|
TX NOSE FX W/O STABILI
|
Facility
|
OP
|
$5,386.00
|
|
| Hospital Charge Code |
8121315
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,346.50 |
| Max. Negotiated Rate |
$5,116.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,231.60
|
| Rate for Payer: Cash Price |
$3,231.60
|
| Rate for Payer: Cigna Commercial |
$4,578.10
|
| Rate for Payer: First Health Commercial |
$4,847.40
|
| Rate for Payer: First Health Workers Compensation |
$2,079.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,847.40
|
| Rate for Payer: GEHA Commercial |
$4,308.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,847.40
|
| Rate for Payer: Humana ChoiceCare |
$1,400.36
|
| Rate for Payer: Multiplan All |
$4,901.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,231.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,770.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,847.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,116.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4,039.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,739.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,346.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,008.98
|
| Rate for Payer: Zelis Auto |
$2,154.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,693.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,470.38
|
|
|
TX SUPERFICIAL WOUND DEHISCENCE W/PACKIN
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
20300054
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$138.96 |
| Max. Negotiated Rate |
$483.55 |
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cigna Commercial |
$432.65
|
| Rate for Payer: First Health Commercial |
$458.10
|
| Rate for Payer: First Health Workers Compensation |
$196.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$458.10
|
| Rate for Payer: GEHA Commercial |
$356.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$458.10
|
| Rate for Payer: Multiplan All |
$463.19
|
| Rate for Payer: OMNI Networks Commercial |
$356.30
|
| Rate for Payer: One Health Plan PPO/POS |
$458.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$483.55
|
| Rate for Payer: Three Rivers Provider Network All |
$381.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$473.37
|
| Rate for Payer: Zelis Auto |
$203.60
|
| Rate for Payer: Zelis Worker's Compensation |
$138.96
|
|
|
TX SUPERFICIAL WOUND DEHISCENCE W/PACKIN
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
20300054
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$138.96 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$318.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$305.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$318.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$252.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cigna Commercial |
$432.65
|
| Rate for Payer: First Health Commercial |
$458.10
|
| Rate for Payer: First Health Workers Compensation |
$196.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$458.10
|
| Rate for Payer: GEHA Commercial |
$407.20
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$458.10
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$257.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$463.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$356.30
|
| Rate for Payer: One Health Plan PPO/POS |
$458.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$297.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$257.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$483.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$381.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$257.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$473.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$203.60
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$138.96
|
|
|
TX SUPERFICIAL WOUND DEHISCENCE W/PACKIN
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
6112021
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$117.12 |
| Max. Negotiated Rate |
$407.55 |
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cigna Commercial |
$364.65
|
| Rate for Payer: First Health Commercial |
$386.10
|
| Rate for Payer: First Health Workers Compensation |
$165.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$386.10
|
| Rate for Payer: GEHA Commercial |
$300.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$386.10
|
| Rate for Payer: Multiplan All |
$390.39
|
| Rate for Payer: OMNI Networks Commercial |
$300.30
|
| Rate for Payer: One Health Plan PPO/POS |
$386.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$407.55
|
| Rate for Payer: Three Rivers Provider Network All |
$321.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$398.97
|
| Rate for Payer: Zelis Auto |
$171.60
|
| Rate for Payer: Zelis Worker's Compensation |
$117.12
|
|
|
TX SUPERFICIAL WOUND DEHISCENCE W/PACKIN
|
Facility
|
OP
|
$429.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
6112021
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$117.12 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$318.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$257.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$318.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$252.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cigna Commercial |
$364.65
|
| Rate for Payer: First Health Commercial |
$386.10
|
| Rate for Payer: First Health Workers Compensation |
$165.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$386.10
|
| Rate for Payer: GEHA Commercial |
$343.20
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$386.10
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$257.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$390.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$300.30
|
| Rate for Payer: One Health Plan PPO/POS |
$386.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$297.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$257.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$407.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$321.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$257.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$398.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$171.60
