|
TREAT ULNAR FRACTURE
|
Facility
|
IP
|
$656.00
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
6124670
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$179.09 |
| Max. Negotiated Rate |
$623.20 |
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cigna Commercial |
$557.60
|
| Rate for Payer: First Health Commercial |
$590.40
|
| Rate for Payer: First Health Workers Compensation |
$253.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$590.40
|
| Rate for Payer: GEHA Commercial |
$459.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$590.40
|
| Rate for Payer: Multiplan All |
$596.96
|
| Rate for Payer: OMNI Networks Commercial |
$459.20
|
| Rate for Payer: One Health Plan PPO/POS |
$590.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$623.20
|
| Rate for Payer: Three Rivers Provider Network All |
$492.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$610.08
|
| Rate for Payer: Zelis Auto |
$262.40
|
| Rate for Payer: Zelis Worker's Compensation |
$179.09
|
|
|
TREAT ULNAR FRACTURE
|
Facility
|
OP
|
$656.00
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
6124670
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$623.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$393.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$232.44
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cigna Commercial |
$557.60
|
| Rate for Payer: First Health Commercial |
$590.40
|
| Rate for Payer: First Health Workers Compensation |
$253.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$590.40
|
| Rate for Payer: GEHA Commercial |
$524.80
|
| Rate for Payer: GEHA Medicare |
$232.44
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$590.40
|
| 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 |
$596.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$395.15
|
| Rate for Payer: OMNI Networks Commercial |
$459.20
|
| Rate for Payer: One Health Plan PPO/POS |
$590.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$232.44
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$623.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$464.88
|
| Rate for Payer: Three Rivers Provider Network All |
$492.00
|
| 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 |
$610.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$232.44
|
| Rate for Payer: Zelis Auto |
$262.40
|
| Rate for Payer: Zelis Medicare |
$197.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$278.93
|
| Rate for Payer: Zelis Worker's Compensation |
$179.09
|
|
|
TREAT ULNAR FRACTURE
|
Facility
|
IP
|
$834.00
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
6124675
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$227.68 |
| Max. Negotiated Rate |
$792.30 |
| 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 |
$583.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$750.60
|
| Rate for Payer: Multiplan All |
$758.94
|
| Rate for Payer: OMNI Networks Commercial |
$583.80
|
| Rate for Payer: One Health Plan PPO/POS |
$750.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$792.30
|
| Rate for Payer: Three Rivers Provider Network All |
$625.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$775.62
|
| Rate for Payer: Zelis Auto |
$333.60
|
| Rate for Payer: Zelis Worker's Compensation |
$227.68
|
|
|
TREAT VAGINA INFECTION
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 57150
|
| Hospital Charge Code |
6157150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$154.47 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$53.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$122.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$57.56
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$75.65
|
| Rate for Payer: First Health Commercial |
$80.10
|
| Rate for Payer: First Health Workers Compensation |
$34.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$80.10
|
| Rate for Payer: GEHA Commercial |
$71.20
|
| Rate for Payer: GEHA Medicare |
$57.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$80.10
|
| Rate for Payer: Humana ChoiceCare |
$63.32
|
| Rate for Payer: Humana Medicare Advantage |
$57.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$96.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$124.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$57.56
|
| Rate for Payer: Multiplan All |
$80.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.85
|
| Rate for Payer: OMNI Networks Commercial |
$62.30
|
| Rate for Payer: One Health Plan PPO/POS |
$80.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$144.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$124.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$57.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$84.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$115.12
|
| Rate for Payer: Three Rivers Provider Network All |
$66.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$56.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$124.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$82.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$57.56
|
| Rate for Payer: Zelis Auto |
$35.60
|
| Rate for Payer: Zelis Medicare |
$48.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$69.07
|
| Rate for Payer: Zelis Worker's Compensation |
$24.30
|
|
|
TREAT VAGINA INFECTION
