|
OPEN TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, EACH
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 26735
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,070.11 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,070.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| 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 |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,438.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,112.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| 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 |
$2,803.61
|
|
|
OPEN TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, INCLUDES REPAIR OF TUBEROSITY(S), WHEN PERFORMED;
|
Facility
|
OP
|
$24,435.12
|
|
|
Service Code
|
CPT 23615
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,244.47 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,620.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,244.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: First Health Workers Compensation |
$15,724.00
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,351.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,178.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,351.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,351.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Medicare |
$10,384.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,661.07
|
| Rate for Payer: Zelis Worker's Compensation |
$11,117.98
|
|
|
OPEN TREATMENT OF RADIAL SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 25515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,641.90 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$6,172.77
|
|
|
OPEN TREATMENT OF RADIAL SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, AND CLOSED TREATMENT OF DISTAL RADIOULNAR JOINT DISLOCATION (GALEAZZI FRACTURE/ DISLOCATION), INCLUDES PERCUTANEOUS SKELETAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 25525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,641.90 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$6,172.77
|
|
|
OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, MEDIAL AND/OR LATERAL MALLEOLUS; WITHOUT FIXATION OF POSTERIOR LIP
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 27822
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,641.90 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$6,172.77
|
|
|
OPEN TREATMENT OF ULNAR FRACTURE, PROXIMAL END (EG, OLECRANON OR CORONOID PROCESS[ES]), INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 24685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,641.90 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$6,172.77
|
|
|
OPEN TREATMENT OF ULNAR SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 25545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,641.90 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,597.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,641.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,716.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,290.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,716.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,716.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$6,172.77
|
|
|
OPEN TRTMNT METACARPOPHALANGEAL DISLOCAT
|
Facility
|
OP
|
$1,699.32
|
|
|
Service Code
|
CPT 26715
|
| Hospital Charge Code |
8126715
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$463.91 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,019.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,070.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$1,019.59
|
| Rate for Payer: Cash Price |
$1,019.59
|
| Rate for Payer: Cigna Commercial |
$1,444.42
|
| Rate for Payer: First Health Commercial |
$1,529.39
|
| Rate for Payer: First Health Workers Compensation |
$656.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,529.39
|
| Rate for Payer: GEHA Commercial |
$1,359.46
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,529.39
|
| 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 |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,546.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,189.52
|
| Rate for Payer: One Health Plan PPO/POS |
$1,529.39
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,438.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,112.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,614.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,274.49
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,580.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$679.73
|
| 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 |
$463.91
|
|
|
OPEN TRTMNT METACARPOPHALANGEAL DISLOCAT
|
Facility
|
IP
|
$1,699.32
|
|
|
Service Code
|
CPT 26715
|
| Hospital Charge Code |
8126715
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$463.91 |
| Max. Negotiated Rate |
$1,614.35 |
| Rate for Payer: Cash Price |
$1,019.59
|
| Rate for Payer: Cigna Commercial |
$1,444.42
|
| Rate for Payer: First Health Commercial |
$1,529.39
|
| Rate for Payer: First Health Workers Compensation |
$656.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,529.39
|
| Rate for Payer: GEHA Commercial |
$1,189.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,529.39
|
| Rate for Payer: Multiplan All |
$1,546.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,189.52
|
| Rate for Payer: One Health Plan PPO/POS |
$1,529.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,614.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,274.49
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,580.37
|
| Rate for Payer: Zelis Auto |
$679.73
|
| Rate for Payer: Zelis Worker's Compensation |
$463.91
|
|
|
OPEN TX COMPL FRONT SINUS FX
|
Facility
|
OP
|
$2,873.00
|
|
|
Service Code
|
CPT 21344
|
| Hospital Charge Code |
6121344
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$2,729.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,723.80
|
| Rate for Payer: Cash Price |
$1,723.80
|
| Rate for Payer: Cigna Commercial |
