|
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
|
|
|
PLATE 67MM 3 HL VARIAX BN HUM DIST
|
Facility
|
OP
|
$3,654.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.50 |
| Max. Negotiated Rate |
$3,471.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cigna Commercial |
$3,105.90
|
| Rate for Payer: First Health Commercial |
$3,288.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,288.60
|
| Rate for Payer: GEHA Commercial |
$2,923.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,288.60
|
| Rate for Payer: Humana ChoiceCare |
$950.04
|
| Rate for Payer: Multiplan All |
$3,325.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,192.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,557.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,288.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,471.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,740.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,215.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$913.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,398.22
|
| Rate for Payer: Zelis Auto |
$1,461.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,827.00
|
|
|
PLATE 67MM 3 HL VARIAX BN HUM DIST
|
Facility
|
IP
|
$3,654.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,461.60 |
| Max. Negotiated Rate |
$3,471.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,923.20
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cigna Commercial |
$3,105.90
|
| Rate for Payer: First Health Commercial |
$3,288.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,288.60
|
| Rate for Payer: GEHA Commercial |
$2,557.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,288.60
|
| Rate for Payer: Multiplan All |
$3,325.14
|
| Rate for Payer: OMNI Networks Commercial |
$2,557.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,288.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,471.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,740.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,398.22
|
| Rate for Payer: Zelis Auto |
$1,461.60
|
|
|
PLATE 7HOLE ELBOW VARIAX
|
Facility
|
OP
|
$3,654.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.50 |
| Max. Negotiated Rate |
$3,471.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cigna Commercial |
$3,105.90
|
| Rate for Payer: First Health Commercial |
$3,288.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,288.60
|
| Rate for Payer: GEHA Commercial |
$2,923.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,288.60
|
| Rate for Payer: Humana ChoiceCare |
$950.04
|
| Rate for Payer: Multiplan All |
$3,325.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,192.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,557.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,288.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,471.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,740.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,215.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$913.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,398.22
|
| Rate for Payer: Zelis Auto |
$1,461.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,827.00
|
|
|
PLATE 7HOLE ELBOW VARIAX
|
Facility
|
IP
|
$3,654.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7009021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,461.60 |
| Max. Negotiated Rate |
$3,471.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,923.20
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cigna Commercial |
$3,105.90
|
| Rate for Payer: First Health Commercial |
$3,288.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,288.60
|
| Rate for Payer: GEHA Commercial |
$2,557.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,288.60
|
| Rate for Payer: Multiplan All |
$3,325.14
|
| Rate for Payer: OMNI Networks Commercial |
$2,557.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,288.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,471.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,740.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,398.22
|
| Rate for Payer: Zelis Auto |
$1,461.60
|
|
|
PLATE CALCANEOUS
|
Facility
|
IP
|
$2,879.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.60 |
| Max. Negotiated Rate |
$2,735.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,303.20
|
| Rate for Payer: Cash Price |
$1,727.40
|
| Rate for Payer: Cash Price |
$1,727.40
|
| Rate for Payer: Cigna Commercial |
$2,447.15
|
| Rate for Payer: First Health Commercial |
$2,591.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,591.10
|
| Rate for Payer: GEHA Commercial |
$2,015.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,591.10
|
| Rate for Payer: Multiplan All |
$2,619.89
|
| Rate for Payer: OMNI Networks Commercial |
$2,015.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,591.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,735.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,159.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,677.47
|
| Rate for Payer: Zelis Auto |
$1,151.60
|
|
|
PLATE CALCANEOUS
|
Facility
|
OP
|
$2,879.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$719.75 |
| Max. Negotiated Rate |
$2,735.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,727.40
|
| Rate for Payer: Cash Price |
$1,727.40
|
| Rate for Payer: Cash Price |
$1,727.40
|
| Rate for Payer: Cigna Commercial |
$2,447.15
|
| Rate for Payer: First Health Commercial |
$2,591.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,591.10
|
| Rate for Payer: GEHA Commercial |
$2,303.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,591.10
|
| Rate for Payer: Humana ChoiceCare |
$748.54
|
| Rate for Payer: Multiplan All |
