|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$863.00
|
|
|
Service Code
|
CPT 24530
|
| Hospital Charge Code |
6124530
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$819.85 |
| 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 |
$517.80
|
| 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 |
$232.44
|
| Rate for Payer: Cash Price |
$517.80
|
| Rate for Payer: Cash Price |
$517.80
|
| Rate for Payer: Cigna Commercial |
$733.55
|
| Rate for Payer: First Health Commercial |
$776.70
|
| Rate for Payer: First Health Workers Compensation |
$333.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$776.70
|
| Rate for Payer: GEHA Commercial |
$690.40
|
| Rate for Payer: GEHA Medicare |
$232.44
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$776.70
|
| Rate for Payer: Humana ChoiceCare |
$255.68
|
| Rate for Payer: Humana Medicare Advantage |
$232.44
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$390.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$232.44
|
| Rate for Payer: Multiplan All |
$785.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$395.15
|
| Rate for Payer: OMNI Networks Commercial |
$604.10
|
| Rate for Payer: One Health Plan PPO/POS |
$776.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$232.44
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$819.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$464.88
|
| Rate for Payer: Three Rivers Provider Network All |
$647.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$227.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$232.44
|
| Rate for Payer: United Payors & United Providers UP&UP |
$802.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$232.44
|
| Rate for Payer: Zelis Auto |
$345.20
|
| Rate for Payer: Zelis Medicare |
$197.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$278.93
|
| Rate for Payer: Zelis Worker's Compensation |
$235.60
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$1,768.00
|
|
|
Service Code
|
CPT 24516
|
| Hospital Charge Code |
6124516
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$482.66 |
| Max. Negotiated Rate |
$1,679.60 |
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cigna Commercial |
$1,502.80
|
| Rate for Payer: First Health Commercial |
$1,591.20
|
| Rate for Payer: First Health Workers Compensation |
$682.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,591.20
|
| Rate for Payer: GEHA Commercial |
$1,237.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,591.20
|
| Rate for Payer: Multiplan All |
$1,608.88
|
| Rate for Payer: OMNI Networks Commercial |
$1,237.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,591.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,679.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,326.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,644.24
|
| Rate for Payer: Zelis Auto |
$707.20
|
| Rate for Payer: Zelis Worker's Compensation |
$482.66
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$2,137.00
|
|
|
Service Code
|
CPT 24546
|
| Hospital Charge Code |
6124546
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$583.40 |
| Max. Negotiated Rate |
$2,030.15 |
| Rate for Payer: Cash Price |
$1,282.20
|
| Rate for Payer: Cigna Commercial |
$1,816.45
|
| Rate for Payer: First Health Commercial |
$1,923.30
|
| Rate for Payer: First Health Workers Compensation |
$825.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,923.30
|
| Rate for Payer: GEHA Commercial |
$1,495.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,923.30
|
| Rate for Payer: Multiplan All |
$1,944.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,495.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,923.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,030.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,602.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,987.41
|
| Rate for Payer: Zelis Auto |
$854.80
|
| Rate for Payer: Zelis Worker's Compensation |
$583.40
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$863.00
|
|
|
Service Code
|
CPT 24530
|
| Hospital Charge Code |
6124530
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$235.60 |
| Max. Negotiated Rate |
$819.85 |
| Rate for Payer: Cash Price |
$517.80
|
| Rate for Payer: Cigna Commercial |
$733.55
|
| Rate for Payer: First Health Commercial |
$776.70
|
| Rate for Payer: First Health Workers Compensation |
$333.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$776.70
|
| Rate for Payer: GEHA Commercial |
$604.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$776.70
|
| Rate for Payer: Multiplan All |
$785.33
|
| Rate for Payer: OMNI Networks Commercial |
$604.10
|
| Rate for Payer: One Health Plan PPO/POS |
$776.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$819.85
|
| Rate for Payer: Three Rivers Provider Network All |
$647.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$802.59
|
| Rate for Payer: Zelis Auto |
$345.20
|
| Rate for Payer: Zelis Worker's Compensation |
$235.60
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$639.00
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
6123620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$174.45 |
| Max. Negotiated Rate |
$607.05 |
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Cigna Commercial |
$543.15
|
| Rate for Payer: First Health Commercial |
$575.10
|
| Rate for Payer: First Health Workers Compensation |
$246.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$575.10
|
| Rate for Payer: GEHA Commercial |
$447.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$575.10
|
| Rate for Payer: Multiplan All |
$581.49
|
| Rate for Payer: OMNI Networks Commercial |
$447.30
|
| Rate for Payer: One Health Plan PPO/POS |
$575.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$607.05
|
| Rate for Payer: Three Rivers Provider Network All |
$479.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$594.27