$2,442.05
|
| Rate for Payer: First Health Commercial |
$2,585.70
|
| Rate for Payer: First Health Workers Compensation |
$1,109.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,585.70
|
| Rate for Payer: GEHA Commercial |
$2,298.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,585.70
|
| Rate for Payer: Humana ChoiceCare |
$746.98
|
| Rate for Payer: Multiplan All |
$2,614.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,723.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,011.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,585.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,729.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,154.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,528.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$718.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,671.89
|
| Rate for Payer: Zelis Auto |
$1,149.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,436.50
|
| Rate for Payer: Zelis Worker's Compensation |
$784.33
|
|
|
OPEN TX COMPL FRONT SINUS FX
|
Facility
|
IP
|
$2,873.00
|
|
|
Service Code
|
CPT 21344
|
| Hospital Charge Code |
6121344
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$784.33 |
| Max. Negotiated Rate |
$2,729.35 |
| Rate for Payer: Cash Price |
$1,723.80
|
| Rate for Payer: Cigna Commercial |
$2,442.05
|
| Rate for Payer: First Health Commercial |
$2,585.70
|
| Rate for Payer: First Health Workers Compensation |
$1,109.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,585.70
|
| Rate for Payer: GEHA Commercial |
$2,011.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,585.70
|
| Rate for Payer: Multiplan All |
$2,614.43
|
| Rate for Payer: OMNI Networks Commercial |
$2,011.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,585.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,729.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,154.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,671.89
|
| Rate for Payer: Zelis Auto |
$1,149.20
|
| Rate for Payer: Zelis Worker's Compensation |
$784.33
|
|
|
OPEN TX DISTAL PHALANGEAL FRACTURE EACH
|
Facility
|
IP
|
$1,011.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
6126765
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$276.00 |
| Max. Negotiated Rate |
$960.45 |
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$859.35
|
| Rate for Payer: First Health Commercial |
$909.90
|
| Rate for Payer: First Health Workers Compensation |
$390.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$909.90
|
| Rate for Payer: GEHA Commercial |
$707.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$909.90
|
| Rate for Payer: Multiplan All |
$920.01
|
| Rate for Payer: OMNI Networks Commercial |
$707.70
|
| Rate for Payer: One Health Plan PPO/POS |
$909.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$960.45
|
| Rate for Payer: Three Rivers Provider Network All |
$758.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$940.23
|
| Rate for Payer: Zelis Auto |
$404.40
|
| Rate for Payer: Zelis Worker's Compensation |
$276.00
|
|
|
OPEN TX DISTAL PHALANGEAL FRACTURE EACH
|
Facility
|
IP
|
$1,487.28
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
8126765
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$406.03 |
| Max. Negotiated Rate |
$1,412.92 |
| Rate for Payer: Cash Price |
$892.37
|
| Rate for Payer: Cigna Commercial |
$1,264.19
|
| Rate for Payer: First Health Commercial |
$1,338.55
|
| Rate for Payer: First Health Workers Compensation |
$574.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,338.55
|
| Rate for Payer: GEHA Commercial |
$1,041.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,338.55
|
| Rate for Payer: Multiplan All |
$1,353.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,041.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,338.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,412.92
|
| Rate for Payer: Three Rivers Provider Network All |
$1,115.46
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,383.17
|
| Rate for Payer: Zelis Auto |
$594.91
|
| Rate for Payer: Zelis Worker's Compensation |
$406.03
|
|
|
OPEN TX DISTAL PHALANGEAL FRACTURE EACH
|
Facility
|
OP
|
$1,011.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
6126765
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$276.00 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$606.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,070.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna Commercial |
$859.35
|
| Rate for Payer: First Health Commercial |
$909.90
|
| Rate for Payer: First Health Workers Compensation |
$390.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$909.90
|
| Rate for Payer: GEHA Commercial |
$808.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$909.90
|
| 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 |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$920.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$707.70
|
| Rate for Payer: One Health Plan PPO/POS |
$909.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,438.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,112.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$960.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$758.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$940.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$404.40
|
| 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 |
$276.00
|
|
|
OPEN TX DISTAL PHALANGEAL FRACTURE EACH
|
Facility
|
OP
|
$1,487.28
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
8126765
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$406.03 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$892.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,070.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$892.37
|
| Rate for Payer: Cash Price |
$892.37
|
| Rate for Payer: Cigna Commercial |
$1,264.19
|
| Rate for Payer: First Health Commercial |
$1,338.55
|
| Rate for Payer: First Health Workers Compensation |
