|
PLACEMENT OF DRAIN PANCREAS
|
Facility
|
OP
|
$4,831.00
|
|
|
Service Code
|
CPT 48001
|
| Hospital Charge Code |
6148001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,207.75 |
| Max. Negotiated Rate |
$4,589.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,898.60
|
| Rate for Payer: Cash Price |
$2,898.60
|
| Rate for Payer: Cigna Commercial |
$4,106.35
|
| Rate for Payer: First Health Commercial |
$4,347.90
|
| Rate for Payer: First Health Workers Compensation |
$1,865.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,347.90
|
| Rate for Payer: GEHA Commercial |
$3,864.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,347.90
|
| Rate for Payer: Humana ChoiceCare |
$1,256.06
|
| Rate for Payer: Multiplan All |
$4,396.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,898.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,381.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,347.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,589.45
|
| Rate for Payer: Three Rivers Provider Network All |
$3,623.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,251.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,207.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,492.83
|
| Rate for Payer: Zelis Auto |
$1,932.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,415.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,318.86
|
|
|
PLACEMENT OF DRAIN PANCREAS
|
Facility
|
IP
|
$4,831.00
|
|
|
Service Code
|
CPT 48001
|
| Hospital Charge Code |
6148001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,318.86 |
| Max. Negotiated Rate |
$4,589.45 |
| Rate for Payer: Cash Price |
$2,898.60
|
| Rate for Payer: Cigna Commercial |
$4,106.35
|
| Rate for Payer: First Health Commercial |
$4,347.90
|
| Rate for Payer: First Health Workers Compensation |
$1,865.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,347.90
|
| Rate for Payer: GEHA Commercial |
$3,381.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,347.90
|
| Rate for Payer: Multiplan All |
$4,396.21
|
| Rate for Payer: OMNI Networks Commercial |
$3,381.70
|
| Rate for Payer: One Health Plan PPO/POS |
$4,347.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,589.45
|
| Rate for Payer: Three Rivers Provider Network All |
$3,623.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,492.83
|
| Rate for Payer: Zelis Auto |
$1,932.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,318.86
|
|
|
PLACEMENT OF SETON
|
Facility
|
OP
|
$5,208.02
|
|
|
Service Code
|
CPT 46020
|
| Hospital Charge Code |
6146020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,919.98 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: First Health Workers Compensation |
$3,351.36
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$2,369.65
|
|
|
PLACEMENT OF SETON
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
CPT 46020
|
| Hospital Charge Code |
6146020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$360.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$510.00
|
| Rate for Payer: First Health Commercial |
$540.00
|
| Rate for Payer: First Health Workers Compensation |
$231.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$540.00
|
| Rate for Payer: GEHA Commercial |
$480.00
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$540.00
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: Multiplan All |
$546.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: OMNI Networks Commercial |
$420.00
|
| Rate for Payer: One Health Plan PPO/POS |
$540.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$570.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: Three Rivers Provider Network All |
$450.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$558.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Auto |
$240.00
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$163.80
|
|
|
PLACEMENT OF SETON
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
CPT 46020
|
| Hospital Charge Code |
6146020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$510.00
|
| Rate for Payer: First Health Commercial |
$540.00
|
| Rate for Payer: First Health Workers Compensation |
$231.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$540.00
|
| Rate for Payer: GEHA Commercial |
$420.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$540.00
|
| Rate for Payer: Multiplan All |
$546.00
|
| Rate for Payer: OMNI Networks Commercial |
$420.00
|
| Rate for Payer: One Health Plan PPO/POS |
$540.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$570.00
|
| Rate for Payer: Three Rivers Provider Network All |
$450.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$558.00
|
| Rate for Payer: Zelis Auto |
$240.00
|
| Rate for Payer: Zelis Worker's Compensation |
$163.80
|
|
|
PLACEMENT OF SETON
|
Facility
|
OP
|
$5,208.02
|
|
|
Service Code
|
CPT 46020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,919.98 |
| Max. Negotiated Rate |
$5,208.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,423.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,919.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,604.01
|
| Rate for Payer: First Health Workers Compensation |
$3,351.36
|
| Rate for Payer: GEHA Medicare |
$2,604.01
|
| Rate for Payer: Humana ChoiceCare |
$2,864.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,604.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,374.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,959.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,604.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,426.82
