|
TREAT THIGH FX GROWTH PLATE
|
Facility
|
OP
|
$966.00
|
|
|
Service Code
|
CPT 27516
|
| Hospital Charge Code |
6127516
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$917.70 |
| 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 |
$579.60
|
| 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 |
$579.60
|
| Rate for Payer: Cash Price |
$579.60
|
| Rate for Payer: Cigna Commercial |
$821.10
|
| Rate for Payer: First Health Commercial |
$869.40
|
| Rate for Payer: First Health Workers Compensation |
$372.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$869.40
|
| Rate for Payer: GEHA Commercial |
$772.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$869.40
|
| 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 |
$879.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$676.20
|
| Rate for Payer: One Health Plan PPO/POS |
$869.40
|
| 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 |
$917.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$724.50
|
| 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 |
$898.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$386.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$263.72
|
|
|
TREAT THIGH FX GROWTH PLATE
|
Facility
|
OP
|
$1,383.00
|
|
|
Service Code
|
CPT 27517
|
| Hospital Charge Code |
6127517
|
|
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 |
$829.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$829.80
|
| Rate for Payer: Cash Price |
$829.80
|
| Rate for Payer: Cigna Commercial |
$1,175.55
|
| Rate for Payer: First Health Commercial |
$1,244.70
|
| Rate for Payer: First Health Workers Compensation |
$533.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,244.70
|
| Rate for Payer: GEHA Commercial |
$1,106.40
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,244.70
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$1,258.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$968.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,244.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,313.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,037.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,286.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$553.20
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$377.56
|
|
|
TREAT THORAX SPINE FRACTURE
|
Facility
|
OP
|
$3,157.00
|
|
|
Service Code
|
CPT 22327
|
| Hospital Charge Code |
6122327
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$789.25 |
| Max. Negotiated Rate |
$2,999.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,894.20
|
| Rate for Payer: Cash Price |
$1,894.20
|
| Rate for Payer: Cigna Commercial |
$2,683.45
|
| Rate for Payer: First Health Commercial |
$2,841.30
|
| Rate for Payer: First Health Workers Compensation |
$1,218.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,841.30
|
| Rate for Payer: GEHA Commercial |
$2,525.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,841.30
|
| Rate for Payer: Humana ChoiceCare |
$820.82
|
| Rate for Payer: Multiplan All |
$2,872.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,894.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,209.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,841.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,999.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,367.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,778.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$789.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,936.01
|
| Rate for Payer: Zelis Auto |
$1,262.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,578.50
|
| Rate for Payer: Zelis Worker's Compensation |
$861.86
|
|
|
TREAT THORAX SPINE FRACTURE
|
Facility
|
IP
|
$3,157.00
|
|
|
Service Code
|
CPT 22327
|
| Hospital Charge Code |
6122327
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$861.86 |
| Max. Negotiated Rate |
$2,999.15 |
| Rate for Payer: Cash Price |
$1,894.20
|
| Rate for Payer: Cigna Commercial |
$2,683.45
|
| Rate for Payer: First Health Commercial |
$2,841.30
|
| Rate for Payer: First Health Workers Compensation |
$1,218.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,841.30
|
| Rate for Payer: GEHA Commercial |
$2,209.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,841.30
|
| Rate for Payer: Multiplan All |
$2,872.87
|
| Rate for Payer: OMNI Networks Commercial |
$2,209.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,841.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,999.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,367.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,936.01
|
| Rate for Payer: Zelis Auto |
$1,262.80
|
| Rate for Payer: Zelis Worker's Compensation |
$861.86
|
|
|
TREAT THUMB FRACTURE
|
Facility
|
IP
|
$976.00
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
6126645
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$266.45 |
| Max. Negotiated Rate |
$927.20 |
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Cigna Commercial |
$829.60
|
| Rate for Payer: First Health Commercial |
$878.40
|
| Rate for Payer: First Health Workers Compensation |
$376.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$878.40
|
| Rate for Payer: GEHA Commercial |
$683.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$878.40
|
| Rate for Payer: Multiplan All |
$888.16
|
| Rate for Payer: OMNI Networks Commercial |
$683.20
|
| Rate for Payer: One Health Plan PPO/POS |
$878.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$927.20
|
| Rate for Payer: Three Rivers Provider Network All |
$732.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$907.68
|
| Rate for Payer: Zelis Auto |
$390.40
|