$574.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,338.55
|
| Rate for Payer: GEHA Commercial |
$1,189.82
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,338.55
|
| 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 |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,353.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,041.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,338.55
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,438.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,112.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,412.92
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,115.46
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,383.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$594.91
|
| 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 |
$406.03
|
|
|
OPEN TX DPRSD FRONT SINUS FX
|
Facility
|
IP
|
$2,444.00
|
|
|
Service Code
|
CPT 21343
|
| Hospital Charge Code |
6121343
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$667.21 |
| Max. Negotiated Rate |
$2,321.80 |
| Rate for Payer: Cash Price |
$1,466.40
|
| Rate for Payer: Cigna Commercial |
$2,077.40
|
| Rate for Payer: First Health Commercial |
$2,199.60
|
| Rate for Payer: First Health Workers Compensation |
$943.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,199.60
|
| Rate for Payer: GEHA Commercial |
$1,710.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,199.60
|
| Rate for Payer: Multiplan All |
$2,224.04
|
| Rate for Payer: OMNI Networks Commercial |
$1,710.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,199.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,321.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,833.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,272.92
|
| Rate for Payer: Zelis Auto |
$977.60
|
| Rate for Payer: Zelis Worker's Compensation |
$667.21
|
|
|
OPEN TX DPRSD FRONT SINUS FX
|
Facility
|
OP
|
$2,444.00
|
|
|
Service Code
|
CPT 21343
|
| Hospital Charge Code |
6121343
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$611.00 |
| Max. Negotiated Rate |
$2,321.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,466.40
|
| Rate for Payer: Cash Price |
$1,466.40
|
| Rate for Payer: Cigna Commercial |
$2,077.40
|
| Rate for Payer: First Health Commercial |
$2,199.60
|
| Rate for Payer: First Health Workers Compensation |
$943.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,199.60
|
| Rate for Payer: GEHA Commercial |
$1,955.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,199.60
|
| Rate for Payer: Humana ChoiceCare |
$635.44
|
| Rate for Payer: Multiplan All |
$2,224.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,466.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,710.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,199.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,321.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,833.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,150.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$611.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,272.92
|
| Rate for Payer: Zelis Auto |
$977.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,222.00
|
| Rate for Payer: Zelis Worker's Compensation |
$667.21
|
|
|
OPEN TX NOSE FX UNCOMPLICATD
|
Facility
|
IP
|
$946.00
|
|
|
Service Code
|
CPT 21325
|
| Hospital Charge Code |
6121325
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$258.26 |
| Max. Negotiated Rate |
$898.70 |
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cigna Commercial |
$804.10
|
| Rate for Payer: First Health Commercial |
$851.40
|
| Rate for Payer: First Health Workers Compensation |
$365.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$851.40
|
| Rate for Payer: GEHA Commercial |
$662.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$851.40
|
| Rate for Payer: Multiplan All |
$860.86
|
| Rate for Payer: OMNI Networks Commercial |
$662.20
|
| Rate for Payer: One Health Plan PPO/POS |
$851.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$898.70
|
| Rate for Payer: Three Rivers Provider Network All |
$709.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$879.78
|
| Rate for Payer: Zelis Auto |
$378.40
|
| Rate for Payer: Zelis Worker's Compensation |
$258.26
|
|
|
OPEN TX NOSE FX UNCOMPLICATD
|
Facility
|
OP
|
$946.00
|
|
|
Service Code
|
CPT 21325
|
| Hospital Charge Code |
6121325
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$258.26 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$567.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cigna Commercial |
$804.10
|
| Rate for Payer: First Health Commercial |
$851.40
|
| Rate for Payer: First Health Workers Compensation |
$365.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$851.40
|
| Rate for Payer: GEHA Commercial |
$756.80
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$851.40
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$860.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$662.20
|
| Rate for Payer: One Health Plan PPO/POS |
$851.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$898.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$709.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$879.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$378.40
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$258.26
|
|
|
OPEN TX NOSE FX W/SKELE FIXJ
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
CPT 21330
|
| Hospital Charge Code |
6121330
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$311.49 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$684.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$684.60
|
| Rate for Payer: Cash Price |
$684.60
|
| Rate for Payer: Cigna Commercial |
$969.85
|
| Rate for Payer: First Health Commercial |
$1,026.90
|
| Rate for Payer: First Health Workers Compensation |
$440.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,026.90
|
| Rate for Payer: GEHA Commercial |
$912.80
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,026.90
