|
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
|
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
|
$815.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
6124500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$774.25 |
| 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 |
$489.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$489.00
|
| 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 |
$652.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$733.50
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$741.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$570.50
|
| Rate for Payer: One Health Plan PPO/POS |
$733.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$774.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$611.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$757.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$326.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$222.50
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
CPT 24535
|
| Hospital Charge Code |
6124535
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$313.95 |
| Max. Negotiated Rate |
$1,092.50 |
| 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 |
$805.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,035.00
|
| Rate for Payer: Multiplan All |
$1,046.50
|
| Rate for Payer: OMNI Networks Commercial |
$805.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,035.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,092.50
|
| Rate for Payer: Three Rivers Provider Network All |
$862.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,069.50
|
| Rate for Payer: Zelis Auto |
$460.00
|
| Rate for Payer: Zelis Worker's Compensation |
$313.95
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$1,491.00
|
|
|
Service Code
|
CPT 24575
|
| Hospital Charge Code |
6124575
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$407.04 |
| Max. Negotiated Rate |
$24,435.12 |
| 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 |
$894.60
|
| 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 |
$12,217.56
|
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Cigna Commercial |
$1,267.35
|
| Rate for Payer: First Health Commercial |
$1,341.90
|
| Rate for Payer: First Health Workers Compensation |
$575.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,341.90
|
| Rate for Payer: GEHA Commercial |
$1,192.80
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,341.90
|
| 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 |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,356.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,043.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,341.90
|
| 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 |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,416.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,118.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,386.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$596.40
|
| 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 |
$407.04
|
|
|
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 |
$227.78
|
| 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 |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$776.70
|
| 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 |
$785.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| 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 |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$819.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$647.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$802.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$345.20
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$235.60
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$1,599.00
|
|
|
Service Code
|
CPT 23630
|
| Hospital Charge Code |
6123630
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$436.53 |
| 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 |
$959.40
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$959.40
|
| Rate for Payer: Cash Price |
$959.40
|
| Rate for Payer: Cigna Commercial |
$1,359.15
|
| Rate for Payer: First Health Commercial |
$1,439.10
|
| Rate for Payer: First Health Workers Compensation |
$617.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,439.10
|
| Rate for Payer: GEHA Commercial |
$1,279.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,439.10
|
| 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 |
$1,455.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,119.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,439.10
|
| 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 |
$1,519.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,199.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,487.07
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$639.60
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$436.53
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$1,599.00
|
|
|
Service Code
|
CPT 23630
|
| Hospital Charge Code |
6123630
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$436.53 |
| Max. Negotiated Rate |
$1,519.05 |
| Rate for Payer: Cash Price |
$959.40
|
| Rate for Payer: Cigna Commercial |
$1,359.15
|
| Rate for Payer: First Health Commercial |
$1,439.10
|
| Rate for Payer: First Health Workers Compensation |
$617.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,439.10
|
| Rate for Payer: GEHA Commercial |
$1,119.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,439.10
|
| Rate for Payer: Multiplan All |
$1,455.09
|
| Rate for Payer: OMNI Networks Commercial |
$1,119.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,439.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,519.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,199.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,487.07
|
| Rate for Payer: Zelis Auto |
$639.60
|
| Rate for Payer: Zelis Worker's Compensation |
$436.53
|
|
|
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
|
$2,562.00
|
|
|
Service Code
|
CPT 23616
|
| Hospital Charge Code |
6123616
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$699.43 |
| Max. Negotiated Rate |
$34,924.18 |
| 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 |
$17,462.09
|
| 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 |
$17,462.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,305.80
|
| Rate for Payer: Humana ChoiceCare |
$19,208.30
|
| Rate for Payer: Humana Medicare Advantage |
$17,462.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29,336.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,462.09
|
| Rate for Payer: Multiplan All |
$2,331.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29,685.55
|
| 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 |
