|
CLTX HUMERAL CONDYLAR FX MEDL/LAT W/MANJ
|
Facility
|
IP
|
$3,451.00
|
|
|
Service Code
|
CPT 24577
|
| Hospital Charge Code |
8124577
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$942.12 |
| Max. Negotiated Rate |
$3,278.45 |
| Rate for Payer: Cash Price |
$2,070.60
|
| Rate for Payer: Cigna Commercial |
$2,933.35
|
| Rate for Payer: First Health Commercial |
$3,105.90
|
| Rate for Payer: First Health Workers Compensation |
$1,332.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,105.90
|
| Rate for Payer: GEHA Commercial |
$2,415.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,105.90
|
| Rate for Payer: Multiplan All |
$3,140.41
|
| Rate for Payer: OMNI Networks Commercial |
$2,415.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,105.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,278.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,588.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,209.43
|
| Rate for Payer: Zelis Auto |
$1,380.40
|
| Rate for Payer: Zelis Worker's Compensation |
$942.12
|
|
|
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
|
|
|
CLTX HUMERAL CONDYLAR FX MEDL/LAT W/MANJ
|
Facility
|
OP
|
$3,451.00
|
|
|
Service Code
|
CPT 24577
|
| Hospital Charge Code |
8124577
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$384.03 |
| Max. Negotiated Rate |
$3,278.45 |
| 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 |
$2,070.60
|
| 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 |
$2,070.60
|
| Rate for Payer: Cash Price |
$2,070.60
|
| Rate for Payer: Cigna Commercial |
$2,933.35
|
| Rate for Payer: First Health Commercial |
$3,105.90
|
| Rate for Payer: First Health Workers Compensation |
$1,332.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,105.90
|
| Rate for Payer: GEHA Commercial |
$2,760.80
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,105.90
|
| 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 |
$3,140.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$2,415.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,105.90
|
| 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 |
$3,278.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,588.25
|
| 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 |
$3,209.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$1,380.40
|
| 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 |
$942.12
|
|
|
CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W
|
Facility
|
IP
|
$3,760.00
|
|
| Hospital Charge Code |
8124565
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,026.48 |
| Max. Negotiated Rate |
$3,572.00 |
| Rate for Payer: Cash Price |
$2,256.00
|
| Rate for Payer: Cigna Commercial |
$3,196.00
|
| Rate for Payer: First Health Commercial |
$3,384.00
|
| Rate for Payer: First Health Workers Compensation |
$1,451.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,384.00
|
| Rate for Payer: GEHA Commercial |
$2,632.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,384.00
|
| Rate for Payer: Multiplan All |
$3,421.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,632.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,384.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,572.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,820.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,496.80
|
| Rate for Payer: Zelis Auto |
$1,504.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,026.48
|
|
|
CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W
|
Facility
|
OP
|
$3,760.00
|
|
| Hospital Charge Code |
8124565
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$940.00 |
| Max. Negotiated Rate |
$3,572.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,256.00
|
| Rate for Payer: Cash Price |
$2,256.00
|
| Rate for Payer: Cigna Commercial |
$3,196.00
|
| Rate for Payer: First Health Commercial |
$3,384.00
|
| Rate for Payer: First Health Workers Compensation |
$1,451.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,384.00
|
| Rate for Payer: GEHA Commercial |
$3,008.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,384.00
|
| Rate for Payer: Humana ChoiceCare |
$977.60
|
| Rate for Payer: Multiplan All |
$3,421.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,256.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,632.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,384.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,572.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,820.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,308.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$940.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,496.80
|
| Rate for Payer: Zelis Auto |
$1,504.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,880.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,026.48
|
|
|
CLTX INTERPHALANGEAL JNT DISLOC W/O ANES
|
Facility
|
OP
|
$351.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
8300040
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$95.82 |
| 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 |
$210.60
|
| 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 |
$210.60
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cigna Commercial |
$298.35
|
| Rate for Payer: First Health Commercial |
$315.90
|
| Rate for Payer: First Health Workers Compensation |
$135.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$315.90
|
| Rate for Payer: GEHA Commercial |
$280.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$315.90
|
| 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 |
$319.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$245.70
