|
CLOSED TX ORBIT W/O MANIPULJ
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 21400
|
| Hospital Charge Code |
6121400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$128.31 |
| Max. Negotiated Rate |
$446.50 |
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$399.50
|
| Rate for Payer: First Health Commercial |
$423.00
|
| Rate for Payer: First Health Workers Compensation |
$181.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$423.00
|
| Rate for Payer: GEHA Commercial |
$329.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$423.00
|
| Rate for Payer: Multiplan All |
$427.70
|
| Rate for Payer: OMNI Networks Commercial |
$329.00
|
| Rate for Payer: One Health Plan PPO/POS |
$423.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$446.50
|
| Rate for Payer: Three Rivers Provider Network All |
$352.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$437.10
|
| Rate for Payer: Zelis Auto |
$188.00
|
| Rate for Payer: Zelis Worker's Compensation |
$128.31
|
|
|
CLOSED TX ORBIT W/O MANIPULJ
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 21400
|
| Hospital Charge Code |
6121400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$128.31 |
| Max. Negotiated Rate |
$967.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$282.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$483.55
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$399.50
|
| Rate for Payer: First Health Commercial |
$423.00
|
| Rate for Payer: First Health Workers Compensation |
$181.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$423.00
|
| Rate for Payer: GEHA Commercial |
$376.00
|
| Rate for Payer: GEHA Medicare |
$483.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$423.00
|
| Rate for Payer: Humana ChoiceCare |
$531.90
|
| Rate for Payer: Humana Medicare Advantage |
$483.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$812.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$483.55
|
| Rate for Payer: Multiplan All |
$427.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$822.03
|
| Rate for Payer: OMNI Networks Commercial |
$329.00
|
| Rate for Payer: One Health Plan PPO/POS |
$423.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$483.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$446.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$967.10
|
| Rate for Payer: Three Rivers Provider Network All |
$352.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$473.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$483.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$437.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$483.55
|
| Rate for Payer: Zelis Auto |
$188.00
|
| Rate for Payer: Zelis Medicare |
$411.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$580.26
|
| Rate for Payer: Zelis Worker's Compensation |
$128.31
|
|
|
CLOSED TX PATELLAR DISLOCATION W/ANESTHE
|
Facility
|
IP
|
$953.00
|
|
|
Service Code
|
CPT 27562
|
| Hospital Charge Code |
6127562
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$260.17 |
| Max. Negotiated Rate |
$905.35 |
| Rate for Payer: Cash Price |
$571.80
|
| Rate for Payer: Cigna Commercial |
$810.05
|
| Rate for Payer: First Health Commercial |
$857.70
|
| Rate for Payer: First Health Workers Compensation |
$367.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$857.70
|
| Rate for Payer: GEHA Commercial |
$667.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$857.70
|
| Rate for Payer: Multiplan All |
$867.23
|
| Rate for Payer: OMNI Networks Commercial |
$667.10
|
| Rate for Payer: One Health Plan PPO/POS |
$857.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$905.35
|
| Rate for Payer: Three Rivers Provider Network All |
$714.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$886.29
|
| Rate for Payer: Zelis Auto |
$381.20
|
| Rate for Payer: Zelis Worker's Compensation |
$260.17
|
|
|
CLOSED TX PATELLAR DISLOCATION W/ANESTHE
|
Facility
|
OP
|
$953.00
|
|
|
Service Code
|
CPT 27562
|
| Hospital Charge Code |
6127562
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$193.61 |
| Max. Negotiated Rate |
$1,546.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$571.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,224.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$571.80
|
| Rate for Payer: Cash Price |
$571.80
|
| Rate for Payer: Cigna Commercial |
$810.05
|
| Rate for Payer: First Health Commercial |
$857.70
|
| Rate for Payer: First Health Workers Compensation |
$367.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$857.70
|
| Rate for Payer: GEHA Commercial |
$762.40
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$857.70
|
| 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 |
$1,249.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$867.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$667.10
|
| Rate for Payer: One Health Plan PPO/POS |
$857.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,443.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,249.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$905.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$714.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,249.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$886.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$381.20
