|
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
|
|
|
TREAT ODONTOID FX W/GRAFT
|
Facility
|
IP
|
$3,887.00
|
|
|
Service Code
|
CPT 22319
|
| Hospital Charge Code |
6122319
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,061.15 |
| Max. Negotiated Rate |
$3,692.65 |
| Rate for Payer: Cash Price |
$2,332.20
|
| Rate for Payer: Cigna Commercial |
$3,303.95
|
| Rate for Payer: First Health Commercial |
$3,498.30
|
| Rate for Payer: First Health Workers Compensation |
$1,500.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,498.30
|
| Rate for Payer: GEHA Commercial |
$2,720.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,498.30
|
| Rate for Payer: Multiplan All |
$3,537.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,720.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,498.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,692.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,915.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,614.91
|
| Rate for Payer: Zelis Auto |
$1,554.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,061.15
|
|
|
TREAT ODONTOID FX W/GRAFT
|
Facility
|
OP
|
$3,887.00
|
|
|
Service Code
|
CPT 22319
|
| Hospital Charge Code |
6122319
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$971.75 |
| Max. Negotiated Rate |
$3,692.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,332.20
|
| Rate for Payer: Cash Price |
$2,332.20
|
| Rate for Payer: Cigna Commercial |
$3,303.95
|
| Rate for Payer: First Health Commercial |
$3,498.30
|
| Rate for Payer: First Health Workers Compensation |
$1,500.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,498.30
|
| Rate for Payer: GEHA Commercial |
$3,109.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,498.30
|
| Rate for Payer: Humana ChoiceCare |
$1,010.62
|
| Rate for Payer: Multiplan All |
$3,537.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,332.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,720.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,498.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,692.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,915.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,420.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$971.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,614.91
|
| Rate for Payer: Zelis Auto |
$1,554.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,943.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,061.15
|
|
|
TREAT ODONTOID FX W/O GRAFT
|
Facility
|
IP
|
$3,491.00
|
|
|
Service Code
|
CPT 22318
|
| Hospital Charge Code |
6122318
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$953.04 |
| Max. Negotiated Rate |
$3,316.45 |
| Rate for Payer: Cash Price |
$2,094.60
|
| Rate for Payer: Cigna Commercial |
$2,967.35
|
| Rate for Payer: First Health Commercial |
$3,141.90
|
| Rate for Payer: First Health Workers Compensation |
$1,347.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,141.90
|
| Rate for Payer: GEHA Commercial |
$2,443.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,141.90
|
| Rate for Payer: Multiplan All |
$3,176.81
|
| Rate for Payer: OMNI Networks Commercial |
$2,443.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,141.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,316.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,618.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,246.63
|
| Rate for Payer: Zelis Auto |
$1,396.40
|
| Rate for Payer: Zelis Worker's Compensation |
$953.04
|
|
|
TREAT ODONTOID FX W/O GRAFT
|
Facility
|
OP
|
$3,491.00
|
|
|
Service Code
|
CPT 22318
|
| Hospital Charge Code |
6122318
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$872.75 |
| Max. Negotiated Rate |
$3,316.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,094.60
|
| Rate for Payer: Cash Price |
$2,094.60
|
| Rate for Payer: Cigna Commercial |
$2,967.35
|
| Rate for Payer: First Health Commercial |
$3,141.90
|
| Rate for Payer: First Health Workers Compensation |
$1,347.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,141.90
|
| Rate for Payer: GEHA Commercial |
$2,792.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,141.90
|
| Rate for Payer: Humana ChoiceCare |
$907.66
|
| Rate for Payer: Multiplan All |
$3,176.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,094.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,443.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,141.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,316.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,618.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,072.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$872.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,246.63
|
| Rate for Payer: Zelis Auto |
$1,396.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,745.50
|
| Rate for Payer: Zelis Worker's Compensation |
$953.04
|
|
|
TREAT PENIS LESION GRAFT
|
Facility
|
OP
|
$1,649.00
|
|
|
Service Code
|
CPT 54111
|
| Hospital Charge Code |
6154111
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$450.18 |
| Max. Negotiated Rate |
$9,851.86 |
| 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 |
$989.40
|
| 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 |
$4,925.93
|
| Rate for Payer: Cash Price |
$989.40
|
| Rate for Payer: Cash Price |
$989.40
|
| Rate for Payer: Cigna Commercial |
