|
CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
8300036
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$131.59 |
| Max. Negotiated Rate |
$457.90 |
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$409.70
|
| Rate for Payer: First Health Commercial |
$433.80
|
| Rate for Payer: First Health Workers Compensation |
$186.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$433.80
|
| Rate for Payer: GEHA Commercial |
$337.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$433.80
|
| Rate for Payer: Multiplan All |
$438.62
|
| Rate for Payer: OMNI Networks Commercial |
$337.40
|
| Rate for Payer: One Health Plan PPO/POS |
$433.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$457.90
|
| Rate for Payer: Three Rivers Provider Network All |
$361.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$448.26
|
| Rate for Payer: Zelis Auto |
$192.80
|
| Rate for Payer: Zelis Worker's Compensation |
$131.59
|
|
|
CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
6128515
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$131.59 |
| Max. Negotiated Rate |
$457.90 |
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$409.70
|
| Rate for Payer: First Health Commercial |
$433.80
|
| Rate for Payer: First Health Workers Compensation |
$186.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$433.80
|
| Rate for Payer: GEHA Commercial |
$337.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$433.80
|
| Rate for Payer: Multiplan All |
$438.62
|
| Rate for Payer: OMNI Networks Commercial |
$337.40
|
| Rate for Payer: One Health Plan PPO/POS |
$433.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$457.90
|
| Rate for Payer: Three Rivers Provider Network All |
$361.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$448.26
|
| Rate for Payer: Zelis Auto |
$192.80
|
| Rate for Payer: Zelis Worker's Compensation |
$131.59
|
|
|
CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
6128515
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$131.59 |
| Max. Negotiated Rate |
$457.90 |
| 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 |
$289.20
|
| 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 |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$409.70
|
| Rate for Payer: First Health Commercial |
$433.80
|
| Rate for Payer: First Health Workers Compensation |
$186.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$433.80
|
| Rate for Payer: GEHA Commercial |
$385.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$433.80
|
| 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 |
$438.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$337.40
|
| Rate for Payer: One Health Plan PPO/POS |
$433.80
|
| 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 |
$457.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$361.50
|
| 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 |
$448.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$192.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$131.59
|
|
|
CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
8728515
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.59 |
| Max. Negotiated Rate |
$457.90 |
| 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 |
$289.20
|
| 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 |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$409.70
|
| Rate for Payer: First Health Commercial |
$433.80
|
| Rate for Payer: First Health Workers Compensation |
$186.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$433.80
|
| Rate for Payer: GEHA Commercial |
$385.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$433.80
|
| 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 |
$438.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$337.40
|
| Rate for Payer: One Health Plan PPO/POS |
$433.80
|
| 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 |
$457.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$361.50
|
| 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 |
$448.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$192.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$131.59
|
|
|
CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ
|
Facility
|
OP
|
$1,815.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
9628515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$1,724.25 |
| 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 |
$1,089.00
|
| 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 |
$1,089.00
|
| Rate for Payer: Cash Price |
$1,089.00
|
| Rate for Payer: Cigna Commercial |
$1,542.75
|
| Rate for Payer: First Health Commercial |
$1,633.50
|
| Rate for Payer: First Health Workers Compensation |
$700.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,633.50
|
| Rate for Payer: GEHA Commercial |
$1,452.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,633.50
|
| 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 |
$1,651.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,270.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,633.50
|
| 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 |
$1,724.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$1,361.25
|
| 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 |
$1,687.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$726.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$495.50
|
|
|
CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
8300036
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$131.59 |
| Max. Negotiated Rate |
$457.90 |
| 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 |
$289.20
|
| 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 |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$409.70
|
| Rate for Payer: First Health Commercial |
$433.80
|
| Rate for Payer: First Health Workers Compensation |
$186.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$433.80
|
| Rate for Payer: GEHA Commercial |
$385.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$433.80
|
| 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 |
$438.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$337.40
|
| Rate for Payer: One Health Plan PPO/POS |
$433.80
|
| 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 |
$457.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$361.50
|
| 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 |
$448.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$192.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$131.59
|
|
|
CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
8728515
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.59 |
| Max. Negotiated Rate |
$457.90 |
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$409.70
|
| Rate for Payer: First Health Commercial |
$433.80
|
| Rate for Payer: First Health Workers Compensation |
$186.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$433.80
|
