|
TREATMENT OF HEEL FRACTURE
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT 28405
|
| Hospital Charge Code |
6128405
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$247.34 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: First Health Workers Compensation |
$349.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$634.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: Zelis Auto |
$362.40
|
| Rate for Payer: Zelis Worker's Compensation |
$247.34
|
|
|
TREATMENT OF HEEL FRACTURE
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT 28405
|
| Hospital Charge Code |
6128405
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$193.61 |
| Max. Negotiated Rate |
$1,860.02 |
| 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 |
$543.60
|
| 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 |
$227.78
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$770.10
|
| Rate for Payer: First Health Commercial |
$815.40
|
| Rate for Payer: First Health Workers Compensation |
$349.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$815.40
|
| Rate for Payer: GEHA Commercial |
$724.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$815.40
|
| 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 |
$1,503.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$824.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$634.20
|
| Rate for Payer: One Health Plan PPO/POS |
$815.40
|
| 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 |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$860.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$679.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,503.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$842.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$362.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$247.34
|
|
|
TREATMENT OF INTERTROCHANTERIC, PERITROCHANTERIC, OR SUBTROCHANTERIC FEMORAL FRACTURE; WITH PLATE/SCREW TYPE IMPLANT, WITH OR WITHOUT CERCLAGE
|
Facility
|
OP
|
$3,729.97
|
|
|
Service Code
|
CPT 27244
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,637.35 |
| Max. Negotiated Rate |
$3,729.97 |
| Rate for Payer: First Health Workers Compensation |
$3,729.97
|
| Rate for Payer: Zelis Worker's Compensation |
$2,637.35
|
|
|
TREATMENT OF PENIS LESION
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
CPT 54110
|
| Hospital Charge Code |
6154110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$354.90 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cigna Commercial |
$1,105.00
|
| Rate for Payer: First Health Commercial |
$1,170.00
|
| Rate for Payer: First Health Workers Compensation |
$501.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,170.00
|
| Rate for Payer: GEHA Commercial |
$910.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,170.00
|
| Rate for Payer: Multiplan All |
$1,183.00
|
| Rate for Payer: OMNI Networks Commercial |
$910.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,170.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,235.00
|
| Rate for Payer: Three Rivers Provider Network All |
$975.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,209.00
|
| Rate for Payer: Zelis Auto |
$520.00
|
| Rate for Payer: Zelis Worker's Compensation |
$354.90
|
|
|
TREATMENT OF PENIS LESION
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
CPT 54110
|
| Hospital Charge Code |
6154110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$354.90 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$780.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,794.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cigna Commercial |
$1,105.00
|
| Rate for Payer: First Health Commercial |
$1,170.00
|
| Rate for Payer: First Health Workers Compensation |
$501.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,170.00
|
| Rate for Payer: GEHA Commercial |
$1,040.00
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,170.00
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,851.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$1,183.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$910.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,170.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,291.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,851.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,235.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$975.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,851.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,209.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$520.00
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$354.90
|
|
|
TREATMENT OF PENIS LESION
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 54200
|
| Hospital Charge Code |
6154200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$69.34 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$98.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$177.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Worker's Compensation |
$69.34
|
|
|
TREATMENT OF PENIS LESION
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT 54200
|
| Hospital Charge Code |
6154200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$69.34 |
| Max. Negotiated Rate |
$461.88 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$152.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$161.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$230.94
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$98.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$203.20
|
| Rate for Payer: GEHA Medicare |