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$117.12
|
|
|
TX SUPERFICL WOUND DEHISCENCE SIMP CLOSE
|
Facility
|
IP
|
$854.80
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
6112020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$233.36 |
| Max. Negotiated Rate |
$812.06 |
| Rate for Payer: Cash Price |
$512.88
|
| Rate for Payer: Cigna Commercial |
$726.58
|
| Rate for Payer: First Health Commercial |
$769.32
|
| Rate for Payer: First Health Workers Compensation |
$330.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$769.32
|
| Rate for Payer: GEHA Commercial |
$598.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$769.32
|
| Rate for Payer: Multiplan All |
$777.87
|
| Rate for Payer: OMNI Networks Commercial |
$598.36
|
| Rate for Payer: One Health Plan PPO/POS |
$769.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$812.06
|
| Rate for Payer: Three Rivers Provider Network All |
$641.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$794.96
|
| Rate for Payer: Zelis Auto |
$341.92
|
| Rate for Payer: Zelis Worker's Compensation |
$233.36
|
|
|
TX SUPERFICL WOUND DEHISCENCE SIMP CLOSE
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
20300053
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$235.87 |
| Max. Negotiated Rate |
$1,162.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$518.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$355.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cigna Commercial |
$734.40
|
| Rate for Payer: First Health Commercial |
$777.60
|
| Rate for Payer: First Health Workers Compensation |
$333.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$777.60
|
| Rate for Payer: GEHA Commercial |
$691.20
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$777.60
|
| Rate for Payer: Humana ChoiceCare |
$639.36
|
| Rate for Payer: Humana Medicare Advantage |
$581.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$976.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$362.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$786.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$604.80
|
| Rate for Payer: One Health Plan PPO/POS |
$777.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$418.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$362.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$820.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$648.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$362.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$803.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$345.60
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$235.87
|
|
|
TX SUPERFICL WOUND DEHISCENCE SIMP CLOSE
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
20300053
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$235.87 |
| Max. Negotiated Rate |
$820.80 |
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cigna Commercial |
$734.40
|
| Rate for Payer: First Health Commercial |
$777.60
|
| Rate for Payer: First Health Workers Compensation |
$333.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$777.60
|
| Rate for Payer: GEHA Commercial |
$604.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$777.60
|
| Rate for Payer: Multiplan All |
$786.24
|
| Rate for Payer: OMNI Networks Commercial |
$604.80
|
| Rate for Payer: One Health Plan PPO/POS |
$777.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$820.80
|
| Rate for Payer: Three Rivers Provider Network All |
$648.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$803.52
|
| Rate for Payer: Zelis Auto |
$345.60
|
| Rate for Payer: Zelis Worker's Compensation |
$235.87
|
|
|
TX SUPERFICL WOUND DEHISCENCE SIMP CLOSE
|
Facility
|
OP
|
$1,346.00
|
|
| Hospital Charge Code |
8112020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$336.50 |
| Max. Negotiated Rate |
$1,278.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$807.60
|
| Rate for Payer: Cash Price |
$807.60
|
| Rate for Payer: Cigna Commercial |
$1,144.10
|
| Rate for Payer: First Health Commercial |
$1,211.40
|
| Rate for Payer: First Health Workers Compensation |
$519.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,211.40
|
| Rate for Payer: GEHA Commercial |
$1,076.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,211.40
|
| Rate for Payer: Humana ChoiceCare |
$349.96
|
| Rate for Payer: Multiplan All |
$1,224.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$807.60
|
| Rate for Payer: OMNI Networks Commercial |
$942.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,211.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,278.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,009.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,184.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$336.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,251.78
|
| Rate for Payer: Zelis Auto |
$538.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$673.00
|
| Rate for Payer: Zelis Worker's Compensation |
$367.46
|
|
|
TX SUPERFICL WOUND DEHISCENCE SIMP CLOSE
|
Facility
|
IP
|
$1,346.00
|
|
| Hospital Charge Code |
8112020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$367.46 |
| Max. Negotiated Rate |
$1,278.70 |
| Rate for Payer: Cash Price |
$807.60
|
| Rate for Payer: Cigna Commercial |
$1,144.10
|
| Rate for Payer: First Health Commercial |
$1,211.40
|
| Rate for Payer: First Health Workers Compensation |
$519.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,211.40
|
| Rate for Payer: GEHA Commercial |
$942.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,211.40
|
| Rate for Payer: Multiplan All |
$1,224.86
|
| Rate for Payer: OMNI Networks Commercial |
$942.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,211.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,278.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,009.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,251.78
|
| Rate for Payer: Zelis Auto |
$538.40
|
| Rate for Payer: Zelis Worker's Compensation |
$367.46
|
|
|
TX SUPERFICL WOUND DEHISCENCE SIMP CLOSE
|
Facility
|
OP
|
$854.80
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