|
| Rate for Payer: One Health Plan PPO/POS |
$315.90
|
| 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 |
$333.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$263.25
|
| 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 |
$326.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$140.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$95.82
|
|
|
CLTX INTERPHALANGEAL JNT DISLOC W/O ANES
|
Facility
|
OP
|
$351.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
8728660
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$95.82 |
| 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 |
$210.60
|
| 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 |
$210.60
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cigna Commercial |
$298.35
|
| Rate for Payer: First Health Commercial |
$315.90
|
| Rate for Payer: First Health Workers Compensation |
$135.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$315.90
|
| Rate for Payer: GEHA Commercial |
$280.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$315.90
|
| 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 |
$319.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$245.70
|
| Rate for Payer: One Health Plan PPO/POS |
$315.90
|
| 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 |
$333.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$263.25
|
| 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 |
$326.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$140.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$95.82
|
|
|
CLTX INTERPHALANGEAL JNT DISLOC W/O ANES
|
Facility
|
OP
|
$876.00
|
|
| Hospital Charge Code |
8128660
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$832.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cigna Commercial |
$744.60
|
| Rate for Payer: First Health Commercial |
$788.40
|
| Rate for Payer: First Health Workers Compensation |
$338.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$788.40
|
| Rate for Payer: GEHA Commercial |
$700.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$788.40
|
| Rate for Payer: Humana ChoiceCare |
$227.76
|
| Rate for Payer: Multiplan All |
$797.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$525.60
|
| Rate for Payer: OMNI Networks Commercial |
$613.20
|
| Rate for Payer: One Health Plan PPO/POS |
$788.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$832.20
|
| Rate for Payer: Three Rivers Provider Network All |
$657.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$770.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$219.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$814.68
|
| Rate for Payer: Zelis Auto |
$350.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$438.00
|
| Rate for Payer: Zelis Worker's Compensation |
$239.15
|
|
|
CLTX INTERPHALANGEAL JNT DISLOC W/O ANES
|
Facility
|
OP
|
$879.20
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
9628660
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$835.24 |
| 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 |
$527.52
|
| 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 |
$527.52
|
| Rate for Payer: Cash Price |
$527.52
|
| Rate for Payer: Cigna Commercial |
$747.32
|
| Rate for Payer: First Health Commercial |
$791.28
|
| Rate for Payer: First Health Workers Compensation |
$339.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$791.28
|
| Rate for Payer: GEHA Commercial |
$703.36
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$791.28
|
| 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 |
$800.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$615.44
|
| Rate for Payer: One Health Plan PPO/POS |
$791.28
|
| 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 |
$835.24
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$659.40
|
| 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 |
$817.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$351.68
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$240.02
|
|
|
CLTX INTERPHALANGEAL JNT DISLOC W/O ANES
|
Facility
|
OP
|
$351.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
6128660
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$95.82 |
| 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 |
$210.60
|
| 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 |
$210.60
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cigna Commercial |
$298.35
|
| Rate for Payer: First Health Commercial |
$315.90
|
| Rate for Payer: First Health Workers Compensation |
$135.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$315.90
|
| Rate for Payer: GEHA Commercial |
$280.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$315.90
|
| 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 |
$319.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$245.70
|
| Rate for Payer: One Health Plan PPO/POS |
$315.90
|
| 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 |
$333.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$263.25
|
| 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 |
$326.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$140.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$95.82
|
|
|
CLTX INTERPHALANGEAL JNT DISLOC W/O ANES
|
Facility
|
IP
|
$351.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
8300040
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$95.82 |
| Max. Negotiated Rate |
$333.45 |
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cigna Commercial |
$298.35
|
| Rate for Payer: First Health Commercial |
$315.90
|
| Rate for Payer: First Health Workers Compensation |
$135.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$315.90