| Rate for Payer: GEHA Commercial |
$337.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$433.80
|
| Rate for Payer: Multiplan All |
$438.62
|
| Rate for Payer: OMNI Networks Commercial |
$337.40
|
| Rate for Payer: One Health Plan PPO/POS |
$433.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$457.90
|
| Rate for Payer: Three Rivers Provider Network All |
$361.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$448.26
|
| Rate for Payer: Zelis Auto |
$192.80
|
| Rate for Payer: Zelis Worker's Compensation |
$131.59
|
|
|
CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MA
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
8728510
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.01 |
| Max. Negotiated Rate |
$455.56 |
| 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 |
$222.00
|
| 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 |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$314.50
|
| Rate for Payer: First Health Commercial |
$333.00
|
| Rate for Payer: First Health Workers Compensation |
$142.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.00
|
| Rate for Payer: GEHA Commercial |
$296.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.00
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$336.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$259.00
|
| Rate for Payer: One Health Plan PPO/POS |
$333.00
|
| 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 |
$351.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$277.50
|
| 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 |
$344.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$148.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$101.01
|
|
|
CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MA
|
Facility
|
IP
|
$837.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
1000024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.50 |
| Max. Negotiated Rate |
$795.15 |
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cigna Commercial |
$711.45
|
| Rate for Payer: First Health Commercial |
$753.30
|
| Rate for Payer: First Health Workers Compensation |
$323.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$753.30
|
| Rate for Payer: GEHA Commercial |
$585.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$753.30
|
| Rate for Payer: Multiplan All |
$761.67
|
| Rate for Payer: OMNI Networks Commercial |
$585.90
|
| Rate for Payer: One Health Plan PPO/POS |
$753.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$795.15
|
| Rate for Payer: Three Rivers Provider Network All |
$627.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$778.41
|
| Rate for Payer: Zelis Auto |
$334.80
|
| Rate for Payer: Zelis Worker's Compensation |
$228.50
|
|
|
CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MA
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
9628510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$756.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$477.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$477.60
|
| Rate for Payer: Cash Price |
$477.60
|
| Rate for Payer: Cigna Commercial |
$676.60
|
| Rate for Payer: First Health Commercial |
$716.40
|
| Rate for Payer: First Health Workers Compensation |
$307.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$716.40
|
| Rate for Payer: GEHA Commercial |
$636.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$716.40
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$724.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$557.20
|
| Rate for Payer: One Health Plan PPO/POS |
$716.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$756.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$597.00
|
| 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 |
$740.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$318.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$217.31
|
|
|
CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MA
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
8728510
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.01 |
| Max. Negotiated Rate |
$351.50 |
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$314.50
|
| Rate for Payer: First Health Commercial |
$333.00
|
| Rate for Payer: First Health Workers Compensation |
$142.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.00
|
| Rate for Payer: GEHA Commercial |
$259.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.00
|
| Rate for Payer: Multiplan All |
$336.70
|
| Rate for Payer: OMNI Networks Commercial |
$259.00
|
| Rate for Payer: One Health Plan PPO/POS |
$333.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$351.50
|
| Rate for Payer: Three Rivers Provider Network All |
$277.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$344.10
|
| Rate for Payer: Zelis Auto |
$148.00
|
| Rate for Payer: Zelis Worker's Compensation |
$101.01
|
|
|
CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MA
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
9628510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.31 |
| Max. Negotiated Rate |
$756.20 |
| Rate for Payer: Cash Price |
$477.60
|
| Rate for Payer: Cigna Commercial |
$676.60
|
| Rate for Payer: First Health Commercial |
$716.40
|
| Rate for Payer: First Health Workers Compensation |
$307.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$716.40
|
| Rate for Payer: GEHA Commercial |
$557.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$716.40
|
| Rate for Payer: Multiplan All |
$724.36
|
| Rate for Payer: OMNI Networks Commercial |
$557.20
|
| Rate for Payer: One Health Plan PPO/POS |
$716.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$756.20
|
| Rate for Payer: Three Rivers Provider Network All |
$597.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$740.28
|
| Rate for Payer: Zelis Auto |
$318.40
|
| Rate for Payer: Zelis Worker's Compensation |
$217.31
|
|
|
CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MA
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
6128510
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$101.01 |
| Max. Negotiated Rate |
$455.56 |
| 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 |
$222.00
|
| 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 |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$314.50
|
| Rate for Payer: First Health Commercial |
$333.00
|
| Rate for Payer: First Health Workers Compensation |
$142.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.00
|
| Rate for Payer: GEHA Commercial |
$296.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.00
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$336.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$259.00
|
| Rate for Payer: One Health Plan PPO/POS |
$333.00
|
| 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 |
$351.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$277.50
|