|
| Rate for Payer: Zelis Auto |
$255.60
|
| Rate for Payer: Zelis Worker's Compensation |
$174.45
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$1,768.00
|
|
|
Service Code
|
CPT 24516
|
| Hospital Charge Code |
6124516
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$482.66 |
| Max. Negotiated Rate |
$24,935.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,060.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,244.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,467.69
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cigna Commercial |
$1,502.80
|
| Rate for Payer: First Health Commercial |
$1,591.20
|
| Rate for Payer: First Health Workers Compensation |
$682.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,591.20
|
| Rate for Payer: GEHA Commercial |
$1,414.40
|
| Rate for Payer: GEHA Medicare |
$12,467.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,591.20
|
| Rate for Payer: Humana ChoiceCare |
$13,714.46
|
| Rate for Payer: Humana Medicare Advantage |
$12,467.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,945.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,467.69
|
| Rate for Payer: Multiplan All |
$1,608.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21,195.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,237.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,591.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,178.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,351.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,467.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,679.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,935.38
|
| Rate for Payer: Three Rivers Provider Network All |
$1,326.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,218.34
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,467.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,644.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,467.69
|
| Rate for Payer: Zelis Auto |
$707.20
|
| Rate for Payer: Zelis Medicare |
$10,597.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,961.23
|
| Rate for Payer: Zelis Worker's Compensation |
$482.66
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$2,562.00
|
|
|
Service Code
|
CPT 23616
|
| Hospital Charge Code |
6123616
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$699.43 |
| Max. Negotiated Rate |
$2,433.90 |
| Rate for Payer: Cash Price |
$1,537.20
|
| Rate for Payer: Cigna Commercial |
$2,177.70
|
| Rate for Payer: First Health Commercial |
$2,305.80
|
| Rate for Payer: First Health Workers Compensation |
$989.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,305.80
|
| Rate for Payer: GEHA Commercial |
$1,793.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,305.80
|
| Rate for Payer: Multiplan All |
$2,331.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,793.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,305.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,433.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,921.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,382.66
|
| Rate for Payer: Zelis Auto |
$1,024.80
|
| Rate for Payer: Zelis Worker's Compensation |
$699.43
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$1,814.00
|
|
|
Service Code
|
CPT 23615
|
| Hospital Charge Code |
6123615
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$495.22 |
| Max. Negotiated Rate |
$24,935.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,088.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,244.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,467.69
|
| Rate for Payer: Cash Price |
$1,088.40
|
| Rate for Payer: Cash Price |
$1,088.40
|
| Rate for Payer: Cigna Commercial |
$1,541.90
|
| Rate for Payer: First Health Commercial |
$1,632.60
|
| Rate for Payer: First Health Workers Compensation |
$700.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,632.60
|
| Rate for Payer: GEHA Commercial |
$1,451.20
|
| Rate for Payer: GEHA Medicare |
$12,467.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,632.60
|
| Rate for Payer: Humana ChoiceCare |
$13,714.46
|
| Rate for Payer: Humana Medicare Advantage |
$12,467.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,945.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,467.69
|
| Rate for Payer: Multiplan All |
$1,650.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21,195.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,269.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,632.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,178.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,351.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,467.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,723.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,935.38
|
| Rate for Payer: Three Rivers Provider Network All |
$1,360.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,218.34
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,467.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,687.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,467.69
|
| Rate for Payer: Zelis Auto |
$725.60
|
| Rate for Payer: Zelis Medicare |
$10,597.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,961.23
|
| Rate for Payer: Zelis Worker's Compensation |
$495.22
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$639.00
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
6123620
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$607.05 |
| 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 |
$383.40
|
| 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 |
$232.44
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Cigna Commercial |
$543.15
|
| Rate for Payer: First Health Commercial |
$575.10
|
| Rate for Payer: First Health Workers Compensation |
$246.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$575.10
|
