|
CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT
|
Facility
|
IP
|
$537.00
|
|
|
Service Code
|
CPT 26740
|
| Hospital Charge Code |
6126740
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$146.60 |
| Max. Negotiated Rate |
$510.15 |
| Rate for Payer: Cash Price |
$322.20
|
| Rate for Payer: Cigna Commercial |
$456.45
|
| Rate for Payer: First Health Commercial |
$483.30
|
| Rate for Payer: First Health Workers Compensation |
$207.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$483.30
|
| Rate for Payer: GEHA Commercial |
$375.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$483.30
|
| Rate for Payer: Multiplan All |
$488.67
|
| Rate for Payer: OMNI Networks Commercial |
$375.90
|
| Rate for Payer: One Health Plan PPO/POS |
$483.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$510.15
|
| Rate for Payer: Three Rivers Provider Network All |
$402.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$499.41
|
| Rate for Payer: Zelis Auto |
$214.80
|
| Rate for Payer: Zelis Worker's Compensation |
$146.60
|
|
|
CLTX CARPO/METACARPAL DISLOC THUMB W/MAN
|
Facility
|
IP
|
$842.00
|
|
|
Service Code
|
CPT 26641
|
| Hospital Charge Code |
6126641
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$229.87 |
| Max. Negotiated Rate |
$799.90 |
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$715.70
|
| Rate for Payer: First Health Commercial |
$757.80
|
| Rate for Payer: First Health Workers Compensation |
$325.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$757.80
|
| Rate for Payer: GEHA Commercial |
$589.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$757.80
|
| Rate for Payer: Multiplan All |
$766.22
|
| Rate for Payer: OMNI Networks Commercial |
$589.40
|
| Rate for Payer: One Health Plan PPO/POS |
$757.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$799.90
|
| Rate for Payer: Three Rivers Provider Network All |
$631.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.06
|
| Rate for Payer: Zelis Auto |
$336.80
|
| Rate for Payer: Zelis Worker's Compensation |
$229.87
|
|
|
CLTX CARPO/METACARPAL DISLOC THUMB W/MAN
|
Facility
|
IP
|
$1,143.00
|
|
|
Service Code
|
CPT 26641
|
| Hospital Charge Code |
8800050
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$312.04 |
| Max. Negotiated Rate |
$1,085.85 |
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cigna Commercial |
$971.55
|
| Rate for Payer: First Health Commercial |
$1,028.70
|
| Rate for Payer: First Health Workers Compensation |
$441.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,028.70
|
| Rate for Payer: GEHA Commercial |
$800.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,028.70
|
| Rate for Payer: Multiplan All |
$1,040.13
|
| Rate for Payer: OMNI Networks Commercial |
$800.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,028.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,085.85
|
| Rate for Payer: Three Rivers Provider Network All |
$857.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,062.99
|
| Rate for Payer: Zelis Auto |
$457.20
|
| Rate for Payer: Zelis Worker's Compensation |
$312.04
|
|
|
CLTX CARPO/METACARPAL DISLOC THUMB W/MAN
|
Facility
|
OP
|
$1,143.00
|
|
|
Service Code
|
CPT 26641
|
| Hospital Charge Code |
8800050
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$1,085.85 |
| 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 |
$685.80
|
| 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 |
$685.80
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cigna Commercial |
$971.55
|
| Rate for Payer: First Health Commercial |
$1,028.70
|
| Rate for Payer: First Health Workers Compensation |
$441.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,028.70
|
| Rate for Payer: GEHA Commercial |
$914.40
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,028.70
|
| 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 |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$1,040.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$800.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,028.70
|
| 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 |
$1,085.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$857.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,062.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$457.20
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$312.04
|
|
|
CLTX CARPO/METACARPAL DISLOC THUMB W/MAN
|
Facility
|
IP
|
$1,143.00
|
|
|
Service Code
|
CPT 26641
|
| Hospital Charge Code |
8230087
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$312.04 |
| Max. Negotiated Rate |
$1,085.85 |
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cigna Commercial |
$971.55
|
| Rate for Payer: First Health Commercial |
$1,028.70
|
| Rate for Payer: First Health Workers Compensation |
$441.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,028.70
|
| Rate for Payer: GEHA Commercial |
$800.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,028.70
|
| Rate for Payer: Multiplan All |
$1,040.13
|
| Rate for Payer: OMNI Networks Commercial |
$800.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,028.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,085.85
|
| Rate for Payer: Three Rivers Provider Network All |
$857.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,062.99
|
| Rate for Payer: Zelis Auto |
$457.20
|
| Rate for Payer: Zelis Worker's Compensation |
$312.04
|
|
|
CLTX CARPO/METACARPAL DISLOC THUMB W/MAN
|
Facility
|
OP
|
$842.00
|
|
|
Service Code
|
CPT 26641
