|
TREAT METACARPAL FRACTURE
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
6126600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$187.28 |
| Max. Negotiated Rate |
$651.70 |
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cigna Commercial |
$583.10
|
| Rate for Payer: First Health Commercial |
$617.40
|
| Rate for Payer: First Health Workers Compensation |
$264.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$617.40
|
| Rate for Payer: GEHA Commercial |
$480.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$617.40
|
| Rate for Payer: Multiplan All |
$624.26
|
| Rate for Payer: OMNI Networks Commercial |
$480.20
|
| Rate for Payer: One Health Plan PPO/POS |
$617.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$651.70
|
| Rate for Payer: Three Rivers Provider Network All |
$514.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.98
|
| Rate for Payer: Zelis Auto |
$274.40
|
| Rate for Payer: Zelis Worker's Compensation |
$187.28
|
|
|
TREAT METACARPAL FRACTURE
|
Facility
|
OP
|
$919.00
|
|
|
Service Code
|
CPT 26607
|
| Hospital Charge Code |
6126607
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$250.89 |
| Max. Negotiated Rate |
$6,161.78 |
| 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 |
$551.40
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$551.40
|
| Rate for Payer: Cash Price |
$551.40
|
| Rate for Payer: Cigna Commercial |
$781.15
|
| Rate for Payer: First Health Commercial |
$827.10
|
| Rate for Payer: First Health Workers Compensation |
$354.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$827.10
|
| Rate for Payer: GEHA Commercial |
$735.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$827.10
|
| 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 |
$1,503.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$836.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$643.30
|
| Rate for Payer: One Health Plan PPO/POS |
$827.10
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$873.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$689.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,503.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$854.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$367.60
|
| 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 |
$250.89
|
|
|
TREAT METACARPAL FRACTURE
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
6126600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$651.70 |
| 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 |
$411.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cigna Commercial |
$583.10
|
| Rate for Payer: First Health Commercial |
$617.40
|
| Rate for Payer: First Health Workers Compensation |
$264.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$617.40
|
| Rate for Payer: GEHA Commercial |
$548.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$617.40
|
| 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 |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$624.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$480.20
|
| Rate for Payer: One Health Plan PPO/POS |
$617.40
|
| 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 |
$651.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$514.50
|
| 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 |
$637.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$274.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$187.28
|
|
|
TREAT METACARPAL FRACTURE
|
Facility
|
IP
|
$919.00
|
|
|
Service Code
|
CPT 26607
|
| Hospital Charge Code |
6126607
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$250.89 |
| Max. Negotiated Rate |
$873.05 |
| Rate for Payer: Cash Price |
$551.40
|
| Rate for Payer: Cigna Commercial |
$781.15
|
| Rate for Payer: First Health Commercial |
$827.10
|
| Rate for Payer: First Health Workers Compensation |
$354.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$827.10
|
| Rate for Payer: GEHA Commercial |
$643.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$827.10
|
| Rate for Payer: Multiplan All |
$836.29
|
| Rate for Payer: OMNI Networks Commercial |
$643.30
|
| Rate for Payer: One Health Plan PPO/POS |
$827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$873.05
|
| Rate for Payer: Three Rivers Provider Network All |
$689.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$854.67
|
| Rate for Payer: Zelis Auto |
$367.60
|
| Rate for Payer: Zelis Worker's Compensation |
$250.89
|
|
|
TREAT METACARPAL FRACTURE
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
6126605
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$694.45 |
| 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 |
$438.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$621.35
|
| Rate for Payer: First Health Commercial |
$657.90
|
| Rate for Payer: First Health Workers Compensation |
$282.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$657.90
|
| Rate for Payer: GEHA Commercial |
$584.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$657.90
|
| 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 |
$665.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$511.70
|
| Rate for Payer: One Health Plan PPO/POS |
$657.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$694.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$548.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$679.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$292.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$199.56
|
|
|
TREAT METACARPAL FRACTURE
|
Facility
|
OP
|
$1,708.95
|
|
|
Service Code
|
CPT 26615
|
| Hospital Charge Code |
6126615
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$466.54 |
| Max. Negotiated Rate |
