rate for Payer: First Health Commercial |
$2,324.70
|
| Rate for Payer: First Health Workers Compensation |
$997.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,324.70
|
| Rate for Payer: GEHA Commercial |
$1,808.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,324.70
|
| Rate for Payer: Multiplan All |
$2,350.53
|
| Rate for Payer: OMNI Networks Commercial |
$1,808.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,324.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,453.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,937.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,402.19
|
| Rate for Payer: Zelis Auto |
$1,033.20
|
| Rate for Payer: Zelis Worker's Compensation |
$705.16
|
|
|
TREAT HAND BONE LESION
|
Facility
|
IP
|
$1,088.00
|
|
|
Service Code
|
CPT 26034
|
| Hospital Charge Code |
6126034
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$297.02 |
| Max. Negotiated Rate |
$1,033.60 |
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cigna Commercial |
$924.80
|
| Rate for Payer: First Health Commercial |
$979.20
|
| Rate for Payer: First Health Workers Compensation |
$420.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$979.20
|
| Rate for Payer: GEHA Commercial |
$761.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$979.20
|
| Rate for Payer: Multiplan All |
$990.08
|
| Rate for Payer: OMNI Networks Commercial |
$761.60
|
| Rate for Payer: One Health Plan PPO/POS |
$979.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,033.60
|
| Rate for Payer: Three Rivers Provider Network All |
$816.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,011.84
|
| Rate for Payer: Zelis Auto |
$435.20
|
| Rate for Payer: Zelis Worker's Compensation |
$297.02
|
|
|
TREAT HAND BONE LESION
|
Facility
|
OP
|
$1,088.00
|
|
|
Service Code
|
CPT 26034
|
| Hospital Charge Code |
6126034
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$297.02 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$652.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cigna Commercial |
$924.80
|
| Rate for Payer: First Health Commercial |
$979.20
|
| Rate for Payer: First Health Workers Compensation |
$420.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$979.20
|
| Rate for Payer: GEHA Commercial |
$870.40
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$979.20
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$990.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$761.60
|
| Rate for Payer: One Health Plan PPO/POS |
$979.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,033.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$816.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,011.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$435.20
|
| 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 |
$297.02
|
|
|
TREAT HAND DISLOCATION
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
CPT 26675
|
| Hospital Charge Code |
6126675
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$228.23 |
| 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 |
$501.60
|
| 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 |
$501.60
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cigna Commercial |
$710.60
|
| Rate for Payer: First Health Commercial |
$752.40
|
| Rate for Payer: First Health Workers Compensation |
$322.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$752.40
|
| Rate for Payer: GEHA Commercial |
$668.80
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$752.40
|
| 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 |
$760.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$585.20
|
| Rate for Payer: One Health Plan PPO/POS |
$752.40
|
| 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 |
$794.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$627.00
|
| 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 |
$777.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$334.40
|
| 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 |
$228.23
|
|
|
TREAT HAND DISLOCATION
|
Facility
|
OP
|
$1,167.00
|
|
|
Service Code
|
CPT 26685
|
| Hospital Charge Code |
6126685
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$318.59 |
| 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 |
$700.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,070.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Cigna Commercial |
$991.95
|
| Rate for Payer: First Health Commercial |
$1,050.30
|
| Rate for Payer: First Health Workers Compensation |
$450.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,050.30
|
| Rate for Payer: GEHA Commercial |
$933.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,050.30
|
| 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 |
$1,061.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$816.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,050.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,438.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,112.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,108.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$875.25
|
| 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 |
$1,085.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$466.80
|
| 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 |
$318.59
|
|
|
TREAT HAND DISLOCATION
|
Facility
|
IP
|
$1,273.00
|
|
|
Service Code
|
CPT 26686
|
| Hospital Charge Code |
6126686
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$347.53 |
| Max. Negotiated Rate |
$1,209.35 |
| Rate for Payer: Cash Price |
$763.80
|
| Rate for Payer: Cigna Commercial |
$1,082.05
|
| Rate for Payer: First Health Commercial |
$1,145.70
|
| Rate for Payer: First Health Workers Compensation |
$491.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,145.70
|
| Rate for Payer: GEHA Commercial |
$891.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,145.70
|
| Rate for Payer: Multiplan All |
$1,158.43
|
