|
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
|
|
|
CLOSED TX CALCANEAL FRACTURE W/O MANIPUL
|
Facility
|
IP
|
$744.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
8300029
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$203.11 |
| Max. Negotiated Rate |
$706.80 |
| 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 |
$520.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$669.60
|
| Rate for Payer: Multiplan All |
$677.04
|
| Rate for Payer: OMNI Networks Commercial |
$520.80
|
| Rate for Payer: One Health Plan PPO/POS |
$669.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$706.80
|
| Rate for Payer: Three Rivers Provider Network All |
$558.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$691.92
|
| Rate for Payer: Zelis Auto |
$297.60
|
| Rate for Payer: Zelis Worker's Compensation |
$203.11
|
|
|
CLOSED TX CALCANEAL FRACTURE W/O MANIPUL
|
Facility
|
OP
|
$744.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
6128400
|
|
Hospital Revenue Code
|
975
|
| 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
|
|
|
CLOSED TX CALCANEAL FRACTURE W/O MANIPUL
|
Facility
|
IP
|
$744.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
6128400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$203.11 |
| Max. Negotiated Rate |
$706.80 |
| 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 |
$520.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$669.60
|
| Rate for Payer: Multiplan All |
$677.04
|
| Rate for Payer: OMNI Networks Commercial |
$520.80
|
| Rate for Payer: One Health Plan PPO/POS |
$669.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$706.80
|
| Rate for Payer: Three Rivers Provider Network All |
$558.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$691.92
|
| Rate for Payer: Zelis Auto |
$297.60
|
| Rate for Payer: Zelis Worker's Compensation |
$203.11
|
|
|
CLOSED TX CALCANEAL FRACTURE W/O MANIPUL
|
Facility
|
OP
|
$828.44
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
9628400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$787.02 |
| 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 |
$497.06
|
| 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 |
$497.06
|
| Rate for Payer: Cash Price |
$497.06
|
| Rate for Payer: Cigna Commercial |
$704.17
|
| Rate for Payer: First Health Commercial |
$745.60
|
| Rate for Payer: First Health Workers Compensation |
$319.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$745.60
|
| Rate for Payer: GEHA Commercial |
$662.75
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$745.60
|
| 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 |
$753.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$579.91
|
| Rate for Payer: One Health Plan PPO/POS |
$745.60
|
| 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 |
$787.02
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$621.33
|
| 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 |
$770.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$331.38
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$226.16
|
|
|
CLOSED TX CALCANEAL FRACTURE W/O MANIPUL
|
Facility
|
IP
|
$828.44
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
9628400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.16 |
| Max. Negotiated Rate |
$787.02 |
| Rate for Payer: Cash Price |
$497.06
|
| Rate for Payer: Cigna Commercial |
$704.17
|
| Rate for Payer: First Health Commercial |
$745.60
|
| Rate for Payer: First Health Workers Compensation |
$319.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$745.60
|
| Rate for Payer: GEHA Commercial |
$579.91
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$745.60
|
| Rate for Payer: Multiplan All |
$753.88
|
| Rate for Payer: OMNI Networks Commercial |
$579.91
|
| Rate for Payer: One Health Plan PPO/POS |
$745.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$787.02
|
| Rate for Payer: Three Rivers Provider Network All |
$621.33
|
| Rate for Payer: United Payors & United Providers UP&UP |
$770.45
|
| Rate for Payer: Zelis Auto |
$331.38
|
| Rate for Payer: Zelis Worker's Compensation |
$226.16
|
|
|
CLOSED TX CALCANEAL FRACTURE W/O MANIPUL
|
Facility
|
OP
|
$744.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
8300029
|
|
Hospital Revenue Code
|
519
|
| 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
|
|
|
CLOSED TX METATARSAL FRACTURE W/O MANIPU
|
Facility
|
IP
|
$747.27
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
9628470
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$709.91 |
| Rate for Payer: Cash Price |
$448.36
|
| Rate for Payer: Cigna Commercial |
$635.18
|
| Rate for Payer: First Health Commercial |
$672.54
|
| Rate for Payer: First Health Workers Compensation |
$288.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$672.54
|
| Rate for Payer: GEHA Commercial |
$523.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$672.54
|
| Rate for Payer: Multiplan All |
$680.02
|
| Rate for Payer: OMNI Networks Commercial |
$523.09
|
| Rate for Payer: One Health Plan PPO/POS |
$672.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$709.91
|
| Rate for Payer: Three Rivers Provider Network All |
$560.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$694.96
|
| Rate for Payer: Zelis Auto |
$298.91
|
| Rate for Payer: Zelis Worker's Compensation |
$204.00
|
|
|
CLOSED TX METATARSAL FRACTURE W/O MANIPU
|
Facility
|
IP
|
$656.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
8300032
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$179.09 |
| Max. Negotiated Rate |
$623.20 |
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cigna Commercial |
$557.60
|
| Rate for Payer: First Health Commercial |
$590.40
|
| Rate for Payer: First Health Workers Compensation |
$253.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$590.40
|
| Rate for Payer: GEHA Commercial |
$459.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$590.40
|
| Rate for Payer: Multiplan All |
$596.96
|
| Rate for Payer: OMNI Networks Commercial |
$459.20
|
| Rate for Payer: One Health Plan PPO/POS |
$590.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$623.20
|
| Rate for Payer: Three Rivers Provider Network All |