| Rate for Payer: Zelis Worker's Compensation |
$266.45
|
|
|
TREAT THUMB FRACTURE
|
Facility
|
OP
|
$976.00
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
6126645
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$266.45 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$484.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$585.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$484.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$384.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Cigna Commercial |
$829.60
|
| Rate for Payer: First Health Commercial |
$878.40
|
| Rate for Payer: First Health Workers Compensation |
$376.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$878.40
|
| Rate for Payer: GEHA Commercial |
$780.80
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$878.40
|
| 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 |
$391.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$888.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$683.20
|
| Rate for Payer: One Health Plan PPO/POS |
$878.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$452.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$391.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$927.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$732.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$391.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$907.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$390.40
|
| 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 |
$266.45
|
|
|
TREAT THUMB FRACTURE
|
Facility
|
OP
|
$1,286.00
|
|
|
Service Code
|
CPT 26665
|
| Hospital Charge Code |
6126665
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$351.08 |
| 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 |
$771.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$771.60
|
| Rate for Payer: Cash Price |
$771.60
|
| Rate for Payer: Cigna Commercial |
$1,093.10
|
| Rate for Payer: First Health Commercial |
$1,157.40
|
| Rate for Payer: First Health Workers Compensation |
$496.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,157.40
|
| Rate for Payer: GEHA Commercial |
$1,028.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,157.40
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,170.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$900.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,157.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,221.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$964.50
|
| 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 |
$1,195.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$514.40
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$351.08
|
|
|
TREAT THUMB FRACTURE
|
Facility
|
IP
|
$1,286.00
|
|
|
Service Code
|
CPT 26665
|
| Hospital Charge Code |
6126665
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$351.08 |
| Max. Negotiated Rate |
$1,221.70 |
| Rate for Payer: Cash Price |
$771.60
|
| Rate for Payer: Cigna Commercial |
$1,093.10
|
| Rate for Payer: First Health Commercial |
$1,157.40
|
| Rate for Payer: First Health Workers Compensation |
$496.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,157.40
|
| Rate for Payer: GEHA Commercial |
$900.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,157.40
|
| Rate for Payer: Multiplan All |
$1,170.26
|
| Rate for Payer: OMNI Networks Commercial |
$900.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,157.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,221.70
|
| Rate for Payer: Three Rivers Provider Network All |
$964.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,195.98
|
| Rate for Payer: Zelis Auto |
$514.40
|
| Rate for Payer: Zelis Worker's Compensation |
$351.08
|
|
|
TREAT THUMB FRACTURE
|
Facility
|
IP
|
$961.00
|
|
|
Service Code
|
CPT 26650
|
| Hospital Charge Code |
6126650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$262.35 |
| Max. Negotiated Rate |
$912.95 |
| Rate for Payer: Cash Price |
$576.60
|
| Rate for Payer: Cigna Commercial |
$816.85
|
| Rate for Payer: First Health Commercial |
$864.90
|
| Rate for Payer: First Health Workers Compensation |
$371.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$864.90
|
| Rate for Payer: GEHA Commercial |
$672.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$864.90
|
| Rate for Payer: Multiplan All |
$874.51
|
| Rate for Payer: OMNI Networks Commercial |
$672.70
|
| Rate for Payer: One Health Plan PPO/POS |
$864.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$912.95
|
| Rate for Payer: Three Rivers Provider Network All |
$720.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$893.73
|
| Rate for Payer: Zelis Auto |
$384.40
|
| Rate for Payer: Zelis Worker's Compensation |
$262.35
|
|
|
TREAT THUMB FRACTURE
|
Facility
|
OP
|
$961.00
|
|
|
Service Code
|
CPT 26650
|
| Hospital Charge Code |
6126650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$262.35 |
| 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 |
$576.60
|
| 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 |
$576.60
|
| Rate for Payer: Cash Price |
$576.60
|
| Rate for Payer: Cigna Commercial |
$816.85
|
| Rate for Payer: First Health Commercial |
$864.90
|
| Rate for Payer: First Health Workers Compensation |
$371.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$864.90
|
| Rate for Payer: GEHA Commercial |
$768.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$864.90
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$874.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$672.70
|
| Rate for Payer: One Health Plan PPO/POS |
$864.90
|
| 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 |
