|
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 |
21600199
|
|
Hospital Revenue Code
|
517
|
| 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 |
21600199
|
|
Hospital Revenue Code
|
517
|
| 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
|
|
|
CLOSED TX RAD SHAFT FX W/MANI
|
Facility
|
IP
|
$1,491.00
|
|
| Hospital Charge Code |
8125600
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$407.04 |
| Max. Negotiated Rate |
$1,416.45 |
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Cigna Commercial |
$1,267.35
|
| Rate for Payer: First Health Commercial |
$1,341.90
|
| Rate for Payer: First Health Workers Compensation |
$575.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,341.90
|
| Rate for Payer: GEHA Commercial |
$1,043.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,341.90
|
| Rate for Payer: Multiplan All |
$1,356.81
|
| Rate for Payer: OMNI Networks Commercial |
$1,043.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,341.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,416.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,118.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,386.63
|
| Rate for Payer: Zelis Auto |
$596.40
|
| Rate for Payer: Zelis Worker's Compensation |
$407.04
|
|
|
CLOSED TX RAD SHAFT FX W/MANI
|
Facility
|
OP
|
$1,491.00
|
|
| Hospital Charge Code |
8125600
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$372.75 |
| Max. Negotiated Rate |
$1,416.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$894.60
|
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Cigna Commercial |
$1,267.35
|
| Rate for Payer: First Health Commercial |
$1,341.90
|
| Rate for Payer: First Health Workers Compensation |
$575.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,341.90
|
| Rate for Payer: GEHA Commercial |
$1,192.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,341.90
|
| Rate for Payer: Humana ChoiceCare |
$387.66
|
| Rate for Payer: Multiplan All |
$1,356.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$894.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,043.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,341.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,416.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,118.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,312.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$372.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,386.63
|
| Rate for Payer: Zelis Auto |
$596.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$745.50
|
| Rate for Payer: Zelis Worker's Compensation |
$407.04
|
|
|
CLOSED TX SEPTAL&NOSE FX
|
Facility
|
IP
|
$747.00
|
|
|
Service Code
|
CPT 21337
|
| Hospital Charge Code |
6121337
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$203.93 |
| Max. Negotiated Rate |
$709.65 |
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cigna Commercial |
$634.95
|
| Rate for Payer: First Health Commercial |
$672.30
|
| Rate for Payer: First Health Workers Compensation |
$288.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$672.30
|
| Rate for Payer: GEHA Commercial |
$522.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$672.30
|
| Rate for Payer: Multiplan All |
$679.77
|
| Rate for Payer: OMNI Networks Commercial |
$522.90
|
| Rate for Payer: One Health Plan PPO/POS |
$672.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$709.65
|
| Rate for Payer: Three Rivers Provider Network All |
$560.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$694.71
|
| Rate for Payer: Zelis Auto |
$298.80
|
| Rate for Payer: Zelis Worker's Compensation |
$203.93
|
|
|
CLOSED TX SEPTAL&NOSE FX
|
Facility
|
OP
|
$747.00
|
|
|
Service Code
|
CPT 21337
|
| Hospital Charge Code |
6121337
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$203.93 |
| 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 |
$448.20
|
| 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 |
$3,079.42
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cigna Commercial |
$634.95
|
| Rate for Payer: First Health Commercial |
$672.30
|
| Rate for Payer: First Health Workers Compensation |
$288.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$672.30
|
| Rate for Payer: GEHA Commercial |
$597.60
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$672.30
|
| 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 |
$679.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$522.90
|
| Rate for Payer: One Health Plan PPO/POS |
$672.30
|
| 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 |
$709.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$560.25
|
| 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 |
$694.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$298.80
|
| 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 |
$203.93
|
|
|
CLOSED TX TALUS FRACTURE W/O MANIPULATIO
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
6128430
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$193.56 |
| Max. Negotiated Rate |
$673.55 |
| Rate for Payer: Cash Price |
$425.40
|
| Rate for Payer: Cigna Commercial |
$602.65
|
| Rate for Payer: First Health Commercial |
$638.10
|
| Rate for Payer: First Health Workers Compensation |
