|
CLTX PHLNGL FX PROX/MID PX/F/T W/O MA EA
|
Facility
|
OP
|
$589.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
21600196
|
|
Hospital Revenue Code
|
517
|
| 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
|
|
|
CLTX PHLNGL FX PROX/MID PX/F/T W/O MA EA
|
Facility
|
IP
|
$589.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
8226720
|
|
Hospital Revenue Code
|
519
|
| 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
|
|
|
CLTX PHLNGL FX PROX/MID PX/F/T W/O MA EA
|
Facility
|
IP
|
$589.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
8826720
|
|
Hospital Revenue Code
|
519
|
| 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
|
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
|
IP
|
$589.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
6126720
|
|
Hospital Revenue Code
|
975
|
| 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 POST ANKLE FX W/MNPJ
|
Facility
|
OP
|
$891.00
|
|
|
Service Code
|
CPT 27768
|
| Hospital Charge Code |
6127768
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$3,039.30 |
| 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 |
$534.60
|
| 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 |
$1,519.65
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cigna Commercial |
$757.35
|
| Rate for Payer: First Health Commercial |
$801.90
|
| Rate for Payer: First Health Workers Compensation |
$344.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$801.90
|
| Rate for Payer: GEHA Commercial |
$712.80
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$801.90
|
| 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 |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$810.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$623.70
|
| Rate for Payer: One Health Plan PPO/POS |
$801.90
|
| 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 |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$846.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$668.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$828.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$356.40
|
| 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 |
$243.24
|
|
|
CLTX POST ANKLE FX W/MNPJ
|
Facility
|
IP
|
$891.00
|
|
|
Service Code
|
CPT 27768
|
| Hospital Charge Code |
6127768
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$243.24 |
| Max. Negotiated Rate |
$846.45 |
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cigna Commercial |
$757.35
|
| Rate for Payer: First Health Commercial |
$801.90
|
| Rate for Payer: First Health Workers Compensation |
$344.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$801.90
|
| Rate for Payer: GEHA Commercial |
$623.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$801.90
|
| Rate for Payer: Multiplan All |
$810.81
|
| Rate for Payer: OMNI Networks Commercial |
$623.70
|
| Rate for Payer: One Health Plan PPO/POS |
$801.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$846.45
|
| Rate for Payer: Three Rivers Provider Network All |
$668.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$828.63
|
| Rate for Payer: Zelis Auto |
$356.40
|
| Rate for Payer: Zelis Worker's Compensation |
$243.24
|
|
|
CLTX POST HIP ARTHRP DISLC REQ ANES
|
Facility
|
OP
|
$3,695.00
|
|
| Hospital Charge Code |
8150112
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$923.75 |
| Max. Negotiated Rate |
$3,510.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,217.00
|
| Rate for Payer: Cash Price |
$2,217.00
|
| Rate for Payer: Cigna Commercial |
$3,140.75
|
| Rate for Payer: First Health Commercial |
$3,325.50
|
| Rate for Payer: First Health Workers Compensation |
$1,426.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,325.50
|
| Rate for Payer: GEHA Commercial |
$2,956.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,325.50
|
| Rate for Payer: Humana ChoiceCare |
$960.70
|
| Rate for Payer: Multiplan All |
$3,362.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,217.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,586.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,325.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,510.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,771.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,251.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$923.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,436.35
|
| Rate for Payer: Zelis Auto |
$1,478.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,847.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,008.74
|
|
|
CLTX POST HIP ARTHRP DISLC REQ ANES
|
Facility
|
IP
|
$3,695.00
|
|
| Hospital Charge Code |
8150112
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,008.74 |
| Max. Negotiated Rate |
$3,510.25 |
| Rate for Payer: Cash Price |
$2,217.00
|
| Rate for Payer: Cigna Commercial |
$3,140.75
|
| Rate for Payer: First Health Commercial |
$3,325.50
|
| Rate for Payer: First Health Workers Compensation |
$1,426.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,325.50
|
| Rate for Payer: GEHA Commercial |
$2,586.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,325.50
|
| Rate for Payer: Multiplan All |
$3,362.45
|
| Rate for Payer: OMNI Networks Commercial |
$2,586.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,325.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,510.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,771.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,436.35
|
| Rate for Payer: Zelis Auto |