$230.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Humana ChoiceCare |
$254.03
|
| Rate for Payer: Humana Medicare Advantage |
$230.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$387.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$165.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$230.94
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$392.60
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$190.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$165.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$230.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$461.88
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$226.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$230.94
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Medicare |
$196.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.13
|
| Rate for Payer: Zelis Worker's Compensation |
$69.34
|
|
|
TREATMENT OF PENIS LESION
|
Facility
|
IP
|
$1,380.00
|
|
| Hospital Charge Code |
8100060
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$376.74 |
| Max. Negotiated Rate |
$1,311.00 |
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cigna Commercial |
$1,173.00
|
| Rate for Payer: First Health Commercial |
$1,242.00
|
| Rate for Payer: First Health Workers Compensation |
$532.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,242.00
|
| Rate for Payer: GEHA Commercial |
$966.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,242.00
|
| Rate for Payer: Multiplan All |
$1,255.80
|
| Rate for Payer: OMNI Networks Commercial |
$966.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,242.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,311.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,035.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,283.40
|
| Rate for Payer: Zelis Auto |
$552.00
|
| Rate for Payer: Zelis Worker's Compensation |
$376.74
|
|
|
TREATMENT OF PENIS LESION
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
6154220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$113.57 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna Commercial |
$353.60
|
| Rate for Payer: First Health Commercial |
$374.40
|
| Rate for Payer: First Health Workers Compensation |
$160.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$374.40
|
| Rate for Payer: GEHA Commercial |
$291.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$374.40
|
| Rate for Payer: Multiplan All |
$378.56
|
| Rate for Payer: OMNI Networks Commercial |
$291.20
|
| Rate for Payer: One Health Plan PPO/POS |
$374.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$395.20
|
| Rate for Payer: Three Rivers Provider Network All |
$312.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$386.88
|
| Rate for Payer: Zelis Auto |
$166.40
|
| Rate for Payer: Zelis Worker's Compensation |
$113.57
|
|
|
TREATMENT OF PENIS LESION
|
Facility
|
OP
|
$1,380.00
|
|
| Hospital Charge Code |
8100060
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,311.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$828.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cigna Commercial |
$1,173.00
|
| Rate for Payer: First Health Commercial |
$1,242.00
|
| Rate for Payer: First Health Workers Compensation |
$532.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,242.00
|
| Rate for Payer: GEHA Commercial |
$1,104.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,242.00
|
| Rate for Payer: Humana ChoiceCare |
$358.80
|
| Rate for Payer: Multiplan All |
$1,255.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$828.00
|
| Rate for Payer: OMNI Networks Commercial |
$966.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,242.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,311.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,035.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,214.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$345.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,283.40
|
| Rate for Payer: Zelis Auto |
$552.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$690.00
|
| Rate for Payer: Zelis Worker's Compensation |
$376.74
|
|
|
TREATMENT OF PENIS LESION
|
Facility
|
IP
|
$1,092.00
|
|
|
Service Code
|
CPT 54205
|
| Hospital Charge Code |
6154205
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$298.12 |
| Max. Negotiated Rate |
$1,037.40 |
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cigna Commercial |
$928.20
|
| Rate for Payer: First Health Commercial |
$982.80
|
| Rate for Payer: First Health Workers Compensation |
$421.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$982.80
|
| Rate for Payer: GEHA Commercial |
$764.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$982.80
|
| Rate for Payer: Multiplan All |
$993.72
|
| Rate for Payer: OMNI Networks Commercial |
$764.40
|
| Rate for Payer: One Health Plan PPO/POS |
$982.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,037.40
|
| Rate for Payer: Three Rivers Provider Network All |
$819.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,015.56
|
| Rate for Payer: Zelis Auto |
$436.80
|
| Rate for Payer: Zelis Worker's Compensation |
$298.12
|
|
|
TREATMENT OF PENIS LESION
|
Facility
|
OP
|
$1,092.00
|
|
|
Service Code
|
CPT 54205
|
| Hospital Charge Code |
6154205
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$298.12 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$655.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,527.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,794.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cigna Commercial |
$928.20
|
| Rate for Payer: First Health Commercial |