$273.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$638.10
|
| Rate for Payer: GEHA Commercial |
$496.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$638.10
|
| Rate for Payer: Multiplan All |
$645.19
|
| Rate for Payer: OMNI Networks Commercial |
$496.30
|
| Rate for Payer: One Health Plan PPO/POS |
$638.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$673.55
|
| Rate for Payer: Three Rivers Provider Network All |
$531.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$659.37
|
| Rate for Payer: Zelis Auto |
$283.60
|
| Rate for Payer: Zelis Worker's Compensation |
$193.56
|
|
|
CLOSED TX TALUS FRACTURE W/O MANIPULATIO
|
Facility
|
IP
|
$725.00
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
9628430
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$197.93 |
| Max. Negotiated Rate |
$688.75 |
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$616.25
|
| Rate for Payer: First Health Commercial |
$652.50
|
| Rate for Payer: First Health Workers Compensation |
$279.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$652.50
|
| Rate for Payer: GEHA Commercial |
$507.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$652.50
|
| Rate for Payer: Multiplan All |
$659.75
|
| Rate for Payer: OMNI Networks Commercial |
$507.50
|
| Rate for Payer: One Health Plan PPO/POS |
$652.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$688.75
|
| Rate for Payer: Three Rivers Provider Network All |
$543.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$674.25
|
| Rate for Payer: Zelis Auto |
$290.00
|
| Rate for Payer: Zelis Worker's Compensation |
$197.93
|
|
|
CLOSED TX TALUS FRACTURE W/O MANIPULATIO
|
Facility
|
OP
|
$725.00
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
9628430
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$688.75 |
| 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 |
$435.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$616.25
|
| Rate for Payer: First Health Commercial |
$652.50
|
| Rate for Payer: First Health Workers Compensation |
$279.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$652.50
|
| Rate for Payer: GEHA Commercial |
$580.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$652.50
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$659.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$507.50
|
| Rate for Payer: One Health Plan PPO/POS |
$652.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$688.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$543.75
|
| 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 |
$674.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$290.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$197.93
|
|
|
CLOSED TX TALUS FRACTURE W/O MANIPULATIO
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
6128430
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$673.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$425.40
|
| 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 |
$425.40
|
| Rate for Payer: Cash Price |
$425.40
|
| Rate for Payer: Cigna Commercial |
$602.65
|
| Rate for Payer: First Health Commercial |
$638.10
|
| Rate for Payer: First Health Workers Compensation |
$273.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$638.10
|
| Rate for Payer: GEHA Commercial |
$567.20
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$638.10
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$645.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$496.30
|
| Rate for Payer: One Health Plan PPO/POS |
$638.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$673.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$531.75
|
| 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 |
$659.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$283.60
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$193.56
|
|
|
CLOSED TX TALUS FRACTURE W/O MANIPULATIO
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
8728430
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$673.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$425.40
|
| 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 |
$425.40
|
| Rate for Payer: Cash Price |
$425.40
|
| Rate for Payer: Cigna Commercial |
$602.65
|
| Rate for Payer: First Health Commercial |
$638.10
|
| Rate for Payer: First Health Workers Compensation |
$273.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$638.10
|
| Rate for Payer: GEHA Commercial |
$567.20
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$638.10
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$645.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$496.30
|
| Rate for Payer: One Health Plan PPO/POS |
$638.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$673.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$531.75
|
| 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 |
$659.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$283.60
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$193.56
|
|
|
CLOSED TX TALUS FRACTURE W/O MANIPULATIO
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
8300030
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$193.56 |