| Rate for Payer: OMNI Networks Commercial |
$891.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,145.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,209.35
|
| Rate for Payer: Three Rivers Provider Network All |
$954.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,183.89
|
| Rate for Payer: Zelis Auto |
$509.20
|
| Rate for Payer: Zelis Worker's Compensation |
$347.53
|
|
|
TREAT HAND DISLOCATION
|
Facility
|
IP
|
$1,167.00
|
|
|
Service Code
|
CPT 26685
|
| Hospital Charge Code |
6126685
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$318.59 |
| Max. Negotiated Rate |
$1,108.65 |
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Cigna Commercial |
$991.95
|
| Rate for Payer: First Health Commercial |
$1,050.30
|
| Rate for Payer: First Health Workers Compensation |
$450.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,050.30
|
| Rate for Payer: GEHA Commercial |
$816.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,050.30
|
| Rate for Payer: Multiplan All |
$1,061.97
|
| Rate for Payer: OMNI Networks Commercial |
$816.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,050.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,108.65
|
| Rate for Payer: Three Rivers Provider Network All |
$875.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,085.31
|
| Rate for Payer: Zelis Auto |
$466.80
|
| Rate for Payer: Zelis Worker's Compensation |
$318.59
|
|
|
TREAT HAND DISLOCATION
|
Facility
|
OP
|
$1,273.00
|
|
|
Service Code
|
CPT 26686
|
| Hospital Charge Code |
6126686
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$347.53 |
| Max. Negotiated Rate |
$6,620.13 |
| 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 |
$763.80
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$763.80
|
| Rate for Payer: Cash Price |
$763.80
|
| Rate for Payer: Cigna Commercial |
$1,082.05
|
| Rate for Payer: First Health Commercial |
$1,145.70
|
| Rate for Payer: First Health Workers Compensation |
$491.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,145.70
|
| Rate for Payer: GEHA Commercial |
$1,018.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,145.70
|
| 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 |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,158.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$891.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,145.70
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,209.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$954.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,183.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$509.20
|
| 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 |
$347.53
|
|
|
TREAT HAND DISLOCATION
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
CPT 26675
|
| Hospital Charge Code |
6126675
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$228.23 |
| Max. Negotiated Rate |
$794.20 |
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cigna Commercial |
$710.60
|
| Rate for Payer: First Health Commercial |
$752.40
|
| Rate for Payer: First Health Workers Compensation |
$322.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$752.40
|
| Rate for Payer: GEHA Commercial |
$585.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$752.40
|
| Rate for Payer: Multiplan All |
$760.76
|
| Rate for Payer: OMNI Networks Commercial |
$585.20
|
| Rate for Payer: One Health Plan PPO/POS |
$752.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$794.20
|
| Rate for Payer: Three Rivers Provider Network All |
$627.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$777.48
|
| Rate for Payer: Zelis Auto |
$334.40
|
| Rate for Payer: Zelis Worker's Compensation |
$228.23
|
|
|
TREAT HAND DISLOCATION
|
Facility
|
IP
|
$772.00
|
|
|
Service Code
|
CPT 26670
|
| Hospital Charge Code |
6126670
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$210.76 |
| Max. Negotiated Rate |
$733.40 |
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cigna Commercial |
$656.20
|
| Rate for Payer: First Health Commercial |
$694.80
|
| Rate for Payer: First Health Workers Compensation |
$298.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$694.80
|
| Rate for Payer: GEHA Commercial |
$540.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$694.80
|
| Rate for Payer: Multiplan All |
$702.52
|
| Rate for Payer: OMNI Networks Commercial |
$540.40
|
| Rate for Payer: One Health Plan PPO/POS |
$694.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$733.40
|
| Rate for Payer: Three Rivers Provider Network All |
$579.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$717.96
|
| Rate for Payer: Zelis Auto |
$308.80
|
| Rate for Payer: Zelis Worker's Compensation |
$210.76
|
|
|
TREAT HAND DISLOCATION
|
Facility
|
OP
|
$772.00
|
|
|
Service Code
|
CPT 26670
|
| Hospital Charge Code |
6126670
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$733.40 |
| 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 |
$463.20
|
| 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 |
$463.20
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cigna Commercial |
$656.20
|
| Rate for Payer: First Health Commercial |
$694.80
|
| Rate for Payer: First Health Workers Compensation |
$298.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$694.80
|
| Rate for Payer: GEHA Commercial |
$617.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$694.80
|
| 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 |
$702.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$540.40
|
| Rate for Payer: One Health Plan PPO/POS |
$694.80
|
| 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 |
$733.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$579.00
|
| 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 |
$717.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$308.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$210.76
|
|
|
TREAT HEEL FRACTURE
|
Facility
|
IP
|
$2,272.00
|
|
|
Service Code
|
CPT 28415
|
