|
CLTX THIGH FX
|
Facility
|
IP
|
$884.00
|
|
|
Service Code
|
CPT 27267
|
| Hospital Charge Code |
6127267
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$241.33 |
| Max. Negotiated Rate |
$839.80 |
| 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 |
$618.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$795.60
|
| Rate for Payer: Multiplan All |
$804.44
|
| Rate for Payer: OMNI Networks Commercial |
$618.80
|
| Rate for Payer: One Health Plan PPO/POS |
$795.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$839.80
|
| Rate for Payer: Three Rivers Provider Network All |
$663.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$822.12
|
| Rate for Payer: Zelis Auto |
$353.60
|
| Rate for Payer: Zelis Worker's Compensation |
$241.33
|
|
|
CLTX THIGH FX W/MNPJ
|
Facility
|
OP
|
$1,087.00
|
|
|
Service Code
|
CPT 27268
|
| Hospital Charge Code |
6127268
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$271.75 |
| Max. Negotiated Rate |
$1,032.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$652.20
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Cigna Commercial |
$923.95
|
| Rate for Payer: First Health Commercial |
$978.30
|
| Rate for Payer: First Health Workers Compensation |
$419.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$978.30
|
| Rate for Payer: GEHA Commercial |
$869.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$978.30
|
| Rate for Payer: Humana ChoiceCare |
$282.62
|
| Rate for Payer: Multiplan All |
$989.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$652.20
|
| Rate for Payer: OMNI Networks Commercial |
$760.90
|
| Rate for Payer: One Health Plan PPO/POS |
$978.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,032.65
|
| Rate for Payer: Three Rivers Provider Network All |
$815.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$956.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$271.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,010.91
|
| Rate for Payer: Zelis Auto |
$434.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$543.50
|
| Rate for Payer: Zelis Worker's Compensation |
$296.75
|
|
|
CLTX THIGH FX W/MNPJ
|
Facility
|
IP
|
$1,087.00
|
|
|
Service Code
|
CPT 27268
|
| Hospital Charge Code |
6127268
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$296.75 |
| Max. Negotiated Rate |
$1,032.65 |
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Cigna Commercial |
$923.95
|
| Rate for Payer: First Health Commercial |
$978.30
|
| Rate for Payer: First Health Workers Compensation |
$419.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$978.30
|
| Rate for Payer: GEHA Commercial |
$760.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$978.30
|
| Rate for Payer: Multiplan All |
$989.17
|
| Rate for Payer: OMNI Networks Commercial |
$760.90
|
| Rate for Payer: One Health Plan PPO/POS |
$978.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,032.65
|
| Rate for Payer: Three Rivers Provider Network All |
$815.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,010.91
|
| Rate for Payer: Zelis Auto |
$434.80
|
| Rate for Payer: Zelis Worker's Compensation |
$296.75
|
|
|
CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TR
|
Facility
|
OP
|
$4,750.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
8127752
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,291.70 |
| Max. Negotiated Rate |
$4,512.50 |
| 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 |
$2,850.00
|
| 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 |
$2,850.00
|
| Rate for Payer: Cash Price |
$2,850.00
|
| Rate for Payer: Cigna Commercial |
$4,037.50
|
| Rate for Payer: First Health Commercial |
$4,275.00
|
| Rate for Payer: First Health Workers Compensation |
$1,833.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,275.00
|
| Rate for Payer: GEHA Commercial |
$3,800.00
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,275.00
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,503.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$4,322.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$3,325.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,275.00
|
| 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 |
$4,512.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,562.50
|
| 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 |
$4,417.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$1,900.00
|
| 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 |
$1,296.75
|
|
|
CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TR
|
Facility
|
IP
|
$4,750.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
8127752
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,296.75 |
| Max. Negotiated Rate |
$4,512.50 |
| Rate for Payer: Cash Price |
$2,850.00
|
| Rate for Payer: Cigna Commercial |
$4,037.50
|
| Rate for Payer: First Health Commercial |
$4,275.00
|
| Rate for Payer: First Health Workers Compensation |
$1,833.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,275.00
|
| Rate for Payer: GEHA Commercial |
$3,325.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,275.00
|
| Rate for Payer: Multiplan All |
$4,322.50
|
| Rate for Payer: OMNI Networks Commercial |
$3,325.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,275.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,512.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,562.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,417.50
|
| Rate for Payer: Zelis Auto |
$1,900.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,296.75
|
|
|
CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TR
|
Facility
|
IP
|
$4,750.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
6127752
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,296.75 |