| Max. Negotiated Rate |
$673.55 |
| Rate for Payer: Cash Price |
$425.40
|
| Rate for Payer: Cigna Commercial |
$602.65
|
| Rate for Payer: First Health Commercial |
$638.10
|
| Rate for Payer: First Health Workers Compensation |
$273.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$638.10
|
| Rate for Payer: GEHA Commercial |
$496.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$638.10
|
| Rate for Payer: Multiplan All |
$645.19
|
| Rate for Payer: OMNI Networks Commercial |
$496.30
|
| Rate for Payer: One Health Plan PPO/POS |
$638.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$673.55
|
| Rate for Payer: Three Rivers Provider Network All |
$531.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$659.37
|
| Rate for Payer: Zelis Auto |
$283.60
|
| Rate for Payer: Zelis Worker's Compensation |
$193.56
|
|
|
CLOSED TX TALUS FRACTURE W/O MANIPULATIO
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
8728430
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$193.56 |
| Max. Negotiated Rate |
$673.55 |
| Rate for Payer: Cash Price |
$425.40
|
| Rate for Payer: Cigna Commercial |
$602.65
|
| Rate for Payer: First Health Commercial |
$638.10
|
| Rate for Payer: First Health Workers Compensation |
$273.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$638.10
|
| Rate for Payer: GEHA Commercial |
$496.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$638.10
|
| Rate for Payer: Multiplan All |
$645.19
|
| Rate for Payer: OMNI Networks Commercial |
$496.30
|
| Rate for Payer: One Health Plan PPO/POS |
$638.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$673.55
|
| Rate for Payer: Three Rivers Provider Network All |
$531.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$659.37
|
| Rate for Payer: Zelis Auto |
$283.60
|
| Rate for Payer: Zelis Worker's Compensation |
$193.56
|
|
|
CLOSED TX TALUS FRACTURE W/O MANIPULATIO
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
8300030
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$673.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$425.40
|
| 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 |
$425.40
|
| Rate for Payer: Cash Price |
$425.40
|
| Rate for Payer: Cigna Commercial |
$602.65
|
| Rate for Payer: First Health Commercial |
$638.10
|
| Rate for Payer: First Health Workers Compensation |
$273.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$638.10
|
| Rate for Payer: GEHA Commercial |
$567.20
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$638.10
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$645.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$496.30
|
| Rate for Payer: One Health Plan PPO/POS |
$638.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$673.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$531.75
|
| 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 |
$659.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$283.60
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$193.56
|
|
|
CLOSED TX ULNAR SHAFT FRACTURE W/MANIPUL
|
Facility
|
IP
|
$4,527.00
|
|
| Hospital Charge Code |
8125535
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,235.87 |
| Max. Negotiated Rate |
$4,300.65 |
| Rate for Payer: Cash Price |
$2,716.20
|
| Rate for Payer: Cigna Commercial |
$3,847.95
|
| Rate for Payer: First Health Commercial |
$4,074.30
|
| Rate for Payer: First Health Workers Compensation |
$1,747.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,074.30
|
| Rate for Payer: GEHA Commercial |
$3,168.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,074.30
|
| Rate for Payer: Multiplan All |
$4,119.57
|
| Rate for Payer: OMNI Networks Commercial |
$3,168.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,074.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,300.65
|
| Rate for Payer: Three Rivers Provider Network All |
$3,395.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,210.11
|
| Rate for Payer: Zelis Auto |
$1,810.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,235.87
|
|
|
CLOSED TX ULNAR SHAFT FRACTURE W/MANIPUL
|
Facility
|
OP
|
$4,527.00
|
|
| Hospital Charge Code |
8125535
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,131.75 |
| Max. Negotiated Rate |
$4,300.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,716.20
|
| Rate for Payer: Cash Price |
$2,716.20
|
| Rate for Payer: Cigna Commercial |
$3,847.95
|
| Rate for Payer: First Health Commercial |
$4,074.30
|
| Rate for Payer: First Health Workers Compensation |
$1,747.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,074.30
|
| Rate for Payer: GEHA Commercial |
$3,621.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,074.30
|
| Rate for Payer: Humana ChoiceCare |
$1,177.02
|
| Rate for Payer: Multiplan All |
$4,119.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,716.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,168.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,074.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,300.65
|
| Rate for Payer: Three Rivers Provider Network All |
$3,395.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,983.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,131.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,210.11