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 57150
|
| Hospital Charge Code |
6157150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$75.65
|
| Rate for Payer: First Health Commercial |
$80.10
|
| Rate for Payer: First Health Workers Compensation |
$34.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$80.10
|
| Rate for Payer: GEHA Commercial |
$62.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$80.10
|
| Rate for Payer: Multiplan All |
$80.99
|
| Rate for Payer: OMNI Networks Commercial |
$62.30
|
| Rate for Payer: One Health Plan PPO/POS |
$80.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$84.55
|
| Rate for Payer: Three Rivers Provider Network All |
$66.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$82.77
|
| Rate for Payer: Zelis Auto |
$35.60
|
| Rate for Payer: Zelis Worker's Compensation |
$24.30
|
|
|
TREAT VAGINAL BLEEDING
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
CPT 57180
|
| Hospital Charge Code |
6157180
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$389.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$192.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$122.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$194.93
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$272.00
|
| Rate for Payer: First Health Commercial |
$288.00
|
| Rate for Payer: First Health Workers Compensation |
$123.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$288.00
|
| Rate for Payer: GEHA Commercial |
$256.00
|
| Rate for Payer: GEHA Medicare |
$194.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$288.00
|
| Rate for Payer: Humana ChoiceCare |
$214.42
|
| Rate for Payer: Humana Medicare Advantage |
$194.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$327.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$124.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$194.93
|
| Rate for Payer: Multiplan All |
$291.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$331.38
|
| Rate for Payer: OMNI Networks Commercial |
$224.00
|
| Rate for Payer: One Health Plan PPO/POS |
$288.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$144.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$124.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$194.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$304.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$389.86
|
| Rate for Payer: Three Rivers Provider Network All |
$240.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$191.03
|
| Rate for Payer: United Healthcare Managed Medicaid |
$124.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$194.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$297.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$194.93
|
| Rate for Payer: Zelis Auto |
$128.00
|
| Rate for Payer: Zelis Medicare |
$165.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$233.92
|
| Rate for Payer: Zelis Worker's Compensation |
$87.36
|
|
|
TREAT VAGINAL BLEEDING
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 57180
|
| Hospital Charge Code |
6157180
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$272.00
|
| Rate for Payer: First Health Commercial |
$288.00
|
| Rate for Payer: First Health Workers Compensation |
$123.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$288.00
|
| Rate for Payer: GEHA Commercial |
$224.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$288.00
|
| Rate for Payer: Multiplan All |
$291.20
|
| Rate for Payer: OMNI Networks Commercial |
$224.00
|
| Rate for Payer: One Health Plan PPO/POS |
$288.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$304.00
|
| Rate for Payer: Three Rivers Provider Network All |
$240.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$297.60
|
| Rate for Payer: Zelis Auto |
$128.00
|
| Rate for Payer: Zelis Worker's Compensation |
$87.36
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
IP
|
$1,156.00
|
|
|
Service Code
|
CPT 25645
|
| Hospital Charge Code |
6125645
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$315.59 |
| Max. Negotiated Rate |
$1,098.20 |
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cigna Commercial |
$982.60
|
| Rate for Payer: First Health Commercial |
$1,040.40
|
| Rate for Payer: First Health Workers Compensation |
$446.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,040.40
|
| Rate for Payer: GEHA Commercial |
$809.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,040.40
|
| Rate for Payer: Multiplan All |
$1,051.96
|
| Rate for Payer: OMNI Networks Commercial |
$809.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,040.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,098.20
|
| Rate for Payer: Three Rivers Provider Network All |
$867.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,075.08
|
| Rate for Payer: Zelis Auto |
$462.40
|
| Rate for Payer: Zelis Worker's Compensation |
$315.59
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
OP
|
$1,156.00
|
|
|
Service Code
|
CPT 25645
|
| Hospital Charge Code |
6125645
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$315.59 |
| Max. Negotiated Rate |
$6,287.92 |
| 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 |
$693.60
|
| 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 |
$3,143.96
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cigna Commercial |
$982.60
