|
CLTX METATARSOPHLNGL JT DISLC REQ ANES
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 28635
|
| Hospital Charge Code |
21600192
|
|
Hospital Revenue Code
|
517
|
| 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 W/O ANES
|
Facility
|
IP
|
$998.00
|
|
| Hospital Charge Code |
8128630
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$272.45 |
| Max. Negotiated Rate |
$948.10 |
| Rate for Payer: Cash Price |
$598.80
|
| Rate for Payer: Cigna Commercial |
$848.30
|
| Rate for Payer: First Health Commercial |
$898.20
|
| Rate for Payer: First Health Workers Compensation |
$385.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$898.20
|
| Rate for Payer: GEHA Commercial |
$698.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$898.20
|
| Rate for Payer: Multiplan All |
$908.18
|
| Rate for Payer: OMNI Networks Commercial |
$698.60
|
| Rate for Payer: One Health Plan PPO/POS |
$898.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$948.10
|
| Rate for Payer: Three Rivers Provider Network All |
$748.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$928.14
|
| Rate for Payer: Zelis Auto |
$399.20
|
| Rate for Payer: Zelis Worker's Compensation |
$272.45
|
|
|
CLTX METATARSOPHLNGL JT DISLC W/O ANES
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
6128630
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$129.13 |
| 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 |
$283.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$402.05
|
| Rate for Payer: First Health Commercial |
$425.70
|
| Rate for Payer: First Health Workers Compensation |
$182.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$425.70
|
| Rate for Payer: GEHA Commercial |
$378.40
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$425.70
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$430.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$331.10
|
| Rate for Payer: One Health Plan PPO/POS |
$425.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$449.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$354.75
|
| 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 |
$439.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$189.20
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$129.13
|
|
|
CLTX METATARSOPHLNGL JT DISLC W/O ANES
|
Facility
|
IP
|
$627.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
9628630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.17 |
| Max. Negotiated Rate |
$595.65 |
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cigna Commercial |
$532.95
|
| Rate for Payer: First Health Commercial |
$564.30
|
| Rate for Payer: First Health Workers Compensation |
$242.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$564.30
|
| Rate for Payer: GEHA Commercial |
$438.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$564.30
|
| Rate for Payer: Multiplan All |
$570.57
|
| Rate for Payer: OMNI Networks Commercial |
$438.90
|
| Rate for Payer: One Health Plan PPO/POS |
$564.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$595.65
|
| Rate for Payer: Three Rivers Provider Network All |
$470.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$583.11
|
| Rate for Payer: Zelis Auto |
$250.80
|
| Rate for Payer: Zelis Worker's Compensation |
$171.17
|
|
|
CLTX METATARSOPHLNGL JT DISLC W/O ANES
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
6128630
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$129.13 |
| Max. Negotiated Rate |
$449.35 |
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$402.05
|
| Rate for Payer: First Health Commercial |
$425.70
|
| Rate for Payer: First Health Workers Compensation |
$182.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$425.70
|
| Rate for Payer: GEHA Commercial |
$331.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$425.70
|
| Rate for Payer: Multiplan All |
$430.43
|
| Rate for Payer: OMNI Networks Commercial |
$331.10
|
| Rate for Payer: One Health Plan PPO/POS |
$425.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$449.35
|
| Rate for Payer: Three Rivers Provider Network All |
$354.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$439.89
|
| Rate for Payer: Zelis Auto |
$189.20
|
| Rate for Payer: Zelis Worker's Compensation |
$129.13
|
|
|
CLTX METATARSOPHLNGL JT DISLC W/O ANES
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
21600191
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$129.13 |
| 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 |
$283.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$402.05
|
| Rate for Payer: First Health Commercial |
$425.70
|
| Rate for Payer: First Health Workers Compensation |
$182.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$425.70
|
| Rate for Payer: GEHA Commercial |
$378.40
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$425.70
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$430.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$331.10
|
| Rate for Payer: One Health Plan PPO/POS |
$425.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$449.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$354.75
|
| 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 |
$439.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$189.20