$982.80
|
| Rate for Payer: First Health Workers Compensation |
$421.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$982.80
|
| Rate for Payer: GEHA Commercial |
$873.60
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$982.80
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,851.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$993.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$764.40
|
| Rate for Payer: One Health Plan PPO/POS |
$982.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,291.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,851.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,037.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$819.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,851.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,015.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$436.80
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$298.12
|
|
|
TREATMENT OF PENIS LESION
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
6154220
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$113.57 |
| Max. Negotiated Rate |
$461.88 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$249.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$161.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$230.94
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna Commercial |
$353.60
|
| Rate for Payer: First Health Commercial |
$374.40
|
| Rate for Payer: First Health Workers Compensation |
$160.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$374.40
|
| Rate for Payer: GEHA Commercial |
$332.80
|
| Rate for Payer: GEHA Medicare |
$230.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$374.40
|
| Rate for Payer: Humana ChoiceCare |
$254.03
|
| Rate for Payer: Humana Medicare Advantage |
$230.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$387.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$165.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$230.94
|
| Rate for Payer: Multiplan All |
$378.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$392.60
|
| Rate for Payer: OMNI Networks Commercial |
$291.20
|
| Rate for Payer: One Health Plan PPO/POS |
$374.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$190.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$165.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$230.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$395.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$461.88
|
| Rate for Payer: Three Rivers Provider Network All |
$312.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$226.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$386.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$230.94
|
| Rate for Payer: Zelis Auto |
$166.40
|
| Rate for Payer: Zelis Medicare |
$196.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.13
|
| Rate for Payer: Zelis Worker's Compensation |
$113.57
|
|
|
TREATMENT OF RECTAL PROLAPSE
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 45520
|
| Hospital Charge Code |
6145520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$1,731.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$75.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$865.71
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$106.25
|
| Rate for Payer: First Health Commercial |
$112.50
|
| Rate for Payer: First Health Workers Compensation |
$48.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$112.50
|
| Rate for Payer: GEHA Commercial |
$100.00
|
| Rate for Payer: GEHA Medicare |
$865.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$112.50
|
| Rate for Payer: Humana ChoiceCare |
$952.28
|
| Rate for Payer: Humana Medicare Advantage |
$865.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,454.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$865.71
|
| Rate for Payer: Multiplan All |
$113.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,471.71
|
| Rate for Payer: OMNI Networks Commercial |
$87.50
|
| Rate for Payer: One Health Plan PPO/POS |
$112.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$865.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$118.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,731.42
|
| Rate for Payer: Three Rivers Provider Network All |
$93.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$848.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$865.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$116.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$865.71
|
| Rate for Payer: Zelis Auto |
$50.00
|
| Rate for Payer: Zelis Medicare |
$735.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,038.85
|
| Rate for Payer: Zelis Worker's Compensation |
$34.12
|
|
|
TREATMENT OF RECTAL PROLAPSE
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 45520
|
| Hospital Charge Code |
6145520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$118.75 |
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$106.25
|
| Rate for Payer: First Health Commercial |
$112.50
|
| Rate for Payer: First Health Workers Compensation |
$48.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$112.50
|
| Rate for Payer: GEHA Commercial |
$87.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$112.50
|
| Rate for Payer: Multiplan All |
$113.75
|
| Rate for Payer: OMNI Networks Commercial |
$87.50
|
| Rate for Payer: One Health Plan PPO/POS |
$112.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$118.75
|
| Rate for Payer: Three Rivers Provider Network All |
$93.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$116.25
|
| Rate for Payer: Zelis Auto |