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$260.17
|
|
|
CLOSED TX PATELLAR DISLOCATION W/ANESTHE
|
Facility
|
IP
|
$953.00
|
|
|
Service Code
|
CPT 27562
|
| Hospital Charge Code |
8827562
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$260.17 |
| Max. Negotiated Rate |
$905.35 |
| Rate for Payer: Cash Price |
$571.80
|
| Rate for Payer: Cigna Commercial |
$810.05
|
| Rate for Payer: First Health Commercial |
$857.70
|
| Rate for Payer: First Health Workers Compensation |
$367.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$857.70
|
| Rate for Payer: GEHA Commercial |
$667.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$857.70
|
| Rate for Payer: Multiplan All |
$867.23
|
| Rate for Payer: OMNI Networks Commercial |
$667.10
|
| Rate for Payer: One Health Plan PPO/POS |
$857.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$905.35
|
| Rate for Payer: Three Rivers Provider Network All |
$714.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$886.29
|
| Rate for Payer: Zelis Auto |
$381.20
|
| Rate for Payer: Zelis Worker's Compensation |
$260.17
|
|
|
CLOSED TX PATELLAR DISLOCATION W/ANESTHE
|
Facility
|
OP
|
$953.00
|
|
|
Service Code
|
CPT 27562
|
| Hospital Charge Code |
8227562
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$193.61 |
| Max. Negotiated Rate |
$1,546.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$571.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,224.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$571.80
|
| Rate for Payer: Cash Price |
$571.80
|
| Rate for Payer: Cigna Commercial |
$810.05
|
| Rate for Payer: First Health Commercial |
$857.70
|
| Rate for Payer: First Health Workers Compensation |
$367.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$857.70
|
| Rate for Payer: GEHA Commercial |
$762.40
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$857.70
|
| 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 |
$1,249.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$867.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$667.10
|
| Rate for Payer: One Health Plan PPO/POS |
$857.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,443.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,249.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$905.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$714.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,249.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$886.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$381.20
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$260.17
|
|
|
CLOSED TX PATELLAR DISLOCATION W/ANESTHE
|
Facility
|
IP
|
$953.00
|
|
|
Service Code
|
CPT 27562
|
| Hospital Charge Code |
8227562
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$260.17 |
| Max. Negotiated Rate |
$905.35 |
| Rate for Payer: Cash Price |
$571.80
|
| Rate for Payer: Cigna Commercial |
$810.05
|
| Rate for Payer: First Health Commercial |
$857.70
|
| Rate for Payer: First Health Workers Compensation |
$367.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$857.70
|
| Rate for Payer: GEHA Commercial |
$667.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$857.70
|
| Rate for Payer: Multiplan All |
$867.23
|
| Rate for Payer: OMNI Networks Commercial |
$667.10
|
| Rate for Payer: One Health Plan PPO/POS |
$857.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$905.35
|
| Rate for Payer: Three Rivers Provider Network All |
$714.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$886.29
|
| Rate for Payer: Zelis Auto |
$381.20
|
| Rate for Payer: Zelis Worker's Compensation |
$260.17
|
|
|
CLOSED TX PATELLAR DISLOCATION W/ANESTHE
|
Facility
|
OP
|
$953.00
|
|
|
Service Code
|
CPT 27562
|
| Hospital Charge Code |
8827562
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$193.61 |
| Max. Negotiated Rate |
$1,546.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$571.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,224.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$571.80
|
| Rate for Payer: Cash Price |
$571.80
|
| Rate for Payer: Cigna Commercial |
$810.05
|
| Rate for Payer: First Health Commercial |
$857.70
|
| Rate for Payer: First Health Workers Compensation |
$367.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$857.70
|
| Rate for Payer: GEHA Commercial |
$762.40
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$857.70
|
| 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 |
$1,249.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$867.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$667.10
|
| Rate for Payer: One Health Plan PPO/POS |
$857.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,443.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,249.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$905.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$714.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,249.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$886.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$381.20
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$260.17
|
|
|