|
| Rate for Payer: GEHA Commercial |
$245.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$315.90
|
| Rate for Payer: Multiplan All |
$319.41
|
| Rate for Payer: OMNI Networks Commercial |
$245.70
|
| Rate for Payer: One Health Plan PPO/POS |
$315.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$333.45
|
| Rate for Payer: Three Rivers Provider Network All |
$263.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$326.43
|
| Rate for Payer: Zelis Auto |
$140.40
|
| Rate for Payer: Zelis Worker's Compensation |
$95.82
|
|
|
CLTX INTERPHALANGEAL JNT DISLOC W/O ANES
|
Facility
|
IP
|
$351.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
6128660
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$95.82 |
| Max. Negotiated Rate |
$333.45 |
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cigna Commercial |
$298.35
|
| Rate for Payer: First Health Commercial |
$315.90
|
| Rate for Payer: First Health Workers Compensation |
$135.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$315.90
|
| Rate for Payer: GEHA Commercial |
$245.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$315.90
|
| Rate for Payer: Multiplan All |
$319.41
|
| Rate for Payer: OMNI Networks Commercial |
$245.70
|
| Rate for Payer: One Health Plan PPO/POS |
$315.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$333.45
|
| Rate for Payer: Three Rivers Provider Network All |
$263.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$326.43
|
| Rate for Payer: Zelis Auto |
$140.40
|
| Rate for Payer: Zelis Worker's Compensation |
$95.82
|
|
|
CLTX INTERPHALANGEAL JNT DISLOC W/O ANES
|
Facility
|
IP
|
$876.00
|
|
| Hospital Charge Code |
8128660
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$239.15 |
| Max. Negotiated Rate |
$832.20 |
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cigna Commercial |
$744.60
|
| Rate for Payer: First Health Commercial |
$788.40
|
| Rate for Payer: First Health Workers Compensation |
$338.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$788.40
|
| Rate for Payer: GEHA Commercial |
$613.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$788.40
|
| Rate for Payer: Multiplan All |
$797.16
|
| Rate for Payer: OMNI Networks Commercial |
$613.20
|
| Rate for Payer: One Health Plan PPO/POS |
$788.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$832.20
|
| Rate for Payer: Three Rivers Provider Network All |
$657.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$814.68
|
| Rate for Payer: Zelis Auto |
$350.40
|
| Rate for Payer: Zelis Worker's Compensation |
$239.15
|
|
|
CLTX INTERPHALANGEAL JNT DISLOC W/O ANES
|
Facility
|
IP
|
$879.20
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
9628660
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.02 |
| Max. Negotiated Rate |
$835.24 |
| Rate for Payer: Cash Price |
$527.52
|
| Rate for Payer: Cigna Commercial |
$747.32
|
| Rate for Payer: First Health Commercial |
$791.28
|
| Rate for Payer: First Health Workers Compensation |
$339.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$791.28
|
| Rate for Payer: GEHA Commercial |
$615.44
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$791.28
|
| Rate for Payer: Multiplan All |
$800.07
|
| Rate for Payer: OMNI Networks Commercial |
$615.44
|
| Rate for Payer: One Health Plan PPO/POS |
$791.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$835.24
|
| Rate for Payer: Three Rivers Provider Network All |
$659.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$817.66
|
| Rate for Payer: Zelis Auto |
$351.68
|
| Rate for Payer: Zelis Worker's Compensation |
$240.02
|
|
|
CLTX INTERPHALANGEAL JNT DISLOC W/O ANES
|
Facility
|
IP
|
$351.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
8728660
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$95.82 |
| Max. Negotiated Rate |
$333.45 |
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cigna Commercial |
$298.35
|
| Rate for Payer: First Health Commercial |
$315.90
|
| Rate for Payer: First Health Workers Compensation |
$135.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$315.90
|
| Rate for Payer: GEHA Commercial |
$245.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$315.90
|
| Rate for Payer: Multiplan All |
$319.41
|
| Rate for Payer: OMNI Networks Commercial |
$245.70
|
| Rate for Payer: One Health Plan PPO/POS |
$315.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$333.45
|
| Rate for Payer: Three Rivers Provider Network All |
$263.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$326.43
|
| Rate for Payer: Zelis Auto |
$140.40
|
| Rate for Payer: Zelis Worker's Compensation |
$95.82
|
|
|
CLTX IPHAL JT DISLC W/MANJ REQ ANES
|
Facility
|
IP
|
$2,309.00
|
|
|
Service Code
|
CPT 26775
|
| Hospital Charge Code |
8826775
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$630.36 |
| Max. Negotiated Rate |
$2,193.55 |
| Rate for Payer: Cash Price |
$1,385.40
|
| Rate for Payer: Cigna Commercial |
$1,962.65
|
| Rate for Payer: First Health Commercial |
$2,078.10
|
| Rate for Payer: First Health Workers Compensation |
$891.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,078.10
|
| Rate for Payer: GEHA Commercial |
$1,616.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,078.10
|
| Rate for Payer: Multiplan All |
$2,101.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,616.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,078.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,193.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,731.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,147.37
|
| Rate for Payer: Zelis Auto |
