|
TREAT HIP DISLOCATION
|
Facility
|
IP
|
$2,292.00
|
|
|
Service Code
|
CPT 27258
|
| Hospital Charge Code |
6127258
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$625.72 |
| Max. Negotiated Rate |
$2,177.40 |
| 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 |
$1,604.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,062.80
|
| Rate for Payer: Multiplan All |
$2,085.72
|
| 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: United Payors & United Providers UP&UP |
$2,131.56
|
| Rate for Payer: Zelis Auto |
$916.80
|
| Rate for Payer: Zelis Worker's Compensation |
$625.72
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
IP
|
$2,618.00
|
|
|
Service Code
|
CPT 27254
|
| Hospital Charge Code |
6127254
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$714.71 |
| Max. Negotiated Rate |
$2,487.10 |
| Rate for Payer: Cash Price |
$1,570.80
|
| Rate for Payer: Cigna Commercial |
$2,225.30
|
| Rate for Payer: First Health Commercial |
$2,356.20
|
| Rate for Payer: First Health Workers Compensation |
$1,010.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,356.20
|
| Rate for Payer: GEHA Commercial |
$1,832.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,356.20
|
| Rate for Payer: Multiplan All |
$2,382.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,832.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,356.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,487.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,963.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,434.74
|
| Rate for Payer: Zelis Auto |
$1,047.20
|
| Rate for Payer: Zelis Worker's Compensation |
$714.71
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
IP
|
$3,217.00
|
|
|
Service Code
|
CPT 27259
|
| Hospital Charge Code |
6127259
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$878.24 |
| Max. Negotiated Rate |
$3,056.15 |
| Rate for Payer: Cash Price |
$1,930.20
|
| Rate for Payer: Cigna Commercial |
$2,734.45
|
| Rate for Payer: First Health Commercial |
$2,895.30
|
| Rate for Payer: First Health Workers Compensation |
$1,242.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,895.30
|
| Rate for Payer: GEHA Commercial |
$2,251.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,895.30
|
| Rate for Payer: Multiplan All |
$2,927.47
|
| Rate for Payer: OMNI Networks Commercial |
$2,251.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,895.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,056.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,412.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,991.81
|
| Rate for Payer: Zelis Auto |
$1,286.80
|
| Rate for Payer: Zelis Worker's Compensation |
$878.24
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
OP
|
$939.00
|
|
|
Service Code
|
CPT 27257
|
| Hospital Charge Code |
6127257
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$256.35 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$563.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,224.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cigna Commercial |
$798.15
|
| Rate for Payer: First Health Commercial |
$845.10
|
| Rate for Payer: First Health Workers Compensation |
$362.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$845.10
|
| Rate for Payer: GEHA Commercial |
$751.20
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$845.10
|
| 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 |
$1,249.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$854.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$657.30
|
| Rate for Payer: One Health Plan PPO/POS |
$845.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,443.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,249.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$892.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$704.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,249.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$873.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$375.60
|
| 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 |
$256.35
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
CPT 27250
|
| Hospital Charge Code |
6127250
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$156.16 |
| Max. Negotiated Rate |
$543.40 |
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$486.20
|
| Rate for Payer: First Health Commercial |
$514.80
|
| Rate for Payer: First Health Workers Compensation |
$220.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$514.80
|
| Rate for Payer: GEHA Commercial |
$400.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$514.80
|
| Rate for Payer: Multiplan All |
$520.52
|
| Rate for Payer: OMNI Networks Commercial |
$400.40
|
| Rate for Payer: One Health Plan PPO/POS |
$514.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$543.40
|
| Rate for Payer: Three Rivers Provider Network All |
$429.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.96
|
| Rate for Payer: Zelis Auto |
$228.80
|
| Rate for Payer: Zelis Worker's Compensation |
$156.16
|
|
|
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
|
$1,937.00
|
|
|
Service Code
|
CPT 27253
|
| Hospital Charge Code |
6127253
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$528.80 |
| Max. Negotiated Rate |
$1,840.15 |
| 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 |
$1,355.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,743.30
|
| Rate for Payer: Multiplan All |
$1,762.67
|
| 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: United Payors & United Providers UP&UP |
$1,801.41
|
| Rate for Payer: Zelis Auto |
$774.80
|
| Rate for Payer: Zelis Worker's Compensation |
$528.80
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
OP
|
$1,561.00
|
|
|
Service Code
|
CPT 27252
|
| Hospital Charge Code |
6127252
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$426.15 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$936.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,224.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$936.60
|
| Rate for Payer: Cash Price |
$936.60
|
| Rate for Payer: Cigna Commercial |
$1,326.85
|
| Rate for Payer: First Health Commercial |
$1,404.90
|
| Rate for Payer: First Health Workers Compensation |
$602.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,404.90
|
| Rate for Payer: GEHA Commercial |
$1,248.80