|
| Hospital Charge Code |
6126641
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$799.90 |
| 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 |
$505.20
|
| 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 |
$505.20
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$715.70
|
| Rate for Payer: First Health Commercial |
$757.80
|
| Rate for Payer: First Health Workers Compensation |
$325.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$757.80
|
| Rate for Payer: GEHA Commercial |
$673.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$757.80
|
| 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 |
$766.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$589.40
|
| Rate for Payer: One Health Plan PPO/POS |
$757.80
|
| 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 |
$799.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$631.50
|
| 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 |
$783.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$336.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$229.87
|
|
|
CLTX CARPO/METACARPAL DISLOC THUMB W/MAN
|
Facility
|
IP
|
$1,566.00
|
|
| Hospital Charge Code |
8126641
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$427.52 |
| Max. Negotiated Rate |
$1,487.70 |
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$1,331.10
|
| Rate for Payer: First Health Commercial |
$1,409.40
|
| Rate for Payer: First Health Workers Compensation |
$604.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,409.40
|
| Rate for Payer: GEHA Commercial |
$1,096.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,409.40
|
| Rate for Payer: Multiplan All |
$1,425.06
|
| Rate for Payer: OMNI Networks Commercial |
$1,096.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,409.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,487.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,174.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,456.38
|
| Rate for Payer: Zelis Auto |
$626.40
|
| Rate for Payer: Zelis Worker's Compensation |
$427.52
|
|
|
CLTX CARPO/METACARPAL DISLOC THUMB W/MAN
|
Facility
|
OP
|
$1,566.00
|
|
| Hospital Charge Code |
8126641
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$391.50 |
| Max. Negotiated Rate |
$1,487.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$939.60
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$1,331.10
|
| Rate for Payer: First Health Commercial |
$1,409.40
|
| Rate for Payer: First Health Workers Compensation |
$604.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,409.40
|
| Rate for Payer: GEHA Commercial |
$1,252.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,409.40
|
| Rate for Payer: Humana ChoiceCare |
$407.16
|
| Rate for Payer: Multiplan All |
$1,425.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$939.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,096.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,409.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,487.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,174.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$391.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,456.38
|
| Rate for Payer: Zelis Auto |
$626.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$783.00
|
| Rate for Payer: Zelis Worker's Compensation |
$427.52
|
|
|
CLTX CARPO/METACARPAL DISLOC THUMB W/MAN
|
Facility
|
OP
|
$1,143.00
|
|
|
Service Code
|
CPT 26641
|
| Hospital Charge Code |
8230087
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$1,085.85 |
| 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 |
$685.80
|
| 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 |
$685.80
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cigna Commercial |
$971.55
|
| Rate for Payer: First Health Commercial |
$1,028.70
|
| Rate for Payer: First Health Workers Compensation |
$441.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,028.70
|
| Rate for Payer: GEHA Commercial |
$914.40
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,028.70
|
| 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 |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$1,040.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$800.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,028.70
|
| 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 |
$1,085.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$857.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,062.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$457.20
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$312.04
|
|
|
CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
8300024
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$896.80 |
| 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 |
$566.40
|
| 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 |
$566.40
|
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Cigna Commercial |
$802.40
|
| Rate for Payer: First Health Commercial |
$849.60
|
| Rate for Payer: First Health Workers Compensation |
$364.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$849.60
|
| Rate for Payer: GEHA Commercial |
$755.20
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$849.60
|
| 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 |
$859.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$660.80
|
| Rate for Payer: One Health Plan PPO/POS |
$849.60
|
| 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 |
