|
CLTX PROX HUMRL FX W/MANJ W/WO SKELTL TR
|
Facility
|
OP
|
$4,312.00
|
|
| Hospital Charge Code |
8123605
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,078.00 |
| Max. Negotiated Rate |
$4,096.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,587.20
|
| 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 |
$3,449.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,880.80
|
| Rate for Payer: Humana ChoiceCare |
$1,121.12
|
| Rate for Payer: Multiplan All |
$3,923.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,587.20
|
| 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: TriWest Veterans Administration/VAPC3 |
$3,794.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,078.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,010.16
|
| Rate for Payer: Zelis Auto |
$1,724.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,156.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,177.18
|
|
|
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
|
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 RDL HEAD SUBLXTJ CHLD NRSE ELB W/MA
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
8823606
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: First Health Workers Compensation |
$108.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Worker's Compensation |
$76.44
|
|
|
CLTX RDL HEAD SUBLXTJ CHLD NRSE ELB W/MA
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
8223606
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: First Health Workers Compensation |
$108.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Worker's Compensation |
$76.44
|
|
|
CLTX RDL HEAD SUBLXTJ CHLD NRSE ELB W/MA
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
8823606
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$76.44 |
| 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 |
$168.00
|
| 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 |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: First Health Workers Compensation |
$108.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$224.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| 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 |
$260.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$76.44
|
|
|
CLTX RDL HEAD SUBLXTJ CHLD NRSE ELB W/MA
|
Facility
|
IP
|
$889.00
|
|
| Hospital Charge Code |
8150082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$242.70 |
| Max. Negotiated Rate |
$844.55 |
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cigna Commercial |
$755.65
|
| Rate for Payer: First Health Commercial |
$800.10
|
| Rate for Payer: First Health Workers Compensation |
$343.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$800.10
|
| Rate for Payer: GEHA Commercial |
$622.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$800.10
|
| Rate for Payer: Multiplan All |
$808.99
|
| Rate for Payer: OMNI Networks Commercial |
$622.30
|
| Rate for Payer: One Health Plan PPO/POS |
$800.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$844.55
|
| Rate for Payer: Three Rivers Provider Network All |
$666.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$826.77
|
| Rate for Payer: Zelis Auto |
$355.60
|
| Rate for Payer: Zelis Worker's Compensation |
$242.70
|
|
|
CLTX RDL HEAD SUBLXTJ CHLD NRSE ELB W/MA
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
6124640
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: First Health Workers Compensation |
$108.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Worker's Compensation |
$76.44
|
|
|
CLTX RDL HEAD SUBLXTJ CHLD NRSE ELB W/MA
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
21600193
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: First Health Workers Compensation |
$108.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Worker's Compensation |
$76.44
|
|
|
CLTX RDL HEAD SUBLXTJ CHLD NRSE ELB W/MA
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
6124640
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$76.44 |
| 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 |
$168.00
|
| 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 |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: First Health Workers Compensation |
$108.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$224.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| 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 |
$260.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$76.44
|
|
|
CLTX RDL HEAD SUBLXTJ CHLD NRSE ELB W/MA
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
8223606
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$76.44 |
| 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 |
$168.00
|
| 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 |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: First Health Workers Compensation |
$108.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$224.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| 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 |
$260.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$76.44
|
|
|
CLTX RDL HEAD SUBLXTJ CHLD NRSE ELB W/MA
|
Facility
|
OP
|
$889.00
|
|
| Hospital Charge Code |
8150082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$222.25 |
| Max. Negotiated Rate |
$844.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$533.40
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cigna Commercial |
$755.65
|
| Rate for Payer: First Health Commercial |
$800.10
|
| Rate for Payer: First Health Workers Compensation |
$343.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$800.10
|
| Rate for Payer: GEHA Commercial |
$711.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$800.10
|
| Rate for Payer: Humana ChoiceCare |
$231.14
|
| Rate for Payer: Multiplan All |
$808.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$533.40
|
| Rate for Payer: OMNI Networks Commercial |
$622.30
|
| Rate for Payer: One Health Plan PPO/POS |
$800.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$844.55
|
| Rate for Payer: Three Rivers Provider Network All |
$666.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$782.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$222.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$826.77
|
| Rate for Payer: Zelis Auto |
$355.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$444.50
|
| Rate for Payer: Zelis Worker's Compensation |
$242.70
|
|
|
CLTX RDL HEAD SUBLXTJ CHLD NRSE ELB W/MA
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
21600193
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$76.44 |
| 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 |
$168.00
|
| 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 |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: First Health Workers Compensation |