| Max. Negotiated Rate |
$4,512.50 |
| Rate for Payer: Cash Price |
$2,850.00
|
| Rate for Payer: Cigna Commercial |
$4,037.50
|
| Rate for Payer: First Health Commercial |
$4,275.00
|
| Rate for Payer: First Health Workers Compensation |
$1,833.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,275.00
|
| Rate for Payer: GEHA Commercial |
$3,325.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,275.00
|
| Rate for Payer: Multiplan All |
$4,322.50
|
| Rate for Payer: OMNI Networks Commercial |
$3,325.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,275.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,512.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,562.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,417.50
|
| Rate for Payer: Zelis Auto |
$1,900.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,296.75
|
|
|
CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TR
|
Facility
|
OP
|
$4,750.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
6127752
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,291.70 |
| Max. Negotiated Rate |
$4,512.50 |
| 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 |
$2,850.00
|
| 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 |
$2,850.00
|
| Rate for Payer: Cash Price |
$2,850.00
|
| Rate for Payer: Cigna Commercial |
$4,037.50
|
| Rate for Payer: First Health Commercial |
$4,275.00
|
| Rate for Payer: First Health Workers Compensation |
$1,833.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,275.00
|
| Rate for Payer: GEHA Commercial |
$3,800.00
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,275.00
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,503.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$4,322.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$3,325.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,275.00
|
| 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 |
$4,512.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,562.50
|
| 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 |
$4,417.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$1,900.00
|
| 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 |
$1,296.75
|
|
|
CLTX TIBIAL SHAFT FX W/O MANIPULATION
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
8300021
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$983.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$621.00
|
| 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 |
$621.00
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cigna Commercial |
$879.75
|
| Rate for Payer: First Health Commercial |
$931.50
|
| Rate for Payer: First Health Workers Compensation |
$399.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$931.50
|
| Rate for Payer: GEHA Commercial |
$828.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$931.50
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$941.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$724.50
|
| Rate for Payer: One Health Plan PPO/POS |
$931.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$983.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$776.25
|
| 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 |
$962.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$414.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$282.56
|
|
|
CLTX TIBIAL SHAFT FX W/O MANIPULATION
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
6127750
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$282.56 |
| Max. Negotiated Rate |
$983.25 |
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cigna Commercial |
$879.75
|
| Rate for Payer: First Health Commercial |
$931.50
|
| Rate for Payer: First Health Workers Compensation |
$399.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$931.50
|
| Rate for Payer: GEHA Commercial |
$724.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$931.50
|
| Rate for Payer: Multiplan All |
$941.85
|
| Rate for Payer: OMNI Networks Commercial |
$724.50
|
| Rate for Payer: One Health Plan PPO/POS |
$931.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$983.25
|
| Rate for Payer: Three Rivers Provider Network All |
$776.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$962.55
|
| Rate for Payer: Zelis Auto |
$414.00
|
| Rate for Payer: Zelis Worker's Compensation |
$282.56
|
|
|
CLTX TIBIAL SHAFT FX W/O MANIPULATION
|
Facility
|
OP
|
$1,201.71
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
9627750
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$1,141.62 |
| 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 |
$721.03
|
| 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 |
$721.03
|
| Rate for Payer: Cash Price |
$721.03
|
| Rate for Payer: Cigna Commercial |
$1,021.45
|
| Rate for Payer: First Health Commercial |
$1,081.54
|
| Rate for Payer: First Health Workers Compensation |
$463.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,081.54
|
| Rate for Payer: GEHA Commercial |
$961.37
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,081.54
|
| 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 |
$1,093.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$841.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,081.54
|
| 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 |
$1,141.62
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$901.28
|
| 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 |
$1,117.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$480.68
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$328.07
|
|
|
CLTX TIBIAL SHAFT FX W/O MANIPULATION
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
8300021
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$282.56 |