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,038.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$798.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,026.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,083.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$855.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,061.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$456.40
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$311.49
|
|
|
OPEN TX NOSE FX W/SKELE FIXJ
|
Facility
|
IP
|
$1,141.00
|
|
|
Service Code
|
CPT 21330
|
| Hospital Charge Code |
6121330
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$311.49 |
| Max. Negotiated Rate |
$1,083.95 |
| Rate for Payer: Cash Price |
$684.60
|
| Rate for Payer: Cigna Commercial |
$969.85
|
| Rate for Payer: First Health Commercial |
$1,026.90
|
| Rate for Payer: First Health Workers Compensation |
$440.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,026.90
|
| Rate for Payer: GEHA Commercial |
$798.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,026.90
|
| Rate for Payer: Multiplan All |
$1,038.31
|
| Rate for Payer: OMNI Networks Commercial |
$798.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,026.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,083.95
|
| Rate for Payer: Three Rivers Provider Network All |
$855.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,061.13
|
| Rate for Payer: Zelis Auto |
$456.40
|
| Rate for Payer: Zelis Worker's Compensation |
$311.49
|
|
|
OPEN TX NOSE & SEPTAL FX
|
Facility
|
IP
|
$1,477.00
|
|
|
Service Code
|
CPT 21335
|
| Hospital Charge Code |
6121335
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$403.22 |
| Max. Negotiated Rate |
$1,403.15 |
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$1,255.45
|
| Rate for Payer: First Health Commercial |
$1,329.30
|
| Rate for Payer: First Health Workers Compensation |
$570.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,329.30
|
| Rate for Payer: GEHA Commercial |
$1,033.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,329.30
|
| Rate for Payer: Multiplan All |
$1,344.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,033.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,329.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,403.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,107.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,373.61
|
| Rate for Payer: Zelis Auto |
$590.80
|
| Rate for Payer: Zelis Worker's Compensation |
$403.22
|
|
|
OPEN TX NOSE & SEPTAL FX
|
Facility
|
OP
|
$1,477.00
|
|
|
Service Code
|
CPT 21335
|
| Hospital Charge Code |
6121335
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$403.22 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$886.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cash Price |
$886.20
|
| Rate for Payer: Cigna Commercial |
$1,255.45
|
| Rate for Payer: First Health Commercial |
$1,329.30
|
| Rate for Payer: First Health Workers Compensation |
$570.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,329.30
|
| Rate for Payer: GEHA Commercial |
$1,181.60
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,329.30
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$1,344.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$1,033.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,329.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,403.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$1,107.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,373.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$590.80
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$403.22
|
|
|
OPEN TX PHALANGEAL SHAFT FX PROX/MIDDLE
|
Facility
|
IP
|
$1,209.00
|
|
|
Service Code
|
CPT 26735
|
| Hospital Charge Code |
6126735
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$330.06 |
| Max. Negotiated Rate |
$1,148.55 |
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cigna Commercial |
$1,027.65
|
| Rate for Payer: First Health Commercial |
$1,088.10
|
| Rate for Payer: First Health Workers Compensation |
$466.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,088.10
|
| Rate for Payer: GEHA Commercial |
$846.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,088.10
|
| Rate for Payer: Multiplan All |
$1,100.19
|
| Rate for Payer: OMNI Networks Commercial |
$846.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,088.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,148.55
|
| Rate for Payer: Three Rivers Provider Network All |
$906.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,124.37
|
| Rate for Payer: Zelis Auto |
$483.60
|
| Rate for Payer: Zelis Worker's Compensation |
$330.06
|
|
|
OPEN TX PHALANGEAL SHAFT FX PROX/MIDDLE
|
Facility
|
OP
|
$1,209.00
|
|
|
Service Code
|
CPT 26735
|
| Hospital Charge Code |
6126735
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$330.06 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$725.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,070.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cigna Commercial |
$1,027.65
|
| Rate for Payer: First Health Commercial |
$1,088.10
|
| Rate for Payer: First Health Workers Compensation |
$466.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,088.10
|
| Rate for Payer: GEHA Commercial |
$967.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,088.10
|
| 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 |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,100.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$846.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,088.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,438.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,112.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,148.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$906.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,124.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$483.60
|
| 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 |
$330.06
|
|