$108.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$224.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| 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 |
$260.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$76.44
|
|
|
CLTX SHOULDER DISLC W/FX HUMERAL TUBRST
|
Facility
|
IP
|
$2,312.00
|
|
| Hospital Charge Code |
8123665
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$631.18 |
| Max. Negotiated Rate |
$2,196.40 |
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cigna Commercial |
$1,965.20
|
| Rate for Payer: First Health Commercial |
$2,080.80
|
| Rate for Payer: First Health Workers Compensation |
$892.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,080.80
|
| Rate for Payer: GEHA Commercial |
$1,618.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,080.80
|
| Rate for Payer: Multiplan All |
$2,103.92
|
| Rate for Payer: OMNI Networks Commercial |
$1,618.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,080.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,196.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,734.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,150.16
|
| Rate for Payer: Zelis Auto |
$924.80
|
| Rate for Payer: Zelis Worker's Compensation |
$631.18
|
|
|
CLTX SHOULDER DISLC W/FX HUMERAL TUBRST
|
Facility
|
OP
|
$2,312.00
|
|
| Hospital Charge Code |
8123665
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$578.00 |
| Max. Negotiated Rate |
$2,196.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,387.20
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cigna Commercial |
$1,965.20
|
| Rate for Payer: First Health Commercial |
$2,080.80
|
| Rate for Payer: First Health Workers Compensation |
$892.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,080.80
|
| Rate for Payer: GEHA Commercial |
$1,849.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,080.80
|
| Rate for Payer: Humana ChoiceCare |
$601.12
|
| Rate for Payer: Multiplan All |
$2,103.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,387.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,618.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,080.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,196.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,734.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,034.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$578.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,150.16
|
| Rate for Payer: Zelis Auto |
$924.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,156.00
|
| Rate for Payer: Zelis Worker's Compensation |
$631.18
|
|
|
CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/
|
Facility
|
IP
|
$1,980.00
|
|
|
Service Code
|
CPT 24530
|
| Hospital Charge Code |
224530
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$540.54 |
| Max. Negotiated Rate |
$1,881.00 |
| Rate for Payer: Cash Price |
$1,188.00
|
| Rate for Payer: Cigna Commercial |
$1,683.00
|
| Rate for Payer: First Health Commercial |
$1,782.00
|
| Rate for Payer: First Health Workers Compensation |
$764.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,782.00
|
| Rate for Payer: GEHA Commercial |
$1,386.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,782.00
|
| Rate for Payer: Multiplan All |
$1,801.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,386.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,782.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,881.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,485.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,841.40
|
| Rate for Payer: Zelis Auto |
$792.00
|
| Rate for Payer: Zelis Worker's Compensation |
$540.54
|
|
|
CLTX TARSAL DISLC OTH/THN TALOTAR W/O AN
|
Facility
|
IP
|
$621.00
|
|
|
Service Code
|
CPT 28540
|
| Hospital Charge Code |
8728540
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$169.53 |
| Max. Negotiated Rate |
$589.95 |
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$527.85
|
| Rate for Payer: First Health Commercial |
$558.90
|
| Rate for Payer: First Health Workers Compensation |
$239.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$558.90
|
| Rate for Payer: GEHA Commercial |
$434.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$558.90
|
| Rate for Payer: Multiplan All |
$565.11
|
| Rate for Payer: OMNI Networks Commercial |
$434.70
|
| Rate for Payer: One Health Plan PPO/POS |
$558.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$589.95
|
| Rate for Payer: Three Rivers Provider Network All |
$465.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$577.53
|
| Rate for Payer: Zelis Auto |
$248.40
|
| Rate for Payer: Zelis Worker's Compensation |
$169.53
|
|
|
CLTX TARSAL DISLC OTH/THN TALOTAR W/O AN
|
Facility
|
OP
|
$621.00
|
|
|
Service Code
|
CPT 28540
|
| Hospital Charge Code |
8728540
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$589.95 |
| 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 |
$372.60
|
| 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 |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$527.85
|
| Rate for Payer: First Health Commercial |
$558.90
|
| Rate for Payer: First Health Workers Compensation |
$239.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$558.90
|
| Rate for Payer: GEHA Commercial |
$496.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$558.90
|
| 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 |
$565.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$434.70
|
| Rate for Payer: One Health Plan PPO/POS |
$558.90
|
| 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 |
$589.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$465.75
|
| 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 |
$577.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$248.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$169.53
|
|
|
CLTX TARSAL DISLC OTH/THN TALOTAR W/O AN
|
Facility
|
OP
|
$621.00
|
|
|
Service Code
|
CPT 28540
|
| Hospital Charge Code |
8300038
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$589.95 |
| 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 |
$372.60
|
| 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 |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$527.85
|
| Rate for Payer: First Health Commercial |
$558.90
|
| Rate for Payer: First Health Workers Compensation |
$239.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$558.90
|
| Rate for Payer: GEHA Commercial |
$496.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$558.90
|
| 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 |
$565.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$434.70
|
| Rate for Payer: One Health Plan PPO/POS |
$558.90
|
| 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 |
$589.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$465.75
|
| 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 |
