|
TREAT KNUCKLE DISLOCATION
|
Facility
|
IP
|
$1,157.00
|
|
|
Service Code
|
CPT 26715
|
| Hospital Charge Code |
6126715
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$315.86 |
| Max. Negotiated Rate |
$1,099.15 |
| Rate for Payer: Cash Price |
$694.20
|
| Rate for Payer: Cigna Commercial |
$983.45
|
| Rate for Payer: First Health Commercial |
$1,041.30
|
| Rate for Payer: First Health Workers Compensation |
$446.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,041.30
|
| Rate for Payer: GEHA Commercial |
$809.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,041.30
|
| Rate for Payer: Multiplan All |
$1,052.87
|
| Rate for Payer: OMNI Networks Commercial |
$809.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,041.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,099.15
|
| Rate for Payer: Three Rivers Provider Network All |
$867.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,076.01
|
| Rate for Payer: Zelis Auto |
$462.80
|
| Rate for Payer: Zelis Worker's Compensation |
$315.86
|
|
|
TREAT LARYNX FRACTURE
|
Facility
|
IP
|
$3,084.00
|
|
|
Service Code
|
CPT 31584
|
| Hospital Charge Code |
6131584
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$841.93 |
| Max. Negotiated Rate |
$2,929.80 |
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cigna Commercial |
$2,621.40
|
| Rate for Payer: First Health Commercial |
$2,775.60
|
| Rate for Payer: First Health Workers Compensation |
$1,190.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,775.60
|
| Rate for Payer: GEHA Commercial |
$2,158.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,775.60
|
| Rate for Payer: Multiplan All |
$2,806.44
|
| Rate for Payer: OMNI Networks Commercial |
$2,158.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,775.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,929.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,313.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,868.12
|
| Rate for Payer: Zelis Auto |
$1,233.60
|
| Rate for Payer: Zelis Worker's Compensation |
$841.93
|
|
|
TREAT LARYNX FRACTURE
|
Facility
|
OP
|
$3,084.00
|
|
|
Service Code
|
CPT 31584
|
| Hospital Charge Code |
6131584
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$841.93 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,369.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,850.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,369.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6,630.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cigna Commercial |
$2,621.40
|
| Rate for Payer: First Health Commercial |
$2,775.60
|
| Rate for Payer: First Health Workers Compensation |
$1,190.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,775.60
|
| Rate for Payer: GEHA Commercial |
$2,467.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,775.60
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6,765.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$2,806.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,158.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,775.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7,811.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6,765.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,929.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$2,313.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6,765.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,868.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$1,233.60
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$841.93
|
|
|
TREAT LOWER JAW FRACTURE
|
Facility
|
OP
|
$993.00
|
|
|
Service Code
|
CPT 21450
|
| Hospital Charge Code |
6121450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$271.09 |
| Max. Negotiated Rate |
$967.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$595.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$274.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$483.55
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cigna Commercial |
$844.05
|
| Rate for Payer: First Health Commercial |
$893.70
|
| Rate for Payer: First Health Workers Compensation |
$383.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$893.70
|
| Rate for Payer: GEHA Commercial |
$794.40
|
| Rate for Payer: GEHA Medicare |
$483.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$893.70
|
| Rate for Payer: Humana ChoiceCare |
$531.90
|
| Rate for Payer: Humana Medicare Advantage |
$483.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$812.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$279.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$483.55
|
| Rate for Payer: Multiplan All |
$903.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$822.03
|
| Rate for Payer: OMNI Networks Commercial |
$695.10
|
| Rate for Payer: One Health Plan PPO/POS |
$893.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$323.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$279.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$483.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$943.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$967.10
|
| Rate for Payer: Three Rivers Provider Network All |
$744.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$473.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$483.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$923.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$483.55
|
| Rate for Payer: Zelis Auto |
$397.20
|
| Rate for Payer: Zelis Medicare |
$411.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$580.26
|
| Rate for Payer: Zelis Worker's Compensation |
$271.09
|
|
|
TREAT LOWER JAW FRACTURE
|
Facility
|
IP
|
$1,289.00
|
|
|
