|
CLOSED TREAT PST MALLEOLUS FRACT W/O MAN
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
CPT 27767
|
| Hospital Charge Code |
9627767
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$796.10 |
| 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 |
$502.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cigna Commercial |
$712.30
|
| Rate for Payer: First Health Commercial |
$754.20
|
| Rate for Payer: First Health Workers Compensation |
$323.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$754.20
|
| Rate for Payer: GEHA Commercial |
$670.40
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$754.20
|
| 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 |
$762.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$586.60
|
| Rate for Payer: One Health Plan PPO/POS |
$754.20
|
| 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 |
$796.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$628.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$779.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$335.20
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$228.77
|
|
|
CLOSED TREAT PST MALLEOLUS FRACT W/O MAN
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
CPT 27767
|
| Hospital Charge Code |
9627767
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.77 |
| Max. Negotiated Rate |
$796.10 |
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cigna Commercial |
$712.30
|
| Rate for Payer: First Health Commercial |
$754.20
|
| Rate for Payer: First Health Workers Compensation |
$323.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$754.20
|
| Rate for Payer: GEHA Commercial |
$586.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$754.20
|
| Rate for Payer: Multiplan All |
$762.58
|
| Rate for Payer: OMNI Networks Commercial |
$586.60
|
| Rate for Payer: One Health Plan PPO/POS |
$754.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$796.10
|
| Rate for Payer: Three Rivers Provider Network All |
$628.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$779.34
|
| Rate for Payer: Zelis Auto |
$335.20
|
| Rate for Payer: Zelis Worker's Compensation |
$228.77
|
|
|
CLOSED TREAT PST MALLEOLUS FRACT W/O MAN
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
CPT 27767
|
| Hospital Charge Code |
8300023
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$228.77 |
| Max. Negotiated Rate |
$796.10 |
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cigna Commercial |
$712.30
|
| Rate for Payer: First Health Commercial |
$754.20
|
| Rate for Payer: First Health Workers Compensation |
$323.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$754.20
|
| Rate for Payer: GEHA Commercial |
$586.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$754.20
|
| Rate for Payer: Multiplan All |
$762.58
|
| Rate for Payer: OMNI Networks Commercial |
$586.60
|
| Rate for Payer: One Health Plan PPO/POS |
$754.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$796.10
|
| Rate for Payer: Three Rivers Provider Network All |
$628.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$779.34
|
| Rate for Payer: Zelis Auto |
$335.20
|
| Rate for Payer: Zelis Worker's Compensation |
$228.77
|
|
|
CLOSED TREAT PST MALLEOLUS FRACT W/O MAN
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
CPT 27767
|
| Hospital Charge Code |
8727767
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$228.77 |
| Max. Negotiated Rate |
$796.10 |
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cigna Commercial |
$712.30
|
| Rate for Payer: First Health Commercial |
$754.20
|
| Rate for Payer: First Health Workers Compensation |
$323.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$754.20
|
| Rate for Payer: GEHA Commercial |
$586.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$754.20
|
| Rate for Payer: Multiplan All |
$762.58
|
| Rate for Payer: OMNI Networks Commercial |
$586.60
|
| Rate for Payer: One Health Plan PPO/POS |
$754.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$796.10
|
| Rate for Payer: Three Rivers Provider Network All |
$628.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$779.34
|
| Rate for Payer: Zelis Auto |
$335.20
|
| Rate for Payer: Zelis Worker's Compensation |
$228.77
|
|
|
CLOSED TX ANKLE DISLOCATION W/O ANESTHES
|
Facility
|
IP
|
$1,270.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
9627840
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$346.71 |
| Max. Negotiated Rate |
$1,206.50 |
| Rate for Payer: Cash Price |
$762.00
|
| Rate for Payer: Cigna Commercial |
$1,079.50
|
| Rate for Payer: First Health Commercial |
$1,143.00
|
| Rate for Payer: First Health Workers Compensation |
$490.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,143.00
|
| Rate for Payer: GEHA Commercial |
$889.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,143.00
|
| Rate for Payer: Multiplan All |
$1,155.70
|
| Rate for Payer: OMNI Networks Commercial |
$889.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,143.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,206.50
|
| Rate for Payer: Three Rivers Provider Network All |
$952.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,181.10
|
| Rate for Payer: Zelis Auto |
$508.00
|
| Rate for Payer: Zelis Worker's Compensation |
$346.71
|
|
|
CLOSED TX ANKLE DISLOCATION W/O ANESTHES
|
Facility
|
OP
|
$1,117.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
6127840
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$193.61 |
| Max. Negotiated Rate |
$1,061.15 |
| 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 |
$670.20
|
| 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 |
$227.78
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$949.45