$1,401.65
|
| Rate for Payer: First Health Commercial |
$1,484.10
|
| Rate for Payer: First Health Workers Compensation |
$636.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,484.10
|
| Rate for Payer: GEHA Commercial |
$1,319.20
|
| Rate for Payer: GEHA Medicare |
$4,925.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,484.10
|
| Rate for Payer: Humana ChoiceCare |
$5,418.52
|
| Rate for Payer: Humana Medicare Advantage |
$4,925.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,275.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,851.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,925.93
|
| Rate for Payer: Multiplan All |
$1,500.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,374.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,154.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,484.10
|
| 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 |
$4,925.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,566.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,851.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,236.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,827.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,851.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,925.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,533.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,925.93
|
| Rate for Payer: Zelis Auto |
$659.60
|
| Rate for Payer: Zelis Medicare |
$4,187.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,911.12
|
| Rate for Payer: Zelis Worker's Compensation |
$450.18
|
|
|
TREAT PENIS LESION GRAFT
|
Facility
|
IP
|
$1,649.00
|
|
|
Service Code
|
CPT 54111
|
| Hospital Charge Code |
6154111
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$450.18 |
| Max. Negotiated Rate |
$1,566.55 |
| Rate for Payer: Cash Price |
$989.40
|
| Rate for Payer: Cigna Commercial |
$1,401.65
|
| Rate for Payer: First Health Commercial |
$1,484.10
|
| Rate for Payer: First Health Workers Compensation |
$636.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,484.10
|
| Rate for Payer: GEHA Commercial |
$1,154.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,484.10
|
| Rate for Payer: Multiplan All |
$1,500.59
|
| Rate for Payer: OMNI Networks Commercial |
$1,154.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,484.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,566.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,236.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,533.57
|
| Rate for Payer: Zelis Auto |
$659.60
|
| Rate for Payer: Zelis Worker's Compensation |
$450.18
|
|
|
TREAT PENIS LESION GRAFT
|
Facility
|
IP
|
$1,939.00
|
|
|
Service Code
|
CPT 54112
|
| Hospital Charge Code |
6154112
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$529.35 |
| Max. Negotiated Rate |
$1,842.05 |
| Rate for Payer: Cash Price |
$1,163.40
|
| Rate for Payer: Cigna Commercial |
$1,648.15
|
| Rate for Payer: First Health Commercial |
$1,745.10
|
| Rate for Payer: First Health Workers Compensation |
$748.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,745.10
|
| Rate for Payer: GEHA Commercial |
$1,357.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,745.10
|
| Rate for Payer: Multiplan All |
$1,764.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,357.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,745.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,842.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,454.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,803.27
|
| Rate for Payer: Zelis Auto |
$775.60
|
| Rate for Payer: Zelis Worker's Compensation |
$529.35
|
|
|
TREAT PENIS LESION GRAFT
|
Facility
|
OP
|
$1,939.00
|
|
|
Service Code
|
CPT 54112
|
| Hospital Charge Code |
6154112
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$529.35 |
| Max. Negotiated Rate |
$17,920.60 |
| 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 |
$1,163.40
|
| 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 |
$8,960.30
|
| Rate for Payer: Cash Price |
$1,163.40
|
| Rate for Payer: Cash Price |
$1,163.40
|
| Rate for Payer: Cigna Commercial |
$1,648.15
|
| Rate for Payer: First Health Commercial |
$1,745.10
|
| Rate for Payer: First Health Workers Compensation |
$748.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,745.10
|
| Rate for Payer: GEHA Commercial |
$1,551.20
|
| Rate for Payer: GEHA Medicare |
$8,960.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,745.10
|
| Rate for Payer: Humana ChoiceCare |
$9,856.33
|
| Rate for Payer: Humana Medicare Advantage |
$8,960.30
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15,053.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,851.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8,960.30
|
| Rate for Payer: Multiplan All |
$1,764.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15,232.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,357.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,745.10
|
| 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 |
$8,960.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,842.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17,920.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,454.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,781.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,851.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,960.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,803.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8,960.30