$17,462.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,433.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34,924.18
|
| Rate for Payer: Three Rivers Provider Network All |
$1,921.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17,112.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,462.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,382.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17,462.09
|
| Rate for Payer: Zelis Auto |
$1,024.80
|
| Rate for Payer: Zelis Medicare |
$14,842.78
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20,954.51
|
| Rate for Payer: Zelis Worker's Compensation |
$699.43
|
|
|
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 |
$3,039.30 |
| 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 |
$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 |
$1,519.65
|
| 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 |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,035.00
|
| 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 |
$1,046.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| 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 |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,092.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$862.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$391.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,069.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$460.00
|
| 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 |
$313.95
|
|
|
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 |
$24,435.12 |
| 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 |
$12,217.56
|
| 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 |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,539.90
|
| 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 |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,557.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| 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 |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,625.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,283.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,591.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$684.40
|
| 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 |
$467.10
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$1,796.00
|
|
|
Service Code
|
CPT 24515
|
| Hospital Charge Code |
6124515
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$490.31 |
| Max. Negotiated Rate |
$1,706.20 |
| Rate for Payer: Cash Price |
$1,077.60
|
| Rate for Payer: Cigna Commercial |
$1,526.60
|
| Rate for Payer: First Health Commercial |
$1,616.40
|
| Rate for Payer: First Health Workers Compensation |
$693.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,616.40
|
| Rate for Payer: GEHA Commercial |
$1,257.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,616.40
|
| Rate for Payer: Multiplan All |
$1,634.36
|
| Rate for Payer: OMNI Networks Commercial |
$1,257.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,616.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,706.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,347.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,670.28
|
| Rate for Payer: Zelis Auto |
$718.40
|
| Rate for Payer: Zelis Worker's Compensation |
$490.31
|
|
|
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
|
$888.00
|
|
|
Service Code
|
CPT 23625
|
| Hospital Charge Code |
6123625
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$242.42 |
| Max. Negotiated Rate |
$843.60 |
| 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 |
$621.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$799.20
|
| Rate for Payer: Multiplan All |
$808.08
|
| Rate for Payer: OMNI Networks Commercial |
$621.60
|
| Rate for Payer: One Health Plan PPO/POS |
$799.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$843.60
|
| Rate for Payer: Three Rivers Provider Network All |
$666.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$825.84
|
| Rate for Payer: Zelis Auto |
$355.20
|
| Rate for Payer: Zelis Worker's Compensation |
$242.42
|
|
|
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
|
$1,814.00
|
|
|
Service Code
|
CPT 23615
|
| Hospital Charge Code |
6123615
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$495.22 |
| Max. Negotiated Rate |
$24,435.12 |
| 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 |
$12,217.56
|
| 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 |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,632.60
|
| 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 |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,650.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| 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 |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,723.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,360.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,687.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$725.60
|
| 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 |
$495.22
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$1,639.00
|
|
|
Service Code
|
CPT 24582
|
| Hospital Charge Code |
6124582
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$447.45 |
| Max. Negotiated Rate |
$1,557.05 |
| Rate for Payer: Cash Price |
$983.40
|
| Rate for Payer: Cigna Commercial |
$1,393.15
|
| Rate for Payer: First Health Commercial |
$1,475.10
|
| Rate for Payer: First Health Workers Compensation |
$632.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,475.10
|
| Rate for Payer: GEHA Commercial |
$1,147.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,475.10
|
| Rate for Payer: Multiplan All |
$1,491.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,147.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,475.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,557.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,229.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,524.27
|
| Rate for Payer: Zelis Auto |
$655.60
|
| Rate for Payer: Zelis Worker's Compensation |
$447.45
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$1,518.00
|
|
|
Service Code
|
CPT 24538
|
| Hospital Charge Code |
6124538
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$414.41 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$910.80
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$910.80
|
| 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 |
$1,214.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,366.20
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,381.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,062.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,366.20