$2,619.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,727.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,015.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,591.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,735.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,159.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,533.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$719.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,677.47
|
| Rate for Payer: Zelis Auto |
$1,151.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,439.50
|
|
|
PLATE DR LEFT NARROW
|
Facility
|
IP
|
$4,386.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006460
|
|
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 DR LEFT NARROW
|
Facility
|
OP
|
$4,386.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006460
|
|
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 DR LEFT NARROW 4 HOLE
|
Facility
|
OP
|
$4,386.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006466
|
|
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 DR LEFT NARROW 4 HOLE
|
Facility
|
IP
|
$4,386.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006466
|
|
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 LEFT LATERAL TIBIA MEDIAL
|
Facility
|
IP
|
$6,013.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,405.40 |
| Max. Negotiated Rate |
$5,712.82 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,810.80
|
| Rate for Payer: Cash Price |
$3,608.10
|
| Rate for Payer: Cash Price |
$3,608.10
|
| Rate for Payer: Cigna Commercial |
$5,111.48
|
| Rate for Payer: First Health Commercial |
$5,412.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,412.15
|
| Rate for Payer: GEHA Commercial |
$4,209.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,412.15
|
| Rate for Payer: Multiplan All |
$5,472.28
|
| Rate for Payer: OMNI Networks Commercial |
$4,209.45
|
| Rate for Payer: One Health Plan PPO/POS |
$5,412.15
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,712.82
|
| Rate for Payer: Three Rivers Provider Network All |
$4,510.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,592.56
|
| Rate for Payer: Zelis Auto |
$2,405.40
|
|
|
PLATE LEFT LATERAL TIBIA MEDIAL
|
Facility
|
OP
|
$6,013.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,503.38 |
| Max. Negotiated Rate |
$5,712.82 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,608.10
|
| Rate for Payer: Cash Price |
$3,608.10
|
| Rate for Payer: Cash Price |
$3,608.10
|
| Rate for Payer: Cigna Commercial |
$5,111.48
|
| Rate for Payer: First Health Commercial |
$5,412.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,412.15
|
| Rate for Payer: GEHA Commercial |
$4,810.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,412.15
|
| Rate for Payer: Humana ChoiceCare |
$1,563.51
|
| Rate for Payer: Multiplan All |
$5,472.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,608.10
|
| Rate for Payer: OMNI Networks Commercial |
$4,209.45
|
| Rate for Payer: One Health Plan PPO/POS |
$5,412.15
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,712.82
|
| Rate for Payer: Three Rivers Provider Network All |
$4,510.12
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,291.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,503.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,592.56
|
| Rate for Payer: Zelis Auto |
$2,405.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,006.75
|
|
|
platelet antibody prof REF117150
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
2200443
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.61 |
| Max. Negotiated Rate |
$365.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$33.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$231.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$33.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$26.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$327.25
|
| Rate for Payer: First Health Commercial |
$346.50
|
| Rate for Payer: First Health Workers Compensation |
$40.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$346.50
|
| Rate for Payer: GEHA Commercial |
$308.00
|
| Rate for Payer: GEHA Medicare |
$18.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$346.50
|
| Rate for Payer: Humana ChoiceCare |
$20.21
|
| Rate for Payer: Humana Medicare Advantage |
$18.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.37
|
| Rate for Payer: Multiplan All |
$350.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.23
|
| Rate for Payer: OMNI Networks Commercial |
$269.50
|
| Rate for Payer: One Health Plan PPO/POS |
$346.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$365.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$36.74
|
| Rate for Payer: Three Rivers Provider Network All |
$288.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.00
|
| Rate for Payer: United Healthcare Commercial |
$327.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$358.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.37
|
| Rate for Payer: Zelis Auto |
$154.00
|
| Rate for Payer: Zelis Medicare |
$15.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.04
|
| Rate for Payer: Zelis Worker's Compensation |
$28.62
|
|
|
platelet antibody prof REF117150
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
2200443
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.62 |
| Max. Negotiated Rate |
$365.75 |
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$327.25
|
| Rate for Payer: First Health Commercial |
$346.50
|
| Rate for Payer: First Health Workers Compensation |
$40.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$346.50
|
| Rate for Payer: GEHA Commercial |
$269.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$346.50
|
| Rate for Payer: Multiplan All |
$350.35
|
| Rate for Payer: OMNI Networks Commercial |
$269.50
|
