|
CLTX MED ANKLE FX W/MNPJ
|
Facility
|
OP
|
$876.00
|
|
|
Service Code
|
CPT 27762
|
| Hospital Charge Code |
6127762
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$239.15 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,860.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$525.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,860.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,473.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$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: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$788.40
|
| 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 |
$1,503.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$797.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$613.20
|
| Rate for Payer: One Health Plan PPO/POS |
$788.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,736.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,503.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$832.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$657.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,503.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$814.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$350.40
|
| 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 |
$239.15
|
|
|
CLTX MED ANKLE FX W/MNPJ
|
Facility
|
IP
|
$876.00
|
|
|
Service Code
|
CPT 27762
|
| Hospital Charge Code |
6127762
|
|
Hospital Revenue Code
|
975
|
| 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 MEDIAL MALLEOLUS FX W/O MANIPULATIO
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
8727760
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$945.25 |
| 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 |
$597.00
|
| 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 |
$597.00
|
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cigna Commercial |
$845.75
|
| Rate for Payer: First Health Commercial |
$895.50
|
| Rate for Payer: First Health Workers Compensation |
$384.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$895.50
|
| Rate for Payer: GEHA Commercial |
$796.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$895.50
|
| 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 |
$905.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$696.50
|
| Rate for Payer: One Health Plan PPO/POS |
$895.50
|
| 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 |
$945.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$746.25
|
| 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 |
$925.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$398.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$271.63
|
|
|
CLTX MEDIAL MALLEOLUS FX W/O MANIPULATIO
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
8727760
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$271.63 |
| Max. Negotiated Rate |
$945.25 |
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cigna Commercial |
$845.75
|
| Rate for Payer: First Health Commercial |
$895.50
|
| Rate for Payer: First Health Workers Compensation |
$384.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$895.50
|
| Rate for Payer: GEHA Commercial |
$696.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$895.50
|
| Rate for Payer: Multiplan All |
$905.45
|
| Rate for Payer: OMNI Networks Commercial |
$696.50
|
| Rate for Payer: One Health Plan PPO/POS |
$895.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$945.25
|
| Rate for Payer: Three Rivers Provider Network All |
$746.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$925.35
|
| Rate for Payer: Zelis Auto |
$398.00
|
| Rate for Payer: Zelis Worker's Compensation |
$271.63
|
|
|
CLTX MEDIAL MALLEOLUS FX W/O MANIPULATIO
|
Facility
|
IP
|
$1,037.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
9627760
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$283.10 |
| Max. Negotiated Rate |
$985.15 |
| Rate for Payer: Cash Price |
$622.20
|
| Rate for Payer: Cigna Commercial |
$881.45
|
| Rate for Payer: First Health Commercial |
$933.30
|
| Rate for Payer: First Health Workers Compensation |
$400.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$933.30
|
| Rate for Payer: GEHA Commercial |
$725.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$933.30
|
| Rate for Payer: Multiplan All |
$943.67
|
| Rate for Payer: OMNI Networks Commercial |
$725.90
|
| Rate for Payer: One Health Plan PPO/POS |
$933.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$985.15
|
| Rate for Payer: Three Rivers Provider Network All |
$777.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$964.41
|
| Rate for Payer: Zelis Auto |
$414.80
|
| Rate for Payer: Zelis Worker's Compensation |
$283.10
|
|
|
CLTX MEDIAL MALLEOLUS FX W/O MANIPULATIO
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
6127760
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$945.25 |
| 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 |
$597.00
|
| 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 |
$597.00
|
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cigna Commercial |
$845.75
|
| Rate for Payer: First Health Commercial |
$895.50
|
| Rate for Payer: First Health Workers Compensation |
$384.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$895.50
|
| Rate for Payer: GEHA Commercial |
$796.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$895.50