| Hospital Charge Code |
6128415
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$620.26 |
| Max. Negotiated Rate |
$2,158.40 |
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Cigna Commercial |
$1,931.20
|
| Rate for Payer: First Health Commercial |
$2,044.80
|
| Rate for Payer: First Health Workers Compensation |
$877.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,044.80
|
| Rate for Payer: GEHA Commercial |
$1,590.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,044.80
|
| Rate for Payer: Multiplan All |
$2,067.52
|
| Rate for Payer: OMNI Networks Commercial |
$1,590.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,044.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,158.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,704.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,112.96
|
| Rate for Payer: Zelis Auto |
$908.80
|
| Rate for Payer: Zelis Worker's Compensation |
$620.26
|
|
|
TREAT HEEL FRACTURE
|
Facility
|
OP
|
$2,272.00
|
|
|
Service Code
|
CPT 28415
|
| Hospital Charge Code |
6128415
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$620.26 |
| 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 |
$1,363.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,244.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Cigna Commercial |
$1,931.20
|
| Rate for Payer: First Health Commercial |
$2,044.80
|
| Rate for Payer: First Health Workers Compensation |
$877.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,044.80
|
| Rate for Payer: GEHA Commercial |
$1,817.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,044.80
|
| 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 |
$2,067.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,590.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,044.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,178.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,351.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,158.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,704.00
|
| 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 |
$2,112.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$908.80
|
| 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 |
$620.26
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
OP
|
$1,937.00
|
|
|
Service Code
|
CPT 27253
|
| Hospital Charge Code |
6127253
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$484.25 |
| Max. Negotiated Rate |
$1,840.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,162.20
|
| Rate for Payer: Cash Price |
$1,162.20
|
| Rate for Payer: Cigna Commercial |
$1,646.45
|
| Rate for Payer: First Health Commercial |
$1,743.30
|
| Rate for Payer: First Health Workers Compensation |
$747.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,743.30
|
| Rate for Payer: GEHA Commercial |
$1,549.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,743.30
|
| Rate for Payer: Humana ChoiceCare |
$503.62
|
| Rate for Payer: Multiplan All |
$1,762.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,162.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,355.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,743.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,840.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,452.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,704.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$484.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,801.41
|
| Rate for Payer: Zelis Auto |
$774.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$968.50
|
| Rate for Payer: Zelis Worker's Compensation |
$528.80
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT 27256
|
| Hospital Charge Code |
6127256
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$166.26 |
| Max. Negotiated Rate |
$578.55 |
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$517.65
|
| Rate for Payer: First Health Commercial |
$548.10
|
| Rate for Payer: First Health Workers Compensation |
$235.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$548.10
|
| Rate for Payer: GEHA Commercial |
$426.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$548.10
|
| Rate for Payer: Multiplan All |
$554.19
|
| Rate for Payer: OMNI Networks Commercial |
$426.30
|
| Rate for Payer: One Health Plan PPO/POS |
$548.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$578.55
|
| Rate for Payer: Three Rivers Provider Network All |
$456.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$566.37
|
| Rate for Payer: Zelis Auto |
$243.60
|
| Rate for Payer: Zelis Worker's Compensation |
$166.26
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
OP
|
$2,292.00
|
|
|
Service Code
|
CPT 27258
|
| Hospital Charge Code |
6127258
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$573.00 |
| Max. Negotiated Rate |
$2,177.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,375.20
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cigna Commercial |
$1,948.20
|
| Rate for Payer: First Health Commercial |
$2,062.80
|
| Rate for Payer: First Health Workers Compensation |
$884.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,062.80
|
| Rate for Payer: GEHA Commercial |
$1,833.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,062.80
|
| Rate for Payer: Humana ChoiceCare |
$595.92
|
| Rate for Payer: Multiplan All |
$2,085.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,375.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,604.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,062.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,177.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,719.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,016.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$573.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,131.56
|
| Rate for Payer: Zelis Auto |
$916.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,146.00
|
| Rate for Payer: Zelis Worker's Compensation |
$625.72
|
|