| Rate for Payer: GEHA Commercial |
$511.20
|
| Rate for Payer: GEHA Medicare |
$232.44
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$575.10
|
| Rate for Payer: Humana ChoiceCare |
$255.68
|
| Rate for Payer: Humana Medicare Advantage |
$232.44
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$390.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$232.44
|
| Rate for Payer: Multiplan All |
$581.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$395.15
|
| Rate for Payer: OMNI Networks Commercial |
$447.30
|
| Rate for Payer: One Health Plan PPO/POS |
$575.10
|
| 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 |
$232.44
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$607.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$464.88
|
| Rate for Payer: Three Rivers Provider Network All |
$479.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$227.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$232.44
|
| Rate for Payer: United Payors & United Providers UP&UP |
$594.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$232.44
|
| Rate for Payer: Zelis Auto |
$255.60
|
| Rate for Payer: Zelis Medicare |
$197.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$278.93
|
| Rate for Payer: Zelis Worker's Compensation |
$174.45
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$1,462.00
|
|
|
Service Code
|
CPT 24566
|
| Hospital Charge Code |
6124566
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$399.13 |
| Max. Negotiated Rate |
$3,101.54 |
| 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 |
$877.20
|
| 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 |
$1,550.77
|
| Rate for Payer: Cash Price |
$877.20
|
| Rate for Payer: Cash Price |
$877.20
|
| Rate for Payer: Cigna Commercial |
$1,242.70
|
| Rate for Payer: First Health Commercial |
$1,315.80
|
| Rate for Payer: First Health Workers Compensation |
$564.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,315.80
|
| Rate for Payer: GEHA Commercial |
$1,169.60
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,315.80
|
| Rate for Payer: Humana ChoiceCare |
$1,705.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,550.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,605.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$1,330.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$1,023.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,315.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,438.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,112.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,388.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$1,096.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,359.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$584.80
|
| Rate for Payer: Zelis Medicare |
$1,318.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,860.92
|
| Rate for Payer: Zelis Worker's Compensation |
$399.13
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$1,462.00
|
|
|
Service Code
|
CPT 24566
|
| Hospital Charge Code |
6124566
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$399.13 |
| Max. Negotiated Rate |
$1,388.90 |
| Rate for Payer: Cash Price |
$877.20
|
| Rate for Payer: Cigna Commercial |
$1,242.70
|
| Rate for Payer: First Health Commercial |
$1,315.80
|
| Rate for Payer: First Health Workers Compensation |
$564.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,315.80
|
| Rate for Payer: GEHA Commercial |
$1,023.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,315.80
|
| Rate for Payer: Multiplan All |
$1,330.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,023.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,315.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,388.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,096.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,359.66
|
| Rate for Payer: Zelis Auto |
$584.80
|
| Rate for Payer: Zelis Worker's Compensation |
$399.13
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
CPT 24560
|
| Hospital Charge Code |
6124560
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$679.25 |
| 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 |
$429.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$232.44
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$607.75
|
| Rate for Payer: First Health Commercial |
$643.50
|
| Rate for Payer: First Health Workers Compensation |
$276.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$643.50
|
| Rate for Payer: GEHA Commercial |
$572.00
|
| Rate for Payer: GEHA Medicare |
$232.44
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$643.50
|
| Rate for Payer: Humana ChoiceCare |
$255.68
|
| Rate for Payer: Humana Medicare Advantage |
$232.44
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$390.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$232.44
|
| Rate for Payer: Multiplan All |
$650.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$395.15
|
| Rate for Payer: OMNI Networks Commercial |
$500.50
|
| Rate for Payer: One Health Plan PPO/POS |
$643.50
|
| 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 |
$232.44
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$679.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$464.88
|
| Rate for Payer: Three Rivers Provider Network All |
$536.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$227.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$232.44
|
| Rate for Payer: United Payors & United Providers UP&UP |
$664.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$232.44
|
| Rate for Payer: Zelis Auto |
$286.00
|
| Rate for Payer: Zelis Medicare |
$197.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$278.93
|
| Rate for Payer: Zelis Worker's Compensation |
$195.19
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$1,711.00
|
|
|
Service Code
|
CPT 24579
|
| Hospital Charge Code |
6124579
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$467.10 |