|
| Rate for Payer: Zelis Auto |
$775.60
|
| Rate for Payer: Zelis Medicare |
$7,616.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10,752.36
|
| Rate for Payer: Zelis Worker's Compensation |
$529.35
|
|
|
TREAT RADIUS FRACTURE
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
CPT 24655
|
| Hospital Charge Code |
6124655
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$271.63 |
| Max. Negotiated Rate |
$3,101.54 |
| 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 |
$597.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$484.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$384.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,550.77
|
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cigna Commercial |
$845.75
|
| Rate for Payer: First Health Commercial |
$895.50
|
| Rate for Payer: First Health Workers Compensation |
$384.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$895.50
|
| Rate for Payer: GEHA Commercial |
$796.00
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$895.50
|
| Rate for Payer: Humana ChoiceCare |
$1,705.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,550.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,605.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$391.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$905.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$696.50
|
| Rate for Payer: One Health Plan PPO/POS |
$895.50
|
| 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 |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$945.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$746.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$391.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$925.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$398.00
|
| Rate for Payer: Zelis Medicare |
$1,318.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,860.92
|
| Rate for Payer: Zelis Worker's Compensation |
$271.63
|
|
|
TREAT RADIUS FRACTURE
|
Facility
|
IP
|
$1,327.00
|
|
|
Service Code
|
CPT 24665
|
| Hospital Charge Code |
6124665
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$362.27 |
| Max. Negotiated Rate |
$1,260.65 |
| Rate for Payer: Cash Price |
$796.20
|
| Rate for Payer: Cigna Commercial |
$1,127.95
|
| Rate for Payer: First Health Commercial |
$1,194.30
|
| Rate for Payer: First Health Workers Compensation |
$512.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,194.30
|
| Rate for Payer: GEHA Commercial |
$928.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,194.30
|
| Rate for Payer: Multiplan All |
$1,207.57
|
| Rate for Payer: OMNI Networks Commercial |
$928.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,194.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,260.65
|
| Rate for Payer: Three Rivers Provider Network All |
$995.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,234.11
|
| Rate for Payer: Zelis Auto |
$530.80
|
| Rate for Payer: Zelis Worker's Compensation |
$362.27
|
|
|
TREAT RADIUS FRACTURE
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
CPT 24655
|
| Hospital Charge Code |
6124655
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$271.63 |
| Max. Negotiated Rate |
$945.25 |
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cigna Commercial |
$845.75
|
| Rate for Payer: First Health Commercial |
$895.50
|
| Rate for Payer: First Health Workers Compensation |
$384.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$895.50
|
| Rate for Payer: GEHA Commercial |
$696.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$895.50
|
| Rate for Payer: Multiplan All |
$905.45
|
| Rate for Payer: OMNI Networks Commercial |
$696.50
|
| Rate for Payer: One Health Plan PPO/POS |
$895.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$945.25
|
| Rate for Payer: Three Rivers Provider Network All |
$746.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$925.35
|
| Rate for Payer: Zelis Auto |
$398.00
|
| Rate for Payer: Zelis Worker's Compensation |
$271.63
|
|
|
TREAT RADIUS FRACTURE
|
Facility
|
OP
|
$1,327.00
|
|
|
Service Code
|
CPT 24665
|
| Hospital Charge Code |
6124665
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$362.27 |
| Max. Negotiated Rate |
$13,844.26 |
| 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 |
$796.20
|
| 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 |
$6,922.13
|
| Rate for Payer: Cash Price |
$796.20
|
| Rate for Payer: Cash Price |
$796.20
|
| Rate for Payer: Cigna Commercial |
$1,127.95
|
| Rate for Payer: First Health Commercial |
$1,194.30
|
| Rate for Payer: First Health Workers Compensation |
$512.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,194.30
|
| Rate for Payer: GEHA Commercial |
$1,061.60
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,194.30
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,207.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$928.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,194.30
|
| 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 |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,260.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$995.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,234.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$530.80