|
| Rate for Payer: Zelis Auto |
$1,810.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,263.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,235.87
|
|
|
CLOSED TX VERT FX W/MANJ
|
Facility
|
OP
|
$1,595.00
|
|
|
Service Code
|
CPT 22315
|
| Hospital Charge Code |
6122315
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$435.44 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,860.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$957.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,860.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,473.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$957.00
|
| Rate for Payer: Cash Price |
$957.00
|
| Rate for Payer: Cigna Commercial |
$1,355.75
|
| Rate for Payer: First Health Commercial |
$1,435.50
|
| Rate for Payer: First Health Workers Compensation |
$615.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,435.50
|
| Rate for Payer: GEHA Commercial |
$1,276.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,435.50
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,503.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,451.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,116.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,435.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,736.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,503.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,515.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,196.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,503.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,483.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$638.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$435.44
|
|
|
CLOSED TX VERT FX W/MANJ
|
Facility
|
IP
|
$1,595.00
|
|
|
Service Code
|
CPT 22315
|
| Hospital Charge Code |
6122315
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$435.44 |
| Max. Negotiated Rate |
$1,515.25 |
| Rate for Payer: Cash Price |
$957.00
|
| Rate for Payer: Cigna Commercial |
$1,355.75
|
| Rate for Payer: First Health Commercial |
$1,435.50
|
| Rate for Payer: First Health Workers Compensation |
$615.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,435.50
|
| Rate for Payer: GEHA Commercial |
$1,116.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,435.50
|
| Rate for Payer: Multiplan All |
$1,451.45
|
| Rate for Payer: OMNI Networks Commercial |
$1,116.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,435.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,515.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,196.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,483.35
|
| Rate for Payer: Zelis Auto |
$638.00
|
| Rate for Payer: Zelis Worker's Compensation |
$435.44
|
|
|
CLOSED TX VERT FX W/O MANJ
|
Facility
|
OP
|
$727.00
|
|
|
Service Code
|
CPT 22310
|
| Hospital Charge Code |
6122310
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$193.61 |
| Max. Negotiated Rate |
$690.65 |
| 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 |
$436.20
|
| 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 |
$436.20
|
| Rate for Payer: Cash Price |
$436.20
|
| Rate for Payer: Cigna Commercial |
$617.95
|
| Rate for Payer: First Health Commercial |
$654.30
|
| Rate for Payer: First Health Workers Compensation |
$280.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$654.30
|
| Rate for Payer: GEHA Commercial |
$581.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$654.30
|
| 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 |
$661.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$508.90
|
| Rate for Payer: One Health Plan PPO/POS |
$654.30
|
| 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 |
$690.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$545.25
|
| 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 |
$676.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$290.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$198.47
|
|
|
CLOSED TX VERT FX W/O MANJ
|
Facility
|
IP
|
$727.00
|
|
|
Service Code
|
CPT 22310
|
| Hospital Charge Code |
6122310
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$198.47 |
| Max. Negotiated Rate |
$690.65 |
| Rate for Payer: Cash Price |
$436.20
|
| Rate for Payer: Cigna Commercial |
$617.95
|
| Rate for Payer: First Health Commercial |
$654.30
|
| Rate for Payer: First Health Workers Compensation |
$280.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$654.30
|
| Rate for Payer: GEHA Commercial |
$508.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$654.30
|
| Rate for Payer: Multiplan All |
$661.57
|
| Rate for Payer: OMNI Networks Commercial |
$508.90
|
| Rate for Payer: One Health Plan PPO/POS |
$654.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$690.65
|
| Rate for Payer: Three Rivers Provider Network All |
$545.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$676.11
|
| Rate for Payer: Zelis Auto |
$290.80
|
| Rate for Payer: Zelis Worker's Compensation |
$198.47
|
|
|
CLOSE KIDNEY-SKIN FISTULA
|
Facility
|
IP
|
$2,358.00
|
|
|
Service Code
|
CPT 50520
|
| Hospital Charge Code |
6150520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$643.73 |