CLOSED TX PATELLAR DISLOCATION W/O ANEST
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
21600195
|
|
Hospital Revenue Code
|
517
|
| 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 PATELLAR DISLOCATION W/O ANEST
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
6127560
|
|
Hospital Revenue Code
|
975
|
| 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 PATELLAR DISLOCATION W/O ANEST
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
21600195
|
|
Hospital Revenue Code
|
517
|
| 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 TX PATELLAR DISLOCATION W/O ANEST
|
Facility
|
OP
|
$1,363.00
|
|
| Hospital Charge Code |
8127560
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.75 |
| Max. Negotiated Rate |
$1,294.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$817.80
|
| Rate for Payer: Cash Price |
$817.80
|
| Rate for Payer: Cigna Commercial |
$1,158.55
|
| Rate for Payer: First Health Commercial |
$1,226.70
|
| Rate for Payer: First Health Workers Compensation |
$526.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,226.70
|
| Rate for Payer: GEHA Commercial |
$1,090.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,226.70
|
| Rate for Payer: Humana ChoiceCare |
$354.38
|
| Rate for Payer: Multiplan All |
$1,240.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$817.80
|
| Rate for Payer: OMNI Networks Commercial |
$954.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,226.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,294.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,022.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,199.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$340.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,267.59
|
| Rate for Payer: Zelis Auto |
$545.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$681.50
|
| Rate for Payer: Zelis Worker's Compensation |
$372.10
|
|
|
CLOSED TX PATELLAR DISLOCATION W/O ANEST
|
Facility
|
IP
|
$1,363.00
|
|
| Hospital Charge Code |
8127560
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$372.10 |
| Max. Negotiated Rate |
$1,294.85 |
| Rate for Payer: Cash Price |
$817.80
|
| Rate for Payer: Cigna Commercial |
$1,158.55
|
| Rate for Payer: First Health Commercial |
$1,226.70
|
| Rate for Payer: First Health Workers Compensation |
$526.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,226.70
|
| Rate for Payer: GEHA Commercial |
$954.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,226.70
|
| Rate for Payer: Multiplan All |
$1,240.33
|
| Rate for Payer: OMNI Networks Commercial |
$954.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,226.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,294.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,022.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,267.59
|
| Rate for Payer: Zelis Auto |
$545.20
|
| Rate for Payer: Zelis Worker's Compensation |
$372.10
|
|
|
CLOSED TX PATELLAR DISLOCATION W/O ANEST
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
6127560
|
|
Hospital Revenue Code
|
975
|
| 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 TX RADIAL HEAD/NECK FX W/MANIPULA
|
Facility
|
OP
|
$3,370.00
|
|
| Hospital Charge Code |
8124655
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$842.50 |
| Max. Negotiated Rate |
$3,201.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,022.00
|
| Rate for Payer: Cash Price |
$2,022.00
|
| Rate for Payer: Cigna Commercial |
$2,864.50
|
| Rate for Payer: First Health Commercial |
$3,033.00
|
| Rate for Payer: First Health Workers Compensation |
$1,301.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,033.00
|
| Rate for Payer: GEHA Commercial |
$2,696.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,033.00
|
| Rate for Payer: Humana ChoiceCare |
$876.20
|
| Rate for Payer: Multiplan All |
$3,066.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,022.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,359.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,033.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,201.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,527.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,965.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$842.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,134.10
|
| Rate for Payer: Zelis Auto |
$1,348.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,685.00
|
| Rate for Payer: Zelis Worker's Compensation |
$920.01
|
|
|
CLOSED TX RADIAL HEAD/NECK FX W/MANIPULA
|
Facility
|
IP
|
$3,370.00
|
|
| Hospital Charge Code |
8124655
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$920.01 |
| Max. Negotiated Rate |
$3,201.50 |
| Rate for Payer: Cash Price |
$2,022.00
|
| Rate for Payer: Cigna Commercial |
$2,864.50
|
| Rate for Payer: First Health Commercial |
$3,033.00
|
| Rate for Payer: First Health Workers Compensation |
$1,301.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,033.00
|
| Rate for Payer: GEHA Commercial |
$2,359.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,033.00
|
| Rate for Payer: Multiplan All |
$3,066.70
|
| Rate for Payer: OMNI Networks Commercial |