$1,478.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,008.74
|
|
|
CLTX POST HIP ARTHRP DISLC W/O ANES
|
Facility
|
IP
|
$2,473.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
8127265
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$675.13 |
| Max. Negotiated Rate |
$2,349.35 |
| Rate for Payer: Cash Price |
$1,483.80
|
| Rate for Payer: Cigna Commercial |
$2,102.05
|
| Rate for Payer: First Health Commercial |
$2,225.70
|
| Rate for Payer: First Health Workers Compensation |
$954.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,225.70
|
| Rate for Payer: GEHA Commercial |
$1,731.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,225.70
|
| Rate for Payer: Multiplan All |
$2,250.43
|
| Rate for Payer: OMNI Networks Commercial |
$1,731.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,225.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,349.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,854.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,299.89
|
| Rate for Payer: Zelis Auto |
$989.20
|
| Rate for Payer: Zelis Worker's Compensation |
$675.13
|
|
|
CLTX POST HIP ARTHRP DISLC W/O ANES
|
Facility
|
OP
|
$2,473.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
8127265
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$2,349.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,483.80
|
| 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 |
$1,483.80
|
| Rate for Payer: Cash Price |
$1,483.80
|
| Rate for Payer: Cigna Commercial |
$2,102.05
|
| Rate for Payer: First Health Commercial |
$2,225.70
|
| Rate for Payer: First Health Workers Compensation |
$954.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,225.70
|
| Rate for Payer: GEHA Commercial |
$1,978.40
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,225.70
|
| 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 |
$2,250.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,731.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,225.70
|
| 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 |
$2,349.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$1,854.75
|
| 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 |
$2,299.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$989.20
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$675.13
|
|
|
CLTX POST HIP ARTHRP DISLC W/O ANES
|
Facility
|
OP
|
$1,009.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
6127265
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$958.55 |
| 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 |
$605.40
|
| 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 |
$605.40
|
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cigna Commercial |
$857.65
|
| Rate for Payer: First Health Commercial |
$908.10
|
| Rate for Payer: First Health Workers Compensation |
$389.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$908.10
|
| Rate for Payer: GEHA Commercial |
$807.20
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$908.10
|
| 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 |
$918.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$706.30
|
| Rate for Payer: One Health Plan PPO/POS |
$908.10
|
| 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 |
$958.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$756.75
|
| 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 |
$938.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$403.60
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$275.46
|
|
|
CLTX POST HIP ARTHRP DISLC W/O ANES
|
Facility
|
IP
|
$1,009.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
6127265
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$275.46 |
| Max. Negotiated Rate |
$958.55 |
| Rate for Payer: Cash Price |
$605.40
|
| Rate for Payer: Cigna Commercial |
$857.65
|
| Rate for Payer: First Health Commercial |
$908.10
|
| Rate for Payer: First Health Workers Compensation |
$389.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$908.10
|
| Rate for Payer: GEHA Commercial |
$706.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$908.10
|
| Rate for Payer: Multiplan All |
$918.19
|
| Rate for Payer: OMNI Networks Commercial |
$706.30
|
| Rate for Payer: One Health Plan PPO/POS |
$908.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$958.55
|
| Rate for Payer: Three Rivers Provider Network All |
$756.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$938.37
|
| Rate for Payer: Zelis Auto |
$403.60
|
| Rate for Payer: Zelis Worker's Compensation |
$275.46
|
|
|
CLTX PROX FIBULA/SHFT FX W/O MANJ
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 27780
|
| Hospital Charge Code |
9600001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$190.01 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna Commercial |
$591.60
|
| Rate for Payer: First Health Commercial |
$626.40
|
| Rate for Payer: First Health Workers Compensation |
$268.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$626.40
|
| Rate for Payer: GEHA Commercial |
$487.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$626.40
|
| Rate for Payer: Multiplan All |
$633.36
|
| Rate for Payer: OMNI Networks Commercial |
$487.20
|
| Rate for Payer: One Health Plan PPO/POS |
$626.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$661.20
|
| Rate for Payer: Three Rivers Provider Network All |
$522.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$647.28
|
| Rate for Payer: Zelis Auto |
$278.40
|
| Rate for Payer: Zelis Worker's Compensation |