6112020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$233.36 |
| Max. Negotiated Rate |
$1,162.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$512.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$355.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: Cash Price |
$512.88
|
| Rate for Payer: Cash Price |
$512.88
|
| Rate for Payer: Cigna Commercial |
$726.58
|
| Rate for Payer: First Health Commercial |
$769.32
|
| Rate for Payer: First Health Workers Compensation |
$330.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$769.32
|
| Rate for Payer: GEHA Commercial |
$683.84
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$769.32
|
| Rate for Payer: Humana ChoiceCare |
$639.36
|
| Rate for Payer: Humana Medicare Advantage |
$581.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$976.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$362.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$777.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$598.36
|
| Rate for Payer: One Health Plan PPO/POS |
$769.32
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$418.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$362.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$812.06
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$641.10
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$362.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$794.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$341.92
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$233.36
|
|
|
TX TARSAL BONE FX XCP TALUS&CALCN W/O MA
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
9628450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$703.00 |
| 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 |
$444.00
|
| 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 |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna Commercial |
$629.00
|
| Rate for Payer: First Health Commercial |
$666.00
|
| Rate for Payer: First Health Workers Compensation |
$285.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$666.00
|
| Rate for Payer: GEHA Commercial |
$592.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$666.00
|
| 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 |
$673.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$518.00
|
| Rate for Payer: One Health Plan PPO/POS |
$666.00
|
| 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 |
$703.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$555.00
|
| 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 |
$688.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$296.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$202.02
|
|
|
TX TARSAL BONE FX XCP TALUS&CALCN W/O MA
|
Facility
|
IP
|
$647.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
6128450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$176.63 |
| Max. Negotiated Rate |
$614.65 |
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cigna Commercial |
$549.95
|
| Rate for Payer: First Health Commercial |
$582.30
|
| Rate for Payer: First Health Workers Compensation |
$249.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$582.30
|
| Rate for Payer: GEHA Commercial |
$452.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$582.30
|
| Rate for Payer: Multiplan All |
$588.77
|
| Rate for Payer: OMNI Networks Commercial |
$452.90
|
| Rate for Payer: One Health Plan PPO/POS |
$582.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$614.65
|
| Rate for Payer: Three Rivers Provider Network All |
$485.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$601.71
|
| Rate for Payer: Zelis Auto |
$258.80
|
| Rate for Payer: Zelis Worker's Compensation |
$176.63
|
|
|
TX TARSAL BONE FX XCP TALUS&CALCN W/O MA
|
Facility
|
OP
|
$647.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
6128450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$614.65 |
| 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 |
$388.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cigna Commercial |
$549.95
|
| Rate for Payer: First Health Commercial |
$582.30
|
| Rate for Payer: First Health Workers Compensation |
$249.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$582.30
|
| Rate for Payer: GEHA Commercial |
$517.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$582.30
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$588.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$452.90
|
| Rate for Payer: One Health Plan PPO/POS |
$582.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$614.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$485.25
|
| 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 |
$601.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$258.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$176.63
|
|
|
TX TARSAL BONE FX XCP TALUS&CALCN W/O MA
|
Facility
|
IP
|
$647.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
8728450
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$176.63 |
| Max. Negotiated Rate |
$614.65 |
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cigna Commercial |
$549.95
|
| Rate for Payer: First Health Commercial |
$582.30
|
| Rate for Payer: First Health Workers Compensation |
$249.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$582.30
|
| Rate for Payer: GEHA Commercial |
$452.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$582.30
|
| Rate for Payer: Multiplan All |
$588.77
|
| Rate for Payer: OMNI Networks Commercial |
$452.90
|
| Rate for Payer: One Health Plan PPO/POS |
$582.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$614.65
|
| Rate for Payer: Three Rivers Provider Network All |
$485.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$601.71
|
| Rate for Payer: Zelis Auto |
$258.80
|
| Rate for Payer: Zelis Worker's Compensation |
$176.63
|
|
|
TX TARSAL BONE FX XCP TALUS&CALCN W/O MA
|
Facility
|
OP
|
$647.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
8728450
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$614.65 |
| 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 |
$388.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cigna Commercial |
$549.95
|
| Rate for Payer: First Health Commercial |