$492.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$610.08
|
| Rate for Payer: Zelis Auto |
$262.40
|
| Rate for Payer: Zelis Worker's Compensation |
$179.09
|
|
|
CLOSED TX METATARSAL FRACTURE W/O MANIPU
|
Facility
|
IP
|
$656.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
6128470
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$179.09 |
| Max. Negotiated Rate |
$623.20 |
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cigna Commercial |
$557.60
|
| Rate for Payer: First Health Commercial |
$590.40
|
| Rate for Payer: First Health Workers Compensation |
$253.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$590.40
|
| Rate for Payer: GEHA Commercial |
$459.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$590.40
|
| Rate for Payer: Multiplan All |
$596.96
|
| Rate for Payer: OMNI Networks Commercial |
$459.20
|
| Rate for Payer: One Health Plan PPO/POS |
$590.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$623.20
|
| Rate for Payer: Three Rivers Provider Network All |
$492.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$610.08
|
| Rate for Payer: Zelis Auto |
$262.40
|
| Rate for Payer: Zelis Worker's Compensation |
$179.09
|
|
|
CLOSED TX METATARSAL FRACTURE W/O MANIPU
|
Facility
|
OP
|
$656.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
6128470
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$623.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$393.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cigna Commercial |
$557.60
|
| Rate for Payer: First Health Commercial |
$590.40
|
| Rate for Payer: First Health Workers Compensation |
$253.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$590.40
|
| Rate for Payer: GEHA Commercial |
$524.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$590.40
|
| 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 |
$596.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$459.20
|
| Rate for Payer: One Health Plan PPO/POS |
$590.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$623.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$492.00
|
| 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 |
$610.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$262.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$179.09
|
|
|
CLOSED TX METATARSAL FRACTURE W/O MANIPU
|
Facility
|
IP
|
$656.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
8728470
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$179.09 |
| Max. Negotiated Rate |
$623.20 |
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cigna Commercial |
$557.60
|
| Rate for Payer: First Health Commercial |
$590.40
|
| Rate for Payer: First Health Workers Compensation |
$253.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$590.40
|
| Rate for Payer: GEHA Commercial |
$459.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$590.40
|
| Rate for Payer: Multiplan All |
$596.96
|
| Rate for Payer: OMNI Networks Commercial |
$459.20
|
| Rate for Payer: One Health Plan PPO/POS |
$590.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$623.20
|
| Rate for Payer: Three Rivers Provider Network All |
$492.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$610.08
|
| Rate for Payer: Zelis Auto |
$262.40
|
| Rate for Payer: Zelis Worker's Compensation |
$179.09
|
|
|
CLOSED TX METATARSAL FRACTURE W/O MANIPU
|
Facility
|
OP
|
$656.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
8300032
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$623.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$393.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cigna Commercial |
$557.60
|
| Rate for Payer: First Health Commercial |
$590.40
|
| Rate for Payer: First Health Workers Compensation |
$253.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$590.40
|
| Rate for Payer: GEHA Commercial |
$524.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$590.40
|
| 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 |
$596.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$459.20
|
| Rate for Payer: One Health Plan PPO/POS |
$590.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$623.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$492.00
|
| 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 |
$610.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$262.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$179.09
|
|
|
CLOSED TX METATARSAL FRACTURE W/O MANIPU
|
Facility
|
OP
|
$747.27
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
9628470
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$709.91 |
| 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 |
$448.36
|
| 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 |
$448.36
|
| Rate for Payer: Cash Price |
$448.36
|
| Rate for Payer: Cigna Commercial |
$635.18
|
| Rate for Payer: First Health Commercial |
$672.54
|
| Rate for Payer: First Health Workers Compensation |
$288.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$672.54
|
| Rate for Payer: GEHA Commercial |
$597.82
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$672.54
|
| 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 |
$680.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$523.09
|
| Rate for Payer: One Health Plan PPO/POS |
$672.54
|
| 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 |
$709.91
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$560.45
|
| 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 |
$694.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$298.91
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$204.00
|
|
|
CLOSED TX METATARSAL FRACTURE W/O MANIPU
|
Facility
|
OP
|
$656.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
8728470
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$623.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$393.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cigna Commercial |
$557.60
|
| Rate for Payer: First Health Commercial |
$590.40
|
| Rate for Payer: First Health Workers Compensation |
$253.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$590.40
|
| Rate for Payer: GEHA Commercial |