|
| 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 |
$905.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$696.50
|
| Rate for Payer: One Health Plan PPO/POS |
$895.50
|
| 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 |
$945.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$746.25
|
| 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 |
$925.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$398.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$271.63
|
|
|
CLTX MEDIAL MALLEOLUS FX W/O MANIPULATIO
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
6127760
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$271.63 |
| Max. Negotiated Rate |
$945.25 |
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cigna Commercial |
$845.75
|
| Rate for Payer: First Health Commercial |
$895.50
|
| Rate for Payer: First Health Workers Compensation |
$384.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$895.50
|
| Rate for Payer: GEHA Commercial |
$696.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$895.50
|
| Rate for Payer: Multiplan All |
$905.45
|
| Rate for Payer: OMNI Networks Commercial |
$696.50
|
| Rate for Payer: One Health Plan PPO/POS |
$895.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$945.25
|
| Rate for Payer: Three Rivers Provider Network All |
$746.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$925.35
|
| Rate for Payer: Zelis Auto |
$398.00
|
| Rate for Payer: Zelis Worker's Compensation |
$271.63
|
|
|
CLTX MEDIAL MALLEOLUS FX W/O MANIPULATIO
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
8300022
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$271.63 |
| Max. Negotiated Rate |
$945.25 |
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cigna Commercial |
$845.75
|
| Rate for Payer: First Health Commercial |
$895.50
|
| Rate for Payer: First Health Workers Compensation |
$384.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$895.50
|
| Rate for Payer: GEHA Commercial |
$696.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$895.50
|
| Rate for Payer: Multiplan All |
$905.45
|
| Rate for Payer: OMNI Networks Commercial |
$696.50
|
| Rate for Payer: One Health Plan PPO/POS |
$895.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$945.25
|
| Rate for Payer: Three Rivers Provider Network All |
$746.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$925.35
|
| Rate for Payer: Zelis Auto |
$398.00
|
| Rate for Payer: Zelis Worker's Compensation |
$271.63
|
|
|
CLTX MEDIAL MALLEOLUS FX W/O MANIPULATIO
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
8300022
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$945.25 |
| 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 |
$597.00
|
| 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 |
$597.00
|
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cigna Commercial |
$845.75
|
| Rate for Payer: First Health Commercial |
$895.50
|
| Rate for Payer: First Health Workers Compensation |
$384.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$895.50
|
| Rate for Payer: GEHA Commercial |
$796.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$895.50
|
| 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 |
$905.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$696.50
|
| Rate for Payer: One Health Plan PPO/POS |
$895.50
|
| 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 |
$945.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$746.25
|
| 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 |
$925.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$398.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$271.63
|
|
|
CLTX MEDIAL MALLEOLUS FX W/O MANIPULATIO
|
Facility
|
OP
|
$1,037.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
9627760
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$985.15 |
| 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 |
$622.20
|
| 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 |
$622.20
|
| Rate for Payer: Cash Price |
$622.20
|
| Rate for Payer: Cigna Commercial |
$881.45
|
| Rate for Payer: First Health Commercial |
$933.30
|
| Rate for Payer: First Health Workers Compensation |
$400.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$933.30
|
| Rate for Payer: GEHA Commercial |
$829.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$933.30
|
| 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 |
$943.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$725.90
|
| Rate for Payer: One Health Plan PPO/POS |
$933.30
|
| 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 |
$985.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$777.75
|
| 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 |
$964.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$414.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$283.10
|
|
|
CLTX METACARPAL FX W/MANIPULATION EACH B
|
Facility
|
IP
|
$731.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
21600198
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$199.56 |
| Max. Negotiated Rate |
$694.45 |
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$621.35
|
| Rate for Payer: First Health Commercial |
$657.90
|
| Rate for Payer: First Health Workers Compensation |
$282.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$657.90