$6,161.78 |
| 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 |
$1,025.37
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,025.37
|
| Rate for Payer: Cash Price |
$1,025.37
|
| Rate for Payer: Cigna Commercial |
$1,452.61
|
| Rate for Payer: First Health Commercial |
$1,538.06
|
| Rate for Payer: First Health Workers Compensation |
$659.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,538.06
|
| Rate for Payer: GEHA Commercial |
$1,367.16
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,538.06
|
| 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 |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,555.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,196.27
|
| Rate for Payer: One Health Plan PPO/POS |
$1,538.06
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,623.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,281.71
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,589.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$683.58
|
| 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 |
$466.54
|
|
|
TREAT METATARSAL FRACTURE
|
Facility
|
OP
|
$1,107.87
|
|
|
Service Code
|
CPT 28476
|
| Hospital Charge Code |
6128476
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$302.45 |
| Max. Negotiated Rate |
$6,161.78 |
| 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 |
$664.72
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$664.72
|
| Rate for Payer: Cash Price |
$664.72
|
| Rate for Payer: Cigna Commercial |
$941.69
|
| Rate for Payer: First Health Commercial |
$997.08
|
| Rate for Payer: First Health Workers Compensation |
$427.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$997.08
|
| Rate for Payer: GEHA Commercial |
$886.30
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$997.08
|
| 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 |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,008.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$775.51
|
| Rate for Payer: One Health Plan PPO/POS |
$997.08
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,052.48
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$830.90
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,030.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$443.15
|
| 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 |
$302.45
|
|
|
TREAT METATARSAL FRACTURE
|
Facility
|
OP
|
$577.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
6128475
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$548.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$346.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cigna Commercial |
$490.45
|
| Rate for Payer: First Health Commercial |
$519.30
|
| Rate for Payer: First Health Workers Compensation |
$222.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$519.30
|
| Rate for Payer: GEHA Commercial |
$461.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$519.30
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$525.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$403.90
|
| Rate for Payer: One Health Plan PPO/POS |
$519.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$548.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$432.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$536.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$230.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$157.52
|
|
|
TREAT METATARSAL FRACTURE
|
Facility
|
OP
|
$1,605.90
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
6128485
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$438.41 |
| 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 |
$963.54
|
| 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 |
$963.54
|
| Rate for Payer: Cash Price |
$963.54
|
| Rate for Payer: Cigna Commercial |
$1,365.02
|
| Rate for Payer: First Health Commercial |
$1,445.31
|
| Rate for Payer: First Health Workers Compensation |
$620.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,445.31
|
| Rate for Payer: GEHA Commercial |
$1,284.72
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,445.31
|
| 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 |
$1,461.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,124.13
|
| Rate for Payer: One Health Plan PPO/POS |
$1,445.31
|
| 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 |
$1,525.61
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,204.42
|
| 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 |
$1,493.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$642.36
|
| 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 |
$438.41
|
|
|
TREAT METATARSAL FRACTURE
|
Facility
|
IP
|
$1,605.90
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
6128485
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$438.41 |
| Max. Negotiated Rate |
$1,525.61 |
| Rate for Payer: Cash Price |
$963.54
|
| Rate for Payer: Cigna Commercial |
$1,365.02
|
| Rate for Payer: First Health Commercial |
$1,445.31
|
| Rate for Payer: First Health Workers Compensation |
$620.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,445.31
|
| Rate for Payer: GEHA Commercial |
$1,124.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,445.31
|
| Rate for Payer: Multiplan All |
$1,461.37
|
| Rate for Payer: OMNI Networks Commercial |
$1,124.13
|
| Rate for Payer: One Health Plan PPO/POS |
$1,445.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,525.61
|
| Rate for Payer: Three Rivers Provider Network All |
$1,204.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,493.49
|
| Rate for Payer: Zelis Auto |
$642.36
|
| Rate for Payer: Zelis Worker's Compensation |
$438.41
|
|
|
TREAT METATARSAL FRACTURE
|