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,404.90
|
| 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 |
$1,249.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$1,420.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$1,092.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,404.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,443.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,249.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,482.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,170.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,249.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,451.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$624.40
|
| 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 |
$426.15
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
IP
|
$1,561.00
|
|
|
Service Code
|
CPT 27252
|
| Hospital Charge Code |
6127252
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$426.15 |
| Max. Negotiated Rate |
$1,482.95 |
| Rate for Payer: Cash Price |
$936.60
|
| Rate for Payer: Cigna Commercial |
$1,326.85
|
| Rate for Payer: First Health Commercial |
$1,404.90
|
| Rate for Payer: First Health Workers Compensation |
$602.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,404.90
|
| Rate for Payer: GEHA Commercial |
$1,092.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,404.90
|
| Rate for Payer: Multiplan All |
$1,420.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,092.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,404.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,482.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,170.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,451.73
|
| Rate for Payer: Zelis Auto |
$624.40
|
| Rate for Payer: Zelis Worker's Compensation |
$426.15
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
CPT 27250
|
| Hospital Charge Code |
6127250
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$543.40 |
| 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 |
$343.20
|
| 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 |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$486.20
|
| Rate for Payer: First Health Commercial |
$514.80
|
| Rate for Payer: First Health Workers Compensation |
$220.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$514.80
|
| Rate for Payer: GEHA Commercial |
$457.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$514.80
|
| 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 |
$520.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$400.40
|
| Rate for Payer: One Health Plan PPO/POS |
$514.80
|
| 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 |
$543.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$429.00
|
| 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 |
$531.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$228.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$156.16
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
OP
|
$3,217.00
|
|
|
Service Code
|
CPT 27259
|
| Hospital Charge Code |
6127259
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$804.25 |
| Max. Negotiated Rate |
$3,056.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,930.20
|
| Rate for Payer: Cash Price |
$1,930.20
|
| Rate for Payer: Cigna Commercial |
$2,734.45
|
| Rate for Payer: First Health Commercial |
$2,895.30
|
| Rate for Payer: First Health Workers Compensation |
$1,242.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,895.30
|
| Rate for Payer: GEHA Commercial |
$2,573.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,895.30
|
| Rate for Payer: Humana ChoiceCare |
$836.42
|
| Rate for Payer: Multiplan All |
$2,927.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,930.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,251.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,895.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,056.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,412.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,830.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$804.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,991.81
|
| Rate for Payer: Zelis Auto |
$1,286.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,608.50
|
| Rate for Payer: Zelis Worker's Compensation |
$878.24
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
IP
|
$1,190.00
|
|
|
Service Code
|
CPT 27266
|
| Hospital Charge Code |
6127266
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$324.87 |
| Max. Negotiated Rate |
$1,130.50 |
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cigna Commercial |
$1,011.50
|
| Rate for Payer: First Health Commercial |
$1,071.00
|
| Rate for Payer: First Health Workers Compensation |
$459.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,071.00
|
| Rate for Payer: GEHA Commercial |
$833.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,071.00
|
| Rate for Payer: Multiplan All |
$1,082.90
|
| Rate for Payer: OMNI Networks Commercial |
$833.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,071.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,130.50
|
| Rate for Payer: Three Rivers Provider Network All |
$892.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,106.70
|
| Rate for Payer: Zelis Auto |
$476.00
|
| Rate for Payer: Zelis Worker's Compensation |
$324.87
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
IP
|
$939.00
|
|
|
Service Code
|
CPT 27257
|
| Hospital Charge Code |
6127257
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$256.35 |
| Max. Negotiated Rate |
$892.05 |
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cigna Commercial |
$798.15
|
| Rate for Payer: First Health Commercial |
$845.10
|
| Rate for Payer: First Health Workers Compensation |
$362.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$845.10
|
| Rate for Payer: GEHA Commercial |
$657.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$845.10
|
| Rate for Payer: Multiplan All |
$854.49
|
| Rate for Payer: OMNI Networks Commercial |
$657.30
|
| Rate for Payer: One Health Plan PPO/POS |
$845.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$892.05
|
| Rate for Payer: Three Rivers Provider Network All |
$704.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$873.27
|
| Rate for Payer: Zelis Auto |
$375.60
|
| Rate for Payer: Zelis Worker's Compensation |
$256.35