|
| Rate for Payer: GEHA Commercial |
$511.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$657.90
|
| Rate for Payer: Multiplan All |
$665.21
|
| Rate for Payer: OMNI Networks Commercial |
$511.70
|
| Rate for Payer: One Health Plan PPO/POS |
$657.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$694.45
|
| Rate for Payer: Three Rivers Provider Network All |
$548.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$679.83
|
| Rate for Payer: Zelis Auto |
$292.40
|
| Rate for Payer: Zelis Worker's Compensation |
$199.56
|
|
|
CLTX METACARPAL FX W/MANIPULATION EACH B
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
21600198
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$694.45 |
| 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 |
$438.60
|
| 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 |
$438.60
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$621.35
|
| Rate for Payer: First Health Commercial |
$657.90
|
| Rate for Payer: First Health Workers Compensation |
$282.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$657.90
|
| Rate for Payer: GEHA Commercial |
$584.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$657.90
|
| 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 |
$665.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$511.70
|
| Rate for Payer: One Health Plan PPO/POS |
$657.90
|
| 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 |
$694.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$548.25
|
| 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 |
$679.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$292.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$199.56
|
|
|
CLTX METACARPOPHALANG DISLC W/MAN W/O AN
|
Facility
|
OP
|
$1,002.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
8230088
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$951.90 |
| 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 |
$601.20
|
| 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 |
$601.20
|
| Rate for Payer: Cash Price |
$601.20
|
| Rate for Payer: Cigna Commercial |
$851.70
|
| Rate for Payer: First Health Commercial |
$901.80
|
| Rate for Payer: First Health Workers Compensation |
$386.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$901.80
|
| Rate for Payer: GEHA Commercial |
$801.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$901.80
|
| 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 |
$911.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$701.40
|
| Rate for Payer: One Health Plan PPO/POS |
$901.80
|
| 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 |
$951.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$751.50
|
| 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 |
$931.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$400.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$273.55
|
|
|
CLTX METACARPOPHALANG DISLC W/MAN W/O AN
|
Facility
|
OP
|
$1,045.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
8126700
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$992.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$627.00
|
| 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 |
$627.00
|
| Rate for Payer: Cash Price |
$627.00
|
| Rate for Payer: Cigna Commercial |
$888.25
|
| Rate for Payer: First Health Commercial |
$940.50
|
| Rate for Payer: First Health Workers Compensation |
$403.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$940.50
|
| Rate for Payer: GEHA Commercial |
$836.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$940.50
|
| 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 |
$950.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$731.50
|
| Rate for Payer: One Health Plan PPO/POS |
$940.50
|
| 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 |
$992.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$783.75
|
| 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 |
$971.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$418.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$285.29
|
|
|
CLTX METACARPOPHALANG DISLC W/MAN W/O AN
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
20300063
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$273.55 |
| Max. Negotiated Rate |
$951.90 |
| Rate for Payer: Cash Price |
$601.20
|
| Rate for Payer: Cigna Commercial |
$851.70
|
| Rate for Payer: First Health Commercial |
$901.80
|
| Rate for Payer: First Health Workers Compensation |
$386.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$901.80
|
| Rate for Payer: GEHA Commercial |
$701.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$901.80
|
| Rate for Payer: Multiplan All |
$911.82
|
| Rate for Payer: OMNI Networks Commercial |
$701.40
|
| Rate for Payer: One Health Plan PPO/POS |
$901.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$951.90
|
| Rate for Payer: Three Rivers Provider Network All |
$751.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$931.86
|
| Rate for Payer: Zelis Auto |
$400.80
|
| Rate for Payer: Zelis Worker's Compensation |
$273.55
|
|
|
CLTX METACARPOPHALANG DISLC W/MAN W/O AN
|
Facility
|
IP
|
$936.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
6126700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$255.53 |
| Max. Negotiated Rate |
$889.20 |
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cigna Commercial |