$524.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$590.40
|
| 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 |
$596.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$459.20
|
| Rate for Payer: One Health Plan PPO/POS |
$590.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$623.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$492.00
|
| 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 |
$610.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$262.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$179.09
|
|
|
CLOSED TX NOSE FX W/O MANJ
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 21310
|
| Hospital Charge Code |
6121310
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$73.10
|
| Rate for Payer: First Health Commercial |
$77.40
|
| Rate for Payer: First Health Workers Compensation |
$33.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$77.40
|
| Rate for Payer: GEHA Commercial |
$60.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$77.40
|
| Rate for Payer: Multiplan All |
$78.26
|
| Rate for Payer: OMNI Networks Commercial |
$60.20
|
| Rate for Payer: One Health Plan PPO/POS |
$77.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$81.70
|
| Rate for Payer: Three Rivers Provider Network All |
$64.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$79.98
|
| Rate for Payer: Zelis Auto |
$34.40
|
| Rate for Payer: Zelis Worker's Compensation |
$23.48
|
|
|
CLOSED TX NOSE FX W/O MANJ
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 21310
|
| Hospital Charge Code |
6121310
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$73.10
|
| Rate for Payer: First Health Commercial |
$77.40
|
| Rate for Payer: First Health Workers Compensation |
$33.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$77.40
|
| Rate for Payer: GEHA Commercial |
$68.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$77.40
|
| Rate for Payer: Humana ChoiceCare |
$22.36
|
| Rate for Payer: Multiplan All |
$78.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$51.60
|
| Rate for Payer: OMNI Networks Commercial |
$60.20
|
| Rate for Payer: One Health Plan PPO/POS |
$77.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$81.70
|
| Rate for Payer: Three Rivers Provider Network All |
$64.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$75.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$79.98
|
| Rate for Payer: Zelis Auto |
$34.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$43.00
|
| Rate for Payer: Zelis Worker's Compensation |
$23.48
|
|
|
CLOSED TX NOSE FX W/O STABLJ
|
Facility
|
OP
|
$462.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
6121315
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$126.13 |
| Max. Negotiated Rate |
$2,813.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$277.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,406.53
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna Commercial |
$392.70
|
| Rate for Payer: First Health Commercial |
$415.80
|
| Rate for Payer: First Health Workers Compensation |
$178.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$415.80
|
| Rate for Payer: GEHA Commercial |
$369.60
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$415.80
|
| Rate for Payer: Humana ChoiceCare |
$1,547.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,406.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,362.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,406.53
|
| Rate for Payer: Multiplan All |
$420.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$323.40
|
| Rate for Payer: One Health Plan PPO/POS |
$415.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,406.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$438.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$346.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,406.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$429.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$184.80
|
| Rate for Payer: Zelis Medicare |
$1,195.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,687.84
|
| Rate for Payer: Zelis Worker's Compensation |
$126.13
|
|
|
CLOSED TX NOSE FX W/O STABLJ
|
Facility
|
IP
|
$462.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
6121315
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$126.13 |
| Max. Negotiated Rate |
$438.90 |
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna Commercial |
$392.70
|
| Rate for Payer: First Health Commercial |
$415.80
|
| Rate for Payer: First Health Workers Compensation |
$178.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$415.80
|
| Rate for Payer: GEHA Commercial |
$323.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$415.80
|
| Rate for Payer: Multiplan All |
$420.42
|
| Rate for Payer: OMNI Networks Commercial |
$323.40
|
| Rate for Payer: One Health Plan PPO/POS |
$415.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$438.90
|
| Rate for Payer: Three Rivers Provider Network All |
$346.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$429.66
|
| Rate for Payer: Zelis Auto |
$184.80
|
| Rate for Payer: Zelis Worker's Compensation |
$126.13
|
|
|
CLOSED TX NOSE FX W/ STABLJ
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
CPT 21320
|
| Hospital Charge Code |
6121320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$113.30 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$249.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$373.50
|
| Rate for Payer: First Health Workers Compensation |
$160.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$373.50
|
| Rate for Payer: GEHA Commercial |
$332.00
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$373.50
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$377.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$290.50
|
| Rate for Payer: One Health Plan PPO/POS |
$373.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$394.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$311.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$385.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$166.00
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$113.30
|