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT 27256
|
| Hospital Charge Code |
6127256
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$578.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$365.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$365.40
|
| 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 |
$487.20
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$548.10
|
| 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 |
$554.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$426.30
|
| Rate for Payer: One Health Plan PPO/POS |
$548.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$578.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$456.75
|
| 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 |
$566.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$243.60
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$166.26
|
|
|
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 FRACTURE(S)
|
Facility
|
OP
|
$3,438.00
|
|
|
Service Code
|
CPT 27227
|
| Hospital Charge Code |
6127227
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$859.50 |
| Max. Negotiated Rate |
$3,266.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,062.80
|
| Rate for Payer: Cash Price |
$2,062.80
|
| Rate for Payer: Cigna Commercial |
$2,922.30
|
| Rate for Payer: First Health Commercial |
$3,094.20
|
| Rate for Payer: First Health Workers Compensation |
$1,327.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,094.20
|
| Rate for Payer: GEHA Commercial |
$2,750.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,094.20
|
| Rate for Payer: Humana ChoiceCare |
$893.88
|
| Rate for Payer: Multiplan All |
$3,128.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,062.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,406.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,094.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,266.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,578.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,025.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$859.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,197.34
|
| Rate for Payer: Zelis Auto |
$1,375.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,719.00
|
| Rate for Payer: Zelis Worker's Compensation |
$938.57
|
|
|
TREAT HIP FRACTURE(S)
|
Facility
|
OP
|
$3,924.00
|
|
|
Service Code
|
CPT 27228
|
| Hospital Charge Code |
6127228
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$981.00 |
| Max. Negotiated Rate |
$3,727.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,354.40
|
| Rate for Payer: Cash Price |
$2,354.40
|
| Rate for Payer: Cigna Commercial |
$3,335.40
|
| Rate for Payer: First Health Commercial |
$3,531.60
|
| Rate for Payer: First Health Workers Compensation |
$1,515.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,531.60
|
| Rate for Payer: GEHA Commercial |
$3,139.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,531.60
|
| Rate for Payer: Humana ChoiceCare |
$1,020.24
|
| Rate for Payer: Multiplan All |
$3,570.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,354.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,746.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,531.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,727.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,943.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,453.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$981.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,649.32
|
| Rate for Payer: Zelis Auto |
$1,569.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,962.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,071.25
|
|
|
TREAT HIP FRACTURE(S)
|
Facility
|
IP
|
$3,438.00
|
|
|
Service Code
|
CPT 27227
|
| Hospital Charge Code |
6127227
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$938.57 |
| Max. Negotiated Rate |
$3,266.10 |
| Rate for Payer: Cash Price |
$2,062.80
|
| Rate for Payer: Cigna Commercial |
$2,922.30
|
| Rate for Payer: First Health Commercial |
$3,094.20
|
| Rate for Payer: First Health Workers Compensation |
$1,327.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,094.20
|
| Rate for Payer: GEHA Commercial |
$2,406.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,094.20
|
| Rate for Payer: Multiplan All |
$3,128.58
|
| Rate for Payer: OMNI Networks Commercial |
$2,406.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,094.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,266.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,578.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,197.34
|
| Rate for Payer: Zelis Auto |
$1,375.20
|
| Rate for Payer: Zelis Worker's Compensation |
$938.57
|
|
|
TREAT HIP FRACTURE(S)
|
Facility
|
IP
|
$3,924.00
|
|
|
Service Code
|
CPT 27228
|
| Hospital Charge Code |
6127228
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,071.25 |
| Max. Negotiated Rate |
$3,727.80 |
| Rate for Payer: Cash Price |
$2,354.40
|
| Rate for Payer: Cigna Commercial |
$3,335.40
|
| Rate for Payer: First Health Commercial |
$3,531.60
|
| Rate for Payer: First Health Workers Compensation |
$1,515.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,531.60
|
| Rate for Payer: GEHA Commercial |
$2,746.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,531.60
|
| Rate for Payer: Multiplan All |
$3,570.84
|
| Rate for Payer: OMNI Networks Commercial |
$2,746.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,531.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,727.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,943.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,649.32
|
| Rate for Payer: Zelis Auto |
$1,569.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,071.25
|
|
|
TREAT HIP SOCKET FRACTURE
|
Facility
|
IP
|
$1,072.00
|
|
|
Service Code
|
CPT 27220
|
| Hospital Charge Code |
6127220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$292.66 |
| Max. Negotiated Rate |
$1,018.40 |
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cigna Commercial |
$911.20
|
| Rate for Payer: First Health Commercial |
$964.80
|
| Rate for Payer: First Health Workers Compensation |
$413.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$964.80
|
| Rate for Payer: GEHA Commercial |
$750.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$964.80
|
| Rate for Payer: Multiplan All |
$975.52
|