| Max. Negotiated Rate |
$2,240.10 |
| Rate for Payer: Cash Price |
$1,414.80
|
| Rate for Payer: Cigna Commercial |
$2,004.30
|
| Rate for Payer: First Health Commercial |
$2,122.20
|
| Rate for Payer: First Health Workers Compensation |
$910.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,122.20
|
| Rate for Payer: GEHA Commercial |
$1,650.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,122.20
|
| Rate for Payer: Multiplan All |
$2,145.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,650.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,122.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,240.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,768.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,192.94
|
| Rate for Payer: Zelis Auto |
$943.20
|
| Rate for Payer: Zelis Worker's Compensation |
$643.73
|
|
|
CLOSE KIDNEY-SKIN FISTULA
|
Facility
|
OP
|
$2,358.00
|
|
|
Service Code
|
CPT 50520
|
| Hospital Charge Code |
6150520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$589.50 |
| Max. Negotiated Rate |
$2,240.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,414.80
|
| Rate for Payer: Cash Price |
$1,414.80
|
| Rate for Payer: Cigna Commercial |
$2,004.30
|
| Rate for Payer: First Health Commercial |
$2,122.20
|
| Rate for Payer: First Health Workers Compensation |
$910.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,122.20
|
| Rate for Payer: GEHA Commercial |
$1,886.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,122.20
|
| Rate for Payer: Humana ChoiceCare |
$613.08
|
| Rate for Payer: Multiplan All |
$2,145.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,414.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,650.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,122.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,240.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,768.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,075.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$589.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,192.94
|
| Rate for Payer: Zelis Auto |
$943.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,179.00
|
| Rate for Payer: Zelis Worker's Compensation |
$643.73
|
|
|
clostridium diff toxin pcr REF183988
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
2200710
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$170.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$53.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$37.27
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$241.40
|
| Rate for Payer: First Health Commercial |
$255.60
|
| Rate for Payer: First Health Workers Compensation |
$63.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$255.60
|
| Rate for Payer: GEHA Commercial |
$227.20
|
| Rate for Payer: GEHA Medicare |
$37.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$255.60
|
| Rate for Payer: Humana ChoiceCare |
$41.00
|
| Rate for Payer: Humana Medicare Advantage |
$37.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$62.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$54.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$37.27
|
| Rate for Payer: Multiplan All |
$258.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$63.36
|
| Rate for Payer: OMNI Networks Commercial |
$198.80
|
| Rate for Payer: One Health Plan PPO/POS |
$255.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$62.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$54.22
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$37.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$269.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$74.54
|
| Rate for Payer: Three Rivers Provider Network All |
$213.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$36.52
|
| Rate for Payer: United Healthcare Commercial |
$241.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$54.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$264.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$37.27
|
| Rate for Payer: Zelis Auto |
$113.60
|
| Rate for Payer: Zelis Medicare |
$31.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$44.72
|
| Rate for Payer: Zelis Worker's Compensation |
$44.88
|
|
|
clostridium diff toxin pcr REF183988
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
2200710
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.88 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$241.40
|
| Rate for Payer: First Health Commercial |
$255.60
|
| Rate for Payer: First Health Workers Compensation |
$63.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$255.60
|
| Rate for Payer: GEHA Commercial |
$198.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$255.60
|
| Rate for Payer: Multiplan All |
$258.44
|
| Rate for Payer: OMNI Networks Commercial |
$198.80
|
| Rate for Payer: One Health Plan PPO/POS |
$255.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$269.80
|
| Rate for Payer: Three Rivers Provider Network All |
$213.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$264.12
|
| Rate for Payer: Zelis Auto |
$113.60
|
| Rate for Payer: Zelis Worker's Compensation |
$44.88
|
|