| Max. Negotiated Rate |
$24,935.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,026.60
|
| 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 |
$12,467.69
|
| Rate for Payer: Cash Price |
$1,026.60
|
| Rate for Payer: Cash Price |
$1,026.60
|
| Rate for Payer: Cigna Commercial |
$1,454.35
|
| Rate for Payer: First Health Commercial |
$1,539.90
|
| Rate for Payer: First Health Workers Compensation |
$660.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,539.90
|
| Rate for Payer: GEHA Commercial |
$1,368.80
|
| Rate for Payer: GEHA Medicare |
$12,467.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,539.90
|
| Rate for Payer: Humana ChoiceCare |
$13,714.46
|
| Rate for Payer: Humana Medicare Advantage |
$12,467.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,945.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,467.69
|
| Rate for Payer: Multiplan All |
$1,557.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21,195.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,197.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,539.90
|
| 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 |
$12,467.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,625.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,935.38
|
| Rate for Payer: Three Rivers Provider Network All |
$1,283.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,218.34
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,467.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,591.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,467.69
|
| Rate for Payer: Zelis Auto |
$684.40
|
| Rate for Payer: Zelis Medicare |
$10,597.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,961.23
|
| Rate for Payer: Zelis Worker's Compensation |
$467.10
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
6124505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$3,101.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$546.60
|
| 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 |
$1,550.77
|
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cigna Commercial |
$774.35
|
| Rate for Payer: First Health Commercial |
$819.90
|
| Rate for Payer: First Health Workers Compensation |
$351.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$819.90
|
| Rate for Payer: GEHA Commercial |
$728.80
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$819.90
|
| Rate for Payer: Humana ChoiceCare |
$1,705.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,550.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,605.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$829.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$637.70
|
| Rate for Payer: One Health Plan PPO/POS |
$819.90
|
| 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 |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$865.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$683.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$847.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$364.40
|
| Rate for Payer: Zelis Medicare |
$1,318.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,860.92
|
| Rate for Payer: Zelis Worker's Compensation |
$248.70
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 23600
|
| Hospital Charge Code |
6123600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$209.12 |
| Max. Negotiated Rate |
$727.70 |
| Rate for Payer: Cash Price |
$459.60
|
| Rate for Payer: Cigna Commercial |
$651.10
|
| Rate for Payer: First Health Commercial |
$689.40
|
| Rate for Payer: First Health Workers Compensation |
$295.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$689.40
|
| Rate for Payer: GEHA Commercial |
$536.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$689.40
|
| Rate for Payer: Multiplan All |
$697.06
|
| Rate for Payer: OMNI Networks Commercial |
$536.20
|
| Rate for Payer: One Health Plan PPO/POS |
$689.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$727.70
|
| Rate for Payer: Three Rivers Provider Network All |
$574.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$712.38
|
| Rate for Payer: Zelis Auto |
$306.40
|
| Rate for Payer: Zelis Worker's Compensation |
$209.12
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
6124505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$248.70 |
| Max. Negotiated Rate |
$865.45 |
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cigna Commercial |
$774.35
|
| Rate for Payer: First Health Commercial |
$819.90
|
| Rate for Payer: First Health Workers Compensation |
$351.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$819.90
|
| Rate for Payer: GEHA Commercial |
$637.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$819.90
|
| Rate for Payer: Multiplan All |
$829.01
|
| Rate for Payer: OMNI Networks Commercial |
$637.70
|
| Rate for Payer: One Health Plan PPO/POS |
$819.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$865.45
|
| Rate for Payer: Three Rivers Provider Network All |
$683.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$847.23
|
| Rate for Payer: Zelis Auto |
$364.40
|
| Rate for Payer: Zelis Worker's Compensation |
$248.70
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$888.00
|
|
|
Service Code
|
CPT 23625
|
| Hospital Charge Code |
6123625
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$242.42 |
| Max. Negotiated Rate |
$3,101.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,860.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$532.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,860.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,473.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,550.77
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cigna Commercial |
$754.80
|
| Rate for Payer: First Health Commercial |
$799.20
|
| Rate for Payer: First Health Workers Compensation |
$342.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$799.20