Service Code
|
CPT 21451
|
| Hospital Charge Code |
6121451
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$351.90 |
| Max. Negotiated Rate |
$1,224.55 |
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$1,095.65
|
| Rate for Payer: First Health Commercial |
$1,160.10
|
| Rate for Payer: First Health Workers Compensation |
$497.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,160.10
|
| Rate for Payer: GEHA Commercial |
$902.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,160.10
|
| Rate for Payer: Multiplan All |
$1,172.99
|
| Rate for Payer: OMNI Networks Commercial |
$902.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,160.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,224.55
|
| Rate for Payer: Three Rivers Provider Network All |
$966.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,198.77
|
| Rate for Payer: Zelis Auto |
$515.60
|
| Rate for Payer: Zelis Worker's Compensation |
$351.90
|
|
|
TREAT LOWER JAW FRACTURE
|
Facility
|
IP
|
$1,970.00
|
|
|
Service Code
|
CPT 21465
|
| Hospital Charge Code |
6121465
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$537.81 |
| Max. Negotiated Rate |
$1,871.50 |
| Rate for Payer: Cash Price |
$1,182.00
|
| Rate for Payer: Cigna Commercial |
$1,674.50
|
| Rate for Payer: First Health Commercial |
$1,773.00
|
| Rate for Payer: First Health Workers Compensation |
$760.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,773.00
|
| Rate for Payer: GEHA Commercial |
$1,379.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,773.00
|
| Rate for Payer: Multiplan All |
$1,792.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,379.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,773.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,871.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,477.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,832.10
|
| Rate for Payer: Zelis Auto |
$788.00
|
| Rate for Payer: Zelis Worker's Compensation |
$537.81
|
|
|
TREAT LOWER JAW FRACTURE
|
Facility
|
OP
|
$2,974.00
|
|
|
Service Code
|
CPT 21461
|
| Hospital Charge Code |
6121461
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$811.90 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,784.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,784.40
|
| Rate for Payer: Cash Price |
$1,784.40
|
| Rate for Payer: Cigna Commercial |
$2,527.90
|
| Rate for Payer: First Health Commercial |
$2,676.60
|
| Rate for Payer: First Health Workers Compensation |
$1,148.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,676.60
|
| Rate for Payer: GEHA Commercial |
$2,379.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,676.60
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$2,706.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,081.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,676.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,825.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$2,230.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,765.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$1,189.60
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$811.90
|
|
|
TREAT LOWER JAW FRACTURE
|
Facility
|
IP
|
$877.00
|
|
|
Service Code
|
CPT 21452
|
| Hospital Charge Code |
6121452
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$239.42 |
| Max. Negotiated Rate |
$833.15 |
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cigna Commercial |
$745.45
|
| Rate for Payer: First Health Commercial |
$789.30
|
| Rate for Payer: First Health Workers Compensation |
$338.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$789.30
|
| Rate for Payer: GEHA Commercial |
$613.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$789.30
|
| Rate for Payer: Multiplan All |
$798.07
|
| Rate for Payer: OMNI Networks Commercial |
$613.90
|
| Rate for Payer: One Health Plan PPO/POS |
$789.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$833.15
|
| Rate for Payer: Three Rivers Provider Network All |
$657.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$815.61
|
| Rate for Payer: Zelis Auto |
$350.80
|
| Rate for Payer: Zelis Worker's Compensation |
$239.42
|
|
|
TREAT LOWER JAW FRACTURE
|
Facility
|
IP
|
$2,974.00
|
|
|
Service Code
|
CPT 21461
|
| Hospital Charge Code |
6121461
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$811.90 |
| Max. Negotiated Rate |
$2,825.30 |
| Rate for Payer: Cash Price |
$1,784.40
|
| Rate for Payer: Cigna Commercial |
$2,527.90
|
| Rate for Payer: First Health Commercial |
$2,676.60
|
| Rate for Payer: First Health Workers Compensation |
$1,148.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,676.60
|
| Rate for Payer: GEHA Commercial |
$2,081.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,676.60
|
| Rate for Payer: Multiplan All |
$2,706.34
|
| Rate for Payer: OMNI Networks Commercial |
$2,081.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,676.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,825.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,230.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,765.82
|
| Rate for Payer: Zelis Auto |
$1,189.60
|
| Rate for Payer: Zelis Worker's Compensation |
$811.90
|
|
|
TREAT LOWER JAW FRACTURE
|
Facility
|
OP
|
$2,487.00
|
|
|
Service Code
|
CPT 21470
|
| Hospital Charge Code |
6121470
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$678.95 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,492.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,492.20
|
| Rate for Payer: Cash Price |
$1,492.20
|
| Rate for Payer: Cigna Commercial |
$2,113.95
|
| Rate for Payer: First Health Commercial |
$2,238.30
|
| Rate for Payer: First Health Workers Compensation |