| 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 |
$344.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$148.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$101.01
|
|
|
CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MA
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
6128510
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$101.01 |
| Max. Negotiated Rate |
$351.50 |
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$314.50
|
| Rate for Payer: First Health Commercial |
$333.00
|
| Rate for Payer: First Health Workers Compensation |
$142.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.00
|
| Rate for Payer: GEHA Commercial |
$259.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.00
|
| Rate for Payer: Multiplan All |
$336.70
|
| Rate for Payer: OMNI Networks Commercial |
$259.00
|
| Rate for Payer: One Health Plan PPO/POS |
$333.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$351.50
|
| Rate for Payer: Three Rivers Provider Network All |
$277.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$344.10
|
| Rate for Payer: Zelis Auto |
$148.00
|
| Rate for Payer: Zelis Worker's Compensation |
$101.01
|
|
|
CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MA
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
8300035
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$101.01 |
| Max. Negotiated Rate |
$351.50 |
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$314.50
|
| Rate for Payer: First Health Commercial |
$333.00
|
| Rate for Payer: First Health Workers Compensation |
$142.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.00
|
| Rate for Payer: GEHA Commercial |
$259.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.00
|
| Rate for Payer: Multiplan All |
$336.70
|
| Rate for Payer: OMNI Networks Commercial |
$259.00
|
| Rate for Payer: One Health Plan PPO/POS |
$333.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$351.50
|
| Rate for Payer: Three Rivers Provider Network All |
$277.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$344.10
|
| Rate for Payer: Zelis Auto |
$148.00
|
| Rate for Payer: Zelis Worker's Compensation |
$101.01
|
|
|
CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MA
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
8300035
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$101.01 |
| Max. Negotiated Rate |
$455.56 |
| 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 |
$222.00
|
| 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 |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$314.50
|
| Rate for Payer: First Health Commercial |
$333.00
|
| Rate for Payer: First Health Workers Compensation |
$142.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.00
|
| Rate for Payer: GEHA Commercial |
$296.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.00
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$336.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$259.00
|
| Rate for Payer: One Health Plan PPO/POS |
$333.00
|
| 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 |
$351.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$277.50
|
| 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 |
$344.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$148.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$101.01
|
|
|
CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/O
|
Facility
|
IP
|
$1,022.61
|
|
|
Service Code
|
CPT 27824
|
| Hospital Charge Code |
9627824
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$279.17 |
| Max. Negotiated Rate |
$971.48 |
| Rate for Payer: Cash Price |
$613.57
|
| Rate for Payer: Cigna Commercial |
$869.22
|
| Rate for Payer: First Health Commercial |
$920.35
|
| Rate for Payer: First Health Workers Compensation |
$394.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$920.35
|
| Rate for Payer: GEHA Commercial |
$715.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$920.35
|
| Rate for Payer: Multiplan All |
$930.58
|
| Rate for Payer: OMNI Networks Commercial |
$715.83
|
| Rate for Payer: One Health Plan PPO/POS |
$920.35
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$971.48
|
| Rate for Payer: Three Rivers Provider Network All |
$766.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$951.03
|
| Rate for Payer: Zelis Auto |
$409.04
|
| Rate for Payer: Zelis Worker's Compensation |
$279.17
|
|
|
CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/O
|
Facility
|
OP
|
$942.00
|
|
|
Service Code
|
CPT 27824
|
| Hospital Charge Code |
8300027
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$894.90 |
| 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 |
$565.20
|
| 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 |
$565.20
|
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Cigna Commercial |
$800.70
|
| Rate for Payer: First Health Commercial |
$847.80
|
| Rate for Payer: First Health Workers Compensation |
$363.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$847.80
|
| Rate for Payer: GEHA Commercial |
$753.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$847.80
|
| 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 |
$857.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$659.40
|
| Rate for Payer: One Health Plan PPO/POS |
$847.80
|
| 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 |
$894.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$706.50
|
| 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 |
$876.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$376.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$257.17
|
|
|
CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/O
|
Facility
|
OP
|
$942.00
|
|
|
Service Code
|
CPT 27824
|
| Hospital Charge Code |
6127824
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$894.90 |
| 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 |
$565.20
|
| 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 |
$565.20
|
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Cigna Commercial |
$800.70
|
| Rate for Payer: First Health Commercial |
$847.80
|
| Rate for Payer: First Health Workers Compensation |
$363.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$847.80
|
| Rate for Payer: GEHA Commercial |
$753.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$847.80
|
| 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 |
$857.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$659.40
|
| Rate for Payer: One Health Plan PPO/POS |
$847.80
|
| 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 |
$894.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$706.50
|
| 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 |
$876.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$376.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$257.17
|
|
|
CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/O
|
Facility
|
IP
|
$942.00
|
|
|
Service Code
|
