|
TREATMENT OF ANKLE FRACTURE
|
Facility
|
IP
|
$970.00
|
|
|
Service Code
|
CPT 27788
|
| Hospital Charge Code |
6127788
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$264.81 |
| Max. Negotiated Rate |
$921.50 |
| Rate for Payer: Cash Price |
$582.00
|
| Rate for Payer: Cigna Commercial |
$824.50
|
| Rate for Payer: First Health Commercial |
$873.00
|
| Rate for Payer: First Health Workers Compensation |
$374.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$873.00
|
| Rate for Payer: GEHA Commercial |
$679.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$873.00
|
| Rate for Payer: Multiplan All |
$882.70
|
| Rate for Payer: OMNI Networks Commercial |
$679.00
|
| Rate for Payer: One Health Plan PPO/POS |
$873.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$921.50
|
| Rate for Payer: Three Rivers Provider Network All |
$727.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$902.10
|
| Rate for Payer: Zelis Auto |
$388.00
|
| Rate for Payer: Zelis Worker's Compensation |
$264.81
|
|
|
TREATMENT OF ANKLE FRACTURE
|
Facility
|
OP
|
$970.00
|
|
|
Service Code
|
CPT 27788
|
| Hospital Charge Code |
6127788
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$921.50 |
| 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 |
$582.00
|
| 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 |
$582.00
|
| Rate for Payer: Cash Price |
$582.00
|
| Rate for Payer: Cigna Commercial |
$824.50
|
| Rate for Payer: First Health Commercial |
$873.00
|
| Rate for Payer: First Health Workers Compensation |
$374.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$873.00
|
| Rate for Payer: GEHA Commercial |
$776.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$873.00
|
| 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 |
$882.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$679.00
|
| Rate for Payer: One Health Plan PPO/POS |
$873.00
|
| 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 |
$921.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$727.50
|
| 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 |
$902.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$388.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$264.81
|
|
|
TREATMENT OF ANKLE FRACTURE
|
Facility
|
OP
|
$857.00
|
|
|
Service Code
|
CPT 27810
|
| Hospital Charge Code |
6127810
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$233.96 |
| 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 |
$514.20
|
| 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 |
$514.20
|
| Rate for Payer: Cash Price |
$514.20
|
| Rate for Payer: Cigna Commercial |
$728.45
|
| Rate for Payer: First Health Commercial |
$771.30
|
| Rate for Payer: First Health Workers Compensation |
$330.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$771.30
|
| Rate for Payer: GEHA Commercial |
$685.60
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$771.30
|
| 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 |
$779.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$599.90
|
| Rate for Payer: One Health Plan PPO/POS |
$771.30
|
| 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 |
$814.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$642.75
|
| 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 |
$797.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$342.80
|
| 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 |
$233.96
|
|
|
TREATMENT OF ANKLE FRACTURE
|
Facility
|
IP
|
$908.00
|
|
|
Service Code
|
CPT 28436
|
| Hospital Charge Code |
6128436
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$247.88 |
| Max. Negotiated Rate |
$862.60 |
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cigna Commercial |
$771.80
|
| Rate for Payer: First Health Commercial |
$817.20
|
| Rate for Payer: First Health Workers Compensation |
$350.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$817.20
|
| Rate for Payer: GEHA Commercial |
$635.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$817.20
|
| Rate for Payer: Multiplan All |
$826.28
|
| Rate for Payer: OMNI Networks Commercial |
$635.60
|
| Rate for Payer: One Health Plan PPO/POS |
$817.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$862.60
|
| Rate for Payer: Three Rivers Provider Network All |
$681.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$844.44
|
| Rate for Payer: Zelis Auto |
$363.20
|
| Rate for Payer: Zelis Worker's Compensation |
$247.88
|
|
|
TREATMENT OF ANKLE FRACTURE
|
Facility
|
IP
|
$857.00
|
|
|
Service Code
|
CPT 27810
|
| Hospital Charge Code |
6127810
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$233.96 |
| Max. Negotiated Rate |
$814.15 |
| Rate for Payer: Cash Price |
$514.20
|
| Rate for Payer: Cigna Commercial |
$728.45
|
| Rate for Payer: First Health Commercial |
$771.30
|
| Rate for Payer: First Health Workers Compensation |
$330.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$771.30
|
| Rate for Payer: GEHA Commercial |
$599.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$771.30
|
| Rate for Payer: Multiplan All |
$779.87
|
| Rate for Payer: OMNI Networks Commercial |
$599.90
|
| Rate for Payer: One Health Plan PPO/POS |
$771.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$814.15
|
| Rate for Payer: Three Rivers Provider Network All |
$642.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$797.01
|
| Rate for Payer: Zelis Auto |
$342.80
|
| Rate for Payer: Zelis Worker's Compensation |
$233.96
|
|
|
TREATMENT OF ANKLE FRACTURE
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
CPT 28436
|
| Hospital Charge Code |
6128436
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$247.88 |
| 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 |