$795.60
|
| Rate for Payer: First Health Commercial |
$842.40
|
| Rate for Payer: First Health Workers Compensation |
$361.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$842.40
|
| Rate for Payer: GEHA Commercial |
$655.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$842.40
|
| Rate for Payer: Multiplan All |
$851.76
|
| Rate for Payer: OMNI Networks Commercial |
$655.20
|
| Rate for Payer: One Health Plan PPO/POS |
$842.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$889.20
|
| Rate for Payer: Three Rivers Provider Network All |
$702.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$870.48
|
| Rate for Payer: Zelis Auto |
$374.40
|
| Rate for Payer: Zelis Worker's Compensation |
$255.53
|
|
|
CLTX METACARPOPHALANG DISLC W/MAN W/O AN
|
Facility
|
OP
|
$936.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
6126700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$889.20 |
| 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 |
$561.60
|
| 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 |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cigna Commercial |
$795.60
|
| Rate for Payer: First Health Commercial |
$842.40
|
| Rate for Payer: First Health Workers Compensation |
$361.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$842.40
|
| Rate for Payer: GEHA Commercial |
$748.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$842.40
|
| 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 |
$851.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$655.20
|
| Rate for Payer: One Health Plan PPO/POS |
$842.40
|
| 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 |
$889.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$702.00
|
| 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 |
$870.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$374.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$255.53
|
|
|
CLTX METACARPOPHALANG DISLC W/MAN W/O AN
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
8230088
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$273.55 |
| Max. Negotiated Rate |
$951.90 |
| Rate for Payer: Cash Price |
$601.20
|
| Rate for Payer: Cigna Commercial |
$851.70
|
| Rate for Payer: First Health Commercial |
$901.80
|
| Rate for Payer: First Health Workers Compensation |
$386.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$901.80
|
| Rate for Payer: GEHA Commercial |
$701.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$901.80
|
| Rate for Payer: Multiplan All |
$911.82
|
| Rate for Payer: OMNI Networks Commercial |
$701.40
|
| Rate for Payer: One Health Plan PPO/POS |
$901.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$951.90
|
| Rate for Payer: Three Rivers Provider Network All |
$751.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$931.86
|
| Rate for Payer: Zelis Auto |
$400.80
|
| Rate for Payer: Zelis Worker's Compensation |
$273.55
|
|
|
CLTX METACARPOPHALANG DISLC W/MAN W/O AN
|
Facility
|
OP
|
$1,002.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
21600189
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$951.90 |
| 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 |
$601.20
|
| 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 |
$601.20
|
| Rate for Payer: Cash Price |
$601.20
|
| Rate for Payer: Cigna Commercial |
$851.70
|
| Rate for Payer: First Health Commercial |
$901.80
|
| Rate for Payer: First Health Workers Compensation |
$386.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$901.80
|
| Rate for Payer: GEHA Commercial |
$801.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$901.80
|
| 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 |
$911.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$701.40
|
| Rate for Payer: One Health Plan PPO/POS |
$901.80
|
| 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 |
$951.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$751.50
|
| 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 |
$931.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$400.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$273.55
|
|
|
CLTX METACARPOPHALANG DISLC W/MAN W/O AN
|
Facility
|
OP
|
$1,002.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
20300063
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$951.90 |
| 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 |
$601.20
|
| 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 |
$601.20
|
| Rate for Payer: Cash Price |
$601.20
|
| Rate for Payer: Cigna Commercial |
$851.70
|
| Rate for Payer: First Health Commercial |
$901.80
|
| Rate for Payer: First Health Workers Compensation |
$386.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$901.80
|
| Rate for Payer: GEHA Commercial |
$801.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$901.80
|
| 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 |
$911.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$701.40
|
| Rate for Payer: One Health Plan PPO/POS |
$901.80
|
| 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 |
$951.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$751.50
|
| 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 |
$931.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$400.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$273.55
|
|
|