|
| Rate for Payer: First Health Commercial |
$1,040.40
|
| Rate for Payer: First Health Workers Compensation |
$446.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,040.40
|
| Rate for Payer: GEHA Commercial |
$924.80
|
| Rate for Payer: GEHA Medicare |
$3,143.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,040.40
|
| Rate for Payer: Humana ChoiceCare |
$3,458.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,143.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,281.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,143.96
|
| Rate for Payer: Multiplan All |
$1,051.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,344.73
|
| Rate for Payer: OMNI Networks Commercial |
$809.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,040.40
|
| 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 |
$3,143.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,098.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,287.92
|
| Rate for Payer: Three Rivers Provider Network All |
$867.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,081.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,143.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,075.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,143.96
|
| Rate for Payer: Zelis Auto |
$462.40
|
| Rate for Payer: Zelis Medicare |
$2,672.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,772.75
|
| Rate for Payer: Zelis Worker's Compensation |
$315.59
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
IP
|
$1,470.00
|
|
|
Service Code
|
CPT 25628
|
| Hospital Charge Code |
6125628
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$401.31 |
| Max. Negotiated Rate |
$1,396.50 |
| Rate for Payer: Cash Price |
$882.00
|
| Rate for Payer: Cigna Commercial |
$1,249.50
|
| Rate for Payer: First Health Commercial |
$1,323.00
|
| Rate for Payer: First Health Workers Compensation |
$567.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,323.00
|
| Rate for Payer: GEHA Commercial |
$1,029.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,323.00
|
| Rate for Payer: Multiplan All |
$1,337.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,029.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,323.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,396.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,102.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,367.10
|
| Rate for Payer: Zelis Auto |
$588.00
|
| Rate for Payer: Zelis Worker's Compensation |
$401.31
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
IP
|
$956.00
|
|
|
Service Code
|
CPT 25635
|
| Hospital Charge Code |
6125635
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$260.99 |
| Max. Negotiated Rate |
$908.20 |
| Rate for Payer: Cash Price |
$573.60
|
| Rate for Payer: Cigna Commercial |
$812.60
|
| Rate for Payer: First Health Commercial |
$860.40
|
| Rate for Payer: First Health Workers Compensation |
$369.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$860.40
|
| Rate for Payer: GEHA Commercial |
$669.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$860.40
|
| Rate for Payer: Multiplan All |
$869.96
|
| Rate for Payer: OMNI Networks Commercial |
$669.20
|
| Rate for Payer: One Health Plan PPO/POS |
$860.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$908.20
|
| Rate for Payer: Three Rivers Provider Network All |
$717.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$889.08
|
| Rate for Payer: Zelis Auto |
$382.40
|
| Rate for Payer: Zelis Worker's Compensation |
$260.99
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
CPT 25630
|
| Hospital Charge Code |
6125630
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$595.00
|
| Rate for Payer: First Health Commercial |
$630.00
|
| Rate for Payer: First Health Workers Compensation |
$270.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$630.00
|
| Rate for Payer: GEHA Commercial |
$490.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$630.00
|
| Rate for Payer: Multiplan All |
$637.00
|
| Rate for Payer: OMNI Networks Commercial |
$490.00
|
| Rate for Payer: One Health Plan PPO/POS |
$630.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$665.00
|
| Rate for Payer: Three Rivers Provider Network All |
$525.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$651.00
|
| Rate for Payer: Zelis Auto |
$280.00
|
| Rate for Payer: Zelis Worker's Compensation |
$191.10
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
OP
|
$956.00
|
|
|
Service Code
|
CPT 25635
|
| Hospital Charge Code |
6125635
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$260.99 |
| 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 |
$573.60
|
| 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 |
$1,550.77
|
| Rate for Payer: Cash Price |
$573.60
|
| Rate for Payer: Cash Price |
$573.60
|
| Rate for Payer: Cigna Commercial |
$812.60
|
| Rate for Payer: First Health Commercial |
$860.40
|
| Rate for Payer: First Health Workers Compensation |
$369.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$860.40
|
| Rate for Payer: GEHA Commercial |
$764.80
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$860.40
|
| 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 |
$869.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$669.20
|
| Rate for Payer: One Health Plan PPO/POS |