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$362.27
|
|
|
TREAT RADIUS FRACTURE
|
Facility
|
IP
|
$1,498.00
|
|
|
Service Code
|
CPT 24666
|
| Hospital Charge Code |
6124666
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$408.95 |
| Max. Negotiated Rate |
$1,423.10 |
| Rate for Payer: Cash Price |
$898.80
|
| Rate for Payer: Cigna Commercial |
$1,273.30
|
| Rate for Payer: First Health Commercial |
$1,348.20
|
| Rate for Payer: First Health Workers Compensation |
$578.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,348.20
|
| Rate for Payer: GEHA Commercial |
$1,048.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,348.20
|
| Rate for Payer: Multiplan All |
$1,363.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,048.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,348.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,423.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,123.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,393.14
|
| Rate for Payer: Zelis Auto |
$599.20
|
| Rate for Payer: Zelis Worker's Compensation |
$408.95
|
|
|
TREAT RADIUS FRACTURE
|
Facility
|
OP
|
$1,498.00
|
|
|
Service Code
|
CPT 24666
|
| Hospital Charge Code |
6124666
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$408.95 |
| Max. Negotiated Rate |
$24,935.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$898.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,244.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,467.69
|
| Rate for Payer: Cash Price |
$898.80
|
| Rate for Payer: Cash Price |
$898.80
|
| Rate for Payer: Cigna Commercial |
$1,273.30
|
| Rate for Payer: First Health Commercial |
$1,348.20
|
| Rate for Payer: First Health Workers Compensation |
$578.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,348.20
|
| Rate for Payer: GEHA Commercial |
$1,198.40
|
| Rate for Payer: GEHA Medicare |
$12,467.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,348.20
|
| Rate for Payer: Humana ChoiceCare |
$13,714.46
|
| Rate for Payer: Humana Medicare Advantage |
$12,467.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,945.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,467.69
|
| Rate for Payer: Multiplan All |
$1,363.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21,195.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,048.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,348.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,178.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,351.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,467.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,423.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,935.38
|
| Rate for Payer: Three Rivers Provider Network All |
$1,123.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,218.34
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,467.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,393.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,467.69
|
| Rate for Payer: Zelis Auto |
$599.20
|
| Rate for Payer: Zelis Medicare |
$10,597.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,961.23
|
| Rate for Payer: Zelis Worker's Compensation |
$408.95
|
|
|
TREAT SCAPULA FRACTURE
|
Facility
|
OP
|
$2,018.00
|
|
|
Service Code
|
CPT 23585
|
| Hospital Charge Code |
6123585
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$550.91 |
| Max. Negotiated Rate |
$13,844.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,210.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,244.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,922.13
|
| Rate for Payer: Cash Price |
$1,210.80
|
| Rate for Payer: Cash Price |
$1,210.80
|
| Rate for Payer: Cigna Commercial |
$1,715.30
|
| Rate for Payer: First Health Commercial |
$1,816.20
|
| Rate for Payer: First Health Workers Compensation |
$779.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,816.20
|
| Rate for Payer: GEHA Commercial |
$1,614.40
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,816.20
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$1,836.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,412.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,816.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,178.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,351.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,917.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,513.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,876.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$807.20
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$550.91
|
|
|
TREAT SCAPULA FRACTURE
|
Facility
|
IP
|
$2,018.00
|
|
|
Service Code
|
CPT 23585
|
| Hospital Charge Code |
6123585
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$550.91 |
| Max. Negotiated Rate |
$1,917.10 |
| Rate for Payer: Cash Price |
$1,210.80
|
| Rate for Payer: Cigna Commercial |
$1,715.30
|
| Rate for Payer: First Health Commercial |
$1,816.20
|
| Rate for Payer: First Health Workers Compensation |
$779.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,816.20
|
| Rate for Payer: GEHA Commercial |
$1,412.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,816.20
|
| Rate for Payer: Multiplan All |