| Max. Negotiated Rate |
$983.25 |
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cigna Commercial |
$879.75
|
| Rate for Payer: First Health Commercial |
$931.50
|
| Rate for Payer: First Health Workers Compensation |
$399.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$931.50
|
| Rate for Payer: GEHA Commercial |
$724.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$931.50
|
| Rate for Payer: Multiplan All |
$941.85
|
| Rate for Payer: OMNI Networks Commercial |
$724.50
|
| Rate for Payer: One Health Plan PPO/POS |
$931.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$983.25
|
| Rate for Payer: Three Rivers Provider Network All |
$776.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$962.55
|
| Rate for Payer: Zelis Auto |
$414.00
|
| Rate for Payer: Zelis Worker's Compensation |
$282.56
|
|
|
CLTX TIBIAL SHAFT FX W/O MANIPULATION
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
6127750
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$983.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$621.00
|
| 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 |
$621.00
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cigna Commercial |
$879.75
|
| Rate for Payer: First Health Commercial |
$931.50
|
| Rate for Payer: First Health Workers Compensation |
$399.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$931.50
|
| Rate for Payer: GEHA Commercial |
$828.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$931.50
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$941.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$724.50
|
| Rate for Payer: One Health Plan PPO/POS |
$931.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$983.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$776.25
|
| 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 |
$962.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$414.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$282.56
|
|
|
CLTX TIBIAL SHAFT FX W/O MANIPULATION
|
Facility
|
IP
|
$1,201.71
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
9627750
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$328.07 |
| Max. Negotiated Rate |
$1,141.62 |
| Rate for Payer: Cash Price |
$721.03
|
| Rate for Payer: Cigna Commercial |
$1,021.45
|
| Rate for Payer: First Health Commercial |
$1,081.54
|
| Rate for Payer: First Health Workers Compensation |
$463.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,081.54
|
| Rate for Payer: GEHA Commercial |
$841.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,081.54
|
| Rate for Payer: Multiplan All |
$1,093.56
|
| Rate for Payer: OMNI Networks Commercial |
$841.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,081.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,141.62
|
| Rate for Payer: Three Rivers Provider Network All |
$901.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,117.59
|
| Rate for Payer: Zelis Auto |
$480.68
|
| Rate for Payer: Zelis Worker's Compensation |
$328.07
|
|
|
CLTX TIBIAL SHAFT FX W/O MANIPULATION
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
8727750
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$282.56 |
| Max. Negotiated Rate |
$983.25 |
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cigna Commercial |
$879.75
|
| Rate for Payer: First Health Commercial |
$931.50
|
| Rate for Payer: First Health Workers Compensation |
$399.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$931.50
|
| Rate for Payer: GEHA Commercial |
$724.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$931.50
|
| Rate for Payer: Multiplan All |
$941.85
|
| Rate for Payer: OMNI Networks Commercial |
$724.50
|
| Rate for Payer: One Health Plan PPO/POS |
$931.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$983.25
|
| Rate for Payer: Three Rivers Provider Network All |
$776.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$962.55
|
| Rate for Payer: Zelis Auto |
$414.00
|
| Rate for Payer: Zelis Worker's Compensation |
$282.56
|
|
|
CLTX TIBIAL SHAFT FX W/O MANIPULATION
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
8727750
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$983.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$621.00
|
| 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 |
$621.00
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cigna Commercial |
$879.75
|
| Rate for Payer: First Health Commercial |
$931.50
|
| Rate for Payer: First Health Workers Compensation |
$399.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$931.50
|
| Rate for Payer: GEHA Commercial |
$828.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$931.50
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$941.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$724.50
|
| Rate for Payer: One Health Plan PPO/POS |
$931.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$983.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$776.25
|
| 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 |
$962.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$414.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$282.56
|
|
|
CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATIO
|
Facility
|
OP
|
$879.00
|
|
|
Service Code
|
CPT 27818
|
| Hospital Charge Code |
8827818
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$239.97 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$484.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$527.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$484.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$384.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cigna Commercial |
$747.15
|
| Rate for Payer: First Health Commercial |
$791.10
|