$544.80
|
| 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 |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cigna Commercial |
$771.80
|
| Rate for Payer: First Health Commercial |
$817.20
|
| Rate for Payer: First Health Workers Compensation |
$350.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$817.20
|
| Rate for Payer: GEHA Commercial |
$726.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$817.20
|
| 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 |
$826.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$635.60
|
| Rate for Payer: One Health Plan PPO/POS |
$817.20
|
| 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 |
$862.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$681.00
|
| 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 |
$844.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$363.20
|
| 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 |
$247.88
|
|
|
TREATMENT OF ANKLE FRACTURE
|
Facility
|
OP
|
$1,719.00
|
|
|
Service Code
|
CPT 27822
|
| Hospital Charge Code |
6127822
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$469.29 |
| 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 |
$1,031.40
|
| 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 |
$1,031.40
|
| Rate for Payer: Cash Price |
$1,031.40
|
| Rate for Payer: Cigna Commercial |
$1,461.15
|
| Rate for Payer: First Health Commercial |
$1,547.10
|
| Rate for Payer: First Health Workers Compensation |
$663.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,547.10
|
| Rate for Payer: GEHA Commercial |
$1,375.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,547.10
|
| 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 |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,564.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,203.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,547.10
|
| 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 |
$1,633.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,289.25
|
| 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 |
$1,598.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$687.60
|
| 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 |
$469.29
|
|
|
TREATMENT OF ANKLE FRACTURE
|
Facility
|
IP
|
$1,336.00
|
|
|
Service Code
|
CPT 27792
|
| Hospital Charge Code |
6127792
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$364.73 |
| Max. Negotiated Rate |
$1,269.20 |
| Rate for Payer: Cash Price |
$801.60
|
| Rate for Payer: Cigna Commercial |
$1,135.60
|
| Rate for Payer: First Health Commercial |
$1,202.40
|
| Rate for Payer: First Health Workers Compensation |
$515.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,202.40
|
| Rate for Payer: GEHA Commercial |
$935.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,202.40
|
| Rate for Payer: Multiplan All |
$1,215.76
|
| Rate for Payer: OMNI Networks Commercial |
$935.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,202.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,269.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,002.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,242.48
|
| Rate for Payer: Zelis Auto |
$534.40
|
| Rate for Payer: Zelis Worker's Compensation |
$364.73
|
|
|
TREATMENT OF ANKLE FRACTURE
|
Facility
|
IP
|
$879.00
|
|
|
Service Code
|
CPT 27818
|
| Hospital Charge Code |
6127818
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$239.97 |
| Max. Negotiated Rate |
$835.05 |
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cigna Commercial |
$747.15
|
| Rate for Payer: First Health Commercial |
$791.10
|
| Rate for Payer: First Health Workers Compensation |
$339.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$791.10
|
| Rate for Payer: GEHA Commercial |
$615.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$791.10
|
| Rate for Payer: Multiplan All |
$799.89
|
| Rate for Payer: OMNI Networks Commercial |
$615.30
|
| Rate for Payer: One Health Plan PPO/POS |
$791.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$835.05
|
| Rate for Payer: Three Rivers Provider Network All |
$659.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$817.47
|
| Rate for Payer: Zelis Auto |
$351.60
|
| Rate for Payer: Zelis Worker's Compensation |
$239.97
|
|
|
TREATMENT OF ANKLE FRACTURE
|
Facility
|
IP
|
$1,719.00
|
|
|
Service Code
|
CPT 27822
|
| Hospital Charge Code |
6127822
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$469.29 |
| Max. Negotiated Rate |
$1,633.05 |
| Rate for Payer: Cash Price |
$1,031.40
|
| Rate for Payer: Cigna Commercial |
$1,461.15
|
| Rate for Payer: First Health Commercial |
$1,547.10
|
| Rate for Payer: First Health Workers Compensation |
$663.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,547.10
|
| Rate for Payer: GEHA Commercial |
$1,203.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,547.10
|
| Rate for Payer: Multiplan All |
$1,564.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,203.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,547.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,633.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,289.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,598.67
|
| Rate for Payer: Zelis Auto |
$687.60
|
| Rate for Payer: Zelis Worker's Compensation |
$469.29
|
|
|
TREATMENT OF ANKLE FRACTURE
|
Facility
|
IP
|
$718.00
|
|
|
Service Code
|
CPT 28435
|
| Hospital Charge Code |
6128435
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$196.01 |
| Max. Negotiated Rate |
$682.10 |
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cigna Commercial |
$610.30
|
| Rate for Payer: First Health Commercial |
$646.20
|