$1,836.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,412.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,816.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,917.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,513.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,876.74
|
| Rate for Payer: Zelis Auto |
$807.20
|
| Rate for Payer: Zelis Worker's Compensation |
$550.91
|
|
|
TREAT SESAMOID BONE FRACTURE
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT 28531
|
| Hospital Charge Code |
6128531
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$152.33 |
| Max. Negotiated Rate |
$13,844.26 |
| 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 |
$334.80
|
| 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 |
$6,922.13
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: First Health Workers Compensation |
$215.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$446.40
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Humana ChoiceCare |
$7,614.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,922.13
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,629.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,922.13
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| 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 |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,783.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,922.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$223.20
|
| Rate for Payer: Zelis Medicare |
$5,883.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,306.56
|
| Rate for Payer: Zelis Worker's Compensation |
$152.33
|
|
|
TREAT SESAMOID BONE FRACTURE
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
CPT 28531
|
| Hospital Charge Code |
6128531
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$152.33 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$474.30
|
| Rate for Payer: First Health Commercial |
$502.20
|
| Rate for Payer: First Health Workers Compensation |
$215.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$502.20
|
| Rate for Payer: GEHA Commercial |
$390.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$502.20
|
| Rate for Payer: Multiplan All |
$507.78
|
| Rate for Payer: OMNI Networks Commercial |
$390.60
|
| Rate for Payer: One Health Plan PPO/POS |
$502.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$530.10
|
| Rate for Payer: Three Rivers Provider Network All |
$418.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.94
|
| Rate for Payer: Zelis Auto |
$223.20
|
| Rate for Payer: Zelis Worker's Compensation |
$152.33
|
|
|
TREAT SHOULDER BLADE FX
|
Facility
|
OP
|
$943.00
|
|
|
Service Code
|
CPT 23575
|
| Hospital Charge Code |
6123575
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$257.44 |
| Max. Negotiated Rate |
$3,101.54 |
| 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 |
$565.80
|
| 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 |
$1,550.77
|
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cigna Commercial |
$801.55
|
| Rate for Payer: First Health Commercial |
$848.70
|
| Rate for Payer: First Health Workers Compensation |
$364.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$848.70
|
| Rate for Payer: GEHA Commercial |
$754.40
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$848.70
|
| Rate for Payer: Humana ChoiceCare |
$1,705.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,550.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,605.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$391.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$858.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$660.10
|
| Rate for Payer: One Health Plan PPO/POS |
$848.70
|
| 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 |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$895.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$707.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$391.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$876.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$377.20
|
| Rate for Payer: Zelis Medicare |
$1,318.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,860.92
|
| Rate for Payer: Zelis Worker's Compensation |
$257.44
|
|
|
TREAT SHOULDER BLADE FX
|
Facility
|
IP
|
$943.00
|
|
|
Service Code
|
CPT 23575
|
| Hospital Charge Code |
6123575
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$257.44 |
| Max. Negotiated Rate |
$895.85 |
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cigna Commercial |
$801.55
|
| Rate for Payer: First Health Commercial |
$848.70
|
| Rate for Payer: First Health Workers Compensation |
$364.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$848.70
|
| Rate for Payer: GEHA Commercial |
$660.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$848.70
|
| Rate for Payer: Multiplan All |
$858.13
|
| Rate for Payer: OMNI Networks Commercial |
$660.10
|
| Rate for Payer: One Health Plan PPO/POS |
$848.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$895.85
|
| Rate for Payer: Three Rivers Provider Network All |
$707.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$876.99
|
| Rate for Payer: Zelis Auto |
$377.20
|
| Rate for Payer: Zelis Worker's Compensation |
$257.44
|
|
|
TREAT SHOULDER BLADE FX
|
Facility
|
IP
|
$597.00
|
|
|
Service Code
|
CPT 23570
|
| Hospital Charge Code |
6123570
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$162.98 |
| Max. Negotiated Rate |
$567.15 |