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,262.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,959.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,604.01
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,208.02
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,551.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,959.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,604.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,604.01
|
| Rate for Payer: Zelis Medicare |
$2,213.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,124.81
|
| Rate for Payer: Zelis Worker's Compensation |
$2,369.65
|
|
|
PLACE NDL MUSC/TIS FOR RT
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
CPT 20555
|
| Hospital Charge Code |
6120555
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$232.05 |
| Max. Negotiated Rate |
$807.50 |
| Rate for Payer: Cash Price |
$510.00
|
| Rate for Payer: Cigna Commercial |
$722.50
|
| Rate for Payer: First Health Commercial |
$765.00
|
| Rate for Payer: First Health Workers Compensation |
$328.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$765.00
|
| Rate for Payer: GEHA Commercial |
$595.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$765.00
|
| Rate for Payer: Multiplan All |
$773.50
|
| Rate for Payer: OMNI Networks Commercial |
$595.00
|
| Rate for Payer: One Health Plan PPO/POS |
$765.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$807.50
|
| Rate for Payer: Three Rivers Provider Network All |
$637.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$790.50
|
| Rate for Payer: Zelis Auto |
$340.00
|
| Rate for Payer: Zelis Worker's Compensation |
$232.05
|
|
|
PLACE NDL MUSC/TIS FOR RT
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
CPT 20555
|
| Hospital Charge Code |
6120555
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$232.05 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$510.00
|
| Rate for Payer: Cash Price |
$510.00
|
| Rate for Payer: Cigna Commercial |
$722.50
|
| Rate for Payer: First Health Commercial |
$765.00
|
| Rate for Payer: First Health Workers Compensation |
$328.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$765.00
|
| Rate for Payer: GEHA Commercial |
$680.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$765.00
|
| 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 |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$773.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$595.00
|
| Rate for Payer: One Health Plan PPO/POS |
$765.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$807.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$637.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$790.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$340.00
|
| 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 |
$232.05
|
|
|
PLACE NEEDLES PELVIC FOR RT
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
CPT 55920
|
| Hospital Charge Code |
6155920
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$252.53 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,748.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$555.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,748.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,177.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cigna Commercial |
$786.25
|
| Rate for Payer: First Health Commercial |
$832.50
|
| Rate for Payer: First Health Workers Compensation |
$357.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$832.50
|
| Rate for Payer: GEHA Commercial |
$740.00
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$832.50
|
| Rate for Payer: Humana ChoiceCare |
$5,156.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,687.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,874.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,221.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: Multiplan All |
$841.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: OMNI Networks Commercial |
$647.50
|
| Rate for Payer: One Health Plan PPO/POS |
$832.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,565.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,221.87
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$878.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: Three Rivers Provider Network All |
$693.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,221.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: United Payors & United Providers UP&UP |
$860.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Auto |
$370.00
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| Rate for Payer: Zelis Worker's Compensation |
$252.53
|
|
|
PLACE NEEDLES PELVIC FOR RT
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 55920
|
| Hospital Charge Code |
6155920
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$252.53 |
| Max. Negotiated Rate |
$878.75 |
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cigna Commercial |
$786.25
|
| Rate for Payer: First Health Commercial |
$832.50
|
| Rate for Payer: First Health Workers Compensation |
$357.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$832.50
|
| Rate for Payer: GEHA Commercial |
$647.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$832.50
|
| Rate for Payer: Multiplan All |
$841.75
|
| Rate for Payer: OMNI Networks Commercial |
$647.50
|
| Rate for Payer: One Health Plan PPO/POS |
$832.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$878.75
|
| Rate for Payer: Three Rivers Provider Network All |
$693.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$860.25
|
| Rate for Payer: Zelis Auto |
$370.00
|
| Rate for Payer: Zelis Worker's Compensation |
$252.53
|
|
|
PLACENTAL TISSUE 2.0CC VIAFLOW
|
Facility
|
IP