$582.30
|
| Rate for Payer: First Health Workers Compensation |
$249.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$582.30
|
| Rate for Payer: GEHA Commercial |
$517.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$582.30
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$588.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$452.90
|
| Rate for Payer: One Health Plan PPO/POS |
$582.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$614.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$485.25
|
| 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 |
$601.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$258.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$176.63
|
|
|
TX TARSAL BONE FX XCP TALUS&CALCN W/O MA
|
Facility
|
IP
|
$740.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
9628450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.02 |
| Max. Negotiated Rate |
$703.00 |
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna Commercial |
$629.00
|
| Rate for Payer: First Health Commercial |
$666.00
|
| Rate for Payer: First Health Workers Compensation |
$285.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$666.00
|
| Rate for Payer: GEHA Commercial |
$518.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$666.00
|
| Rate for Payer: Multiplan All |
$673.40
|
| Rate for Payer: OMNI Networks Commercial |
$518.00
|
| Rate for Payer: One Health Plan PPO/POS |
$666.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$703.00
|
| Rate for Payer: Three Rivers Provider Network All |
$555.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$688.20
|
| Rate for Payer: Zelis Auto |
$296.00
|
| Rate for Payer: Zelis Worker's Compensation |
$202.02
|
|
|
TX TARSAL BONE FX XCP TALUS&CALCN W/O MA
|
Facility
|
OP
|
$647.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
8300031
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$614.65 |
| 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 |
$388.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cigna Commercial |
$549.95
|
| Rate for Payer: First Health Commercial |
$582.30
|
| Rate for Payer: First Health Workers Compensation |
$249.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$582.30
|
| Rate for Payer: GEHA Commercial |
$517.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$582.30
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$588.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$452.90
|
| Rate for Payer: One Health Plan PPO/POS |
$582.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$614.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$485.25
|
| 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 |
$601.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$258.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$176.63
|
|
|
TX TARSAL BONE FX XCP TALUS&CALCN W/O MA
|
Facility
|
IP
|
$647.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
8300031
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$176.63 |
| Max. Negotiated Rate |
$614.65 |
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cigna Commercial |
$549.95
|
| Rate for Payer: First Health Commercial |
$582.30
|
| Rate for Payer: First Health Workers Compensation |
$249.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$582.30
|
| Rate for Payer: GEHA Commercial |
$452.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$582.30
|
| Rate for Payer: Multiplan All |
$588.77
|
| Rate for Payer: OMNI Networks Commercial |
$452.90
|
| Rate for Payer: One Health Plan PPO/POS |
$582.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$614.65
|
| Rate for Payer: Three Rivers Provider Network All |
$485.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$601.71
|
| Rate for Payer: Zelis Auto |
$258.80
|
| Rate for Payer: Zelis Worker's Compensation |
$176.63
|
|
|
TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/
|
Facility
|
OP
|
$2,058.00
|
|
|
Service Code
|
CPT 27759
|
| Hospital Charge Code |
6127759
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$561.83 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,234.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,244.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: Cigna Commercial |
$1,749.30
|
| Rate for Payer: First Health Commercial |
$1,852.20
|
| Rate for Payer: First Health Workers Compensation |
$794.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,852.20
|
| Rate for Payer: GEHA Commercial |
$1,646.40
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,852.20
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,872.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,440.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,852.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,178.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,351.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,955.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$1,543.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,913.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$823.20
|
| Rate for Payer: Zelis Medicare |
$10,384.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,661.07
|
| Rate for Payer: Zelis Worker's Compensation |
$561.83
|
|
|
TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/
|
Facility
|
IP
|
$2,058.00
|
|
|
Service Code
|
CPT 27759
|
| Hospital Charge Code |
6127759
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$561.83 |
| Max. Negotiated Rate |
$1,955.10 |
| Rate for Payer: Cash Price |
$1,234.80
|
| Rate for Payer: Cigna Commercial |
$1,749.30
|
| Rate for Payer: First Health Commercial |
$1,852.20
|
| Rate for Payer: First Health Workers Compensation |
$794.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,852.20
|
| Rate for Payer: GEHA Commercial |
$1,440.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,852.20
|
| Rate for Payer: Multiplan All |
$1,872.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,440.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,852.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,955.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,543.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,913.94