$2,359.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,033.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,201.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,527.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,134.10
|
| Rate for Payer: Zelis Auto |
$1,348.00
|
| Rate for Payer: Zelis Worker's Compensation |
$920.01
|
|
|
CLOSED TX RADIAL HEAD/NECK FX W/O MANIPU
|
Facility
|
IP
|
$597.00
|
|
|
Service Code
|
CPT 24650
|
| Hospital Charge Code |
8824650
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$162.98 |
| Max. Negotiated Rate |
$567.15 |
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cigna Commercial |
$507.45
|
| Rate for Payer: First Health Commercial |
$537.30
|
| Rate for Payer: First Health Workers Compensation |
$230.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$537.30
|
| Rate for Payer: GEHA Commercial |
$417.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$537.30
|
| Rate for Payer: Multiplan All |
$543.27
|
| Rate for Payer: OMNI Networks Commercial |
$417.90
|
| Rate for Payer: One Health Plan PPO/POS |
$537.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$567.15
|
| Rate for Payer: Three Rivers Provider Network All |
$447.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$555.21
|
| Rate for Payer: Zelis Auto |
$238.80
|
| Rate for Payer: Zelis Worker's Compensation |
$162.98
|
|
|
CLOSED TX RADIAL HEAD/NECK FX W/O MANIPU
|
Facility
|
IP
|
$597.00
|
|
|
Service Code
|
CPT 24650
|
| Hospital Charge Code |
8224650
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$162.98 |
| Max. Negotiated Rate |
$567.15 |
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cigna Commercial |
$507.45
|
| Rate for Payer: First Health Commercial |
$537.30
|
| Rate for Payer: First Health Workers Compensation |
$230.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$537.30
|
| Rate for Payer: GEHA Commercial |
$417.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$537.30
|
| Rate for Payer: Multiplan All |
$543.27
|
| Rate for Payer: OMNI Networks Commercial |
$417.90
|
| Rate for Payer: One Health Plan PPO/POS |
$537.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$567.15
|
| Rate for Payer: Three Rivers Provider Network All |
$447.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$555.21
|
| Rate for Payer: Zelis Auto |
$238.80
|
| Rate for Payer: Zelis Worker's Compensation |
$162.98
|
|
|
CLOSED TX RADIAL HEAD/NECK FX W/O MANIPU
|
Facility
|
IP
|
$597.00
|
|
|
Service Code
|
CPT 24650
|
| Hospital Charge Code |
6124650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$162.98 |
| Max. Negotiated Rate |
$567.15 |
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cigna Commercial |
$507.45
|
| Rate for Payer: First Health Commercial |
$537.30
|
| Rate for Payer: First Health Workers Compensation |
$230.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$537.30
|
| Rate for Payer: GEHA Commercial |
$417.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$537.30
|
| Rate for Payer: Multiplan All |
$543.27
|
| Rate for Payer: OMNI Networks Commercial |
$417.90
|
| Rate for Payer: One Health Plan PPO/POS |
$537.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$567.15
|
| Rate for Payer: Three Rivers Provider Network All |
$447.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$555.21
|
| Rate for Payer: Zelis Auto |
$238.80
|
| Rate for Payer: Zelis Worker's Compensation |
$162.98
|
|
|
CLOSED TX RADIAL HEAD/NECK FX W/O MANIPU
|
Facility
|
OP
|
$597.00
|
|
|
Service Code
|
CPT 24650
|
| Hospital Charge Code |
6124650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$567.15 |
| 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 |
$358.20
|
| 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 |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cigna Commercial |
$507.45
|
| Rate for Payer: First Health Commercial |
$537.30
|
| Rate for Payer: First Health Workers Compensation |
$230.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$537.30
|
| Rate for Payer: GEHA Commercial |
$477.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$537.30
|
| 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 |
$543.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$417.90
|
| Rate for Payer: One Health Plan PPO/POS |
$537.30
|
| 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 |
$567.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$447.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$555.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$238.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$162.98
|
|
|
CLOSED TX RADIAL HEAD/NECK FX W/O MANIPU
|
Facility
|
OP
|
$597.00
|
|
|
Service Code
|
CPT 24650
|
| Hospital Charge Code |
8824650
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$567.15 |
| 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 |
$358.20
|
| 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 |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cigna Commercial |
$507.45
|
| Rate for Payer: First Health Commercial |
$537.30
|
| Rate for Payer: First Health Workers Compensation |
$230.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$537.30
|
| Rate for Payer: GEHA Commercial |
$477.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$537.30