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$129.13
|
|
|
CLTX METATARSOPHLNGL JT DISLC W/O ANES
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
8300039
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$129.13 |
| 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 |
$283.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$402.05
|
| Rate for Payer: First Health Commercial |
$425.70
|
| Rate for Payer: First Health Workers Compensation |
$182.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$425.70
|
| Rate for Payer: GEHA Commercial |
$378.40
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$425.70
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$430.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$331.10
|
| Rate for Payer: One Health Plan PPO/POS |
$425.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$449.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$354.75
|
| 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 |
$439.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$189.20
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$129.13
|
|
|
CLTX METATARSOPHLNGL JT DISLC W/O ANES
|
Facility
|
OP
|
$627.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
9628630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$595.65 |
| 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 |
$376.20
|
| 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 |
$376.20
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cigna Commercial |
$532.95
|
| Rate for Payer: First Health Commercial |
$564.30
|
| Rate for Payer: First Health Workers Compensation |
$242.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$564.30
|
| Rate for Payer: GEHA Commercial |
$501.60
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$564.30
|
| 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 |
$570.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$438.90
|
| Rate for Payer: One Health Plan PPO/POS |
$564.30
|
| 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 |
$595.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$470.25
|
| 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 |
$583.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$250.80
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$171.17
|
|
|
CLTX METATARSOPHLNGL JT DISLC W/O ANES
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
21600191
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$129.13 |
| Max. Negotiated Rate |
$449.35 |
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$402.05
|
| Rate for Payer: First Health Commercial |
$425.70
|
| Rate for Payer: First Health Workers Compensation |
$182.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$425.70
|
| Rate for Payer: GEHA Commercial |
$331.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$425.70
|
| Rate for Payer: Multiplan All |
$430.43
|
| Rate for Payer: OMNI Networks Commercial |
$331.10
|
| Rate for Payer: One Health Plan PPO/POS |
$425.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$449.35
|
| Rate for Payer: Three Rivers Provider Network All |
$354.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$439.89
|
| Rate for Payer: Zelis Auto |
$189.20
|
| Rate for Payer: Zelis Worker's Compensation |
$129.13
|
|
|
CLTX METATARSOPHLNGL JT DISLC W/O ANES
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
8300039
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$129.13 |
| Max. Negotiated Rate |
$449.35 |
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$402.05
|
| Rate for Payer: First Health Commercial |
$425.70
|
| Rate for Payer: First Health Workers Compensation |
$182.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$425.70
|
| Rate for Payer: GEHA Commercial |
$331.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$425.70
|
| Rate for Payer: Multiplan All |
$430.43
|
| Rate for Payer: OMNI Networks Commercial |
$331.10
|
| Rate for Payer: One Health Plan PPO/POS |
$425.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$449.35
|
| Rate for Payer: Three Rivers Provider Network All |
$354.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$439.89
|
| Rate for Payer: Zelis Auto |
$189.20
|
| Rate for Payer: Zelis Worker's Compensation |
$129.13
|
|
|
CLTX METATARSOPHLNGL JT DISLC W/O ANES
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
8728630
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$129.13 |
| Max. Negotiated Rate |
$449.35 |
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$402.05
|
| Rate for Payer: First Health Commercial |
$425.70
|
| Rate for Payer: First Health Workers Compensation |
$182.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$425.70
|
| Rate for Payer: GEHA Commercial |
$331.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$425.70
|
| Rate for Payer: Multiplan All |
$430.43
|
| Rate for Payer: OMNI Networks Commercial |
$331.10
|
| Rate for Payer: One Health Plan PPO/POS |
$425.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$449.35
|
| Rate for Payer: Three Rivers Provider Network All |
$354.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$439.89
|
| Rate for Payer: Zelis Auto |
$189.20
|
| Rate for Payer: Zelis Worker's Compensation |
$129.13
|
|
|