$190.01
|
|
|
CLTX PROX FIBULA/SHFT FX W/O MANJ
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 27780
|
| Hospital Charge Code |
9600001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$661.20 |
| 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 |
$417.60
|
| 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 |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna Commercial |
$591.60
|
| Rate for Payer: First Health Commercial |
$626.40
|
| Rate for Payer: First Health Workers Compensation |
$268.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$626.40
|
| Rate for Payer: GEHA Commercial |
$556.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$626.40
|
| 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 |
$633.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$487.20
|
| Rate for Payer: One Health Plan PPO/POS |
$626.40
|
| 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 |
$661.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$522.00
|
| 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 |
$647.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$278.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$190.01
|
|
|
CLTX PROX FIBULA/SHFT FX W/O MANJ
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 27780
|
| Hospital Charge Code |
8727780
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$190.01 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna Commercial |
$591.60
|
| Rate for Payer: First Health Commercial |
$626.40
|
| Rate for Payer: First Health Workers Compensation |
$268.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$626.40
|
| Rate for Payer: GEHA Commercial |
$487.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$626.40
|
| Rate for Payer: Multiplan All |
$633.36
|
| Rate for Payer: OMNI Networks Commercial |
$487.20
|
| Rate for Payer: One Health Plan PPO/POS |
$626.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$661.20
|
| Rate for Payer: Three Rivers Provider Network All |
$522.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$647.28
|
| Rate for Payer: Zelis Auto |
$278.40
|
| Rate for Payer: Zelis Worker's Compensation |
$190.01
|
|
|
CLTX PROX FIBULA/SHFT FX W/O MANJ
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 27780
|
| Hospital Charge Code |
6127780
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$661.20 |
| 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 |
$417.60
|
| 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 |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna Commercial |
$591.60
|
| Rate for Payer: First Health Commercial |
$626.40
|
| Rate for Payer: First Health Workers Compensation |
$268.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$626.40
|
| Rate for Payer: GEHA Commercial |
$556.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$626.40
|
| 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 |
$633.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$487.20
|
| Rate for Payer: One Health Plan PPO/POS |
$626.40
|
| 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 |
$661.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$522.00
|
| 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 |
$647.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$278.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$190.01
|
|
|
CLTX PROX FIBULA/SHFT FX W/O MANJ
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 27780
|
| Hospital Charge Code |
8727780
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$661.20 |
| 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 |
$417.60
|
| 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 |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna Commercial |
$591.60
|
| Rate for Payer: First Health Commercial |
$626.40
|
| Rate for Payer: First Health Workers Compensation |
$268.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$626.40
|
| Rate for Payer: GEHA Commercial |
$556.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$626.40
|
| 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 |
$633.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$487.20
|
| Rate for Payer: One Health Plan PPO/POS |
$626.40
|
| 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 |
$661.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$522.00
|
| 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 |
$647.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$278.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$190.01
|
|
|
CLTX PROX FIBULA/SHFT FX W/O MANJ
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 27780
|
| Hospital Charge Code |
6127780
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$190.01 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cigna Commercial |
$591.60
|
| Rate for Payer: First Health Commercial |
$626.40
|
| Rate for Payer: First Health Workers Compensation |
$268.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$626.40
|
| Rate for Payer: GEHA Commercial |
$487.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$626.40
|
| Rate for Payer: Multiplan All |
$633.36
|
| Rate for Payer: OMNI Networks Commercial |
$487.20
|
| Rate for Payer: One Health Plan PPO/POS |
$626.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$661.20
|
| Rate for Payer: Three Rivers Provider Network All |
$522.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$647.28
|
| Rate for Payer: Zelis Auto |
$278.40
|
| Rate for Payer: Zelis Worker's Compensation |
$190.01