$923.60
|
| Rate for Payer: Zelis Worker's Compensation |
$630.36
|
|
|
CLTX IPHAL JT DISLC W/MANJ REQ ANES
|
Facility
|
IP
|
$2,309.00
|
|
|
Service Code
|
CPT 26775
|
| Hospital Charge Code |
8226775
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$630.36 |
| Max. Negotiated Rate |
$2,193.55 |
| Rate for Payer: Cash Price |
$1,385.40
|
| Rate for Payer: Cigna Commercial |
$1,962.65
|
| Rate for Payer: First Health Commercial |
$2,078.10
|
| Rate for Payer: First Health Workers Compensation |
$891.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,078.10
|
| Rate for Payer: GEHA Commercial |
$1,616.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,078.10
|
| Rate for Payer: Multiplan All |
$2,101.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,616.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,078.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,193.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,731.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,147.37
|
| Rate for Payer: Zelis Auto |
$923.60
|
| Rate for Payer: Zelis Worker's Compensation |
$630.36
|
|
|
CLTX IPHAL JT DISLC W/MANJ REQ ANES
|
Facility
|
OP
|
$2,309.00
|
|
|
Service Code
|
CPT 26775
|
| Hospital Charge Code |
8826775
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$214.35 |
| Max. Negotiated Rate |
$2,193.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,385.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,224.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$252.18
|
| Rate for Payer: Cash Price |
$1,385.40
|
| Rate for Payer: Cash Price |
$1,385.40
|
| Rate for Payer: Cigna Commercial |
$1,962.65
|
| Rate for Payer: First Health Commercial |
$2,078.10
|
| Rate for Payer: First Health Workers Compensation |
$891.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,078.10
|
| Rate for Payer: GEHA Commercial |
$1,847.20
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,078.10
|
| Rate for Payer: Humana ChoiceCare |
$277.40
|
| Rate for Payer: Humana Medicare Advantage |
$252.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$423.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,249.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$252.18
|
| Rate for Payer: Multiplan All |
$2,101.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$1,616.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,078.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,443.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,249.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$252.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,193.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$1,731.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$247.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,249.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,147.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$923.60
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$630.36
|
|
|
CLTX IPHAL JT DISLC W/MANJ REQ ANES
|
Facility
|
OP
|
$2,309.00
|
|
|
Service Code
|
CPT 26775
|
| Hospital Charge Code |
8226775
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$214.35 |
| Max. Negotiated Rate |
$2,193.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,385.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,224.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$252.18
|
| Rate for Payer: Cash Price |
$1,385.40
|
| Rate for Payer: Cash Price |
$1,385.40
|
| Rate for Payer: Cigna Commercial |
$1,962.65
|
| Rate for Payer: First Health Commercial |
$2,078.10
|
| Rate for Payer: First Health Workers Compensation |
$891.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,078.10
|
| Rate for Payer: GEHA Commercial |
$1,847.20
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,078.10
|
| Rate for Payer: Humana ChoiceCare |
$277.40
|
| Rate for Payer: Humana Medicare Advantage |
$252.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$423.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,249.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$252.18
|
| Rate for Payer: Multiplan All |
$2,101.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$1,616.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,078.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,443.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,249.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$252.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,193.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$1,731.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$247.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,249.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,147.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$923.60
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$630.36
|
|
|
CLTX IPHAL JT DISLC W/MANJ W/O ANES
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
21600190
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$173.90 |
| Max. Negotiated Rate |
$605.15 |
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$541.45
|
| Rate for Payer: First Health Commercial |
$573.30
|
| Rate for Payer: First Health Workers Compensation |
$245.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$573.30
|
| Rate for Payer: GEHA Commercial |
$445.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$573.30
|
| Rate for Payer: Multiplan All |
$579.67
|
| Rate for Payer: OMNI Networks Commercial |
$445.90
|
| Rate for Payer: One Health Plan PPO/POS |
$573.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$605.15
|
| Rate for Payer: Three Rivers Provider Network All |