CLTX METATARSOPHLNGL JT DISLC W/O ANES
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
8728630
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$129.13 |
| 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 |
$283.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$402.05
|
| Rate for Payer: First Health Commercial |
$425.70
|
| Rate for Payer: First Health Workers Compensation |
$182.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$425.70
|
| Rate for Payer: GEHA Commercial |
$378.40
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$425.70
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$430.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$331.10
|
| Rate for Payer: One Health Plan PPO/POS |
$425.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$449.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$354.75
|
| 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 |
$439.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$189.20
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$129.13
|
|
|
CLTX METATARSOPHLNGL JT DISLC W/O ANES
|
Facility
|
OP
|
$998.00
|
|
| Hospital Charge Code |
8128630
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$249.50 |
| Max. Negotiated Rate |
$948.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$598.80
|
| Rate for Payer: Cash Price |
$598.80
|
| Rate for Payer: Cigna Commercial |
$848.30
|
| Rate for Payer: First Health Commercial |
$898.20
|
| Rate for Payer: First Health Workers Compensation |
$385.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$898.20
|
| Rate for Payer: GEHA Commercial |
$798.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$898.20
|
| Rate for Payer: Humana ChoiceCare |
$259.48
|
| Rate for Payer: Multiplan All |
$908.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$598.80
|
| Rate for Payer: OMNI Networks Commercial |
$698.60
|
| Rate for Payer: One Health Plan PPO/POS |
$898.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$948.10
|
| Rate for Payer: Three Rivers Provider Network All |
$748.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$878.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$249.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$928.14
|
| Rate for Payer: Zelis Auto |
$399.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$499.00
|
| Rate for Payer: Zelis Worker's Compensation |
$272.45
|
|
|
CLTX PHLNGL FX PROX/MID PX/F/T W/MANJ EA
|
Facility
|
OP
|
$761.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
6126725
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$722.95 |
| 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 |
$456.60
|
| 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 |
$456.60
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cigna Commercial |
$646.85
|
| Rate for Payer: First Health Commercial |
$684.90
|
| Rate for Payer: First Health Workers Compensation |
$293.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$684.90
|
| Rate for Payer: GEHA Commercial |
$608.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$684.90
|
| 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 |
$692.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$532.70
|
| Rate for Payer: One Health Plan PPO/POS |
$684.90
|
| 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 |
$722.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$570.75
|
| 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 |
$707.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$304.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$207.75
|
|
|
CLTX PHLNGL FX PROX/MID PX/F/T W/MANJ EA
|
Facility
|
IP
|
$761.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
8226725
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$207.75 |
| Max. Negotiated Rate |
$722.95 |
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cigna Commercial |
$646.85
|
| Rate for Payer: First Health Commercial |
$684.90
|
| Rate for Payer: First Health Workers Compensation |
$293.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$684.90
|
| Rate for Payer: GEHA Commercial |
$532.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$684.90
|
| Rate for Payer: Multiplan All |
$692.51
|
| Rate for Payer: OMNI Networks Commercial |
$532.70
|
| Rate for Payer: One Health Plan PPO/POS |
$684.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$722.95
|
| Rate for Payer: Three Rivers Provider Network All |
$570.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$707.73
|
| Rate for Payer: Zelis Auto |
$304.40
|
| Rate for Payer: Zelis Worker's Compensation |
$207.75
|
|
|
CLTX PHLNGL FX PROX/MID PX/F/T W/MANJ EA
|
Facility
|
OP
|
$761.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
8826725
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$722.95 |
| 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 |
$456.60
|
| 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 |
$456.60
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cigna Commercial |
$646.85
|
| Rate for Payer: First Health Commercial |
$684.90
|
| Rate for Payer: First Health Workers Compensation |
$293.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$684.90
|
| Rate for Payer: GEHA Commercial |
$608.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$684.90