| Rate for Payer: One Health Plan PPO/POS |
$346.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$365.75
|
| Rate for Payer: Three Rivers Provider Network All |
$288.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$358.05
|
| Rate for Payer: Zelis Auto |
$154.00
|
| Rate for Payer: Zelis Worker's Compensation |
$28.62
|
|
|
PLATELET COUNT AUTOMATED
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
2299815
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$44.20
|
| Rate for Payer: First Health Commercial |
$46.80
|
| Rate for Payer: First Health Workers Compensation |
$7.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$46.80
|
| Rate for Payer: GEHA Commercial |
$36.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$46.80
|
| Rate for Payer: Multiplan All |
$47.32
|
| Rate for Payer: OMNI Networks Commercial |
$36.40
|
| Rate for Payer: One Health Plan PPO/POS |
$46.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$49.40
|
| Rate for Payer: Three Rivers Provider Network All |
$39.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$48.36
|
| Rate for Payer: Zelis Auto |
$20.80
|
| Rate for Payer: Zelis Worker's Compensation |
$5.42
|
|
|
PLATELET COUNT AUTOMATED
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
2299815
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$31.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.48
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$44.20
|
| Rate for Payer: First Health Commercial |
$46.80
|
| Rate for Payer: First Health Workers Compensation |
$7.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$46.80
|
| Rate for Payer: GEHA Commercial |
$41.60
|
| Rate for Payer: GEHA Medicare |
$4.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$46.80
|
| Rate for Payer: Humana ChoiceCare |
$4.93
|
| Rate for Payer: Humana Medicare Advantage |
$4.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.48
|
| Rate for Payer: Multiplan All |
$47.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.62
|
| Rate for Payer: OMNI Networks Commercial |
$36.40
|
| Rate for Payer: One Health Plan PPO/POS |
$46.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6.52
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$49.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$8.96
|
| Rate for Payer: Three Rivers Provider Network All |
$39.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.39
|
| Rate for Payer: United Healthcare Commercial |
$44.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$48.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.48
|
| Rate for Payer: Zelis Auto |
$20.80
|
| Rate for Payer: Zelis Medicare |
$3.81
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.38
|
| Rate for Payer: Zelis Worker's Compensation |
$5.42
|
|
|
PLATE NARROW DR
|
Facility
|
IP
|
$6,878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,751.20 |
| Max. Negotiated Rate |
$6,534.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,502.40
|
| Rate for Payer: Cash Price |
$4,126.80
|
| Rate for Payer: Cash Price |
$4,126.80
|
| Rate for Payer: Cigna Commercial |
$5,846.30
|
| Rate for Payer: First Health Commercial |
$6,190.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,190.20
|
| Rate for Payer: GEHA Commercial |
$4,814.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,190.20
|
| Rate for Payer: Multiplan All |
$6,258.98
|
| Rate for Payer: OMNI Networks Commercial |
$4,814.60
|
| Rate for Payer: One Health Plan PPO/POS |
$6,190.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,534.10
|
| Rate for Payer: Three Rivers Provider Network All |
$5,158.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,396.54
|
| Rate for Payer: Zelis Auto |
$2,751.20
|
|
|
PLATE NARROW DR
|
Facility
|
OP
|
$6,878.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,719.50 |
| Max. Negotiated Rate |
$6,534.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,126.80
|
| Rate for Payer: Cash Price |
$4,126.80
|
| Rate for Payer: Cash Price |
$4,126.80
|
| Rate for Payer: Cigna Commercial |
$5,846.30
|
| Rate for Payer: First Health Commercial |
$6,190.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,190.20
|
| Rate for Payer: GEHA Commercial |
$5,502.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,190.20
|
| Rate for Payer: Humana ChoiceCare |
$1,788.28
|
| Rate for Payer: Multiplan All |
$6,258.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,126.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,814.60
|
| Rate for Payer: One Health Plan PPO/POS |
$6,190.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,534.10
|
| Rate for Payer: Three Rivers Provider Network All |
$5,158.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,052.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,719.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,396.54
|
| Rate for Payer: Zelis Auto |
$2,751.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,439.00
|
|
|
PLATE RADIUS PLATE
|
Facility
|
IP
|
$5,726.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,290.40 |
| Max. Negotiated Rate |
$5,439.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,580.80
|
| Rate for Payer: Cash Price |
$3,435.60
|
| Rate for Payer: Cash Price |
$3,435.60
|
| Rate for Payer: Cigna Commercial |
$4,867.10
|
| Rate for Payer: First Health Commercial |
$5,153.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,153.40
|
| Rate for Payer: GEHA Commercial |
$4,008.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,153.40
|
| Rate for Payer: Multiplan All |
$5,210.66
|
| Rate for Payer: OMNI Networks Commercial |
$4,008.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,153.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,439.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4,294.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,325.18