Facility
|
IP
|
$1,107.87
|
|
|
Service Code
|
CPT 28476
|
| Hospital Charge Code |
6128476
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$302.45 |
| Max. Negotiated Rate |
$1,052.48 |
| Rate for Payer: Cash Price |
$664.72
|
| Rate for Payer: Cigna Commercial |
$941.69
|
| Rate for Payer: First Health Commercial |
$997.08
|
| Rate for Payer: First Health Workers Compensation |
$427.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$997.08
|
| Rate for Payer: GEHA Commercial |
$775.51
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$997.08
|
| Rate for Payer: Multiplan All |
$1,008.16
|
| Rate for Payer: OMNI Networks Commercial |
$775.51
|
| Rate for Payer: One Health Plan PPO/POS |
$997.08
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,052.48
|
| Rate for Payer: Three Rivers Provider Network All |
$830.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,030.32
|
| Rate for Payer: Zelis Auto |
$443.15
|
| Rate for Payer: Zelis Worker's Compensation |
$302.45
|
|
|
TREAT METATARSAL FRACTURE
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
6128475
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$157.52 |
| Max. Negotiated Rate |
$548.15 |
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cigna Commercial |
$490.45
|
| Rate for Payer: First Health Commercial |
$519.30
|
| Rate for Payer: First Health Workers Compensation |
$222.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$519.30
|
| Rate for Payer: GEHA Commercial |
$403.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$519.30
|
| Rate for Payer: Multiplan All |
$525.07
|
| Rate for Payer: OMNI Networks Commercial |
$403.90
|
| Rate for Payer: One Health Plan PPO/POS |
$519.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$548.15
|
| Rate for Payer: Three Rivers Provider Network All |
$432.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$536.61
|
| Rate for Payer: Zelis Auto |
$230.80
|
| Rate for Payer: Zelis Worker's Compensation |
$157.52
|
|
|
TREAT MIDFOOT FRACTURE
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
CPT 28456
|
| Hospital Charge Code |
6128456
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna Commercial |
$680.00
|
| Rate for Payer: First Health Commercial |
$720.00
|
| Rate for Payer: First Health Workers Compensation |
$308.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$720.00
|
| Rate for Payer: GEHA Commercial |
$560.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$720.00
|
| Rate for Payer: Multiplan All |
$728.00
|
| Rate for Payer: OMNI Networks Commercial |
$560.00
|
| Rate for Payer: One Health Plan PPO/POS |
$720.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$760.00
|
| Rate for Payer: Three Rivers Provider Network All |
$600.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$744.00
|
| Rate for Payer: Zelis Auto |
$320.00
|
| Rate for Payer: Zelis Worker's Compensation |
$218.40
|
|
|
TREAT MIDFOOT FRACTURE
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
CPT 28456
|
| Hospital Charge Code |
6128456
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$218.40 |
| 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 |
$480.00
|
| 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 |
$480.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna Commercial |
$680.00
|
| Rate for Payer: First Health Commercial |
$720.00
|
| Rate for Payer: First Health Workers Compensation |
$308.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$720.00
|
| Rate for Payer: GEHA Commercial |
$640.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$720.00
|
| 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 |
$728.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$560.00
|
| Rate for Payer: One Health Plan PPO/POS |
$720.00
|
| 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 |
$760.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$600.00
|
| 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 |
$744.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$320.00
|
| 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 |
$218.40
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Facility
|
IP
|
$656.00
|
|
|
Service Code
|
CPT 28455
|
| Hospital Charge Code |
6128455
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$179.09 |
| Max. Negotiated Rate |
$623.20 |
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cigna Commercial |
$557.60
|
| Rate for Payer: First Health Commercial |
$590.40
|
| Rate for Payer: First Health Workers Compensation |
$253.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$590.40
|
| Rate for Payer: GEHA Commercial |
$459.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$590.40
|
| Rate for Payer: Multiplan All |
$596.96
|
| Rate for Payer: OMNI Networks Commercial |
$459.20
|
| Rate for Payer: One Health Plan PPO/POS |
$590.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$623.20
|
| Rate for Payer: Three Rivers Provider Network All |
$492.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$610.08
|
| Rate for Payer: Zelis Auto |
$262.40
|
| Rate for Payer: Zelis Worker's Compensation |
$179.09
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Facility
|
OP
|
$656.00
|
|
|
Service Code
|
CPT 28455
|
| Hospital Charge Code |
6128455
|
|
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 |
$393.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cigna Commercial |
$557.60
|
| Rate for Payer: First Health Commercial |
$590.40
|
| Rate for Payer: First Health Workers Compensation |
$253.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$590.40
|
| Rate for Payer: GEHA Commercial |
$524.80
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$590.40