$960.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,238.30
|
| Rate for Payer: GEHA Commercial |
$1,989.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,238.30
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$2,263.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,740.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,238.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,362.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,865.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,312.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$994.80
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$678.95
|
|
|
TREAT LOWER JAW FRACTURE
|
Facility
|
OP
|
$3,318.00
|
|
|
Service Code
|
CPT 21462
|
| Hospital Charge Code |
6121462
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$905.81 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,990.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna Commercial |
$2,820.30
|
| Rate for Payer: First Health Commercial |
$2,986.20
|
| Rate for Payer: First Health Workers Compensation |
$1,281.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,986.20
|
| Rate for Payer: GEHA Commercial |
$2,654.40
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,986.20
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$3,019.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,322.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,986.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,152.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$2,488.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,085.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$1,327.20
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$905.81
|
|
|
TREAT LOWER JAW FRACTURE
|
Facility
|
IP
|
$2,487.00
|
|
|
Service Code
|
CPT 21470
|
| Hospital Charge Code |
6121470
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$678.95 |
| Max. Negotiated Rate |
$2,362.65 |
| Rate for Payer: Cash Price |
$1,492.20
|
| Rate for Payer: Cigna Commercial |
$2,113.95
|
| Rate for Payer: First Health Commercial |
$2,238.30
|
| Rate for Payer: First Health Workers Compensation |
$960.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,238.30
|
| Rate for Payer: GEHA Commercial |
$1,740.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,238.30
|
| Rate for Payer: Multiplan All |
$2,263.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,740.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,238.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,362.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,865.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,312.91
|
| Rate for Payer: Zelis Auto |
$994.80
|
| Rate for Payer: Zelis Worker's Compensation |
$678.95
|
|
|
TREAT LOWER JAW FRACTURE
|
Facility
|
IP
|
$993.00
|
|
|
Service Code
|
CPT 21450
|
| Hospital Charge Code |
6121450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$271.09 |
| Max. Negotiated Rate |
$943.35 |
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cigna Commercial |
$844.05
|
| Rate for Payer: First Health Commercial |
$893.70
|
| Rate for Payer: First Health Workers Compensation |
$383.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$893.70
|
| Rate for Payer: GEHA Commercial |
$695.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$893.70
|
| Rate for Payer: Multiplan All |
$903.63
|
| Rate for Payer: OMNI Networks Commercial |
$695.10
|
| Rate for Payer: One Health Plan PPO/POS |
$893.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$943.35
|
| Rate for Payer: Three Rivers Provider Network All |
$744.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$923.49
|
| Rate for Payer: Zelis Auto |
$397.20
|
| Rate for Payer: Zelis Worker's Compensation |
$271.09
|
|
|
TREAT LOWER JAW FRACTURE
|
Facility
|
IP
|
$1,574.00
|
|
|
Service Code
|
CPT 21453
|
| Hospital Charge Code |
6121453
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$429.70 |
| Max. Negotiated Rate |
$1,495.30 |
| Rate for Payer: Cash Price |
$944.40
|
| Rate for Payer: Cigna Commercial |
$1,337.90
|
| Rate for Payer: First Health Commercial |
$1,416.60
|
| Rate for Payer: First Health Workers Compensation |
$607.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,416.60
|
| Rate for Payer: GEHA Commercial |
$1,101.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,416.60
|
| Rate for Payer: Multiplan All |
$1,432.34
|
| Rate for Payer: OMNI Networks Commercial |
$1,101.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,416.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,495.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,180.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,463.82
|
| Rate for Payer: Zelis Auto |
$629.60
|
| Rate for Payer: Zelis Worker's Compensation |
$429.70
|
|
|
TREAT LOWER JAW FRACTURE
|
Facility
|
OP
|
$1,574.00
|
|
|
Service Code
|
CPT 21453
|
| Hospital Charge Code |
6121453
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$429.70 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$944.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$944.40
|
| Rate for Payer: Cash Price |
$944.40
|
| Rate for Payer: Cigna Commercial |
$1,337.90
|
| Rate for Payer: First Health Commercial |
$1,416.60
|
| Rate for Payer: First Health Workers Compensation |
$607.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,416.60
|
| Rate for Payer: GEHA Commercial |
$1,259.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,416.60