$912.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$720.75
|
| 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 |
$893.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$384.40
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$262.35
|
|
|
TREAT TOE DISLOCATION
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
CPT 28636
|
| Hospital Charge Code |
6128636
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$151.51 |
| Max. Negotiated Rate |
$527.25 |
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna Commercial |
$471.75
|
| Rate for Payer: First Health Commercial |
$499.50
|
| Rate for Payer: First Health Workers Compensation |
$214.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$499.50
|
| Rate for Payer: GEHA Commercial |
$388.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$499.50
|
| Rate for Payer: Multiplan All |
$505.05
|
| Rate for Payer: OMNI Networks Commercial |
$388.50
|
| Rate for Payer: One Health Plan PPO/POS |
$499.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$527.25
|
| Rate for Payer: Three Rivers Provider Network All |
$416.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$516.15
|
| Rate for Payer: Zelis Auto |
$222.00
|
| Rate for Payer: Zelis Worker's Compensation |
$151.51
|
|
|
TREAT TOE DISLOCATION
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 28665
|
| Hospital Charge Code |
6128665
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: First Health Commercial |
$360.00
|
| Rate for Payer: First Health Workers Compensation |
$154.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.00
|
| Rate for Payer: GEHA Commercial |
$280.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.00
|
| Rate for Payer: Multiplan All |
$364.00
|
| Rate for Payer: OMNI Networks Commercial |
$280.00
|
| Rate for Payer: One Health Plan PPO/POS |
$360.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.00
|
| Rate for Payer: Three Rivers Provider Network All |
$300.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.00
|
| Rate for Payer: Zelis Auto |
$160.00
|
| Rate for Payer: Zelis Worker's Compensation |
$109.20
|
|
|
TREAT TOE DISLOCATION
|
Facility
|
IP
|
$574.00
|
|
|
Service Code
|
CPT 28666
|
| Hospital Charge Code |
6128666
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$156.70 |
| Max. Negotiated Rate |
$545.30 |
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cigna Commercial |
$487.90
|
| Rate for Payer: First Health Commercial |
$516.60
|
| Rate for Payer: First Health Workers Compensation |
$221.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$516.60
|
| Rate for Payer: GEHA Commercial |
$401.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$516.60
|
| Rate for Payer: Multiplan All |
$522.34
|
| Rate for Payer: OMNI Networks Commercial |
$401.80
|
| Rate for Payer: One Health Plan PPO/POS |
$516.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$545.30
|
| Rate for Payer: Three Rivers Provider Network All |
$430.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$533.82
|
| Rate for Payer: Zelis Auto |
$229.60
|
| Rate for Payer: Zelis Worker's Compensation |
$156.70
|
|
|
TREAT TOE DISLOCATION
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 28665
|
| Hospital Charge Code |
6128665
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$1,546.18 |
| 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 |
$240.00
|
| 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 |
$252.18
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$340.00
|
| Rate for Payer: First Health Commercial |
$360.00
|
| Rate for Payer: First Health Workers Compensation |
$154.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.00
|
| Rate for Payer: GEHA Commercial |
$320.00
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.00
|
| Rate for Payer: Humana ChoiceCare |
$277.40
|
| Rate for Payer: Humana Medicare Advantage |
$252.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$423.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,249.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$252.18
|
| Rate for Payer: Multiplan All |
$364.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$280.00
|
| Rate for Payer: One Health Plan PPO/POS |
$360.00
|
| 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 |
$252.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$300.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$247.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,249.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$160.00
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$109.20
|
|
|
TREAT TOE DISLOCATION
|
Facility
|
OP
|
$574.00
|
|
|
Service Code
|
CPT 28666
|
| Hospital Charge Code |
6128666
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$156.70 |
| 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 |
$344.40
|
| 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 |
$344.40
|
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cigna Commercial |
$487.90
|
| Rate for Payer: First Health Commercial |
$516.60
|
| Rate for Payer: First Health Workers Compensation |
$221.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$516.60
|
| Rate for Payer: GEHA Commercial |
$459.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$516.60
|
| 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 |
$522.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$401.80
|
| Rate for Payer: One Health Plan PPO/POS |
$516.60
|
| 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 |
$545.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$430.50
|
| 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 |
$533.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$229.60