$860.40
|
| 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 |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$908.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$717.00
|
| 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 |
$889.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$382.40
|
| 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 |
$260.99
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
OP
|
$871.00
|
|
|
Service Code
|
CPT 25624
|
| Hospital Charge Code |
6125624
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$237.78 |
| 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 |
$522.60
|
| 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 |
$1,550.77
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cigna Commercial |
$740.35
|
| Rate for Payer: First Health Commercial |
$783.90
|
| Rate for Payer: First Health Workers Compensation |
$336.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.90
|
| Rate for Payer: GEHA Commercial |
$696.80
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.90
|
| 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 |
$792.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$609.70
|
| Rate for Payer: One Health Plan PPO/POS |
$783.90
|
| 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 |
$827.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$653.25
|
| 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 |
$810.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$348.40
|
| 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 |
$237.78
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
IP
|
$749.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
6125650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$204.48 |
| Max. Negotiated Rate |
$711.55 |
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: Cigna Commercial |
$636.65
|
| Rate for Payer: First Health Commercial |
$674.10
|
| Rate for Payer: First Health Workers Compensation |
$289.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$674.10
|
| Rate for Payer: GEHA Commercial |
$524.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$674.10
|
| Rate for Payer: Multiplan All |
$681.59
|
| Rate for Payer: OMNI Networks Commercial |
$524.30
|
| Rate for Payer: One Health Plan PPO/POS |
$674.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$711.55
|
| Rate for Payer: Three Rivers Provider Network All |
$561.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$696.57
|
| Rate for Payer: Zelis Auto |
$299.60
|
| Rate for Payer: Zelis Worker's Compensation |
$204.48
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
IP
|
$871.00
|
|
|
Service Code
|
CPT 25624
|
| Hospital Charge Code |
6125624
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$237.78 |
| Max. Negotiated Rate |
$827.45 |
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cigna Commercial |
$740.35
|
| Rate for Payer: First Health Commercial |
$783.90
|
| Rate for Payer: First Health Workers Compensation |
$336.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.90
|
| Rate for Payer: GEHA Commercial |
$609.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.90
|
| Rate for Payer: Multiplan All |
$792.61
|
| Rate for Payer: OMNI Networks Commercial |
$609.70
|
| Rate for Payer: One Health Plan PPO/POS |
$783.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$827.45
|
| Rate for Payer: Three Rivers Provider Network All |
$653.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$810.03
|
| Rate for Payer: Zelis Auto |
$348.40
|
| Rate for Payer: Zelis Worker's Compensation |
$237.78
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
OP
|
$1,470.00
|
|
|
Service Code
|
CPT 25628
|
| Hospital Charge Code |
6125628
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$401.31 |
| 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 |
$882.00
|
| 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 |
$882.00
|
| Rate for Payer: Cash Price |
$882.00
|
| Rate for Payer: Cigna Commercial |
$1,249.50
|
| Rate for Payer: First Health Commercial |
$1,323.00
|
| Rate for Payer: First Health Workers Compensation |
$567.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,323.00
|
| Rate for Payer: GEHA Commercial |
$1,176.00
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,323.00
|
| 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 |
$1,337.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,029.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,323.00
|
| 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 |
$1,396.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$1,102.50
|
| 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 |
$1,367.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$588.00
|
| 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 |
$401.31
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
OP
|
$749.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
6125650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$711.55 |
| 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 |
$449.40
|
| 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 |
$232.44
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: Cigna Commercial |
$636.65
|
| Rate for Payer: First Health Commercial |
$674.10
|