|
| Rate for Payer: First Health Commercial |
$1,005.30
|
| Rate for Payer: First Health Workers Compensation |
$431.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,005.30
|
| Rate for Payer: GEHA Commercial |
$893.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,005.30
|
| 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 |
$391.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$1,016.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$781.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,005.30
|
| 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 |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,061.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$837.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$391.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,038.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$446.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$304.94
|
|
|
CLOSED TX ANKLE DISLOCATION W/O ANESTHES
|
Facility
|
IP
|
$1,117.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
8727840
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$304.94 |
| Max. Negotiated Rate |
$1,061.15 |
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$949.45
|
| Rate for Payer: First Health Commercial |
$1,005.30
|
| Rate for Payer: First Health Workers Compensation |
$431.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,005.30
|
| Rate for Payer: GEHA Commercial |
$781.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,005.30
|
| Rate for Payer: Multiplan All |
$1,016.47
|
| Rate for Payer: OMNI Networks Commercial |
$781.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,005.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,061.15
|
| Rate for Payer: Three Rivers Provider Network All |
$837.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,038.81
|
| Rate for Payer: Zelis Auto |
$446.80
|
| Rate for Payer: Zelis Worker's Compensation |
$304.94
|
|
|
CLOSED TX ANKLE DISLOCATION W/O ANESTHES
|
Facility
|
OP
|
$1,270.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
9627840
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.61 |
| Max. Negotiated Rate |
$1,206.50 |
| 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 |
$762.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$484.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$384.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$762.00
|
| Rate for Payer: Cash Price |
$762.00
|
| Rate for Payer: Cigna Commercial |
$1,079.50
|
| Rate for Payer: First Health Commercial |
$1,143.00
|
| Rate for Payer: First Health Workers Compensation |
$490.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,143.00
|
| Rate for Payer: GEHA Commercial |
$1,016.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,143.00
|
| 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 |
$391.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$1,155.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$889.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,143.00
|
| 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 |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,206.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$952.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$391.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,181.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$508.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$346.71
|
|
|
CLOSED TX ANKLE DISLOCATION W/O ANESTHES
|
Facility
|
OP
|
$1,117.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
8300028
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$193.61 |
| Max. Negotiated Rate |
$1,061.15 |
| 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 |
$670.20
|
| 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 |
$227.78
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$949.45
|
| Rate for Payer: First Health Commercial |
$1,005.30
|
| Rate for Payer: First Health Workers Compensation |
$431.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,005.30
|
| Rate for Payer: GEHA Commercial |
$893.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,005.30
|
| 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 |
$391.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$1,016.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$781.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,005.30
|
| 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 |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,061.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$837.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$391.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,038.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$446.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$304.94
|
|
|
CLOSED TX ANKLE DISLOCATION W/O ANESTHES
|
Facility
|
OP
|
$1,117.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
8727840
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$193.61 |
| Max. Negotiated Rate |
$1,061.15 |
| 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 |
$670.20
|
| 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 |
$227.78
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$949.45
|
| Rate for Payer: First Health Commercial |
$1,005.30
|
| Rate for Payer: First Health Workers Compensation |
$431.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,005.30
|
| Rate for Payer: GEHA Commercial |
$893.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,005.30
|
| 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 |
$391.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$1,016.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$781.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,005.30