|
| 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 |
$156.70
|
|
|
TREAT TOE DISLOCATION
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT 28636
|
| Hospital Charge Code |
6128636
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$151.51 |
| 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 |
$333.00
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna Commercial |
$471.75
|
| Rate for Payer: First Health Commercial |
$499.50
|
| Rate for Payer: First Health Workers Compensation |
$214.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$499.50
|
| Rate for Payer: GEHA Commercial |
$444.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$499.50
|
| 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 |
$505.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$388.50
|
| Rate for Payer: One Health Plan PPO/POS |
$499.50
|
| 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 |
$527.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$416.25
|
| 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 |
$516.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$222.00
|
| 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 |
$151.51
|
|
|
TREAT TOE FRACTURE
|
Facility
|
OP
|
$1,014.00
|
|
|
Service Code
|
CPT 28525
|
| Hospital Charge Code |
6128525
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$276.82 |
| 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 |
$608.40
|
| 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 |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna Commercial |
$861.90
|
| Rate for Payer: First Health Commercial |
$912.60
|
| Rate for Payer: First Health Workers Compensation |
$391.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$912.60
|
| Rate for Payer: GEHA Commercial |
$811.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$912.60
|
| 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 |
$922.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$709.80
|
| Rate for Payer: One Health Plan PPO/POS |
$912.60
|
| 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 |
$963.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$760.50
|
| 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 |
$943.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$405.60
|
| 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 |
$276.82
|
|
|
TREAT TOE FRACTURE
|
Facility
|
IP
|
$1,014.00
|
|
|
Service Code
|
CPT 28525
|
| Hospital Charge Code |
6128525
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$276.82 |
| Max. Negotiated Rate |
$963.30 |
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna Commercial |
$861.90
|
| Rate for Payer: First Health Commercial |
$912.60
|
| Rate for Payer: First Health Workers Compensation |
$391.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$912.60
|
| Rate for Payer: GEHA Commercial |
$709.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$912.60
|
| Rate for Payer: Multiplan All |
$922.74
|
| Rate for Payer: OMNI Networks Commercial |
$709.80
|
| Rate for Payer: One Health Plan PPO/POS |
$912.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$963.30
|
| Rate for Payer: Three Rivers Provider Network All |
$760.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$943.02
|
| Rate for Payer: Zelis Auto |
$405.60
|
| Rate for Payer: Zelis Worker's Compensation |
$276.82
|
|
|
TREAT TRIGEMINAL NERVE
|
Facility
|
IP
|
$1,883.00
|
|
|
Service Code
|
CPT 61790
|
| Hospital Charge Code |
6161790
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$514.06 |
| Max. Negotiated Rate |
$1,788.85 |
| Rate for Payer: Cash Price |
$1,129.80
|
| Rate for Payer: Cigna Commercial |
$1,600.55
|
| Rate for Payer: First Health Commercial |
$1,694.70
|
| Rate for Payer: First Health Workers Compensation |
$727.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,694.70
|
| Rate for Payer: GEHA Commercial |
$1,318.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,694.70
|
| Rate for Payer: Multiplan All |
$1,713.53
|
| Rate for Payer: OMNI Networks Commercial |
$1,318.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,694.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,788.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,412.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,751.19
|
| Rate for Payer: Zelis Auto |
$753.20
|
| Rate for Payer: Zelis Worker's Compensation |
$514.06
|
|
|
TREAT TRIGEMINAL NERVE
|
Facility
|
OP
|
$1,883.00
|
|
|
Service Code
|
CPT 61790
|
| Hospital Charge Code |
6161790
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$514.06 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,129.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$1,129.80
|
| Rate for Payer: Cash Price |
$1,129.80
|
| Rate for Payer: Cigna Commercial |
$1,600.55
|
| Rate for Payer: First Health Commercial |
$1,694.70
|
| Rate for Payer: First Health Workers Compensation |
$727.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,694.70
|
| Rate for Payer: GEHA Commercial |
$1,506.40
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,694.70
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$1,713.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,318.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,694.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,788.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$1,412.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,751.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$753.20
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$514.06
|
|
|
TREAT TRIGEMINAL TRACT
|
Facility
|
IP
|
$2,286.00
|
|
|
Service Code
|
CPT 61791
|
| Hospital Charge Code |