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,432.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,101.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,416.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,495.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,180.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,463.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$629.60
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$429.70
|
|
|
TREAT LOWER JAW FRACTURE
|
Facility
|
OP
|
$1,212.00
|
|
|
Service Code
|
CPT 21454
|
| Hospital Charge Code |
6121454
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$330.88 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$727.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Cigna Commercial |
$1,030.20
|
| Rate for Payer: First Health Commercial |
$1,090.80
|
| Rate for Payer: First Health Workers Compensation |
$467.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,090.80
|
| Rate for Payer: GEHA Commercial |
$969.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,090.80
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,102.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$848.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,090.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,151.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$909.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,127.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$484.80
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$330.88
|
|
|
TREAT LOWER JAW FRACTURE
|
Facility
|
IP
|
$1,212.00
|
|
|
Service Code
|
CPT 21454
|
| Hospital Charge Code |
6121454
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$330.88 |
| Max. Negotiated Rate |
$1,151.40 |
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Cigna Commercial |
$1,030.20
|
| Rate for Payer: First Health Commercial |
$1,090.80
|
| Rate for Payer: First Health Workers Compensation |
$467.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,090.80
|
| Rate for Payer: GEHA Commercial |
$848.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,090.80
|
| Rate for Payer: Multiplan All |
$1,102.92
|
| Rate for Payer: OMNI Networks Commercial |
$848.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,090.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,151.40
|
| Rate for Payer: Three Rivers Provider Network All |
$909.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,127.16
|
| Rate for Payer: Zelis Auto |
$484.80
|
| Rate for Payer: Zelis Worker's Compensation |
$330.88
|
|
|
TREAT LOWER JAW FRACTURE
|
Facility
|
OP
|
$1,970.00
|
|
|
Service Code
|
CPT 21465
|
| Hospital Charge Code |
6121465
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$537.81 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,182.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,182.00
|
| Rate for Payer: Cash Price |
$1,182.00
|
| Rate for Payer: Cigna Commercial |
$1,674.50
|
| Rate for Payer: First Health Commercial |
$1,773.00
|
| Rate for Payer: First Health Workers Compensation |
$760.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,773.00
|
| Rate for Payer: GEHA Commercial |
$1,576.00
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,773.00
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,792.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,379.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,773.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,871.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,477.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,832.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$788.00
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$537.81
|
|
|
TREAT LOWER JAW FRACTURE
|
Facility
|
OP
|
$877.00
|
|
|
Service Code
|
CPT 21452
|
| Hospital Charge Code |
6121452
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$239.42 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$526.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cigna Commercial |
$745.45
|
| Rate for Payer: First Health Commercial |
$789.30
|
| Rate for Payer: First Health Workers Compensation |
$338.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$789.30
|
| Rate for Payer: GEHA Commercial |
$701.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$789.30
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$798.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$613.90
|
| Rate for Payer: One Health Plan PPO/POS |
$789.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$833.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$657.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$815.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$350.80
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$239.42
|
|
|
TREAT LOWER JAW FRACTURE
|
Facility
|
IP
|
$3,318.00
|
|
|
Service Code
|
CPT 21462
|
| Hospital Charge Code |
6121462
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$905.81 |
| Max. Negotiated Rate |
$3,152.10 |
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna Commercial |
$2,820.30
|
| Rate for Payer: First Health Commercial |
$2,986.20
|
| Rate for Payer: First Health Workers Compensation |
$1,281.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,986.20
|
| Rate for Payer: GEHA Commercial |
$2,322.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,986.20
|
| Rate for Payer: Multiplan All |
$3,019.38
|
| Rate for Payer: OMNI Networks Commercial |
$2,322.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,986.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,152.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,488.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,085.74
|
| Rate for Payer: Zelis Auto |
$1,327.20
|
| Rate for Payer: Zelis Worker's Compensation |
$905.81
|
|
|
TREAT LOWER JAW FRACTURE
|
Facility
|
OP
|
$1,289.00
|