| Rate for Payer: First Health Workers Compensation |
$277.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$646.20
|
| Rate for Payer: GEHA Commercial |
$502.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$646.20
|
| Rate for Payer: Multiplan All |
$653.38
|
| Rate for Payer: OMNI Networks Commercial |
$502.60
|
| Rate for Payer: One Health Plan PPO/POS |
$646.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$682.10
|
| Rate for Payer: Three Rivers Provider Network All |
$538.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$667.74
|
| Rate for Payer: Zelis Auto |
$287.20
|
| Rate for Payer: Zelis Worker's Compensation |
$196.01
|
|
|
TREATMENT OF ANKLE FRACTURE
|
Facility
|
OP
|
$1,336.00
|
|
|
Service Code
|
CPT 27792
|
| Hospital Charge Code |
6127792
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$364.73 |
| 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 |
$801.60
|
| 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 |
$801.60
|
| Rate for Payer: Cash Price |
$801.60
|
| Rate for Payer: Cigna Commercial |
$1,135.60
|
| Rate for Payer: First Health Commercial |
$1,202.40
|
| Rate for Payer: First Health Workers Compensation |
$515.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,202.40
|
| Rate for Payer: GEHA Commercial |
$1,068.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,202.40
|
| 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 |
$1,215.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$935.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,202.40
|
| 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 |
$1,269.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,002.00
|
| 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 |
$1,242.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$534.40
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$364.73
|
|
|
TREATMENT OF ANKLE FRACTURE
|
Facility
|
OP
|
$2,445.00
|
|
| Hospital Charge Code |
8127818
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$611.25 |
| Max. Negotiated Rate |
$2,322.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,467.00
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Cigna Commercial |
$2,078.25
|
| Rate for Payer: First Health Commercial |
$2,200.50
|
| Rate for Payer: First Health Workers Compensation |
$944.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,200.50
|
| Rate for Payer: GEHA Commercial |
$1,956.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,200.50
|
| Rate for Payer: Humana ChoiceCare |
$635.70
|
| Rate for Payer: Multiplan All |
$2,224.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,467.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,711.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,200.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,322.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,833.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,151.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$611.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,273.85
|
| Rate for Payer: Zelis Auto |
$978.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,222.50
|
| Rate for Payer: Zelis Worker's Compensation |
$667.49
|
|
|
TREATMENT OF FIBULA FRACTURE
|
Facility
|
IP
|
$987.00
|
|
|
Service Code
|
CPT 27781
|
| Hospital Charge Code |
6127781
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$269.45 |
| Max. Negotiated Rate |
$937.65 |
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cigna Commercial |
$838.95
|
| Rate for Payer: First Health Commercial |
$888.30
|
| Rate for Payer: First Health Workers Compensation |
$381.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$888.30
|
| Rate for Payer: GEHA Commercial |
$690.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$888.30
|
| Rate for Payer: Multiplan All |
$898.17
|
| Rate for Payer: OMNI Networks Commercial |
$690.90
|
| Rate for Payer: One Health Plan PPO/POS |
$888.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$937.65
|
| Rate for Payer: Three Rivers Provider Network All |
$740.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$917.91
|
| Rate for Payer: Zelis Auto |
$394.80
|
| Rate for Payer: Zelis Worker's Compensation |
$269.45
|
|
|
TREATMENT OF FIBULA FRACTURE
|
Facility
|
OP
|
$1,467.00
|
|
|
Service Code
|
CPT 27784
|
| Hospital Charge Code |
6127784
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$400.49 |
| 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 |
$880.20
|
| 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 |
$880.20
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cigna Commercial |
$1,246.95
|
| Rate for Payer: First Health Commercial |
$1,320.30
|
| Rate for Payer: First Health Workers Compensation |
$566.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,320.30
|
| Rate for Payer: GEHA Commercial |
$1,173.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,320.30
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,334.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,026.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,320.30
|
| 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 |
$1,393.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,100.25
|
| 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 |
$1,364.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$586.80
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$400.49
|
|
|
TREATMENT OF FIBULA FRACTURE
|
Facility
|
OP
|
$987.00
|
|
|
Service Code
|
CPT 27781
|
| Hospital Charge Code |
6127781