| Rate for Payer: First Health Workers Compensation |
$289.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$674.10
|
| Rate for Payer: GEHA Commercial |
$599.20
|
| Rate for Payer: GEHA Medicare |
$232.44
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$674.10
|
| 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 |
$681.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$395.15
|
| Rate for Payer: OMNI Networks Commercial |
$524.30
|
| Rate for Payer: One Health Plan PPO/POS |
$674.10
|
| 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 |
$711.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$464.88
|
| Rate for Payer: Three Rivers Provider Network All |
$561.75
|
| 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 |
$696.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$232.44
|
| Rate for Payer: Zelis Auto |
$299.60
|
| Rate for Payer: Zelis Medicare |
$197.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$278.93
|
| Rate for Payer: Zelis Worker's Compensation |
$204.48
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
IP
|
$689.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
6125622
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$188.10 |
| Max. Negotiated Rate |
$654.55 |
| Rate for Payer: Cash Price |
$413.40
|
| Rate for Payer: Cigna Commercial |
$585.65
|
| Rate for Payer: First Health Commercial |
$620.10
|
| Rate for Payer: First Health Workers Compensation |
$266.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$620.10
|
| Rate for Payer: GEHA Commercial |
$482.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$620.10
|
| Rate for Payer: Multiplan All |
$626.99
|
| Rate for Payer: OMNI Networks Commercial |
$482.30
|
| Rate for Payer: One Health Plan PPO/POS |
$620.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$654.55
|
| Rate for Payer: Three Rivers Provider Network All |
$516.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$640.77
|
| Rate for Payer: Zelis Auto |
$275.60
|
| Rate for Payer: Zelis Worker's Compensation |
$188.10
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 25630
|
| Hospital Charge Code |
6125630
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$665.00 |
| 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 |
$420.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$232.44
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$595.00
|
| Rate for Payer: First Health Commercial |
$630.00
|
| Rate for Payer: First Health Workers Compensation |
$270.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$630.00
|
| Rate for Payer: GEHA Commercial |
$560.00
|
| Rate for Payer: GEHA Medicare |
$232.44
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$630.00
|
| 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 |
$637.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$395.15
|
| Rate for Payer: OMNI Networks Commercial |
$490.00
|
| Rate for Payer: One Health Plan PPO/POS |
$630.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$232.44
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$665.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$464.88
|
| Rate for Payer: Three Rivers Provider Network All |
$525.00
|
| 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 |
$651.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$232.44
|
| Rate for Payer: Zelis Auto |
$280.00
|
| Rate for Payer: Zelis Medicare |
$197.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$278.93
|
| Rate for Payer: Zelis Worker's Compensation |
$191.10
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
OP
|
$689.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
6125622
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$654.55 |
| 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 |
$413.40
|
| 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 |
$232.44
|
| Rate for Payer: Cash Price |
$413.40
|
| Rate for Payer: Cash Price |
$413.40
|
| Rate for Payer: Cigna Commercial |
$585.65
|
| Rate for Payer: First Health Commercial |
$620.10
|
| Rate for Payer: First Health Workers Compensation |
$266.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$620.10
|
| Rate for Payer: GEHA Commercial |
$551.20
|
| Rate for Payer: GEHA Medicare |
$232.44
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$620.10
|
| 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 |
$626.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$395.15
|
| Rate for Payer: OMNI Networks Commercial |
$482.30
|
| Rate for Payer: One Health Plan PPO/POS |
$620.10
|
| 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 |
$654.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$464.88
|
| Rate for Payer: Three Rivers Provider Network All |
$516.75
|
| 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 |
$640.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$232.44
|
| Rate for Payer: Zelis Auto |
$275.60
|
| Rate for Payer: Zelis Medicare |
$197.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$278.93
|
| Rate for Payer: Zelis Worker's Compensation |
$188.10
|
|
|
TREAT WRIST DISLOCATION
|
Facility
|
IP
|
$1,295.00
|
|
|
Service Code
|
CPT 25695
|
| Hospital Charge Code |
6125695
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$353.54 |
| Max. Negotiated Rate |
$1,230.25 |
| Rate for Payer: Cash Price |
$777.00
|