|
|
|
CLTX PROX HUMRL FX W/MANJ W/WO SKELTL TR
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
8823605
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$389.02 |
| Max. Negotiated Rate |
$1,353.75 |
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cigna Commercial |
$1,211.25
|
| Rate for Payer: First Health Commercial |
$1,282.50
|
| Rate for Payer: First Health Workers Compensation |
$550.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,282.50
|
| Rate for Payer: GEHA Commercial |
$997.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,282.50
|
| Rate for Payer: Multiplan All |
$1,296.75
|
| Rate for Payer: OMNI Networks Commercial |
$997.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,282.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,353.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,068.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,325.25
|
| Rate for Payer: Zelis Auto |
$570.00
|
| Rate for Payer: Zelis Worker's Compensation |
$389.02
|
|
|
CLTX PROX HUMRL FX W/MANJ W/WO SKELTL TR
|
Facility
|
OP
|
$1,425.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
8223605
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$389.02 |
| 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 |
$855.00
|
| 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 |
$855.00
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cigna Commercial |
$1,211.25
|
| Rate for Payer: First Health Commercial |
$1,282.50
|
| Rate for Payer: First Health Workers Compensation |
$550.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,282.50
|
| Rate for Payer: GEHA Commercial |
$1,140.00
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,282.50
|
| 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 |
$1,296.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$997.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,282.50
|
| 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 |
$1,353.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,068.75
|
| 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 |
$1,325.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$570.00
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$389.02
|
|
|
CLTX PROX HUMRL FX W/MANJ W/WO SKELTL TR
|
Facility
|
OP
|
$1,308.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
6123605
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$357.08 |
| 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 |
$784.80
|
| 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 |
$784.80
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cigna Commercial |
$1,111.80
|
| Rate for Payer: First Health Commercial |
$1,177.20
|
| Rate for Payer: First Health Workers Compensation |
$505.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,177.20
|
| Rate for Payer: GEHA Commercial |
$1,046.40
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,177.20
|
| 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 |
$1,190.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$915.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,177.20
|
| 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 |
$1,242.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$981.00
|
| 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 |
$1,216.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$523.20
|
| 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 |
$357.08
|
|
|
CLTX PROX HUMRL FX W/MANJ W/WO SKELTL TR
|
Facility
|
IP
|
$4,312.00
|
|
| Hospital Charge Code |
8123605
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,177.18 |
| Max. Negotiated Rate |
$4,096.40 |
| Rate for Payer: Cash Price |
$2,587.20
|
| Rate for Payer: Cigna Commercial |
$3,665.20
|
| Rate for Payer: First Health Commercial |
$3,880.80
|
| Rate for Payer: First Health Workers Compensation |
$1,664.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,880.80
|
| Rate for Payer: GEHA Commercial |
$3,018.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,880.80
|
| Rate for Payer: Multiplan All |
$3,923.92
|
| Rate for Payer: OMNI Networks Commercial |
$3,018.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,880.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,096.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,234.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,010.16
|
| Rate for Payer: Zelis Auto |
$1,724.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,177.18
|
|
|
CLTX PROX HUMRL FX W/MANJ W/WO SKELTL TR
|
Facility
|
IP
|
$1,308.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
6123605
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$357.08 |
| Max. Negotiated Rate |
$1,242.60 |
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cigna Commercial |
$1,111.80
|
| Rate for Payer: First Health Commercial |
$1,177.20
|
| Rate for Payer: First Health Workers Compensation |
$505.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,177.20
|
| Rate for Payer: GEHA Commercial |
$915.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,177.20
|
| Rate for Payer: Multiplan All |
$1,190.28
|
| Rate for Payer: OMNI Networks Commercial |
$915.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,177.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,242.60
|
| Rate for Payer: Three Rivers Provider Network All |
$981.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,216.44
|
| Rate for Payer: Zelis Auto |
$523.20
|
| Rate for Payer: Zelis Worker's Compensation |
$357.08
|
|