|
| 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 |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$596.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$459.20
|
| Rate for Payer: One Health Plan PPO/POS |
$590.40
|
| 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 |
$623.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$492.00
|
| 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 |
$610.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$262.40
|
| 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 |
$179.09
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Facility
|
OP
|
$1,273.00
|
|
|
Service Code
|
CPT 28465
|
| Hospital Charge Code |
6128465
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$347.53 |
| 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 |
$763.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$763.80
|
| Rate for Payer: Cash Price |
$763.80
|
| Rate for Payer: Cigna Commercial |
$1,082.05
|
| Rate for Payer: First Health Commercial |
$1,145.70
|
| Rate for Payer: First Health Workers Compensation |
$491.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,145.70
|
| Rate for Payer: GEHA Commercial |
$1,018.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,145.70
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,158.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$891.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,145.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,209.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$954.75
|
| 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 |
$1,183.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$509.20
|
| 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 |
$347.53
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Facility
|
IP
|
$1,273.00
|
|
|
Service Code
|
CPT 28465
|
| Hospital Charge Code |
6128465
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$347.53 |
| Max. Negotiated Rate |
$1,209.35 |
| Rate for Payer: Cash Price |
$763.80
|
| Rate for Payer: Cigna Commercial |
$1,082.05
|
| Rate for Payer: First Health Commercial |
$1,145.70
|
| Rate for Payer: First Health Workers Compensation |
$491.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,145.70
|
| Rate for Payer: GEHA Commercial |
$891.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,145.70
|
| Rate for Payer: Multiplan All |
$1,158.43
|
| Rate for Payer: OMNI Networks Commercial |
$891.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,145.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,209.35
|
| Rate for Payer: Three Rivers Provider Network All |
$954.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,183.89
|
| Rate for Payer: Zelis Auto |
$509.20
|
| Rate for Payer: Zelis Worker's Compensation |
$347.53
|
|
|
TREATMNT CLOSED ELBOW DISLOCATION REQ AN
|
Facility
|
IP
|
$3,695.00
|
|
|
Service Code
|
CPT 24605
|
| Hospital Charge Code |
8124605
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,008.74 |
| Max. Negotiated Rate |
$3,510.25 |
| Rate for Payer: Cash Price |
$2,217.00
|
| Rate for Payer: Cigna Commercial |
$3,140.75
|
| Rate for Payer: First Health Commercial |
$3,325.50
|
| Rate for Payer: First Health Workers Compensation |
$1,426.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,325.50
|
| Rate for Payer: GEHA Commercial |
$2,586.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,325.50
|
| Rate for Payer: Multiplan All |
$3,362.45
|
| Rate for Payer: OMNI Networks Commercial |
$2,586.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,325.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,510.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,771.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,436.35
|
| Rate for Payer: Zelis Auto |
$1,478.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,008.74
|
|
|
TREATMNT CLOSED ELBOW DISLOCATION REQ AN
|
Facility
|
OP
|
$3,695.00
|
|
|
Service Code
|
CPT 24605
|
| Hospital Charge Code |
8124605
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,008.74 |
| Max. Negotiated Rate |
$3,510.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,217.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,224.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$2,217.00
|
| Rate for Payer: Cash Price |
$2,217.00
|
| Rate for Payer: Cigna Commercial |
$3,140.75
|
| Rate for Payer: First Health Commercial |
$3,325.50
|
| Rate for Payer: First Health Workers Compensation |
$1,426.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,325.50
|
| Rate for Payer: GEHA Commercial |
$2,956.00
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,325.50
|
| 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 |
$1,249.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$3,362.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$2,586.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,325.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,443.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,249.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,510.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,771.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,249.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,436.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$1,478.00
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$1,008.74
|
|
|
TREATMNT CLOSED ELBOW DISLOCATION REQ AN
|
Facility
|
IP
|
$3,695.00
|
|
|
Service Code
|
CPT 24605
|
| Hospital Charge Code |
6124605
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,008.74 |
| Max. Negotiated Rate |
$3,510.25 |
| Rate for Payer: Cash Price |
$2,217.00
|