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,442.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,138.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,411.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$607.20
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$414.41
|
|
|
TREAT KNEECAP DISLOCATION
|
Facility
|
OP
|
$1,834.00
|
|
|
Service Code
|
CPT 27566
|
| Hospital Charge Code |
6127566
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$500.68 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,100.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,100.40
|
| Rate for Payer: Cash Price |
$1,100.40
|
| Rate for Payer: Cigna Commercial |
$1,558.90
|
| Rate for Payer: First Health Commercial |
$1,650.60
|
| Rate for Payer: First Health Workers Compensation |
$708.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,650.60
|
| Rate for Payer: GEHA Commercial |
$1,467.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,650.60
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,668.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,283.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,650.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,742.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,375.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,705.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$733.60
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$500.68
|
|
|
TREAT KNEECAP DISLOCATION
|
Facility
|
IP
|
$1,834.00
|
|
|
Service Code
|
CPT 27566
|
| Hospital Charge Code |
6127566
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$500.68 |
| Max. Negotiated Rate |
$1,742.30 |
| Rate for Payer: Cash Price |
$1,100.40
|
| Rate for Payer: Cigna Commercial |
$1,558.90
|
| Rate for Payer: First Health Commercial |
$1,650.60
|
| Rate for Payer: First Health Workers Compensation |
$708.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,650.60
|
| Rate for Payer: GEHA Commercial |
$1,283.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,650.60
|
| Rate for Payer: Multiplan All |
$1,668.94
|
| Rate for Payer: OMNI Networks Commercial |
$1,283.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,650.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,742.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,375.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,705.62
|
| Rate for Payer: Zelis Auto |
$733.60
|
| Rate for Payer: Zelis Worker's Compensation |
$500.68
|
|
|
TREAT KNEECAP FRACTURE
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
CPT 27520
|
| Hospital Charge Code |
6127520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$201.20 |
| Max. Negotiated Rate |
$700.15 |
| Rate for Payer: Cash Price |
$442.20
|
| Rate for Payer: Cigna Commercial |
$626.45
|
| Rate for Payer: First Health Commercial |
$663.30
|
| Rate for Payer: First Health Workers Compensation |
$284.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$663.30
|
| Rate for Payer: GEHA Commercial |
$515.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$663.30
|
| Rate for Payer: Multiplan All |
$670.67
|
| Rate for Payer: OMNI Networks Commercial |
$515.90
|
| Rate for Payer: One Health Plan PPO/POS |
$663.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$700.15
|
| Rate for Payer: Three Rivers Provider Network All |
$552.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$685.41
|
| Rate for Payer: Zelis Auto |
$294.80
|
| Rate for Payer: Zelis Worker's Compensation |
$201.20
|
|
|
TREAT KNEECAP FRACTURE
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
CPT 27520
|
| Hospital Charge Code |
6127520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$700.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$442.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$442.20
|
| Rate for Payer: Cash Price |
$442.20
|
| Rate for Payer: Cigna Commercial |
$626.45
|
| Rate for Payer: First Health Commercial |
$663.30
|
| Rate for Payer: First Health Workers Compensation |
$284.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$663.30
|
| Rate for Payer: GEHA Commercial |
$589.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$663.30
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$670.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$515.90
|
| Rate for Payer: One Health Plan PPO/POS |
$663.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$700.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$552.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$685.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$294.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$201.20
|
|
|
TREAT KNEECAP FRACTURE
|
Facility
|
IP
|
$1,543.00
|
|
|
Service Code
|
CPT 27524
|
| Hospital Charge Code |
6127524
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$421.24 |
| Max. Negotiated Rate |
$1,465.85 |
| Rate for Payer: Cash Price |
$925.80
|
| Rate for Payer: Cigna Commercial |
$1,311.55
|
| Rate for Payer: First Health Commercial |
$1,388.70
|
| Rate for Payer: First Health Workers Compensation |
$595.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,388.70
|
| Rate for Payer: GEHA Commercial |
$1,080.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,388.70
|
| Rate for Payer: Multiplan All |
$1,404.13
|
| Rate for Payer: OMNI Networks Commercial |
$1,080.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,388.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,465.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,157.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,434.99
|
| Rate for Payer: Zelis Auto |
$617.20
|
| Rate for Payer: Zelis Worker's Compensation |
$421.24
|
|
|
TREAT KNEECAP FRACTURE
|
Facility
|
OP
|
$1,543.00
|
|
|
Service Code
|
CPT 27524
|
| Hospital Charge Code |
6127524
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$421.24 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$925.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$925.80
|
| Rate for Payer: Cash Price |
$925.80
|
| Rate for Payer: Cigna Commercial |
$1,311.55
|
| Rate for Payer: First Health Commercial |
$1,388.70
|
| Rate for Payer: First Health Workers Compensation |
$595.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,388.70
|
| Rate for Payer: GEHA Commercial |
$1,234.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,388.70
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,404.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,080.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,388.70
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,465.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,157.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,434.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$617.20
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$421.24
|
|