$896.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$708.00
|
| 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 |
$877.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$377.60
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$257.71
|
|
|
CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
6127786
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$257.71 |
| Max. Negotiated Rate |
$896.80 |
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Cigna Commercial |
$802.40
|
| Rate for Payer: First Health Commercial |
$849.60
|
| Rate for Payer: First Health Workers Compensation |
$364.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$849.60
|
| Rate for Payer: GEHA Commercial |
$660.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$849.60
|
| Rate for Payer: Multiplan All |
$859.04
|
| Rate for Payer: OMNI Networks Commercial |
$660.80
|
| Rate for Payer: One Health Plan PPO/POS |
$849.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$896.80
|
| Rate for Payer: Three Rivers Provider Network All |
$708.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$877.92
|
| Rate for Payer: Zelis Auto |
$377.60
|
| Rate for Payer: Zelis Worker's Compensation |
$257.71
|
|
|
CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
8727786
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$896.80 |
| 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 |
$566.40
|
| 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 |
$566.40
|
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Cigna Commercial |
$802.40
|
| Rate for Payer: First Health Commercial |
$849.60
|
| Rate for Payer: First Health Workers Compensation |
$364.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$849.60
|
| Rate for Payer: GEHA Commercial |
$755.20
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$849.60
|
| 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 |
$859.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$660.80
|
| Rate for Payer: One Health Plan PPO/POS |
$849.60
|
| 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 |
$896.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$708.00
|
| 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 |
$877.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$377.60
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$257.71
|
|
|
CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
8300024
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$257.71 |
| Max. Negotiated Rate |
$896.80 |
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Cigna Commercial |
$802.40
|
| Rate for Payer: First Health Commercial |
$849.60
|
| Rate for Payer: First Health Workers Compensation |
$364.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$849.60
|
| Rate for Payer: GEHA Commercial |
$660.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$849.60
|
| Rate for Payer: Multiplan All |
$859.04
|
| Rate for Payer: OMNI Networks Commercial |
$660.80
|
| Rate for Payer: One Health Plan PPO/POS |
$849.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$896.80
|
| Rate for Payer: Three Rivers Provider Network All |
$708.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$877.92
|
| Rate for Payer: Zelis Auto |
$377.60
|
| Rate for Payer: Zelis Worker's Compensation |
$257.71
|
|
|
CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Facility
|
IP
|
$1,624.00
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
1000053
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$443.35 |
| Max. Negotiated Rate |
$1,542.80 |
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cigna Commercial |
$1,380.40
|
| Rate for Payer: First Health Commercial |
$1,461.60
|
| Rate for Payer: First Health Workers Compensation |
$627.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,461.60
|
| Rate for Payer: GEHA Commercial |
$1,136.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,461.60
|
| Rate for Payer: Multiplan All |
$1,477.84
|
| Rate for Payer: OMNI Networks Commercial |
$1,136.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,461.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,542.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,218.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,510.32
|
| Rate for Payer: Zelis Auto |
$649.60
|
| Rate for Payer: Zelis Worker's Compensation |
$443.35
|
|
|
CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Facility
|
IP
|
$1,438.00
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
8127786
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$392.57 |
| Max. Negotiated Rate |
$1,366.10 |
| Rate for Payer: Cash Price |
$862.80
|
| Rate for Payer: Cigna Commercial |
$1,222.30
|
| Rate for Payer: First Health Commercial |
$1,294.20
|
| Rate for Payer: First Health Workers Compensation |
$555.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,294.20
|
| Rate for Payer: GEHA Commercial |
$1,006.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,294.20
|
| Rate for Payer: Multiplan All |
$1,308.58
|
| Rate for Payer: OMNI Networks Commercial |
$1,006.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,294.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,366.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,078.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,337.34
|
| Rate for Payer: Zelis Auto |
$575.20
|
| Rate for Payer: Zelis Worker's Compensation |
$392.57
|
|
|
CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
9627786
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$896.80 |