| Rate for Payer: OMNI Networks Commercial |
$750.40
|
| Rate for Payer: One Health Plan PPO/POS |
$964.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,018.40
|
| Rate for Payer: Three Rivers Provider Network All |
$804.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$996.96
|
| Rate for Payer: Zelis Auto |
$428.80
|
| Rate for Payer: Zelis Worker's Compensation |
$292.66
|
|
|
TREAT HIP SOCKET FRACTURE
|
Facility
|
OP
|
$2,010.00
|
|
|
Service Code
|
CPT 27222
|
| Hospital Charge Code |
6127222
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$502.50 |
| Max. Negotiated Rate |
$1,909.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,206.00
|
| Rate for Payer: Cash Price |
$1,206.00
|
| Rate for Payer: Cigna Commercial |
$1,708.50
|
| Rate for Payer: First Health Commercial |
$1,809.00
|
| Rate for Payer: First Health Workers Compensation |
$776.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,809.00
|
| Rate for Payer: GEHA Commercial |
$1,608.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,809.00
|
| Rate for Payer: Humana ChoiceCare |
$522.60
|
| Rate for Payer: Multiplan All |
$1,829.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,206.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,407.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,809.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,909.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,507.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,768.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$502.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,869.30
|
| Rate for Payer: Zelis Auto |
$804.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,005.00
|
| Rate for Payer: Zelis Worker's Compensation |
$548.73
|
|
|
TREAT HIP SOCKET FRACTURE
|
Facility
|
IP
|
$2,010.00
|
|
|
Service Code
|
CPT 27222
|
| Hospital Charge Code |
6127222
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$548.73 |
| Max. Negotiated Rate |
$1,909.50 |
| Rate for Payer: Cash Price |
$1,206.00
|
| Rate for Payer: Cigna Commercial |
$1,708.50
|
| Rate for Payer: First Health Commercial |
$1,809.00
|
| Rate for Payer: First Health Workers Compensation |
$776.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,809.00
|
| Rate for Payer: GEHA Commercial |
$1,407.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,809.00
|
| Rate for Payer: Multiplan All |
$1,829.10
|
| Rate for Payer: OMNI Networks Commercial |
$1,407.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,809.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,909.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,507.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,869.30
|
| Rate for Payer: Zelis Auto |
$804.00
|
| Rate for Payer: Zelis Worker's Compensation |
$548.73
|
|
|
TREAT HIP SOCKET FRACTURE
|
Facility
|
OP
|
$1,072.00
|
|
|
Service Code
|
CPT 27220
|
| Hospital Charge Code |
6127220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$1,018.40 |
| 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 |
$643.20
|
| 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 |
$643.20
|
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cigna Commercial |
$911.20
|
| Rate for Payer: First Health Commercial |
$964.80
|
| Rate for Payer: First Health Workers Compensation |
$413.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$964.80
|
| Rate for Payer: GEHA Commercial |
$857.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$964.80
|
| 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 |
$975.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$750.40
|
| Rate for Payer: One Health Plan PPO/POS |
$964.80
|
| 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 |
$1,018.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$804.00
|
| 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 |
$996.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$428.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$292.66
|
|
|
TREAT HIP WALL FRACTURE
|
Facility
|
OP
|
$2,180.00
|
|
|
Service Code
|
CPT 27226
|
| Hospital Charge Code |
6127226
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$545.00 |
| Max. Negotiated Rate |
$2,071.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,308.00
|
| Rate for Payer: Cash Price |
$1,308.00
|
| Rate for Payer: Cigna Commercial |
$1,853.00
|
| Rate for Payer: First Health Commercial |
$1,962.00
|
| Rate for Payer: First Health Workers Compensation |
$841.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,962.00
|
| Rate for Payer: GEHA Commercial |
$1,744.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,962.00
|
| Rate for Payer: Humana ChoiceCare |
$566.80
|
| Rate for Payer: Multiplan All |
$1,983.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,308.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,526.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,962.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,071.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,635.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,918.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$545.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,027.40
|
| Rate for Payer: Zelis Auto |
$872.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,090.00
|
| Rate for Payer: Zelis Worker's Compensation |
$595.14
|
|
|
TREAT HIP WALL FRACTURE
|
Facility
|
IP
|
$2,180.00
|
|
|
Service Code
|
CPT 27226
|
| Hospital Charge Code |
6127226
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$595.14 |
| Max. Negotiated Rate |
$2,071.00 |
| Rate for Payer: Cash Price |
$1,308.00
|
| Rate for Payer: Cigna Commercial |
$1,853.00
|
| Rate for Payer: First Health Commercial |
$1,962.00
|
| Rate for Payer: First Health Workers Compensation |
$841.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,962.00
|
| Rate for Payer: GEHA Commercial |
$1,526.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,962.00
|
| Rate for Payer: Multiplan All |
$1,983.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,526.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,962.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,071.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,635.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,027.40
|
| Rate for Payer: Zelis Auto |
$872.00
|
| Rate for Payer: Zelis Worker's Compensation |
$595.14
|
|