|
| 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 |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,061.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$837.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$391.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,038.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$446.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$304.94
|
|
|
CLOSED TX ANKLE DISLOCATION W/O ANESTHES
|
Facility
|
IP
|
$1,117.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
6127840
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$304.94 |
| Max. Negotiated Rate |
$1,061.15 |
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$949.45
|
| Rate for Payer: First Health Commercial |
$1,005.30
|
| Rate for Payer: First Health Workers Compensation |
$431.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,005.30
|
| Rate for Payer: GEHA Commercial |
$781.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,005.30
|
| Rate for Payer: Multiplan All |
$1,016.47
|
| Rate for Payer: OMNI Networks Commercial |
$781.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,005.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,061.15
|
| Rate for Payer: Three Rivers Provider Network All |
$837.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,038.81
|
| Rate for Payer: Zelis Auto |
$446.80
|
| Rate for Payer: Zelis Worker's Compensation |
$304.94
|
|
|
CLOSED TX ANKLE DISLOCATION W/O ANESTHES
|
Facility
|
IP
|
$2,047.00
|
|
| Hospital Charge Code |
8150087
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$558.83 |
| Max. Negotiated Rate |
$1,944.65 |
| Rate for Payer: Cash Price |
$1,228.20
|
| Rate for Payer: Cigna Commercial |
$1,739.95
|
| Rate for Payer: First Health Commercial |
$1,842.30
|
| Rate for Payer: First Health Workers Compensation |
$790.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,842.30
|
| Rate for Payer: GEHA Commercial |
$1,432.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,842.30
|
| Rate for Payer: Multiplan All |
$1,862.77
|
| Rate for Payer: OMNI Networks Commercial |
$1,432.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,842.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,944.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,535.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,903.71
|
| Rate for Payer: Zelis Auto |
$818.80
|
| Rate for Payer: Zelis Worker's Compensation |
$558.83
|
|
|
CLOSED TX ANKLE DISLOCATION W/O ANESTHES
|
Facility
|
OP
|
$2,047.00
|
|
| Hospital Charge Code |
8150087
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$511.75 |
| Max. Negotiated Rate |
$1,944.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,228.20
|
| Rate for Payer: Cash Price |
$1,228.20
|
| Rate for Payer: Cigna Commercial |
$1,739.95
|
| Rate for Payer: First Health Commercial |
$1,842.30
|
| Rate for Payer: First Health Workers Compensation |
$790.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,842.30
|
| Rate for Payer: GEHA Commercial |
$1,637.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,842.30
|
| Rate for Payer: Humana ChoiceCare |
$532.22
|
| Rate for Payer: Multiplan All |
$1,862.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,228.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,432.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,842.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,944.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,535.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,801.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$511.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,903.71
|
| Rate for Payer: Zelis Auto |
$818.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,023.50
|
| Rate for Payer: Zelis Worker's Compensation |
$558.83
|
|
|
CLOSED TX ANKLE DISLOCATION W/O ANESTHES
|
Facility
|
IP
|
$1,117.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
8300028
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$304.94 |
| Max. Negotiated Rate |
$1,061.15 |
| Rate for Payer: Cash Price |
$670.20
|
| Rate for Payer: Cigna Commercial |
$949.45
|
| Rate for Payer: First Health Commercial |
$1,005.30
|
| Rate for Payer: First Health Workers Compensation |
$431.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,005.30
|
| Rate for Payer: GEHA Commercial |
$781.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,005.30
|
| Rate for Payer: Multiplan All |
$1,016.47
|
| Rate for Payer: OMNI Networks Commercial |
$781.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,005.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,061.15
|
| Rate for Payer: Three Rivers Provider Network All |
$837.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,038.81
|
| Rate for Payer: Zelis Auto |
$446.80
|
| Rate for Payer: Zelis Worker's Compensation |
$304.94
|
|
|
CLOSED TX BIMALLEOLAR ANK FRACTUR W/MANJ
|
Facility
|
IP
|
$2,778.00
|
|
| Hospital Charge Code |
8127810
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$758.39 |
| Max. Negotiated Rate |
$2,639.10 |
| Rate for Payer: Cash Price |
$1,666.80
|
| Rate for Payer: Cigna Commercial |
$2,361.30
|
| Rate for Payer: First Health Commercial |
$2,500.20
|
| Rate for Payer: First Health Workers Compensation |
$1,072.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,500.20
|
| Rate for Payer: GEHA Commercial |
$1,944.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,500.20
|
| Rate for Payer: Multiplan All |