|
$11,461.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,584.40 |
| Max. Negotiated Rate |
$10,887.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,168.80
|
| Rate for Payer: Cash Price |
$6,876.60
|
| Rate for Payer: Cash Price |
$6,876.60
|
| Rate for Payer: Cigna Commercial |
$9,741.85
|
| Rate for Payer: First Health Commercial |
$10,314.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,314.90
|
| Rate for Payer: GEHA Commercial |
$8,022.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,314.90
|
| Rate for Payer: Multiplan All |
$10,429.51
|
| Rate for Payer: OMNI Networks Commercial |
$8,022.70
|
| Rate for Payer: One Health Plan PPO/POS |
$10,314.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,887.95
|
| Rate for Payer: Three Rivers Provider Network All |
$8,595.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,658.73
|
| Rate for Payer: Zelis Auto |
$4,584.40
|
|
|
PLACENTAL TISSUE 2.0CC VIAFLOW
|
Facility
|
OP
|
$11,461.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,865.25 |
| Max. Negotiated Rate |
$10,887.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,876.60
|
| Rate for Payer: Cash Price |
$6,876.60
|
| Rate for Payer: Cash Price |
$6,876.60
|
| Rate for Payer: Cigna Commercial |
$9,741.85
|
| Rate for Payer: First Health Commercial |
$10,314.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,314.90
|
| Rate for Payer: GEHA Commercial |
$9,168.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,314.90
|
| Rate for Payer: Humana ChoiceCare |
$2,979.86
|
| Rate for Payer: Multiplan All |
$10,429.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,876.60
|
| Rate for Payer: OMNI Networks Commercial |
$8,022.70
|
| Rate for Payer: One Health Plan PPO/POS |
$10,314.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,887.95
|
| Rate for Payer: Three Rivers Provider Network All |
$8,595.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10,085.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,865.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,658.73
|
| Rate for Payer: Zelis Auto |
$4,584.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,730.50
|
|
|
PLACE PO BREAST CATH FOR RAD
|
Facility
|
OP
|
$677.00
|
|
|
Service Code
|
CPT 19296
|
| Hospital Charge Code |
6119296
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$184.82 |
| Max. Negotiated Rate |
$18,172.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,887.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$406.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,887.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,663.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9,086.20
|
| Rate for Payer: Cash Price |
$406.20
|
| Rate for Payer: Cash Price |
$406.20
|
| Rate for Payer: Cigna Commercial |
$575.45
|
| Rate for Payer: First Health Commercial |
$609.30
|
| Rate for Payer: First Health Workers Compensation |
$261.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$609.30
|
| Rate for Payer: GEHA Commercial |
$541.60
|
| Rate for Payer: GEHA Medicare |
$9,086.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$609.30
|
| Rate for Payer: Humana ChoiceCare |
$9,994.82
|
| Rate for Payer: Humana Medicare Advantage |
$9,086.20
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15,264.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,758.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9,086.20
|
| Rate for Payer: Multiplan All |
$616.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15,446.54
|
| Rate for Payer: OMNI Networks Commercial |
$473.90
|
| Rate for Payer: One Health Plan PPO/POS |
$609.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5,494.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,758.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9,086.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$643.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$18,172.40
|
| Rate for Payer: Three Rivers Provider Network All |
$507.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,904.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,758.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,086.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$629.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,086.20
|
| Rate for Payer: Zelis Auto |
$270.80
|
| Rate for Payer: Zelis Medicare |
$7,723.27
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10,903.44
|
| Rate for Payer: Zelis Worker's Compensation |
$184.82
|
|
|
PLACE PO BREAST CATH FOR RAD
|
Facility
|
IP
|
$677.00
|
|
|
Service Code
|
CPT 19296
|
| Hospital Charge Code |
6119296
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$184.82 |
| Max. Negotiated Rate |
$643.15 |
| Rate for Payer: Cash Price |
$406.20
|
| Rate for Payer: Cigna Commercial |
$575.45
|
| Rate for Payer: First Health Commercial |
$609.30
|
| Rate for Payer: First Health Workers Compensation |
$261.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$609.30
|
| Rate for Payer: GEHA Commercial |
$473.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$609.30
|
| Rate for Payer: Multiplan All |
$616.07
|
| Rate for Payer: OMNI Networks Commercial |
$473.90
|
| Rate for Payer: One Health Plan PPO/POS |
$609.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$643.15
|
| Rate for Payer: Three Rivers Provider Network All |
$507.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$629.61
|
| Rate for Payer: Zelis Auto |
$270.80
|
| Rate for Payer: Zelis Worker's Compensation |
$184.82
|
|
|
PLACE RT DEVICE/MARKER PROS
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
CPT 55876
|
| Hospital Charge Code |
6155876