| 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 |
$566.40
|
| 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 |
$566.40
|
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Cigna Commercial |
$802.40
|
| Rate for Payer: First Health Commercial |
$849.60
|
| Rate for Payer: First Health Workers Compensation |
$364.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$849.60
|
| Rate for Payer: GEHA Commercial |
$755.20
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$849.60
|
| 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 |
$859.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$660.80
|
| Rate for Payer: One Health Plan PPO/POS |
$849.60
|
| 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 |
$896.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$708.00
|
| 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 |
$877.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$377.60
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$257.71
|
|
|
CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
6127786
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$896.80 |
| 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 |
$566.40
|
| 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 |
$566.40
|
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Cigna Commercial |
$802.40
|
| Rate for Payer: First Health Commercial |
$849.60
|
| Rate for Payer: First Health Workers Compensation |
$364.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$849.60
|
| Rate for Payer: GEHA Commercial |
$755.20
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$849.60
|
| 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 |
$859.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$660.80
|
| Rate for Payer: One Health Plan PPO/POS |
$849.60
|
| 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 |
$896.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$708.00
|
| 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 |
$877.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$377.60
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$257.71
|
|
|
CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
9627786
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$257.71 |
| Max. Negotiated Rate |
$896.80 |
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Cigna Commercial |
$802.40
|
| Rate for Payer: First Health Commercial |
$849.60
|
| Rate for Payer: First Health Workers Compensation |
$364.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$849.60
|
| Rate for Payer: GEHA Commercial |
$660.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$849.60
|
| Rate for Payer: Multiplan All |
$859.04
|
| Rate for Payer: OMNI Networks Commercial |
$660.80
|
| Rate for Payer: One Health Plan PPO/POS |
$849.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$896.80
|
| Rate for Payer: Three Rivers Provider Network All |
$708.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$877.92
|
| Rate for Payer: Zelis Auto |
$377.60
|
| Rate for Payer: Zelis Worker's Compensation |
$257.71
|
|
|
CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Facility
|
OP
|
$1,438.00
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
8127786
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$1,366.10 |
| 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 |
$862.80
|
| 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 |
$862.80
|
| Rate for Payer: Cash Price |
$862.80
|
| Rate for Payer: Cigna Commercial |
$1,222.30
|
| Rate for Payer: First Health Commercial |
$1,294.20
|
| Rate for Payer: First Health Workers Compensation |
$555.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,294.20
|
| Rate for Payer: GEHA Commercial |
$1,150.40
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,294.20
|
| 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 |
$1,308.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,006.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,294.20
|
| 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 |
$1,366.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$1,078.50
|
| 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 |
$1,337.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$575.20
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$392.57
|
|
|
CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
8727786
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$257.71 |
| Max. Negotiated Rate |
$896.80 |
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Cigna Commercial |
$802.40
|
| Rate for Payer: First Health Commercial |
$849.60
|
| Rate for Payer: First Health Workers Compensation |
$364.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$849.60
|
| Rate for Payer: GEHA Commercial |
$660.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$849.60
|
| Rate for Payer: Multiplan All |
$859.04
|
| Rate for Payer: OMNI Networks Commercial |
$660.80
|
| Rate for Payer: One Health Plan PPO/POS |
$849.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$896.80
|
| Rate for Payer: Three Rivers Provider Network All |
$708.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$877.92
|
| Rate for Payer: Zelis Auto |
$377.60
|
| Rate for Payer: Zelis Worker's Compensation |
$257.71
|
|
|
CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
CPT 26755
|
| Hospital Charge Code |
8899225
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$907.25 |
| 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 |