$50.00
|
| Rate for Payer: Zelis Worker's Compensation |
$34.12
|
|
|
TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; SIMPLE CLOSURE
|
Facility
|
OP
|
$1,162.48
|
|
|
Service Code
|
CPT 12020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$355.53 |
| Max. Negotiated Rate |
$1,162.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$355.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: First Health Workers Compensation |
$748.06
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Humana ChoiceCare |
$639.36
|
| Rate for Payer: Humana Medicare Advantage |
$581.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$976.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$362.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$418.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$362.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$362.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$528.93
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
IP
|
$1,401.00
|
|
|
Service Code
|
CPT 27510
|
| Hospital Charge Code |
6127510
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$382.47 |
| Max. Negotiated Rate |
$1,330.95 |
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Cigna Commercial |
$1,190.85
|
| Rate for Payer: First Health Commercial |
$1,260.90
|
| Rate for Payer: First Health Workers Compensation |
$540.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,260.90
|
| Rate for Payer: GEHA Commercial |
$980.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,260.90
|
| Rate for Payer: Multiplan All |
$1,274.91
|
| Rate for Payer: OMNI Networks Commercial |
$980.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,260.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,330.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,050.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,302.93
|
| Rate for Payer: Zelis Auto |
$560.40
|
| Rate for Payer: Zelis Worker's Compensation |
$382.47
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
OP
|
$1,648.00
|
|
|
Service Code
|
CPT 27503
|
| Hospital Charge Code |
6127503
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$3,039.30 |
| 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 |
$988.80
|
| 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 |
$1,519.65
|
| Rate for Payer: Cash Price |
$988.80
|
| Rate for Payer: Cash Price |
$988.80
|
| Rate for Payer: Cigna Commercial |
$1,400.80
|
| Rate for Payer: First Health Commercial |
$1,483.20
|
| Rate for Payer: First Health Workers Compensation |
$636.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,483.20
|
| Rate for Payer: GEHA Commercial |
$1,318.40
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,483.20
|
| 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 |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$1,499.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$1,153.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,483.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,565.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,236.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,532.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$659.20
|
| 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 |
$449.90
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
IP
|
$2,761.00
|
|
|
Service Code
|
CPT 27506
|
| Hospital Charge Code |
6127506
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$753.75 |
| Max. Negotiated Rate |
$2,622.95 |
| Rate for Payer: Cash Price |
$1,656.60
|
| Rate for Payer: Cigna Commercial |
$2,346.85
|
| Rate for Payer: First Health Commercial |
$2,484.90
|
| Rate for Payer: First Health Workers Compensation |
$1,066.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,484.90
|
| Rate for Payer: GEHA Commercial |
$1,932.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,484.90
|
| Rate for Payer: Multiplan All |
$2,512.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,932.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,484.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,622.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,070.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,567.73
|
| Rate for Payer: Zelis Auto |
$1,104.40
|
| Rate for Payer: Zelis Worker's Compensation |
$753.75
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
OP
|
$2,761.00
|
|
|
Service Code
|
CPT 27506
|
| Hospital Charge Code |
6127506
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$690.25 |
| Max. Negotiated Rate |
$2,622.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,656.60
|
| Rate for Payer: Cash Price |
$1,656.60
|
| Rate for Payer: Cigna Commercial |
$2,346.85
|
| Rate for Payer: First Health Commercial |
$2,484.90
|
| Rate for Payer: First Health Workers Compensation |
$1,066.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,484.90
|
| Rate for Payer: GEHA Commercial |
$2,208.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,484.90
|
| Rate for Payer: Humana ChoiceCare |
$717.86
|
| Rate for Payer: Multiplan All |
$2,512.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,656.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,932.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,484.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,622.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,070.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,429.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$690.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,567.73
|
| Rate for Payer: Zelis Auto |