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$84.90 |
| Max. Negotiated Rate |
$2,598.44 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,557.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$186.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,557.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,233.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,299.22
|
| Rate for Payer: Cash Price |
$186.60
|
| Rate for Payer: Cash Price |
$186.60
|
| Rate for Payer: Cigna Commercial |
$264.35
|
| Rate for Payer: First Health Commercial |
$279.90
|
| Rate for Payer: First Health Workers Compensation |
$120.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.90
|
| Rate for Payer: GEHA Commercial |
$248.80
|
| Rate for Payer: GEHA Medicare |
$1,299.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.90
|
| Rate for Payer: Humana ChoiceCare |
$1,429.14
|
| Rate for Payer: Humana Medicare Advantage |
$1,299.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,182.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,258.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,299.22
|
| Rate for Payer: Multiplan All |
$283.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,208.67
|
| Rate for Payer: OMNI Networks Commercial |
$217.70
|
| Rate for Payer: One Health Plan PPO/POS |
$279.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,453.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,258.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,299.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$295.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,598.44
|
| Rate for Payer: Three Rivers Provider Network All |
$233.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,273.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,258.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,299.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$289.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,299.22
|
| Rate for Payer: Zelis Auto |
$124.40
|
| Rate for Payer: Zelis Medicare |
$1,104.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,559.06
|
| Rate for Payer: Zelis Worker's Compensation |
$84.90
|
|
|
PLACE RT DEVICE/MARKER PROS
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
CPT 55876
|
| Hospital Charge Code |
6155876
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$84.90 |
| Max. Negotiated Rate |
$295.45 |
| Rate for Payer: Cash Price |
$186.60
|
| Rate for Payer: Cigna Commercial |
$264.35
|
| Rate for Payer: First Health Commercial |
$279.90
|
| Rate for Payer: First Health Workers Compensation |
$120.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.90
|
| Rate for Payer: GEHA Commercial |
$217.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.90
|
| Rate for Payer: Multiplan All |
$283.01
|
| Rate for Payer: OMNI Networks Commercial |
$217.70
|
| Rate for Payer: One Health Plan PPO/POS |
$279.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$295.45
|
| Rate for Payer: Three Rivers Provider Network All |
$233.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$289.23
|
| Rate for Payer: Zelis Auto |
$124.40
|
| Rate for Payer: Zelis Worker's Compensation |
$84.90
|
|
|
PLASTAZOTE SANDAL EACH
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT L3265
|
| Hospital Charge Code |
8230054
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$12.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Humana ChoiceCare |
$3.90
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.00
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.50
|
|
|
PLASTAZOTE SANDAL EACH
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT L3265
|
| Hospital Charge Code |
8230054
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$10.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
|
|
PLATE 14 HOLE STRYKER
|
Facility
|
OP
|
$7,576.02
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,894.01 |
| Max. Negotiated Rate |
$7,197.22 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,545.61
|
| Rate for Payer: Cash Price |
$4,545.61
|
| Rate for Payer: Cash Price |
$4,545.61
|
| Rate for Payer: Cigna Commercial |
$6,439.62
|
| Rate for Payer: First Health Commercial |
$6,818.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,818.42
|
| Rate for Payer: GEHA Commercial |
$6,060.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,818.42
|
| Rate for Payer: Humana ChoiceCare |
$1,969.77
|
| Rate for Payer: Multiplan All |
$6,894.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,545.61
|
| Rate for Payer: OMNI Networks Commercial |
$5,303.21
|
| Rate for Payer: One Health Plan PPO/POS |
$6,818.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,197.22
|
| Rate for Payer: Three Rivers Provider Network All |
$5,682.02
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,666.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,894.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,045.70
|
| Rate for Payer: Zelis Auto |
$3,030.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,788.01
|
|
|
PLATE 14 HOLE STRYKER
|
Facility
|
IP
|
$7,576.02
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,030.41 |
| Max. Negotiated Rate |
$7,197.22 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,060.82
|
| Rate for Payer: Cash Price |
$4,545.61
|
| Rate for Payer: Cash Price |
$4,545.61
|
| Rate for Payer: Cigna Commercial |
$6,439.62
|
| Rate for Payer: First Health Commercial |
$6,818.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,818.42
|
| Rate for Payer: GEHA Commercial |
$5,303.21
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,818.42
|
| Rate for Payer: Multiplan All |