| Rate for Payer: Cigna Commercial |
$1,100.75
|
| Rate for Payer: First Health Commercial |
$1,165.50
|
| Rate for Payer: First Health Workers Compensation |
$500.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,165.50
|
| Rate for Payer: GEHA Commercial |
$906.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,165.50
|
| Rate for Payer: Multiplan All |
$1,178.45
|
| Rate for Payer: OMNI Networks Commercial |
$906.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,165.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,230.25
|
| Rate for Payer: Three Rivers Provider Network All |
$971.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,204.35
|
| Rate for Payer: Zelis Auto |
$518.00
|
| Rate for Payer: Zelis Worker's Compensation |
$353.54
|
|
|
TREAT WRIST DISLOCATION
|
Facility
|
IP
|
$1,235.00
|
|
|
Service Code
|
CPT 25670
|
| Hospital Charge Code |
6125670
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$337.15 |
| Max. Negotiated Rate |
$1,173.25 |
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cigna Commercial |
$1,049.75
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: First Health Workers Compensation |
$476.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,111.50
|
| Rate for Payer: GEHA Commercial |
$864.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,111.50
|
| Rate for Payer: Multiplan All |
$1,123.85
|
| Rate for Payer: OMNI Networks Commercial |
$864.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,111.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,173.25
|
| Rate for Payer: Three Rivers Provider Network All |
$926.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,148.55
|
| Rate for Payer: Zelis Auto |
$494.00
|
| Rate for Payer: Zelis Worker's Compensation |
$337.15
|
|
|
TREAT WRIST DISLOCATION
|
Facility
|
OP
|
$1,235.00
|
|
|
Service Code
|
CPT 25670
|
| Hospital Charge Code |
6125670
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$337.15 |
| 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 |
$741.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,070.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,922.13
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cigna Commercial |
$1,049.75
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: First Health Workers Compensation |
$476.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,111.50
|
| Rate for Payer: GEHA Commercial |
$988.00
|
| Rate for Payer: GEHA Medicare |
$6,922.13
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,111.50
|
| 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 |
$1,123.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,767.62
|
| Rate for Payer: OMNI Networks Commercial |
$864.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,111.50
|
| 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 |
$6,922.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,173.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,844.26
|
| Rate for Payer: Three Rivers Provider Network All |
$926.25
|
| 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 |
$1,148.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,922.13
|
| Rate for Payer: Zelis Auto |
$494.00
|
| 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 |
$337.15
|
|
|
TREAT WRIST DISLOCATION
|
Facility
|
OP
|
$963.00
|
|
|
Service Code
|
CPT 25690
|
| Hospital Charge Code |
6125690
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$262.90 |
| Max. Negotiated Rate |
$3,101.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,860.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$577.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,860.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,473.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,550.77
|
| Rate for Payer: Cash Price |
$577.80
|
| Rate for Payer: Cash Price |
$577.80
|
| Rate for Payer: Cigna Commercial |
$818.55
|
| Rate for Payer: First Health Commercial |
$866.70
|
| Rate for Payer: First Health Workers Compensation |
$371.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$866.70
|
| Rate for Payer: GEHA Commercial |
$770.40
|
| Rate for Payer: GEHA Medicare |
$1,550.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$866.70
|
| 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 |
$1,503.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,550.77
|
| Rate for Payer: Multiplan All |
$876.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,636.31
|
| Rate for Payer: OMNI Networks Commercial |
$674.10
|
| Rate for Payer: One Health Plan PPO/POS |
$866.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,736.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,503.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,550.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$914.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,101.54
|
| Rate for Payer: Three Rivers Provider Network All |
$722.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,519.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,503.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,550.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$895.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,550.77
|
| Rate for Payer: Zelis Auto |
$385.20
|
| 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 |
$262.90
|
|