| Rate for Payer: Cigna Commercial |
$3,140.75
|
| Rate for Payer: First Health Commercial |
$3,325.50
|
| Rate for Payer: First Health Workers Compensation |
$1,426.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,325.50
|
| Rate for Payer: GEHA Commercial |
$2,586.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,325.50
|
| Rate for Payer: Multiplan All |
$3,362.45
|
| Rate for Payer: OMNI Networks Commercial |
$2,586.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,325.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,510.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,771.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,436.35
|
| Rate for Payer: Zelis Auto |
$1,478.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,008.74
|
|
|
TREATMNT CLOSED ELBOW DISLOCATION REQ AN
|
Facility
|
OP
|
$3,695.00
|
|
|
Service Code
|
CPT 24605
|
| Hospital Charge Code |
6124605
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,008.74 |
| Max. Negotiated Rate |
$3,510.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,217.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,224.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$2,217.00
|
| Rate for Payer: Cash Price |
$2,217.00
|
| Rate for Payer: Cigna Commercial |
$3,140.75
|
| Rate for Payer: First Health Commercial |
$3,325.50
|
| Rate for Payer: First Health Workers Compensation |
$1,426.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,325.50
|
| Rate for Payer: GEHA Commercial |
$2,956.00
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,325.50
|
| 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 |
$1,249.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$3,362.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$2,586.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,325.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,443.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,249.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,510.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,771.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,249.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,436.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$1,478.00
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$1,008.74
|
|
|
TREAT MOUTH ROOF FRACTURE
|
Facility
|
IP
|
$1,284.00
|
|
|
Service Code
|
CPT 21421
|
| Hospital Charge Code |
6121421
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$350.53 |
| Max. Negotiated Rate |
$1,219.80 |
| Rate for Payer: Cash Price |
$770.40
|
| Rate for Payer: Cigna Commercial |
$1,091.40
|
| Rate for Payer: First Health Commercial |
$1,155.60
|
| Rate for Payer: First Health Workers Compensation |
$495.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,155.60
|
| Rate for Payer: GEHA Commercial |
$898.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,155.60
|
| Rate for Payer: Multiplan All |
$1,168.44
|
| Rate for Payer: OMNI Networks Commercial |
$898.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,155.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,219.80
|
| Rate for Payer: Three Rivers Provider Network All |
$963.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,194.12
|
| Rate for Payer: Zelis Auto |
$513.60
|
| Rate for Payer: Zelis Worker's Compensation |
$350.53
|
|
|
TREAT MOUTH ROOF FRACTURE
|
Facility
|
OP
|
$1,284.00
|
|
|
Service Code
|
CPT 21421
|
| Hospital Charge Code |
6121421
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$350.53 |
| Max. Negotiated Rate |
$6,158.84 |
| 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 |
$770.40
|
| 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 |
$3,079.42
|
| Rate for Payer: Cash Price |
$770.40
|
| Rate for Payer: Cash Price |
$770.40
|
| Rate for Payer: Cigna Commercial |
$1,091.40
|
| Rate for Payer: First Health Commercial |
$1,155.60
|
| Rate for Payer: First Health Workers Compensation |
$495.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,155.60
|
| Rate for Payer: GEHA Commercial |
$1,027.20
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,155.60
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$1,168.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$898.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,155.60
|
| 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 |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,219.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$963.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,194.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$513.60
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$350.53
|
|
|
TREAT NECK SPINE FRACTURE
|
Facility
|
IP
|
$3,147.00
|
|
|
Service Code
|
CPT 22326
|
| Hospital Charge Code |
6122326
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$859.13 |
| Max. Negotiated Rate |
$2,989.65 |
| Rate for Payer: Cash Price |
$1,888.20
|
| Rate for Payer: Cigna Commercial |
$2,674.95
|
| Rate for Payer: First Health Commercial |
$2,832.30
|
| Rate for Payer: First Health Workers Compensation |
$1,215.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,832.30
|
| Rate for Payer: GEHA Commercial |
$2,202.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,832.30
|
| Rate for Payer: Multiplan All |
$2,863.77
|
| Rate for Payer: OMNI Networks Commercial |
$2,202.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,832.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,989.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,360.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,926.71
|
| Rate for Payer: Zelis Auto |
$1,258.80
|
| Rate for Payer: Zelis Worker's Compensation |
$859.13
|
|