|
| Rate for Payer: GEHA Commercial |
$710.40
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$799.20
|
| Rate for Payer: Humana ChoiceCare |
$1,705.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,550.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,605.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,503.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$808.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$621.60
|
| Rate for Payer: One Health Plan PPO/POS |
$799.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,736.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,503.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$843.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$666.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,503.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$825.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$355.20
|
| Rate for Payer: Zelis Medicare |
$1,318.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,860.92
|
| Rate for Payer: Zelis Worker's Compensation |
$242.42
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$1,518.00
|
|
|
Service Code
|
CPT 24538
|
| Hospital Charge Code |
6124538
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$414.41 |
| Max. Negotiated Rate |
$1,442.10 |
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cigna Commercial |
$1,290.30
|
| Rate for Payer: First Health Commercial |
$1,366.20
|
| Rate for Payer: First Health Workers Compensation |
$586.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,366.20
|
| Rate for Payer: GEHA Commercial |
$1,062.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,366.20
|
| Rate for Payer: Multiplan All |
$1,381.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,062.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,366.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,442.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,138.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,411.74
|
| Rate for Payer: Zelis Auto |
$607.20
|
| Rate for Payer: Zelis Worker's Compensation |
$414.41
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
6124500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$222.50 |
| Max. Negotiated Rate |
$774.25 |
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$692.75
|
| Rate for Payer: First Health Commercial |
$733.50
|
| Rate for Payer: First Health Workers Compensation |
$314.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$733.50
|
| Rate for Payer: GEHA Commercial |
$570.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$733.50
|
| Rate for Payer: Multiplan All |
$741.65
|
| Rate for Payer: OMNI Networks Commercial |
$570.50
|
| Rate for Payer: One Health Plan PPO/POS |
$733.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$774.25
|
| Rate for Payer: Three Rivers Provider Network All |
$611.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$757.95
|
| Rate for Payer: Zelis Auto |
$326.00
|
| Rate for Payer: Zelis Worker's Compensation |
$222.50
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$2,562.00
|
|
|
Service Code
|
CPT 23616
|
| Hospital Charge Code |
6123616
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$699.43 |
| Max. Negotiated Rate |
$35,639.18 |
| 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 |
$1,537.20
|
| 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 |
$17,819.59
|
| Rate for Payer: Cash Price |
$1,537.20
|
| Rate for Payer: Cash Price |
$1,537.20
|
| Rate for Payer: Cigna Commercial |
$2,177.70
|
| Rate for Payer: First Health Commercial |
$2,305.80
|
| Rate for Payer: First Health Workers Compensation |
$989.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,305.80
|
| Rate for Payer: GEHA Commercial |
$2,049.60
|
| Rate for Payer: GEHA Medicare |
$17,819.59
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,305.80
|
| Rate for Payer: Humana ChoiceCare |
$19,601.55
|
| Rate for Payer: Humana Medicare Advantage |
$17,819.59
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29,936.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,819.59
|
| Rate for Payer: Multiplan All |
$2,331.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30,293.30
|
| Rate for Payer: OMNI Networks Commercial |
$1,793.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,305.80
|
| 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 |
$17,819.59
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,433.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$35,639.18
|
| Rate for Payer: Three Rivers Provider Network All |
$1,921.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17,463.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,819.59
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,382.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17,819.59
|
| Rate for Payer: Zelis Auto |
$1,024.80
|
| Rate for Payer: Zelis Medicare |
$15,146.65
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21,383.51
|
| Rate for Payer: Zelis Worker's Compensation |
$699.43
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
CPT 24560
|
| Hospital Charge Code |
6124560
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$195.19 |
| Max. Negotiated Rate |
$679.25 |
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$607.75
|
| Rate for Payer: First Health Commercial |
$643.50
|
| Rate for Payer: First Health Workers Compensation |
$276.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$643.50
|
| Rate for Payer: GEHA Commercial |
$500.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$643.50
|
| Rate for Payer: Multiplan All |
$650.65
|
| Rate for Payer: OMNI Networks Commercial |
$500.50
|
| Rate for Payer: One Health Plan PPO/POS |
$643.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$679.25
|
| Rate for Payer: Three Rivers Provider Network All |
$536.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$664.95