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$269.45 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,860.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$592.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,860.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,473.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cigna Commercial |
$838.95
|
| Rate for Payer: First Health Commercial |
$888.30
|
| Rate for Payer: First Health Workers Compensation |
$381.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$888.30
|
| Rate for Payer: GEHA Commercial |
$789.60
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$888.30
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,503.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$898.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$690.90
|
| Rate for Payer: One Health Plan PPO/POS |
$888.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,736.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,503.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$937.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$740.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,503.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$917.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$394.80
|
| 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 |
$269.45
|
|
|
TREATMENT OF FIBULA FRACTURE
|
Facility
|
IP
|
$1,467.00
|
|
|
Service Code
|
CPT 27784
|
| Hospital Charge Code |
6127784
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$400.49 |
| Max. Negotiated Rate |
$1,393.65 |
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cigna Commercial |
$1,246.95
|
| Rate for Payer: First Health Commercial |
$1,320.30
|
| Rate for Payer: First Health Workers Compensation |
$566.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,320.30
|
| Rate for Payer: GEHA Commercial |
$1,026.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,320.30
|
| Rate for Payer: Multiplan All |
$1,334.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,026.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,320.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,393.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,100.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,364.31
|
| Rate for Payer: Zelis Auto |
$586.80
|
| Rate for Payer: Zelis Worker's Compensation |
$400.49
|
|
|
TREATMENT OF FOOT INFECTION
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
CPT 28002
|
| Hospital Charge Code |
6128002
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$222.77 |
| Max. Negotiated Rate |
$3,039.30 |
| 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 |
$489.60
|
| 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 |
$1,519.65
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$693.60
|
| Rate for Payer: First Health Commercial |
$734.40
|
| Rate for Payer: First Health Workers Compensation |
$315.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$734.40
|
| Rate for Payer: GEHA Commercial |
$652.80
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$734.40
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$742.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$571.20
|
| Rate for Payer: One Health Plan PPO/POS |
$734.40
|
| 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 |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$775.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$612.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$758.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$326.40
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$222.77
|
|
|
TREATMENT OF FOOT INFECTION
|
Facility
|
IP
|
$1,161.00
|
|
|
Service Code
|
CPT 28003
|
| Hospital Charge Code |
6128003
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$316.95 |
| Max. Negotiated Rate |
$1,102.95 |
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cigna Commercial |
$986.85
|
| Rate for Payer: First Health Commercial |
$1,044.90
|
| Rate for Payer: First Health Workers Compensation |
$448.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.90
|
| Rate for Payer: GEHA Commercial |
$812.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.90
|
| Rate for Payer: Multiplan All |
$1,056.51
|
| Rate for Payer: OMNI Networks Commercial |
$812.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,102.95
|
| Rate for Payer: Three Rivers Provider Network All |
$870.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,079.73
|
| Rate for Payer: Zelis Auto |
$464.40
|
| Rate for Payer: Zelis Worker's Compensation |
$316.95
|
|
|
TREATMENT OF FOOT INFECTION
|
Facility
|
OP
|
$1,161.00
|
|
|
Service Code
|
CPT 28003
|
| Hospital Charge Code |
6128003
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$316.95 |
| 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 |
$696.60
|
| 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 |
$696.60
|
| Rate for Payer: Cash Price |
$696.60
|
| Rate for Payer: Cigna Commercial |
$986.85
|
| Rate for Payer: First Health Commercial |
$1,044.90
|
| Rate for Payer: First Health Workers Compensation |
$448.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.90
|
| Rate for Payer: GEHA Commercial |
$928.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.90
|
| 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 |
$1,056.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$812.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.90
|
| 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 |
$1,102.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$870.75
|
| 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 |
$1,079.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$464.40
|
| 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 |
$316.95
|
|
|
TREATMENT OF FOOT INFECTION