$1,104.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,380.50
|
| Rate for Payer: Zelis Worker's Compensation |
$753.75
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
IP
|
$2,009.00
|
|
|
Service Code
|
CPT 27507
|
| Hospital Charge Code |
6127507
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$548.46 |
| Max. Negotiated Rate |
$1,908.55 |
| Rate for Payer: Cash Price |
$1,205.40
|
| Rate for Payer: Cigna Commercial |
$1,707.65
|
| Rate for Payer: First Health Commercial |
$1,808.10
|
| Rate for Payer: First Health Workers Compensation |
$775.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,808.10
|
| Rate for Payer: GEHA Commercial |
$1,406.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,808.10
|
| Rate for Payer: Multiplan All |
$1,828.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,406.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,808.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,908.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,506.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,868.37
|
| Rate for Payer: Zelis Auto |
$803.60
|
| Rate for Payer: Zelis Worker's Compensation |
$548.46
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
OP
|
$2,009.00
|
|
|
Service Code
|
CPT 27507
|
| Hospital Charge Code |
6127507
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$502.25 |
| Max. Negotiated Rate |
$1,908.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,205.40
|
| Rate for Payer: Cash Price |
$1,205.40
|
| Rate for Payer: Cigna Commercial |
$1,707.65
|
| Rate for Payer: First Health Commercial |
$1,808.10
|
| Rate for Payer: First Health Workers Compensation |
$775.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,808.10
|
| Rate for Payer: GEHA Commercial |
$1,607.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,808.10
|
| Rate for Payer: Humana ChoiceCare |
$522.34
|
| Rate for Payer: Multiplan All |
$1,828.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,205.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,406.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,808.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,908.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,506.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,767.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$502.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,868.37
|
| Rate for Payer: Zelis Auto |
$803.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,004.50
|
| Rate for Payer: Zelis Worker's Compensation |
$548.46
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
CPT 27508
|
| Hospital Charge Code |
6127508
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$273.82 |
| Max. Negotiated Rate |
$952.85 |
| Rate for Payer: Cash Price |
$601.80
|
| Rate for Payer: Cigna Commercial |
$852.55
|
| Rate for Payer: First Health Commercial |
$902.70
|
| Rate for Payer: First Health Workers Compensation |
$387.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$902.70
|
| Rate for Payer: GEHA Commercial |
$702.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$902.70
|
| Rate for Payer: Multiplan All |
$912.73
|
| Rate for Payer: OMNI Networks Commercial |
$702.10
|
| Rate for Payer: One Health Plan PPO/POS |
$902.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$952.85
|
| Rate for Payer: Three Rivers Provider Network All |
$752.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$932.79
|
| Rate for Payer: Zelis Auto |
$401.20
|
| Rate for Payer: Zelis Worker's Compensation |
$273.82
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
IP
|
$1,306.00
|
|
|
Service Code
|
CPT 27509
|
| Hospital Charge Code |
6127509
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$356.54 |
| Max. Negotiated Rate |
$1,240.70 |
| Rate for Payer: Cash Price |
$783.60
|
| Rate for Payer: Cigna Commercial |
$1,110.10
|
| Rate for Payer: First Health Commercial |
$1,175.40
|
| Rate for Payer: First Health Workers Compensation |
$504.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,175.40
|
| Rate for Payer: GEHA Commercial |
$914.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,175.40
|
| Rate for Payer: Multiplan All |
$1,188.46
|
| Rate for Payer: OMNI Networks Commercial |
$914.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,175.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,240.70
|
| Rate for Payer: Three Rivers Provider Network All |
$979.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,214.58
|
| Rate for Payer: Zelis Auto |
$522.40
|
| Rate for Payer: Zelis Worker's Compensation |
$356.54
|
|
|
TREATMENT OF THIGH FRACTURE
|
Facility
|
IP
|
$2,062.00
|
|
|
Service Code
|
CPT 27511
|
| Hospital Charge Code |
6127511
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$562.93 |
| Max. Negotiated Rate |
$1,958.90 |
| Rate for Payer: Cash Price |
$1,237.20
|
| Rate for Payer: Cigna Commercial |
$1,752.70
|
| Rate for Payer: First Health Commercial |
$1,855.80
|
| Rate for Payer: First Health Workers Compensation |
$796.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,855.80
|
| Rate for Payer: GEHA Commercial |
$1,443.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,855.80
|
| Rate for Payer: Multiplan All |
$1,876.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,443.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,855.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,958.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,546.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,917.66
|
| Rate for Payer: Zelis Auto |
$824.80
|
| Rate for Payer: Zelis Worker's Compensation |
$562.93
|
|