|
| Rate for Payer: Zelis Auto |
$286.00
|
| Rate for Payer: Zelis Worker's Compensation |
$195.19
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$1,908.00
|
|
|
Service Code
|
CPT 24545
|
| Hospital Charge Code |
6124545
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$520.88 |
| Max. Negotiated Rate |
$24,935.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,144.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,244.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,467.69
|
| Rate for Payer: Cash Price |
$1,144.80
|
| Rate for Payer: Cash Price |
$1,144.80
|
| Rate for Payer: Cigna Commercial |
$1,621.80
|
| Rate for Payer: First Health Commercial |
$1,717.20
|
| Rate for Payer: First Health Workers Compensation |
$736.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,717.20
|
| Rate for Payer: GEHA Commercial |
$1,526.40
|
| Rate for Payer: GEHA Medicare |
$12,467.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,717.20
|
| Rate for Payer: Humana ChoiceCare |
$13,714.46
|
| Rate for Payer: Humana Medicare Advantage |
$12,467.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,945.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,467.69
|
| Rate for Payer: Multiplan All |
$1,736.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21,195.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,335.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,717.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,178.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,351.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,467.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,812.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,935.38
|
| Rate for Payer: Three Rivers Provider Network All |
$1,431.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,218.34
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,467.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,774.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,467.69
|
| Rate for Payer: Zelis Auto |
$763.20
|
| Rate for Payer: Zelis Medicare |
$10,597.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,961.23
|
| Rate for Payer: Zelis Worker's Compensation |
$520.88
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$1,908.00
|
|
|
Service Code
|
CPT 24545
|
| Hospital Charge Code |
6124545
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$520.88 |
| Max. Negotiated Rate |
$1,812.60 |
| Rate for Payer: Cash Price |
$1,144.80
|
| Rate for Payer: Cigna Commercial |
$1,621.80
|
| Rate for Payer: First Health Commercial |
$1,717.20
|
| Rate for Payer: First Health Workers Compensation |
$736.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,717.20
|
| Rate for Payer: GEHA Commercial |
$1,335.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,717.20
|
| Rate for Payer: Multiplan All |
$1,736.28
|
| Rate for Payer: OMNI Networks Commercial |
$1,335.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,717.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,812.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,431.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,774.44
|
| Rate for Payer: Zelis Auto |
$763.20
|
| Rate for Payer: Zelis Worker's Compensation |
$520.88
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$1,814.00
|
|
|
Service Code
|
CPT 23615
|
| Hospital Charge Code |
6123615
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$495.22 |
| Max. Negotiated Rate |
$1,723.30 |
| Rate for Payer: Cash Price |
$1,088.40
|
| Rate for Payer: Cigna Commercial |
$1,541.90
|
| Rate for Payer: First Health Commercial |
$1,632.60
|
| Rate for Payer: First Health Workers Compensation |
$700.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,632.60
|
| Rate for Payer: GEHA Commercial |
$1,269.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,632.60
|
| Rate for Payer: Multiplan All |
$1,650.74
|
| Rate for Payer: OMNI Networks Commercial |
$1,269.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,632.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,723.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,360.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,687.02
|
| Rate for Payer: Zelis Auto |
$725.60
|
| Rate for Payer: Zelis Worker's Compensation |
$495.22
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
CPT 24535
|
| Hospital Charge Code |
6124535
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$313.95 |
| Max. Negotiated Rate |
$3,101.54 |
| 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 |
$690.00
|
| 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 |
$1,550.77
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$977.50
|
| Rate for Payer: First Health Commercial |
$1,035.00
|
| Rate for Payer: First Health Workers Compensation |
$444.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,035.00
|
| Rate for Payer: GEHA Commercial |
$920.00
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,035.00
|
| Rate for Payer: Humana ChoiceCare |
$1,705.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,550.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,605.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$391.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$1,046.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$805.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,035.00
|
| 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 |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,092.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$862.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$391.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,069.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$460.00
|
| Rate for Payer: Zelis Medicare |
$1,318.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,860.92
|
| Rate for Payer: Zelis Worker's Compensation |
$313.95
|
|