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cigna Commercial |
$507.45
|
| Rate for Payer: First Health Commercial |
$537.30
|
| Rate for Payer: First Health Workers Compensation |
$230.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$537.30
|
| Rate for Payer: GEHA Commercial |
$417.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$537.30
|
| Rate for Payer: Multiplan All |
$543.27
|
| Rate for Payer: OMNI Networks Commercial |
$417.90
|
| Rate for Payer: One Health Plan PPO/POS |
$537.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$567.15
|
| Rate for Payer: Three Rivers Provider Network All |
$447.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$555.21
|
| Rate for Payer: Zelis Auto |
$238.80
|
| Rate for Payer: Zelis Worker's Compensation |
$162.98
|
|
|
TREAT SHOULDER BLADE FX
|
Facility
|
OP
|
$597.00
|
|
|
Service Code
|
CPT 23570
|
| Hospital Charge Code |
6123570
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$567.15 |
| 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 |
$358.20
|
| 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 |
$232.44
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cigna Commercial |
$507.45
|
| Rate for Payer: First Health Commercial |
$537.30
|
| Rate for Payer: First Health Workers Compensation |
$230.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$537.30
|
| Rate for Payer: GEHA Commercial |
$477.60
|
| Rate for Payer: GEHA Medicare |
$232.44
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$537.30
|
| Rate for Payer: Humana ChoiceCare |
$255.68
|
| Rate for Payer: Humana Medicare Advantage |
$232.44
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$390.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$232.44
|
| Rate for Payer: Multiplan All |
$543.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$395.15
|
| Rate for Payer: OMNI Networks Commercial |
$417.90
|
| Rate for Payer: One Health Plan PPO/POS |
$537.30
|
| 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 |
$232.44
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$567.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$464.88
|
| Rate for Payer: Three Rivers Provider Network All |
$447.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$227.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$232.44
|
| Rate for Payer: United Payors & United Providers UP&UP |
$555.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$232.44
|
| Rate for Payer: Zelis Auto |
$238.80
|
| Rate for Payer: Zelis Medicare |
$197.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$278.93
|
| Rate for Payer: Zelis Worker's Compensation |
$162.98
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
IP
|
$1,186.00
|
|
|
Service Code
|
CPT 23660
|
| Hospital Charge Code |
6123660
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$323.78 |
| Max. Negotiated Rate |
$1,126.70 |
| Rate for Payer: Cash Price |
$711.60
|
| Rate for Payer: Cigna Commercial |
$1,008.10
|
| Rate for Payer: First Health Commercial |
$1,067.40
|
| Rate for Payer: First Health Workers Compensation |
$457.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,067.40
|
| Rate for Payer: GEHA Commercial |
$830.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,067.40
|
| Rate for Payer: Multiplan All |
$1,079.26
|
| Rate for Payer: OMNI Networks Commercial |
$830.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,067.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,126.70
|
| Rate for Payer: Three Rivers Provider Network All |
$889.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,102.98
|
| Rate for Payer: Zelis Auto |
$474.40
|
| Rate for Payer: Zelis Worker's Compensation |
$323.78
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
OP
|
$1,237.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
6123655
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$337.70 |
| Max. Negotiated Rate |
$3,101.54 |
| 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 |
$742.20
|
| 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 |
$1,550.77
|
| Rate for Payer: Cash Price |
$742.20
|
| Rate for Payer: Cash Price |
$742.20
|
| Rate for Payer: Cigna Commercial |
$1,051.45
|
| Rate for Payer: First Health Commercial |
$1,113.30
|
| Rate for Payer: First Health Workers Compensation |
$477.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,113.30
|
| Rate for Payer: GEHA Commercial |
$989.60
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,113.30
|
| Rate for Payer: Humana ChoiceCare |
$1,705.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,550.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,605.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,249.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$1,125.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$865.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,113.30
|
| 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 |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,175.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$927.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,249.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,150.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$494.80
|
| Rate for Payer: Zelis Medicare |
$1,318.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,860.92
|
| Rate for Payer: Zelis Worker's Compensation |
$337.70
|
|