| Rate for Payer: First Health Workers Compensation |
$339.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$791.10
|
| Rate for Payer: GEHA Commercial |
$703.20
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$791.10
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$391.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$799.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$615.30
|
| Rate for Payer: One Health Plan PPO/POS |
$791.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$452.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$391.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$835.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$659.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$391.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$817.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$351.60
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$239.97
|
|
|
CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATIO
|
Facility
|
IP
|
$879.00
|
|
|
Service Code
|
CPT 27818
|
| Hospital Charge Code |
8827818
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$239.97 |
| Max. Negotiated Rate |
$835.05 |
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cigna Commercial |
$747.15
|
| Rate for Payer: First Health Commercial |
$791.10
|
| Rate for Payer: First Health Workers Compensation |
$339.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$791.10
|
| Rate for Payer: GEHA Commercial |
$615.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$791.10
|
| Rate for Payer: Multiplan All |
$799.89
|
| Rate for Payer: OMNI Networks Commercial |
$615.30
|
| Rate for Payer: One Health Plan PPO/POS |
$791.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$835.05
|
| Rate for Payer: Three Rivers Provider Network All |
$659.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$817.47
|
| Rate for Payer: Zelis Auto |
$351.60
|
| Rate for Payer: Zelis Worker's Compensation |
$239.97
|
|
|
CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATIO
|
Facility
|
OP
|
$879.00
|
|
|
Service Code
|
CPT 27818
|
| Hospital Charge Code |
8227818
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$239.97 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$484.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$527.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$484.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$384.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cigna Commercial |
$747.15
|
| Rate for Payer: First Health Commercial |
$791.10
|
| Rate for Payer: First Health Workers Compensation |
$339.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$791.10
|
| Rate for Payer: GEHA Commercial |
$703.20
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$791.10
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$391.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$799.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$615.30
|
| Rate for Payer: One Health Plan PPO/POS |
$791.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$452.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$391.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$835.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$659.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$391.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$817.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$351.60
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$239.97
|
|
|
CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATIO
|
Facility
|
IP
|
$879.00
|
|
|
Service Code
|
CPT 27818
|
| Hospital Charge Code |
8227818
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$239.97 |
| Max. Negotiated Rate |
$835.05 |
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cigna Commercial |
$747.15
|
| Rate for Payer: First Health Commercial |
$791.10
|
| Rate for Payer: First Health Workers Compensation |
$339.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$791.10
|
| Rate for Payer: GEHA Commercial |
$615.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$791.10
|
| Rate for Payer: Multiplan All |
$799.89
|
| Rate for Payer: OMNI Networks Commercial |
$615.30
|
| Rate for Payer: One Health Plan PPO/POS |
$791.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$835.05
|
| Rate for Payer: Three Rivers Provider Network All |
$659.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$817.47
|
| Rate for Payer: Zelis Auto |
$351.60
|
| Rate for Payer: Zelis Worker's Compensation |
$239.97
|
|
|
CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULAT
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
6127816
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$907.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$573.00
|
| 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 |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cigna Commercial |
$811.75
|
| Rate for Payer: First Health Commercial |
$859.50
|
| Rate for Payer: First Health Workers Compensation |
$368.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$859.50
|
| Rate for Payer: GEHA Commercial |
$764.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$859.50
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$869.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$668.50
|
| Rate for Payer: One Health Plan PPO/POS |
$859.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$907.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$716.25
|
| 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 |
$888.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$382.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$260.71
|
|
|
CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULAT
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
9627816
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$306.03 |
| Max. Negotiated Rate |
$1,064.95 |
| Rate for Payer: Cash Price |
$672.60
|
| Rate for Payer: Cigna Commercial |
$952.85
|
| Rate for Payer: First Health Commercial |
$1,008.90
|
| Rate for Payer: First Health Workers Compensation |
$432.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,008.90
|
| Rate for Payer: GEHA Commercial |
$784.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,008.90
|
| Rate for Payer: Multiplan All |
$1,020.11
|
| Rate for Payer: OMNI Networks Commercial |
$784.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,008.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,064.95
|
| Rate for Payer: Three Rivers Provider Network All |
$840.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,042.53
|
| Rate for Payer: Zelis Auto |
$448.40
|
| Rate for Payer: Zelis Worker's Compensation |
$306.03
|
|
|
CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULAT
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
8300026
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$907.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$573.00
|
| 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 |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cigna Commercial |
$811.75
|
| Rate for Payer: First Health Commercial |
$859.50
|
| Rate for Payer: First Health Workers Compensation |
$368.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$859.50
|
| Rate for Payer: GEHA Commercial |
$764.00
|
| Rate for Payer: GEHA Medicare |
$227.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$859.50
|
| Rate for Payer: Humana ChoiceCare |
$250.56
|
| Rate for Payer: Humana Medicare Advantage |
$227.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$382.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$227.78
|
| Rate for Payer: Multiplan All |
$869.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$387.23
|
| Rate for Payer: OMNI Networks Commercial |
$668.50
|
| Rate for Payer: One Health Plan PPO/POS |
$859.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$227.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$907.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$455.56
|
| Rate for Payer: Three Rivers Provider Network All |
$716.25
|
| 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 |
$888.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$227.78
|
| Rate for Payer: Zelis Auto |
$382.00
|
| Rate for Payer: Zelis Medicare |
$193.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$273.34
|
| Rate for Payer: Zelis Worker's Compensation |
$260.71
|
|
|
CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULAT
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
6127816
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$260.71 |
| Max. Negotiated Rate |
$907.25 |
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cigna Commercial |
$811.75
|
| Rate for Payer: First Health Commercial |
$859.50
|
| Rate for Payer: First Health Workers Compensation |
$368.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$859.50
|
| Rate for Payer: GEHA Commercial |
$668.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$859.50
|
| Rate for Payer: Multiplan All |
$869.05
|
| Rate for Payer: OMNI Networks Commercial |
$668.50
|
| Rate for Payer: One Health Plan PPO/POS |
$859.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$907.25
|
| Rate for Payer: Three Rivers Provider Network All |
$716.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$888.15
|
| Rate for Payer: Zelis Auto |
$382.00
|
| Rate for Payer: Zelis Worker's Compensation |
$260.71
|
|
|
CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULAT
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
8300026
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$260.71 |
| Max. Negotiated Rate |
$907.25 |
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cigna Commercial |
$811.75
|
| Rate for Payer: First Health Commercial |
$859.50
|
| Rate for Payer: First Health Workers Compensation |
$368.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$859.50
|
| Rate for Payer: GEHA Commercial |
$668.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$859.50
|
| Rate for Payer: Multiplan All |
$869.05
|
| Rate for Payer: OMNI Networks Commercial |
$668.50
|
| Rate for Payer: One Health Plan PPO/POS |
$859.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$907.25
|
| Rate for Payer: Three Rivers Provider Network All |
$716.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$888.15
|
| Rate for Payer: Zelis Auto |
$382.00
|
| Rate for Payer: Zelis Worker's Compensation |
$260.71
|
|
|
CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULAT
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
8727816
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$260.71 |
| Max. Negotiated Rate |
$907.25 |
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cigna Commercial |
$811.75
|
| Rate for Payer: First Health Commercial |
$859.50
|
| Rate for Payer: First Health Workers Compensation |
$368.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$859.50
|
| Rate for Payer: GEHA Commercial |
$668.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$859.50
|
| Rate for Payer: Multiplan All |
$869.05
|
| Rate for Payer: OMNI Networks Commercial |
$668.50
|
| Rate for Payer: One Health Plan PPO/POS |
$859.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$907.25
|
| Rate for Payer: Three Rivers Provider Network All |
$716.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$888.15
|
| Rate for Payer: Zelis Auto |
$382.00
|
| Rate for Payer: Zelis Worker's Compensation |
$260.71
|
|