$2,527.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,944.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,500.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,639.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,083.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,583.54
|
| Rate for Payer: Zelis Auto |
$1,111.20
|
| Rate for Payer: Zelis Worker's Compensation |
$758.39
|
|
|
CLOSED TX BIMALLEOLAR ANK FRACTUR W/MANJ
|
Facility
|
OP
|
$2,778.00
|
|
| Hospital Charge Code |
8127810
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$694.50 |
| Max. Negotiated Rate |
$2,639.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,666.80
|
| Rate for Payer: Cash Price |
$1,666.80
|
| Rate for Payer: Cigna Commercial |
$2,361.30
|
| Rate for Payer: First Health Commercial |
$2,500.20
|
| Rate for Payer: First Health Workers Compensation |
$1,072.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,500.20
|
| Rate for Payer: GEHA Commercial |
$2,222.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,500.20
|
| Rate for Payer: Humana ChoiceCare |
$722.28
|
| Rate for Payer: Multiplan All |
$2,527.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,666.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,944.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,500.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,639.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,083.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,444.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$694.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,583.54
|
| Rate for Payer: Zelis Auto |
$1,111.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,389.00
|
| Rate for Payer: Zelis Worker's Compensation |
$758.39
|
|
|
CLOSED TX BIMALLEOLAR ANKLE FX W/O MANJ
|
Facility
|
OP
|
$996.00
|
|
|
Service Code
|
CPT 27808
|
| Hospital Charge Code |
6127808
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$946.20 |
| 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 |
$597.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cigna Commercial |
$846.60
|
| Rate for Payer: First Health Commercial |
$896.40
|
| Rate for Payer: First Health Workers Compensation |
$384.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$896.40
|
| Rate for Payer: GEHA Commercial |
$796.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$896.40
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$906.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$697.20
|
| Rate for Payer: One Health Plan PPO/POS |
$896.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$946.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$747.00
|
| 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 |
$926.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$398.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$271.91
|
|
|
CLOSED TX BIMALLEOLAR ANKLE FX W/O MANJ
|
Facility
|
OP
|
$996.00
|
|
|
Service Code
|
CPT 27808
|
| Hospital Charge Code |
8727808
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$946.20 |
| 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 |
$597.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cigna Commercial |
$846.60
|
| Rate for Payer: First Health Commercial |
$896.40
|
| Rate for Payer: First Health Workers Compensation |
$384.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$896.40
|
| Rate for Payer: GEHA Commercial |
$796.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$896.40
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$906.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$697.20
|
| Rate for Payer: One Health Plan PPO/POS |
$896.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$946.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$747.00
|
| 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 |
$926.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$398.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$271.91
|
|
|
CLOSED TX BIMALLEOLAR ANKLE FX W/O MANJ
|
Facility
|
IP
|
$996.00
|
|
|
Service Code
|
CPT 27808
|
| Hospital Charge Code |
8727808
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$271.91 |
| Max. Negotiated Rate |
$946.20 |
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cigna Commercial |
$846.60
|
| Rate for Payer: First Health Commercial |
$896.40
|
| Rate for Payer: First Health Workers Compensation |
$384.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$896.40
|
| Rate for Payer: GEHA Commercial |
$697.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$896.40
|
| Rate for Payer: Multiplan All |
$906.36
|
| Rate for Payer: OMNI Networks Commercial |
$697.20
|
| Rate for Payer: One Health Plan PPO/POS |
$896.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$946.20
|
| Rate for Payer: Three Rivers Provider Network All |
$747.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$926.28
|
| Rate for Payer: Zelis Auto |
$398.40
|
| Rate for Payer: Zelis Worker's Compensation |
$271.91
|
|
|
CLOSED TX BIMALLEOLAR ANKLE FX W/O MANJ
|
Facility
|
IP
|
$996.00
|
|
|
Service Code
|
CPT 27808
|
| Hospital Charge Code |
8300025
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$271.91 |
| Max. Negotiated Rate |
$946.20 |
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cigna Commercial |
$846.60
|
| Rate for Payer: First Health Commercial |
$896.40
|
| Rate for Payer: First Health Workers Compensation |
$384.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$896.40
|
| Rate for Payer: GEHA Commercial |
$697.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$896.40
|
| Rate for Payer: Multiplan All |
$906.36
|
| Rate for Payer: OMNI Networks Commercial |
$697.20
|
| Rate for Payer: One Health Plan PPO/POS |
$896.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$946.20
|