$477.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$592.41
|
| Rate for Payer: Zelis Auto |
$254.80
|
| Rate for Payer: Zelis Worker's Compensation |
$173.90
|
|
|
CLTX IPHAL JT DISLC W/MANJ W/O ANES
|
Facility
|
OP
|
$637.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
6126770
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$605.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$382.20
|
| 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 |
$382.20
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$541.45
|
| Rate for Payer: First Health Commercial |
$573.30
|
| Rate for Payer: First Health Workers Compensation |
$245.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$573.30
|
| Rate for Payer: GEHA Commercial |
$509.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$573.30
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$579.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$445.90
|
| Rate for Payer: One Health Plan PPO/POS |
$573.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$605.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$477.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$592.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$254.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$173.90
|
|
|
CLTX IPHAL JT DISLC W/MANJ W/O ANES
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
6126770
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$173.90 |
| Max. Negotiated Rate |
$605.15 |
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$541.45
|
| Rate for Payer: First Health Commercial |
$573.30
|
| Rate for Payer: First Health Workers Compensation |
$245.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$573.30
|
| Rate for Payer: GEHA Commercial |
$445.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$573.30
|
| Rate for Payer: Multiplan All |
$579.67
|
| Rate for Payer: OMNI Networks Commercial |
$445.90
|
| Rate for Payer: One Health Plan PPO/POS |
$573.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$605.15
|
| Rate for Payer: Three Rivers Provider Network All |
$477.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$592.41
|
| Rate for Payer: Zelis Auto |
$254.80
|
| Rate for Payer: Zelis Worker's Compensation |
$173.90
|
|
|
CLTX IPHAL JT DISLC W/MANJ W/O ANES
|
Facility
|
IP
|
$1,162.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
8126770
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.23 |
| Max. Negotiated Rate |
$1,103.90 |
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cigna Commercial |
$987.70
|
| Rate for Payer: First Health Commercial |
$1,045.80
|
| Rate for Payer: First Health Workers Compensation |
$448.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,045.80
|
| Rate for Payer: GEHA Commercial |
$813.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,045.80
|
| Rate for Payer: Multiplan All |
$1,057.42
|
| Rate for Payer: OMNI Networks Commercial |
$813.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,045.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,103.90
|
| Rate for Payer: Three Rivers Provider Network All |
$871.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,080.66
|
| Rate for Payer: Zelis Auto |
$464.80
|
| Rate for Payer: Zelis Worker's Compensation |
$317.23
|
|
|
CLTX IPHAL JT DISLC W/MANJ W/O ANES
|
Facility
|
OP
|
$1,162.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
8126770
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$1,103.90 |
| 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 |
$697.20
|
| 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 |
$697.20
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cigna Commercial |
$987.70
|
| Rate for Payer: First Health Commercial |
$1,045.80
|
| Rate for Payer: First Health Workers Compensation |
$448.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,045.80
|
| Rate for Payer: GEHA Commercial |
$929.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,045.80
|
| 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 |
$1,057.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$813.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,045.80
|
| 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 |
$1,103.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$871.50
|
| 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 |
$1,080.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$464.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$317.23
|
|
|
CLTX IPHAL JT DISLC W/MANJ W/O ANES
|
Facility
|
OP
|
$637.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
21600190
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$605.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$382.20
|
| 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 |
$382.20
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$541.45
|
| Rate for Payer: First Health Commercial |
$573.30
|
| Rate for Payer: First Health Workers Compensation |
$245.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$573.30
|
| Rate for Payer: GEHA Commercial |
$509.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$573.30
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$579.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$445.90
|
| Rate for Payer: One Health Plan PPO/POS |
$573.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$605.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$477.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$592.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$254.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$173.90
|
|