CLTX METACARPOPHALANG DISLC W/MAN W/O AN
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
21600189
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$273.55 |
| Max. Negotiated Rate |
$951.90 |
| Rate for Payer: Cash Price |
$601.20
|
| Rate for Payer: Cigna Commercial |
$851.70
|
| Rate for Payer: First Health Commercial |
$901.80
|
| Rate for Payer: First Health Workers Compensation |
$386.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$901.80
|
| Rate for Payer: GEHA Commercial |
$701.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$901.80
|
| Rate for Payer: Multiplan All |
$911.82
|
| Rate for Payer: OMNI Networks Commercial |
$701.40
|
| Rate for Payer: One Health Plan PPO/POS |
$901.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$951.90
|
| Rate for Payer: Three Rivers Provider Network All |
$751.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$931.86
|
| Rate for Payer: Zelis Auto |
$400.80
|
| Rate for Payer: Zelis Worker's Compensation |
$273.55
|
|
|
CLTX METACARPOPHALANG DISLC W/MAN W/O AN
|
Facility
|
IP
|
$1,045.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
8126700
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$285.29 |
| Max. Negotiated Rate |
$992.75 |
| Rate for Payer: Cash Price |
$627.00
|
| Rate for Payer: Cigna Commercial |
$888.25
|
| Rate for Payer: First Health Commercial |
$940.50
|
| Rate for Payer: First Health Workers Compensation |
$403.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$940.50
|
| Rate for Payer: GEHA Commercial |
$731.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$940.50
|
| Rate for Payer: Multiplan All |
$950.95
|
| Rate for Payer: OMNI Networks Commercial |
$731.50
|
| Rate for Payer: One Health Plan PPO/POS |
$940.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$992.75
|
| Rate for Payer: Three Rivers Provider Network All |
$783.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$971.85
|
| Rate for Payer: Zelis Auto |
$418.00
|
| Rate for Payer: Zelis Worker's Compensation |
$285.29
|
|
|
CLTX METATARSOPHLNGL JT DISLC REQ ANES
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 28635
|
| Hospital Charge Code |
6128635
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$109.47 |
| Max. Negotiated Rate |
$3,039.30 |
| 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 |
$240.60
|
| 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 |
$1,519.65
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cigna Commercial |
$340.85
|
| Rate for Payer: First Health Commercial |
$360.90
|
| Rate for Payer: First Health Workers Compensation |
$154.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.90
|
| Rate for Payer: GEHA Commercial |
$320.80
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.90
|
| 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 |
$1,249.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$364.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$280.70
|
| Rate for Payer: One Health Plan PPO/POS |
$360.90
|
| 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 |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$300.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,249.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$160.40
|
| 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 |
$109.47
|
|
|
CLTX METATARSOPHLNGL JT DISLC REQ ANES
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT 28635
|
| Hospital Charge Code |
21600192
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$109.47 |
| Max. Negotiated Rate |
$380.95 |
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cigna Commercial |
$340.85
|
| Rate for Payer: First Health Commercial |
$360.90
|
| Rate for Payer: First Health Workers Compensation |
$154.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.90
|
| Rate for Payer: GEHA Commercial |
$280.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.90
|
| Rate for Payer: Multiplan All |
$364.91
|
| Rate for Payer: OMNI Networks Commercial |
$280.70
|
| Rate for Payer: One Health Plan PPO/POS |
$360.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.95
|
| Rate for Payer: Three Rivers Provider Network All |
$300.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.93
|
| Rate for Payer: Zelis Auto |
$160.40
|
| Rate for Payer: Zelis Worker's Compensation |
$109.47
|
|
|
CLTX METATARSOPHLNGL JT DISLC REQ ANES
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT 28635
|
| Hospital Charge Code |
6128635
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$109.47 |
| Max. Negotiated Rate |
$380.95 |
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cigna Commercial |
$340.85
|
| Rate for Payer: First Health Commercial |
$360.90
|
| Rate for Payer: First Health Workers Compensation |
$154.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.90
|
| Rate for Payer: GEHA Commercial |
$280.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.90
|
| Rate for Payer: Multiplan All |
$364.91
|
| Rate for Payer: OMNI Networks Commercial |
$280.70
|
| Rate for Payer: One Health Plan PPO/POS |
$360.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.95
|
| Rate for Payer: Three Rivers Provider Network All |
$300.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.93
|
| Rate for Payer: Zelis Auto |
$160.40
|
| Rate for Payer: Zelis Worker's Compensation |
$109.47
|
|