|
| 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 |
$692.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$532.70
|
| Rate for Payer: One Health Plan PPO/POS |
$684.90
|
| 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 |
$722.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$570.75
|
| 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 |
$707.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$304.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$207.75
|
|
|
CLTX PHLNGL FX PROX/MID PX/F/T W/MANJ EA
|
Facility
|
IP
|
$761.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
21600197
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$207.75 |
| Max. Negotiated Rate |
$722.95 |
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cigna Commercial |
$646.85
|
| Rate for Payer: First Health Commercial |
$684.90
|
| Rate for Payer: First Health Workers Compensation |
$293.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$684.90
|
| Rate for Payer: GEHA Commercial |
$532.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$684.90
|
| Rate for Payer: Multiplan All |
$692.51
|
| Rate for Payer: OMNI Networks Commercial |
$532.70
|
| Rate for Payer: One Health Plan PPO/POS |
$684.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$722.95
|
| Rate for Payer: Three Rivers Provider Network All |
$570.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$707.73
|
| Rate for Payer: Zelis Auto |
$304.40
|
| Rate for Payer: Zelis Worker's Compensation |
$207.75
|
|
|
CLTX PHLNGL FX PROX/MID PX/F/T W/MANJ EA
|
Facility
|
IP
|
$761.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
6126725
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$207.75 |
| Max. Negotiated Rate |
$722.95 |
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cigna Commercial |
$646.85
|
| Rate for Payer: First Health Commercial |
$684.90
|
| Rate for Payer: First Health Workers Compensation |
$293.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$684.90
|
| Rate for Payer: GEHA Commercial |
$532.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$684.90
|
| Rate for Payer: Multiplan All |
$692.51
|
| Rate for Payer: OMNI Networks Commercial |
$532.70
|
| Rate for Payer: One Health Plan PPO/POS |
$684.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$722.95
|
| Rate for Payer: Three Rivers Provider Network All |
$570.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$707.73
|
| Rate for Payer: Zelis Auto |
$304.40
|
| Rate for Payer: Zelis Worker's Compensation |
$207.75
|
|
|
CLTX PHLNGL FX PROX/MID PX/F/T W/MANJ EA
|
Facility
|
OP
|
$761.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
8226725
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$722.95 |
| 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 |
$456.60
|
| 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 |
$456.60
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cigna Commercial |
$646.85
|
| Rate for Payer: First Health Commercial |
$684.90
|
| Rate for Payer: First Health Workers Compensation |
$293.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$684.90
|
| Rate for Payer: GEHA Commercial |
$608.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$684.90
|
| 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 |
$692.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$532.70
|
| Rate for Payer: One Health Plan PPO/POS |
$684.90
|
| 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 |
$722.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$570.75
|
| 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 |
$707.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$304.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$207.75
|
|
|
CLTX PHLNGL FX PROX/MID PX/F/T W/MANJ EA
|
Facility
|
OP
|
$761.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
21600197
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$722.95 |
| 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 |
$456.60
|
| 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 |
$456.60
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cigna Commercial |
$646.85
|
| Rate for Payer: First Health Commercial |
$684.90
|
| Rate for Payer: First Health Workers Compensation |
$293.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$684.90
|
| Rate for Payer: GEHA Commercial |
$608.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$684.90
|
| 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 |
$692.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$532.70
|
| Rate for Payer: One Health Plan PPO/POS |
$684.90
|
| 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 |
$722.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$570.75
|
| 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 |
$707.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$304.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$207.75
|
|
|
CLTX PHLNGL FX PROX/MID PX/F/T W/MANJ EA
|
Facility
|
IP
|
$1,484.00
|
|
| Hospital Charge Code |
8126725
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$405.13 |
| Max. Negotiated Rate |
$1,409.80 |
| Rate for Payer: Cash Price |
$890.40
|
| Rate for Payer: Cigna Commercial |
$1,261.40
|
| Rate for Payer: First Health Commercial |