$573.00
|
| 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 |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cigna Commercial |
$811.75
|
| Rate for Payer: First Health Commercial |
$859.50
|
| Rate for Payer: First Health Workers Compensation |
$368.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$859.50
|
| Rate for Payer: GEHA Commercial |
$764.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$859.50
|
| 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 |
$869.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$668.50
|
| Rate for Payer: One Health Plan PPO/POS |
$859.50
|
| 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 |
$907.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$716.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Commercial |
$811.75
|
| 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 |
$888.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$382.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$260.71
|
|
|
CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
CPT 26755
|
| Hospital Charge Code |
8299285
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$907.25 |
| 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 |
$573.00
|
| 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 |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cigna Commercial |
$811.75
|
| Rate for Payer: First Health Commercial |
$859.50
|
| Rate for Payer: First Health Workers Compensation |
$368.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$859.50
|
| Rate for Payer: GEHA Commercial |
$764.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$859.50
|
| 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 |
$869.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$668.50
|
| Rate for Payer: One Health Plan PPO/POS |
$859.50
|
| 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 |
$907.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$716.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$888.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$382.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$260.71
|
|
|
CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA
|
Facility
|
IP
|
$1,407.00
|
|
| Hospital Charge Code |
8126755
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$384.11 |
| Max. Negotiated Rate |
$1,336.65 |
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cigna Commercial |
$1,195.95
|
| Rate for Payer: First Health Commercial |
$1,266.30
|
| Rate for Payer: First Health Workers Compensation |
$543.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,266.30
|
| Rate for Payer: GEHA Commercial |
$984.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,266.30
|
| Rate for Payer: Multiplan All |
$1,280.37
|
| Rate for Payer: OMNI Networks Commercial |
$984.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,266.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,336.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,055.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,308.51
|
| Rate for Payer: Zelis Auto |
$562.80
|
| Rate for Payer: Zelis Worker's Compensation |
$384.11
|
|
|
CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA
|
Facility
|
IP
|
$683.00
|
|
|
Service Code
|
CPT 26755
|
| Hospital Charge Code |
6126755
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$186.46 |
| Max. Negotiated Rate |
$648.85 |
| Rate for Payer: Cash Price |
$409.80
|
| Rate for Payer: Cigna Commercial |
$580.55
|
| Rate for Payer: First Health Commercial |
$614.70
|
| Rate for Payer: First Health Workers Compensation |
$263.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$614.70
|
| Rate for Payer: GEHA Commercial |
$478.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$614.70
|
| Rate for Payer: Multiplan All |
$621.53
|
| Rate for Payer: OMNI Networks Commercial |
$478.10
|
| Rate for Payer: One Health Plan PPO/POS |
$614.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$648.85
|
| Rate for Payer: Three Rivers Provider Network All |
$512.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$635.19
|
| Rate for Payer: Zelis Auto |
$273.20
|
| Rate for Payer: Zelis Worker's Compensation |
$186.46
|
|
|
CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA
|
Facility
|
OP
|
$683.00
|
|
|
Service Code
|
CPT 26755
|
| Hospital Charge Code |
6126755
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$648.85 |
| 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 |
$409.80
|
| 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 |
$409.80
|
| Rate for Payer: Cash Price |
$409.80
|
| Rate for Payer: Cigna Commercial |
$580.55
|
| Rate for Payer: First Health Commercial |
$614.70
|
| Rate for Payer: First Health Workers Compensation |
$263.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$614.70
|
| Rate for Payer: GEHA Commercial |
$546.40
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$614.70
|
| 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 |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$621.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$478.10
|
| Rate for Payer: One Health Plan PPO/POS |
$614.70
|
| 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 |
$648.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$512.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$635.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$273.20
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$186.46
|
|