6161791
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$624.08 |
| Max. Negotiated Rate |
$2,171.70 |
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cigna Commercial |
$1,943.10
|
| Rate for Payer: First Health Commercial |
$2,057.40
|
| Rate for Payer: First Health Workers Compensation |
$882.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,057.40
|
| Rate for Payer: GEHA Commercial |
$1,600.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,057.40
|
| Rate for Payer: Multiplan All |
$2,080.26
|
| Rate for Payer: OMNI Networks Commercial |
$1,600.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,057.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,171.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,714.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,125.98
|
| Rate for Payer: Zelis Auto |
$914.40
|
| Rate for Payer: Zelis Worker's Compensation |
$624.08
|
|
|
TREAT TRIGEMINAL TRACT
|
Facility
|
OP
|
$2,286.00
|
|
|
Service Code
|
CPT 61791
|
| Hospital Charge Code |
6161791
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$624.08 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,339.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,371.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,339.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,060.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cigna Commercial |
$1,943.10
|
| Rate for Payer: First Health Commercial |
$2,057.40
|
| Rate for Payer: First Health Workers Compensation |
$882.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,057.40
|
| Rate for Payer: GEHA Commercial |
$1,828.80
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,057.40
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,082.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$2,080.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,600.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,057.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,249.81
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,082.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,171.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$1,714.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,082.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,125.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$914.40
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$624.08
|
|
|
TREAT ULNAR FRACTURE
|
Facility
|
OP
|
$1,332.00
|
|
|
Service Code
|
CPT 24685
|
| Hospital Charge Code |
6124685
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$363.64 |
| 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 |
$799.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cigna Commercial |
$1,132.20
|
| Rate for Payer: First Health Commercial |
$1,198.80
|
| Rate for Payer: First Health Workers Compensation |
$514.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,198.80
|
| Rate for Payer: GEHA Commercial |
$1,065.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,198.80
|
| 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 |
$1,212.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$932.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,198.80
|
| 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 |
$1,265.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$999.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,238.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$532.80
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$363.64
|
|
|
TREAT ULNAR FRACTURE
|
Facility
|
IP
|
$1,332.00
|
|
|
Service Code
|
CPT 24685
|
| Hospital Charge Code |
6124685
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$363.64 |
| Max. Negotiated Rate |
$1,265.40 |
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cigna Commercial |
$1,132.20
|
| Rate for Payer: First Health Commercial |
$1,198.80
|
| Rate for Payer: First Health Workers Compensation |
$514.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,198.80
|
| Rate for Payer: GEHA Commercial |
$932.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,198.80
|
| Rate for Payer: Multiplan All |
$1,212.12
|
| Rate for Payer: OMNI Networks Commercial |
$932.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,198.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,265.40
|
| Rate for Payer: Three Rivers Provider Network All |
$999.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,238.76
|
| Rate for Payer: Zelis Auto |
$532.80
|
| Rate for Payer: Zelis Worker's Compensation |
$363.64
|
|
|
TREAT ULNAR FRACTURE
|
Facility
|
OP
|
$834.00
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
6124675
|
|
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 |
$500.40
|
| 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 |
$500.40
|
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cigna Commercial |
$708.90
|
| Rate for Payer: First Health Commercial |
$750.60
|
| Rate for Payer: First Health Workers Compensation |
$322.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$750.60
|
| Rate for Payer: GEHA Commercial |
$667.20
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$750.60
|
| 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 |
$758.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$583.80
|
| Rate for Payer: One Health Plan PPO/POS |
$750.60
|
| 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 |
$792.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$625.50
|
| 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 |
$775.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$333.60
|
| 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 |
$227.68
|
|