|
| Rate for Payer: Zelis Auto |
$2,290.40
|
|
|
PLATE RADIUS PLATE
|
Facility
|
OP
|
$5,726.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,431.50 |
| Max. Negotiated Rate |
$5,439.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,435.60
|
| Rate for Payer: Cash Price |
$3,435.60
|
| Rate for Payer: Cash Price |
$3,435.60
|
| Rate for Payer: Cigna Commercial |
$4,867.10
|
| Rate for Payer: First Health Commercial |
$5,153.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,153.40
|
| Rate for Payer: GEHA Commercial |
$4,580.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,153.40
|
| Rate for Payer: Humana ChoiceCare |
$1,488.76
|
| Rate for Payer: Multiplan All |
$5,210.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,435.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,008.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,153.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,439.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4,294.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,038.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,431.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,325.18
|
| Rate for Payer: Zelis Auto |
$2,290.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,863.00
|
|
|
PLATE RADIUS PLATE WIDE
|
Facility
|
IP
|
$6,238.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$5,926.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,990.40
|
| Rate for Payer: Cash Price |
$3,742.80
|
| Rate for Payer: Cash Price |
$3,742.80
|
| Rate for Payer: Cigna Commercial |
$5,302.30
|
| Rate for Payer: First Health Commercial |
$5,614.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,614.20
|
| Rate for Payer: GEHA Commercial |
$4,366.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,614.20
|
| Rate for Payer: Multiplan All |
$5,676.58
|
| Rate for Payer: OMNI Networks Commercial |
$4,366.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,614.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,926.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,678.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,801.34
|
| Rate for Payer: Zelis Auto |
$2,495.20
|
|
|
PLATE RADIUS PLATE WIDE
|
Facility
|
OP
|
$6,238.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.50 |
| Max. Negotiated Rate |
$5,926.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,742.80
|
| Rate for Payer: Cash Price |
$3,742.80
|
| Rate for Payer: Cash Price |
$3,742.80
|
| Rate for Payer: Cigna Commercial |
$5,302.30
|
| Rate for Payer: First Health Commercial |
$5,614.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,614.20
|
| Rate for Payer: GEHA Commercial |
$4,990.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,614.20
|
| Rate for Payer: Humana ChoiceCare |
$1,621.88
|
| Rate for Payer: Multiplan All |
$5,676.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,742.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,366.60
|
| Rate for Payer: One Health Plan PPO/POS |
$5,614.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,926.10
|
| Rate for Payer: Three Rivers Provider Network All |
$4,678.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,489.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,559.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,801.34
|
| Rate for Payer: Zelis Auto |
$2,495.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,119.00
|
|
|
PLATE, RIGHT SCAPULA ACROMION
|
Facility
|
OP
|
$10,889.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001718
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,722.25 |
| Max. Negotiated Rate |
$10,344.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,533.40
|
| Rate for Payer: Cash Price |
$6,533.40
|
| Rate for Payer: Cash Price |
$6,533.40
|
| Rate for Payer: Cigna Commercial |
$9,255.65
|
| Rate for Payer: First Health Commercial |
$9,800.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,800.10
|
| Rate for Payer: GEHA Commercial |
$8,711.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,800.10
|
| Rate for Payer: Humana ChoiceCare |
$2,831.14
|
| Rate for Payer: Multiplan All |
$9,908.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,533.40
|
| Rate for Payer: OMNI Networks Commercial |
$7,622.30
|
| Rate for Payer: One Health Plan PPO/POS |
$9,800.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,344.55
|
| Rate for Payer: Three Rivers Provider Network All |
$8,166.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,582.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,722.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,126.77
|
| Rate for Payer: Zelis Auto |
$4,355.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,444.50
|
|
|
PLATE, RIGHT SCAPULA ACROMION
|
Facility
|
IP
|
$10,889.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001718
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,355.60 |
| Max. Negotiated Rate |
$10,344.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,711.20
|
| Rate for Payer: Cash Price |
$6,533.40
|
| Rate for Payer: Cash Price |
$6,533.40
|
| Rate for Payer: Cigna Commercial |
$9,255.65
|
| Rate for Payer: First Health Commercial |
$9,800.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,800.10
|
| Rate for Payer: GEHA Commercial |
$7,622.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,800.10
|
| Rate for Payer: Multiplan All |
$9,908.99
|
| Rate for Payer: OMNI Networks Commercial |
$7,622.30
|
| Rate for Payer: One Health Plan PPO/POS |
$9,800.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,344.55
|
| Rate for Payer: Three Rivers Provider Network All |
$8,166.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,126.77
|
| Rate for Payer: Zelis Auto |
$4,355.60
|
|