|
| Rate for Payer: Zelis Auto |
$823.20
|
| Rate for Payer: Zelis Worker's Compensation |
$561.83
|
|
|
TYMPANOMETRY & REFLEX THRESH
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
21692550
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$79.72 |
| Max. Negotiated Rate |
$297.14 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$176.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$175.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$176.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$140.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$148.57
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cigna Commercial |
$248.20
|
| Rate for Payer: First Health Commercial |
$262.80
|
| Rate for Payer: First Health Workers Compensation |
$112.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$262.80
|
| Rate for Payer: GEHA Commercial |
$233.60
|
| Rate for Payer: GEHA Medicare |
$148.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$262.80
|
| Rate for Payer: Humana ChoiceCare |
$163.43
|
| Rate for Payer: Humana Medicare Advantage |
$148.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$249.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$142.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$148.57
|
| Rate for Payer: Multiplan All |
$265.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.57
|
| Rate for Payer: OMNI Networks Commercial |
$204.40
|
| Rate for Payer: One Health Plan PPO/POS |
$262.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$165.06
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$142.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$148.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$277.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$297.14
|
| Rate for Payer: Three Rivers Provider Network All |
$219.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$142.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$271.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$148.57
|
| Rate for Payer: Zelis Auto |
$116.80
|
| Rate for Payer: Zelis Medicare |
$126.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.28
|
| Rate for Payer: Zelis Worker's Compensation |
$79.72
|
|
|
TYMPANOMETRY & REFLEX THRESH
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
21692550
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$79.72 |
| Max. Negotiated Rate |
$277.40 |
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cigna Commercial |
$248.20
|
| Rate for Payer: First Health Commercial |
$262.80
|
| Rate for Payer: First Health Workers Compensation |
$112.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$262.80
|
| Rate for Payer: GEHA Commercial |
$204.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$262.80
|
| Rate for Payer: Multiplan All |
$265.72
|
| Rate for Payer: OMNI Networks Commercial |
$204.40
|
| Rate for Payer: One Health Plan PPO/POS |
$262.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$277.40
|
| Rate for Payer: Three Rivers Provider Network All |
$219.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$271.56
|
| Rate for Payer: Zelis Auto |
$116.80
|
| Rate for Payer: Zelis Worker's Compensation |
$79.72
|
|
|
TYMPANOMETRY & REFLEX THRESH
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
8592550
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$22.80 |
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$20.40
|
| Rate for Payer: First Health Commercial |
$21.60
|
| Rate for Payer: First Health Workers Compensation |
$9.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$21.60
|
| Rate for Payer: GEHA Commercial |
$16.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$21.60
|
| Rate for Payer: Multiplan All |
$21.84
|
| Rate for Payer: OMNI Networks Commercial |
$16.80
|
| Rate for Payer: One Health Plan PPO/POS |
$21.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$22.80
|
| Rate for Payer: Three Rivers Provider Network All |
$18.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$22.32
|
| Rate for Payer: Zelis Auto |
$9.60
|
| Rate for Payer: Zelis Worker's Compensation |
$6.55
|
|
|
TYMPANOMETRY & REFLEX THRESH
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
8592550
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$297.14 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$176.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$14.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$176.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$140.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$148.57
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$20.40
|
| Rate for Payer: First Health Commercial |
$21.60
|
| Rate for Payer: First Health Workers Compensation |
$9.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$21.60
|
| Rate for Payer: GEHA Commercial |
$19.20
|
| Rate for Payer: GEHA Medicare |
$148.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$21.60
|
| Rate for Payer: Humana ChoiceCare |
$163.43
|
| Rate for Payer: Humana Medicare Advantage |
$148.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$249.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$142.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$148.57
|
| Rate for Payer: Multiplan All |
$21.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.57
|
| Rate for Payer: OMNI Networks Commercial |
$16.80
|
| Rate for Payer: One Health Plan PPO/POS |
$21.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$165.06
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$142.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$148.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$22.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$297.14
|
| Rate for Payer: Three Rivers Provider Network All |
$18.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$142.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$22.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$148.57
|
| Rate for Payer: Zelis Auto |
$9.60
|
| Rate for Payer: Zelis Medicare |
$126.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.28
|
| Rate for Payer: Zelis Worker's Compensation |
$6.55
|
|