| Rate for Payer: Three Rivers Provider Network All |
$747.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$926.28
|
| Rate for Payer: Zelis Auto |
$398.40
|
| Rate for Payer: Zelis Worker's Compensation |
$271.91
|
|
|
CLOSED TX BIMALLEOLAR ANKLE FX W/O MANJ
|
Facility
|
IP
|
$996.00
|
|
|
Service Code
|
CPT 27808
|
| Hospital Charge Code |
9627808
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.91 |
| Max. Negotiated Rate |
$946.20 |
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cigna Commercial |
$846.60
|
| Rate for Payer: First Health Commercial |
$896.40
|
| Rate for Payer: First Health Workers Compensation |
$384.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$896.40
|
| Rate for Payer: GEHA Commercial |
$697.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$896.40
|
| Rate for Payer: Multiplan All |
$906.36
|
| Rate for Payer: OMNI Networks Commercial |
$697.20
|
| Rate for Payer: One Health Plan PPO/POS |
$896.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$946.20
|
| Rate for Payer: Three Rivers Provider Network All |
$747.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$926.28
|
| Rate for Payer: Zelis Auto |
$398.40
|
| Rate for Payer: Zelis Worker's Compensation |
$271.91
|
|
|
CLOSED TX BIMALLEOLAR ANKLE FX W/O MANJ
|
Facility
|
IP
|
$996.00
|
|
|
Service Code
|
CPT 27808
|
| Hospital Charge Code |
6127808
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$271.91 |
| Max. Negotiated Rate |
$946.20 |
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cigna Commercial |
$846.60
|
| Rate for Payer: First Health Commercial |
$896.40
|
| Rate for Payer: First Health Workers Compensation |
$384.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$896.40
|
| Rate for Payer: GEHA Commercial |
$697.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$896.40
|
| Rate for Payer: Multiplan All |
$906.36
|
| Rate for Payer: OMNI Networks Commercial |
$697.20
|
| Rate for Payer: One Health Plan PPO/POS |
$896.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$946.20
|
| Rate for Payer: Three Rivers Provider Network All |
$747.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$926.28
|
| Rate for Payer: Zelis Auto |
$398.40
|
| Rate for Payer: Zelis Worker's Compensation |
$271.91
|
|
|
CLOSED TX BIMALLEOLAR ANKLE FX W/O MANJ
|
Facility
|
OP
|
$996.00
|
|
|
Service Code
|
CPT 27808
|
| Hospital Charge Code |
9627808
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$946.20 |
| 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 |
$597.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cigna Commercial |
$846.60
|
| Rate for Payer: First Health Commercial |
$896.40
|
| Rate for Payer: First Health Workers Compensation |
$384.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$896.40
|
| Rate for Payer: GEHA Commercial |
$796.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$896.40
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$906.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$697.20
|
| Rate for Payer: One Health Plan PPO/POS |
$896.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$946.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$747.00
|
| 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 |
$926.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$398.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$271.91
|
|
|
CLOSED TX BIMALLEOLAR ANKLE FX W/O MANJ
|
Facility
|
OP
|
$996.00
|
|
|
Service Code
|
CPT 27808
|
| Hospital Charge Code |
8300025
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$946.20 |
| 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 |
$597.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cigna Commercial |
$846.60
|
| Rate for Payer: First Health Commercial |
$896.40
|
| Rate for Payer: First Health Workers Compensation |
$384.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$896.40
|
| Rate for Payer: GEHA Commercial |
$796.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$896.40
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$906.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$697.20
|
| Rate for Payer: One Health Plan PPO/POS |
$896.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$946.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$747.00
|
| 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 |
$926.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$398.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$271.91
|
|
|
CLOSED TX CALCANEAL FRACTURE W/O MANIPUL
|
Facility
|
OP
|
$744.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
8708400
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$706.80 |
| 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 |
$446.40
|
| 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 |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cigna Commercial |
$632.40
|
| Rate for Payer: First Health Commercial |
$669.60
|
| Rate for Payer: First Health Workers Compensation |
$287.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$669.60
|
| Rate for Payer: GEHA Commercial |
$595.20
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$669.60
|
| 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 |
$677.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$520.80
|
| Rate for Payer: One Health Plan PPO/POS |
$669.60
|
| 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 |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$706.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$558.00
|
| 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 |
$691.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$297.60
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$203.11
|
|