CPT 27824
|
| Hospital Charge Code |
8727824
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$257.17 |
| Max. Negotiated Rate |
$894.90 |
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Cigna Commercial |
$800.70
|
| Rate for Payer: First Health Commercial |
$847.80
|
| Rate for Payer: First Health Workers Compensation |
$363.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$847.80
|
| Rate for Payer: GEHA Commercial |
$659.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$847.80
|
| Rate for Payer: Multiplan All |
$857.22
|
| Rate for Payer: OMNI Networks Commercial |
$659.40
|
| Rate for Payer: One Health Plan PPO/POS |
$847.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$894.90
|
| Rate for Payer: Three Rivers Provider Network All |
$706.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$876.06
|
| Rate for Payer: Zelis Auto |
$376.80
|
| Rate for Payer: Zelis Worker's Compensation |
$257.17
|
|
|
CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/O
|
Facility
|
IP
|
$942.00
|
|
|
Service Code
|
CPT 27824
|
| Hospital Charge Code |
6127824
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$257.17 |
| Max. Negotiated Rate |
$894.90 |
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Cigna Commercial |
$800.70
|
| Rate for Payer: First Health Commercial |
$847.80
|
| Rate for Payer: First Health Workers Compensation |
$363.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$847.80
|
| Rate for Payer: GEHA Commercial |
$659.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$847.80
|
| Rate for Payer: Multiplan All |
$857.22
|
| Rate for Payer: OMNI Networks Commercial |
$659.40
|
| Rate for Payer: One Health Plan PPO/POS |
$847.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$894.90
|
| Rate for Payer: Three Rivers Provider Network All |
$706.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$876.06
|
| Rate for Payer: Zelis Auto |
$376.80
|
| Rate for Payer: Zelis Worker's Compensation |
$257.17
|
|
|
CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/O
|
Facility
|
IP
|
$942.00
|
|
|
Service Code
|
CPT 27824
|
| Hospital Charge Code |
8300027
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$257.17 |
| Max. Negotiated Rate |
$894.90 |
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Cigna Commercial |
$800.70
|
| Rate for Payer: First Health Commercial |
$847.80
|
| Rate for Payer: First Health Workers Compensation |
$363.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$847.80
|
| Rate for Payer: GEHA Commercial |
$659.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$847.80
|
| Rate for Payer: Multiplan All |
$857.22
|
| Rate for Payer: OMNI Networks Commercial |
$659.40
|
| Rate for Payer: One Health Plan PPO/POS |
$847.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$894.90
|
| Rate for Payer: Three Rivers Provider Network All |
$706.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$876.06
|
| Rate for Payer: Zelis Auto |
$376.80
|
| Rate for Payer: Zelis Worker's Compensation |
$257.17
|
|
|
CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/O
|
Facility
|
OP
|
$942.00
|
|
|
Service Code
|
CPT 27824
|
| Hospital Charge Code |
8727824
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$894.90 |
| 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 |
$565.20
|
| 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 |
$565.20
|
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Cigna Commercial |
$800.70
|
| Rate for Payer: First Health Commercial |
$847.80
|
| Rate for Payer: First Health Workers Compensation |
$363.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$847.80
|
| Rate for Payer: GEHA Commercial |
$753.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$847.80
|
| 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 |
$857.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$659.40
|
| Rate for Payer: One Health Plan PPO/POS |
$847.80
|
| 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 |
$894.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$706.50
|
| 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 |
$876.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$376.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$257.17
|
|
|
CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/O
|
Facility
|
OP
|
$1,022.61
|
|
|
Service Code
|
CPT 27824
|
| Hospital Charge Code |
9627824
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$971.48 |
| 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 |
$613.57
|
| 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 |
$613.57
|
| Rate for Payer: Cash Price |
$613.57
|
| Rate for Payer: Cigna Commercial |
$869.22
|
| Rate for Payer: First Health Commercial |
$920.35
|
| Rate for Payer: First Health Workers Compensation |
$394.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$920.35
|
| Rate for Payer: GEHA Commercial |
$818.09
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$920.35
|
| 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 |
$930.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$715.83
|
| Rate for Payer: One Health Plan PPO/POS |
$920.35
|
| 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 |
$971.48
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$766.96
|
| 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 |
$951.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$409.04
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$279.17
|
|
|
CLTX HUMERAL CONDYLAR FX MEDL/LAT W/MANJ
|
Facility
|
OP
|
$1,010.00
|
|
|
Service Code
|
CPT 24577
|
| Hospital Charge Code |
6124577
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$275.73 |
| 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 |
$606.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$484.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$384.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$606.00
|
| Rate for Payer: Cash Price |
$606.00
|
| Rate for Payer: Cigna Commercial |
$858.50
|
| Rate for Payer: First Health Commercial |
$909.00
|
| Rate for Payer: First Health Workers Compensation |
$389.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$909.00
|
| Rate for Payer: GEHA Commercial |
$808.00
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$909.00
|
| 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 |
$919.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$707.00
|
| Rate for Payer: One Health Plan PPO/POS |
$909.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$452.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$391.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$959.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$757.50
|
| 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 |
$939.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$404.00
|
| 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 |
$275.73
|
|