$6,894.18
|
| Rate for Payer: OMNI Networks Commercial |
$5,303.21
|
| Rate for Payer: One Health Plan PPO/POS |
$6,818.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,197.22
|
| Rate for Payer: Three Rivers Provider Network All |
$5,682.02
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,045.70
|
| Rate for Payer: Zelis Auto |
$3,030.41
|
|
|
PLATE 3 HOLE VOLAR
|
Facility
|
IP
|
$4,386.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,754.40 |
| Max. Negotiated Rate |
$4,166.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,508.80
|
| Rate for Payer: Cash Price |
$2,631.60
|
| Rate for Payer: Cash Price |
$2,631.60
|
| Rate for Payer: Cigna Commercial |
$3,728.10
|
| Rate for Payer: First Health Commercial |
$3,947.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,947.40
|
| Rate for Payer: GEHA Commercial |
$3,070.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,947.40
|
| Rate for Payer: Multiplan All |
$3,991.26
|
| Rate for Payer: OMNI Networks Commercial |
$3,070.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,947.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,166.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,289.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,078.98
|
| Rate for Payer: Zelis Auto |
$1,754.40
|
|
|
PLATE 3 HOLE VOLAR
|
Facility
|
OP
|
$4,386.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,096.50 |
| Max. Negotiated Rate |
$4,166.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,631.60
|
| Rate for Payer: Cash Price |
$2,631.60
|
| Rate for Payer: Cash Price |
$2,631.60
|
| Rate for Payer: Cigna Commercial |
$3,728.10
|
| Rate for Payer: First Health Commercial |
$3,947.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,947.40
|
| Rate for Payer: GEHA Commercial |
$3,508.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,947.40
|
| Rate for Payer: Humana ChoiceCare |
$1,140.36
|
| Rate for Payer: Multiplan All |
$3,991.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,631.60
|
| Rate for Payer: OMNI Networks Commercial |
$3,070.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,947.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,166.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,289.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,859.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,096.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,078.98
|
| Rate for Payer: Zelis Auto |
$1,754.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,193.00
|
|
|
PLATE 3 HOLE VOLAR STANDARD
|
Facility
|
IP
|
$5,598.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,239.20 |
| Max. Negotiated Rate |
$5,318.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,478.40
|
| Rate for Payer: Cash Price |
$3,358.80
|
| Rate for Payer: Cash Price |
$3,358.80
|
| Rate for Payer: Cigna Commercial |
$4,758.30
|
| Rate for Payer: First Health Commercial |
$5,038.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,038.20
|
| Rate for Payer: GEHA Commercial |
$3,918.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,038.20
|
| Rate for Payer: Multiplan All |
$5,094.18
|
| Rate for Payer: OMNI Networks Commercial |
$3,918.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,038.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,318.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,198.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,206.14
|
| Rate for Payer: Zelis Auto |
$2,239.20
|
|
|
PLATE 3 HOLE VOLAR STANDARD
|
Facility
|
OP
|
$5,598.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.50 |
| Max. Negotiated Rate |
$5,318.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,358.80
|
| Rate for Payer: Cash Price |
$3,358.80
|
| Rate for Payer: Cash Price |
$3,358.80
|
| Rate for Payer: Cigna Commercial |
$4,758.30
|
| Rate for Payer: First Health Commercial |
$5,038.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,038.20
|
| Rate for Payer: GEHA Commercial |
$4,478.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,038.20
|
| Rate for Payer: Humana ChoiceCare |
$1,455.48
|
| Rate for Payer: Multiplan All |
$5,094.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,358.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,918.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,038.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,318.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,198.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,926.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,399.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,206.14
|
| Rate for Payer: Zelis Auto |
$2,239.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,799.00
|
|
|
PLATE 4 HOLE VOLAR
|
Facility
|
IP
|
$4,386.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,754.40 |
| Max. Negotiated Rate |
$4,166.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,508.80
|
| Rate for Payer: Cash Price |
$2,631.60
|
| Rate for Payer: Cash Price |
$2,631.60
|
| Rate for Payer: Cigna Commercial |
$3,728.10
|
| Rate for Payer: First Health Commercial |
$3,947.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,947.40
|
| Rate for Payer: GEHA Commercial |
$3,070.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,947.40
|
| Rate for Payer: Multiplan All |
$3,991.26
|
| Rate for Payer: OMNI Networks Commercial |
$3,070.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,947.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,166.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,289.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,078.98
|
| Rate for Payer: Zelis Auto |
$1,754.40
|
|