$1,335.60
|
| Rate for Payer: First Health Workers Compensation |
$572.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,335.60
|
| Rate for Payer: GEHA Commercial |
$1,038.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,335.60
|
| Rate for Payer: Multiplan All |
$1,350.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,038.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,335.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,409.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,113.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,380.12
|
| Rate for Payer: Zelis Auto |
$593.60
|
| Rate for Payer: Zelis Worker's Compensation |
$405.13
|
|
|
CLTX PHLNGL FX PROX/MID PX/F/T W/MANJ EA
|
Facility
|
OP
|
$1,484.00
|
|
| Hospital Charge Code |
8126725
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$371.00 |
| Max. Negotiated Rate |
$1,409.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$890.40
|
| Rate for Payer: Cash Price |
$890.40
|
| Rate for Payer: Cigna Commercial |
$1,261.40
|
| Rate for Payer: First Health Commercial |
$1,335.60
|
| Rate for Payer: First Health Workers Compensation |
$572.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,335.60
|
| Rate for Payer: GEHA Commercial |
$1,187.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,335.60
|
| Rate for Payer: Humana ChoiceCare |
$385.84
|
| Rate for Payer: Multiplan All |
$1,350.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$890.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,038.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,335.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,409.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,113.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,305.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$371.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,380.12
|
| Rate for Payer: Zelis Auto |
$593.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$742.00
|
| Rate for Payer: Zelis Worker's Compensation |
$405.13
|
|
|
CLTX PHLNGL FX PROX/MID PX/F/T W/MANJ EA
|
Facility
|
IP
|
$761.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
8826725
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$207.75 |
| Max. Negotiated Rate |
$722.95 |
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cigna Commercial |
$646.85
|
| Rate for Payer: First Health Commercial |
$684.90
|
| Rate for Payer: First Health Workers Compensation |
$293.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$684.90
|
| Rate for Payer: GEHA Commercial |
$532.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$684.90
|
| Rate for Payer: Multiplan All |
$692.51
|
| Rate for Payer: OMNI Networks Commercial |
$532.70
|
| Rate for Payer: One Health Plan PPO/POS |
$684.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$722.95
|
| Rate for Payer: Three Rivers Provider Network All |
$570.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$707.73
|
| Rate for Payer: Zelis Auto |
$304.40
|
| Rate for Payer: Zelis Worker's Compensation |
$207.75
|
|
|
CLTX PHLNGL FX PROX/MID PX/F/T W/O MA EA
|
Facility
|
IP
|
$589.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
21600196
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$160.80 |
| Max. Negotiated Rate |
$559.55 |
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cigna Commercial |
$500.65
|
| Rate for Payer: First Health Commercial |
$530.10
|
| Rate for Payer: First Health Workers Compensation |
$227.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$530.10
|
| Rate for Payer: GEHA Commercial |
$412.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$530.10
|
| Rate for Payer: Multiplan All |
$535.99
|
| Rate for Payer: OMNI Networks Commercial |
$412.30
|
| Rate for Payer: One Health Plan PPO/POS |
$530.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$559.55
|
| Rate for Payer: Three Rivers Provider Network All |
$441.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$547.77
|
| Rate for Payer: Zelis Auto |
$235.60
|
| Rate for Payer: Zelis Worker's Compensation |
$160.80
|
|
|
CLTX PHLNGL FX PROX/MID PX/F/T W/O MA EA
|
Facility
|
OP
|
$589.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
6126720
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$559.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$353.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$227.78
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cigna Commercial |
$500.65
|
| Rate for Payer: First Health Commercial |
$530.10
|
| Rate for Payer: First Health Workers Compensation |
$227.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$530.10
|
| Rate for Payer: GEHA Commercial |
$471.20
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$530.10
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$535.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$412.30
|
| Rate for Payer: One Health Plan PPO/POS |
$530.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$559.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$441.75
|
| 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 |
$547.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$235.60
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$160.80
|
|