|
|
CLOSED TX NOSE FX W/ STABLJ
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 21320
|
| Hospital Charge Code |
6121320
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$113.30 |
| Max. Negotiated Rate |
$394.25 |
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$373.50
|
| Rate for Payer: First Health Workers Compensation |
$160.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$373.50
|
| Rate for Payer: GEHA Commercial |
$290.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$373.50
|
| Rate for Payer: Multiplan All |
$377.65
|
| Rate for Payer: OMNI Networks Commercial |
$290.50
|
| Rate for Payer: One Health Plan PPO/POS |
$373.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$394.25
|
| Rate for Payer: Three Rivers Provider Network All |
$311.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$385.95
|
| Rate for Payer: Zelis Auto |
$166.00
|
| Rate for Payer: Zelis Worker's Compensation |
$113.30
|
|
|
CLOSED TX NOSE/JAW FX
|
Facility
|
IP
|
$1,338.00
|
|
|
Service Code
|
CPT 21345
|
| Hospital Charge Code |
6121345
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$365.27 |
| Max. Negotiated Rate |
$1,271.10 |
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$1,137.30
|
| Rate for Payer: First Health Commercial |
$1,204.20
|
| Rate for Payer: First Health Workers Compensation |
$516.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,204.20
|
| Rate for Payer: GEHA Commercial |
$936.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,204.20
|
| Rate for Payer: Multiplan All |
$1,217.58
|
| Rate for Payer: OMNI Networks Commercial |
$936.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,204.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,271.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,003.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,244.34
|
| Rate for Payer: Zelis Auto |
$535.20
|
| Rate for Payer: Zelis Worker's Compensation |
$365.27
|
|
|
CLOSED TX NOSE/JAW FX
|
Facility
|
OP
|
$1,338.00
|
|
|
Service Code
|
CPT 21345
|
| Hospital Charge Code |
6121345
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$365.27 |
| Max. Negotiated Rate |
$2,813.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$802.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,406.53
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$1,137.30
|
| Rate for Payer: First Health Commercial |
$1,204.20
|
| Rate for Payer: First Health Workers Compensation |
$516.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,204.20
|
| Rate for Payer: GEHA Commercial |
$1,070.40
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,204.20
|
| Rate for Payer: Humana ChoiceCare |
$1,547.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,406.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,362.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,406.53
|
| Rate for Payer: Multiplan All |
$1,217.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$936.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,204.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,406.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,271.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$1,003.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,406.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,244.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$535.20
|
| Rate for Payer: Zelis Medicare |
$1,195.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,687.84
|
| Rate for Payer: Zelis Worker's Compensation |
$365.27
|
|
|
CLOSED TX ORBIT W/ MANIPULJ
|
Facility
|
IP
|
$729.00
|
|
|
Service Code
|
CPT 21401
|
| Hospital Charge Code |
6121401
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$199.02 |
| Max. Negotiated Rate |
$692.55 |
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cigna Commercial |
$619.65
|
| Rate for Payer: First Health Commercial |
$656.10
|
| Rate for Payer: First Health Workers Compensation |
$281.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$656.10
|
| Rate for Payer: GEHA Commercial |
$510.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$656.10
|
| Rate for Payer: Multiplan All |
$663.39
|
| Rate for Payer: OMNI Networks Commercial |
$510.30
|
| Rate for Payer: One Health Plan PPO/POS |
$656.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$692.55
|
| Rate for Payer: Three Rivers Provider Network All |
$546.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$677.97
|
| Rate for Payer: Zelis Auto |
$291.60
|
| Rate for Payer: Zelis Worker's Compensation |
$199.02
|
|
|
CLOSED TX ORBIT W/ MANIPULJ
|
Facility
|
OP
|
$729.00
|
|
|
Service Code
|
CPT 21401
|
| Hospital Charge Code |
6121401
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$199.02 |
| Max. Negotiated Rate |
$2,813.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$437.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,406.53
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cigna Commercial |
$619.65
|
| Rate for Payer: First Health Commercial |
$656.10
|
| Rate for Payer: First Health Workers Compensation |
$281.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$656.10
|
| Rate for Payer: GEHA Commercial |
$583.20
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$656.10
|
| Rate for Payer: Humana ChoiceCare |
$1,547.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,406.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,362.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,406.53
|
| Rate for Payer: Multiplan All |
$663.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$510.30
|
| Rate for Payer: One Health Plan PPO/POS |
$656.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,406.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$692.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$546.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,406.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$677.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$291.60
|
| Rate for Payer: Zelis Medicare |
$1,195.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,687.84
|
| Rate for Payer: Zelis Worker's Compensation |
$199.02
|
|