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
CPT 28002
|
| Hospital Charge Code |
6128002
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$222.77 |
| Max. Negotiated Rate |
$775.20 |
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$693.60
|
| Rate for Payer: First Health Commercial |
$734.40
|
| Rate for Payer: First Health Workers Compensation |
$315.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$734.40
|
| Rate for Payer: GEHA Commercial |
$571.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$734.40
|
| Rate for Payer: Multiplan All |
$742.56
|
| Rate for Payer: OMNI Networks Commercial |
$571.20
|
| Rate for Payer: One Health Plan PPO/POS |
$734.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$775.20
|
| Rate for Payer: Three Rivers Provider Network All |
$612.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$758.88
|
| Rate for Payer: Zelis Auto |
$326.40
|
| Rate for Payer: Zelis Worker's Compensation |
$222.77
|
|
|
TREATMENT OF HEAD INJURY
|
Facility
|
IP
|
$3,282.00
|
|
|
Service Code
|
CPT 62010
|
| Hospital Charge Code |
6162010
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$895.99 |
| Max. Negotiated Rate |
$3,117.90 |
| Rate for Payer: Cash Price |
$1,969.20
|
| Rate for Payer: Cigna Commercial |
$2,789.70
|
| Rate for Payer: First Health Commercial |
$2,953.80
|
| Rate for Payer: First Health Workers Compensation |
$1,267.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,953.80
|
| Rate for Payer: GEHA Commercial |
$2,297.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,953.80
|
| Rate for Payer: Multiplan All |
$2,986.62
|
| Rate for Payer: OMNI Networks Commercial |
$2,297.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,953.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,117.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,461.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,052.26
|
| Rate for Payer: Zelis Auto |
$1,312.80
|
| Rate for Payer: Zelis Worker's Compensation |
$895.99
|
|
|
TREATMENT OF HEAD INJURY
|
Facility
|
OP
|
$3,282.00
|
|
|
Service Code
|
CPT 62010
|
| Hospital Charge Code |
6162010
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$820.50 |
| Max. Negotiated Rate |
$3,117.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,969.20
|
| Rate for Payer: Cash Price |
$1,969.20
|
| Rate for Payer: Cigna Commercial |
$2,789.70
|
| Rate for Payer: First Health Commercial |
$2,953.80
|
| Rate for Payer: First Health Workers Compensation |
$1,267.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,953.80
|
| Rate for Payer: GEHA Commercial |
$2,625.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,953.80
|
| Rate for Payer: Humana ChoiceCare |
$853.32
|
| Rate for Payer: Multiplan All |
$2,986.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,969.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,297.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,953.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,117.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,461.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,888.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$820.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,052.26
|
| Rate for Payer: Zelis Auto |
$1,312.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,641.00
|
| Rate for Payer: Zelis Worker's Compensation |
$895.99
|
|
|
TREATMENT OF HEEL FRACTURE
|
Facility
|
IP
|
$1,063.00
|
|
|
Service Code
|
CPT 28406
|
| Hospital Charge Code |
6128406
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$290.20 |
| Max. Negotiated Rate |
$1,009.85 |
| Rate for Payer: Cash Price |
$637.80
|
| Rate for Payer: Cigna Commercial |
$903.55
|
| Rate for Payer: First Health Commercial |
$956.70
|
| Rate for Payer: First Health Workers Compensation |
$410.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$956.70
|
| Rate for Payer: GEHA Commercial |
$744.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$956.70
|
| Rate for Payer: Multiplan All |
$967.33
|
| Rate for Payer: OMNI Networks Commercial |
$744.10
|
| Rate for Payer: One Health Plan PPO/POS |
$956.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,009.85
|
| Rate for Payer: Three Rivers Provider Network All |
$797.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$988.59
|
| Rate for Payer: Zelis Auto |
$425.20
|
| Rate for Payer: Zelis Worker's Compensation |
$290.20
|
|
|
TREATMENT OF HEEL FRACTURE
|
Facility
|
OP
|
$1,063.00
|
|
|
Service Code
|
CPT 28406
|
| Hospital Charge Code |
6128406
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$290.20 |
| 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 |
$637.80
|
| 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 |
$637.80
|
| Rate for Payer: Cash Price |
$637.80
|
| Rate for Payer: Cigna Commercial |
$903.55
|
| Rate for Payer: First Health Commercial |
$956.70
|
| Rate for Payer: First Health Workers Compensation |
$410.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$956.70
|
| Rate for Payer: GEHA Commercial |
$850.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$956.70
|
| 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 |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$967.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$744.10
|
| Rate for Payer: One Health Plan PPO/POS |
$956.70
|
| 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 |
$1,009.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$797.25
|
| 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 |
$988.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$425.20
|
| 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 |
$290.20
|
|