$577.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$248.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$169.53
|
|
|
CLTX TARSAL DISLC OTH/THN TALOTAR W/O AN
|
Facility
|
OP
|
$1,289.17
|
|
|
Service Code
|
CPT 28540
|
| Hospital Charge Code |
9628540
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$1,224.71 |
| 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 |
$773.50
|
| 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 |
$773.50
|
| Rate for Payer: Cash Price |
$773.50
|
| Rate for Payer: Cigna Commercial |
$1,095.79
|
| Rate for Payer: First Health Commercial |
$1,160.25
|
| Rate for Payer: First Health Workers Compensation |
$497.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,160.25
|
| Rate for Payer: GEHA Commercial |
$1,031.34
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,160.25
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$1,173.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$902.42
|
| Rate for Payer: One Health Plan PPO/POS |
$1,160.25
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,224.71
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$966.88
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.22
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,198.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$515.67
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$351.94
|
|
|
CLTX TARSAL DISLC OTH/THN TALOTAR W/O AN
|
Facility
|
IP
|
$621.00
|
|
|
Service Code
|
CPT 28540
|
| Hospital Charge Code |
8300038
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$169.53 |
| Max. Negotiated Rate |
$589.95 |
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$527.85
|
| Rate for Payer: First Health Commercial |
$558.90
|
| Rate for Payer: First Health Workers Compensation |
$239.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$558.90
|
| Rate for Payer: GEHA Commercial |
$434.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$558.90
|
| Rate for Payer: Multiplan All |
$565.11
|
| Rate for Payer: OMNI Networks Commercial |
$434.70
|
| Rate for Payer: One Health Plan PPO/POS |
$558.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$589.95
|
| Rate for Payer: Three Rivers Provider Network All |
$465.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$577.53
|
| Rate for Payer: Zelis Auto |
$248.40
|
| Rate for Payer: Zelis Worker's Compensation |
$169.53
|
|
|
CLTX TARSAL DISLC OTH/THN TALOTAR W/O AN
|
Facility
|
IP
|
$621.00
|
|
|
Service Code
|
CPT 28540
|
| Hospital Charge Code |
6128540
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$169.53 |
| Max. Negotiated Rate |
$589.95 |
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$527.85
|
| Rate for Payer: First Health Commercial |
$558.90
|
| Rate for Payer: First Health Workers Compensation |
$239.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$558.90
|
| Rate for Payer: GEHA Commercial |
$434.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$558.90
|
| Rate for Payer: Multiplan All |
$565.11
|
| Rate for Payer: OMNI Networks Commercial |
$434.70
|
| Rate for Payer: One Health Plan PPO/POS |
$558.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$589.95
|
| Rate for Payer: Three Rivers Provider Network All |
$465.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$577.53
|
| Rate for Payer: Zelis Auto |
$248.40
|
| Rate for Payer: Zelis Worker's Compensation |
$169.53
|
|
|
CLTX TARSAL DISLC OTH/THN TALOTAR W/O AN
|
Facility
|
IP
|
$1,289.17
|
|
|
Service Code
|
CPT 28540
|
| Hospital Charge Code |
9628540
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.94 |
| Max. Negotiated Rate |
$1,224.71 |
| Rate for Payer: Cash Price |
$773.50
|
| Rate for Payer: Cigna Commercial |
$1,095.79
|
| Rate for Payer: First Health Commercial |
$1,160.25
|
| Rate for Payer: First Health Workers Compensation |
$497.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,160.25
|
| Rate for Payer: GEHA Commercial |
$902.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,160.25
|
| Rate for Payer: Multiplan All |
$1,173.14
|
| Rate for Payer: OMNI Networks Commercial |
$902.42
|
| Rate for Payer: One Health Plan PPO/POS |
$1,160.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,224.71
|
| Rate for Payer: Three Rivers Provider Network All |
$966.88
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,198.93
|
| Rate for Payer: Zelis Auto |
$515.67
|
| Rate for Payer: Zelis Worker's Compensation |
$351.94
|
|
|
CLTX TARSAL DISLC OTH/THN TALOTAR W/O AN
|
Facility
|
OP
|
$621.00
|
|
|
Service Code
|
CPT 28540
|
| Hospital Charge Code |
6128540
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$589.95 |
| 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 |
$372.60
|
| 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 |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$527.85
|
| Rate for Payer: First Health Commercial |
$558.90
|
| Rate for Payer: First Health Workers Compensation |
$239.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$558.90
|
| Rate for Payer: GEHA Commercial |
$496.80
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$558.90
|
| 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 |
$565.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$434.70
|
| Rate for Payer: One Health Plan PPO/POS |
$558.90
|
| 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 |
$589.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$465.75
|
| 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 |
$577.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$248.40
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$169.53
|
|
|
CLTX THIGH FX
|
Facility
|
OP
|
$884.00
|
|
|
Service Code
|
CPT 27267
|
| Hospital Charge Code |
6127267
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$6,161.78 |
| 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 |
$530.40
|
| 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 |
$3,080.89
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cigna Commercial |
$751.40
|
| Rate for Payer: First Health Commercial |
$795.60
|
| Rate for Payer: First Health Workers Compensation |
$341.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$795.60
|
| Rate for Payer: GEHA Commercial |
$707.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$795.60
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$804.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$618.80
|
| Rate for Payer: One Health Plan PPO/POS |
$795.60
|
| 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 |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$839.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$663.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$822.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$353.60
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$241.33
|
|
