|
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
|
|
|
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 |
$56.40
|
| 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 |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$80.10
|
| Rate for Payer: Humana ChoiceCare |
$62.04
|
| Rate for Payer: Humana Medicare Advantage |
$56.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$94.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$124.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$80.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| 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 |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$84.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$66.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$124.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$82.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$35.60
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| 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
|
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 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 |
$382.04 |
| 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 |
$191.02
|
| 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 |
$191.02
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$288.00
|
| Rate for Payer: Humana ChoiceCare |
$210.12
|
| Rate for Payer: Humana Medicare Advantage |
$191.02
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$320.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$124.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$191.02
|
| Rate for Payer: Multiplan All |
$291.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$324.73
|
| 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 |
$191.02
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$304.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$382.04
|
| Rate for Payer: Three Rivers Provider Network All |
$240.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$187.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$124.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$297.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$191.02
|
| Rate for Payer: Zelis Auto |
$128.00
|
| Rate for Payer: Zelis Medicare |
$162.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$229.22
|
| Rate for Payer: Zelis Worker's Compensation |
$87.36
|
|
|
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 |
$3,039.30 |
| 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 |
$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 |
$1,519.65
|
| 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 |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.90
|
| 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 |
$792.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| 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 |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$827.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$653.25
|
| 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 |
$810.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$348.40
|
| 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 |
$237.78
|
|
|
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
|
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
|
$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 |
$227.78
|
| 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 |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$620.10
|
| 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 |
$626.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| 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 |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$654.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$516.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$640.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$275.60
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$188.10
|
|
|
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
|
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
|
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
|
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 |
$227.78
|
| 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 |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$630.00
|
| 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 |
$637.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| 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 |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$665.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$525.00
|
| 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 |
$651.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$280.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$191.10
|
|
|
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 |
$13,566.52 |
| 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 |
$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 |
$6,783.26
|
| 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 |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,323.00
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,337.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,396.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,102.50
|
| 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 |
$1,367.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$588.00
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$401.31
|
|
|
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
|
OP
|
$956.00
|
|
|
Service Code
|
CPT 25635
|
| Hospital Charge Code |
6125635
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$260.99 |
| 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 |
$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 |
$1,519.65
|
| 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 |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$860.40
|
| 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 |
$869.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| 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 |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$908.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$717.00
|
| 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 |
$889.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$382.40
|
| 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 |
$260.99
|
|
|
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 |
$227.78
|
| 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 |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$674.10
|
| 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 |
$681.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| 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 |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$711.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$561.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$696.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$299.60
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$204.48
|
|
|
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 |
$6,161.78 |
| 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 |
$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 |
$3,080.89
|
| 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 |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,040.40
|
| 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 |
$1,051.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,098.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$867.00
|
| 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 |
$1,075.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$462.40
|
| 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 |
$315.59
|
|
|
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
|
$995.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
6125675
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$271.63 |
| Max. Negotiated Rate |
$945.25 |
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cigna Commercial |
$845.75
|
| Rate for Payer: First Health Commercial |
$895.50
|
| Rate for Payer: First Health Workers Compensation |
$384.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$895.50
|
| Rate for Payer: GEHA Commercial |
$696.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$895.50
|
| Rate for Payer: Multiplan All |
$905.45
|
| Rate for Payer: OMNI Networks Commercial |
$696.50
|
| Rate for Payer: One Health Plan PPO/POS |
$895.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$945.25
|
| Rate for Payer: Three Rivers Provider Network All |
$746.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$925.35
|
| Rate for Payer: Zelis Auto |
$398.00
|
| Rate for Payer: Zelis Worker's Compensation |
$271.63
|
|
|
TREAT WRIST DISLOCATION
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
6125675
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$945.25 |
| 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 |
$597.00
|
| 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 |
$227.78
|
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cigna Commercial |
$845.75
|
| Rate for Payer: First Health Commercial |
$895.50
|
| Rate for Payer: First Health Workers Compensation |
$384.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$895.50
|
| Rate for Payer: GEHA Commercial |
$796.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$895.50
|
| 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 |
$905.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$696.50
|
| Rate for Payer: One Health Plan PPO/POS |
$895.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$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 |
$945.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$746.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$925.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$398.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$271.63
|
|
|
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
|
|