|
|
Service Code
|
CPT 21451
|
| Hospital Charge Code |
6121451
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$351.90 |
| Max. Negotiated Rate |
$2,813.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$773.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,406.53
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$1,095.65
|
| Rate for Payer: First Health Commercial |
$1,160.10
|
| Rate for Payer: First Health Workers Compensation |
$497.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,160.10
|
| Rate for Payer: GEHA Commercial |
$1,031.20
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,160.10
|
| Rate for Payer: Humana ChoiceCare |
$1,547.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,406.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,362.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,406.53
|
| Rate for Payer: Multiplan All |
$1,172.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$902.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,160.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,406.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,224.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$966.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,406.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,198.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$515.60
|
| Rate for Payer: Zelis Medicare |
$1,195.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,687.84
|
| Rate for Payer: Zelis Worker's Compensation |
$351.90
|
|
|
TREAT LOWER LEG BONE LESION
|
Facility
|
IP
|
$1,246.00
|
|
|
Service Code
|
CPT 27607
|
| Hospital Charge Code |
6127607
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$340.16 |
| Max. Negotiated Rate |
$1,183.70 |
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: Cigna Commercial |
$1,059.10
|
| Rate for Payer: First Health Commercial |
$1,121.40
|
| Rate for Payer: First Health Workers Compensation |
$481.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,121.40
|
| Rate for Payer: GEHA Commercial |
$872.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,121.40
|
| Rate for Payer: Multiplan All |
$1,133.86
|
| Rate for Payer: OMNI Networks Commercial |
$872.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,121.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,183.70
|
| Rate for Payer: Three Rivers Provider Network All |
$934.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,158.78
|
| Rate for Payer: Zelis Auto |
$498.40
|
| Rate for Payer: Zelis Worker's Compensation |
$340.16
|
|
|
TREAT LOWER LEG BONE LESION
|
Facility
|
OP
|
$1,246.00
|
|
|
Service Code
|
CPT 27607
|
| Hospital Charge Code |
6127607
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$340.16 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$747.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: Cigna Commercial |
$1,059.10
|
| Rate for Payer: First Health Commercial |
$1,121.40
|
| Rate for Payer: First Health Workers Compensation |
$481.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,121.40
|
| Rate for Payer: GEHA Commercial |
$996.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,121.40
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,133.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$872.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,121.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,183.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$934.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,158.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$498.40
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$340.16
|
|
|
TREAT LOWER LEG DISLOCATION
|
Facility
|
IP
|
$894.00
|
|
|
Service Code
|
CPT 27830
|
| Hospital Charge Code |
6127830
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$244.06 |
| Max. Negotiated Rate |
$849.30 |
| Rate for Payer: Cash Price |
$536.40
|
| Rate for Payer: Cigna Commercial |
$759.90
|
| Rate for Payer: First Health Commercial |
$804.60
|
| Rate for Payer: First Health Workers Compensation |
$345.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$804.60
|
| Rate for Payer: GEHA Commercial |
$625.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$804.60
|
| Rate for Payer: Multiplan All |
$813.54
|
| Rate for Payer: OMNI Networks Commercial |
$625.80
|
| Rate for Payer: One Health Plan PPO/POS |
$804.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$849.30
|
| Rate for Payer: Three Rivers Provider Network All |
$670.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$831.42
|
| Rate for Payer: Zelis Auto |
$357.60
|
| Rate for Payer: Zelis Worker's Compensation |
$244.06
|
|
|
TREAT LOWER LEG DISLOCATION
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
CPT 27831
|
| Hospital Charge Code |
6127831
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$271.63 |
| Max. Negotiated Rate |
$945.25 |
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cigna Commercial |
$845.75
|
| Rate for Payer: First Health Commercial |
$895.50
|
| Rate for Payer: First Health Workers Compensation |
$384.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$895.50
|
| Rate for Payer: GEHA Commercial |
$696.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$895.50
|
| Rate for Payer: Multiplan All |
$905.45
|
| Rate for Payer: OMNI Networks Commercial |
$696.50
|
| Rate for Payer: One Health Plan PPO/POS |
$895.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$945.25
|
| Rate for Payer: Three Rivers Provider Network All |
$746.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$925.35
|
| Rate for Payer: Zelis Auto |
$398.00
|
| Rate for Payer: Zelis Worker's Compensation |
$271.63
|
|