|
| 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 |
$543.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$417.90
|
| Rate for Payer: One Health Plan PPO/POS |
$537.30
|
| 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 |
$567.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$447.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$555.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$238.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$162.98
|
|
|
CLOSED TX RADIAL HEAD/NECK FX W/O MANIPU
|
Facility
|
OP
|
$597.00
|
|
|
Service Code
|
CPT 24650
|
| Hospital Charge Code |
8224650
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$567.15 |
| 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 |
$358.20
|
| 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 |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cigna Commercial |
$507.45
|
| Rate for Payer: First Health Commercial |
$537.30
|
| Rate for Payer: First Health Workers Compensation |
$230.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$537.30
|
| Rate for Payer: GEHA Commercial |
$477.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$537.30
|
| 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 |
$543.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$417.90
|
| Rate for Payer: One Health Plan PPO/POS |
$537.30
|
| 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 |
$567.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$447.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$555.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$238.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$162.98
|
|
|
CLOSED TX RADIAL SHAFT FRACTURE W/MANIPU
|
Facility
|
IP
|
$2,726.00
|
|
| Hospital Charge Code |
8125505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$744.20 |
| Max. Negotiated Rate |
$2,589.70 |
| Rate for Payer: Cash Price |
$1,635.60
|
| Rate for Payer: Cigna Commercial |
$2,317.10
|
| Rate for Payer: First Health Commercial |
$2,453.40
|
| Rate for Payer: First Health Workers Compensation |
$1,052.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,453.40
|
| Rate for Payer: GEHA Commercial |
$1,908.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,453.40
|
| Rate for Payer: Multiplan All |
$2,480.66
|
| Rate for Payer: OMNI Networks Commercial |
$1,908.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,453.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,589.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,044.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,535.18
|
| Rate for Payer: Zelis Auto |
$1,090.40
|
| Rate for Payer: Zelis Worker's Compensation |
$744.20
|
|
|
CLOSED TX RADIAL SHAFT FRACTURE W/MANIPU
|
Facility
|
IP
|
$928.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
6125505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$253.34 |
| Max. Negotiated Rate |
$881.60 |
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cigna Commercial |
$788.80
|
| Rate for Payer: First Health Commercial |
$835.20
|
| Rate for Payer: First Health Workers Compensation |
$358.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$835.20
|
| Rate for Payer: GEHA Commercial |
$649.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$835.20
|
| Rate for Payer: Multiplan All |
$844.48
|
| Rate for Payer: OMNI Networks Commercial |
$649.60
|
| Rate for Payer: One Health Plan PPO/POS |
$835.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$881.60
|
| Rate for Payer: Three Rivers Provider Network All |
$696.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$863.04
|
| Rate for Payer: Zelis Auto |
$371.20
|
| Rate for Payer: Zelis Worker's Compensation |
$253.34
|
|
|
CLOSED TX RADIAL SHAFT FRACTURE W/MANIPU
|
Facility
|
OP
|
$928.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
6125505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$253.34 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$484.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$556.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$484.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$384.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cigna Commercial |
$788.80
|
| Rate for Payer: First Health Commercial |
$835.20
|
| Rate for Payer: First Health Workers Compensation |
$358.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$835.20
|
| Rate for Payer: GEHA Commercial |
$742.40
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$835.20
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$391.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$844.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$649.60
|
| Rate for Payer: One Health Plan PPO/POS |
$835.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$452.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$391.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$881.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$696.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$391.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$863.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$371.20
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$253.34
|
|
