|
RA TRACER ID OF SENTINL NODE
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
6138792
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: First Health Workers Compensation |
$47.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$85.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Worker's Compensation |
$33.31
|
|
|
RBC FOLATE REF266015
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 82747
|
| Hospital Charge Code |
22990750
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$31.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$31.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.65
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$227.80
|
| Rate for Payer: First Health Commercial |
$241.20
|
| Rate for Payer: First Health Workers Compensation |
$26.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$241.20
|
| Rate for Payer: GEHA Commercial |
$214.40
|
| Rate for Payer: GEHA Medicare |
$17.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$241.20
|
| Rate for Payer: Humana ChoiceCare |
$19.41
|
| Rate for Payer: Humana Medicare Advantage |
$17.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.65
|
| Rate for Payer: Multiplan All |
$243.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.00
|
| Rate for Payer: OMNI Networks Commercial |
$187.60
|
| Rate for Payer: One Health Plan PPO/POS |
$241.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$29.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25.68
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$254.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$35.30
|
| Rate for Payer: Three Rivers Provider Network All |
$201.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.30
|
| Rate for Payer: United Healthcare Commercial |
$227.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$249.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.65
|
| Rate for Payer: Zelis Auto |
$107.20
|
| Rate for Payer: Zelis Medicare |
$15.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.18
|
| Rate for Payer: Zelis Worker's Compensation |
$18.64
|
|
|
RBC FOLATE REF266015
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 82747
|
| Hospital Charge Code |
22990750
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$227.80
|
| Rate for Payer: First Health Commercial |
$241.20
|
| Rate for Payer: First Health Workers Compensation |
$26.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$241.20
|
| Rate for Payer: GEHA Commercial |
$187.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$241.20
|
| Rate for Payer: Multiplan All |
$243.88
|
| Rate for Payer: OMNI Networks Commercial |
$187.60
|
| Rate for Payer: One Health Plan PPO/POS |
$241.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$254.60
|
| Rate for Payer: Three Rivers Provider Network All |
$201.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$249.24
|
| Rate for Payer: Zelis Auto |
$107.20
|
| Rate for Payer: Zelis Worker's Compensation |
$18.64
|
|
|
rbc potassium rbc REF202314
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
2200454
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$76.50
|
| Rate for Payer: First Health Commercial |
$81.00
|
| Rate for Payer: First Health Workers Compensation |
$8.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.00
|
| Rate for Payer: GEHA Commercial |
$63.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.00
|
| Rate for Payer: Multiplan All |
$81.90
|
| Rate for Payer: OMNI Networks Commercial |
$63.00
|
| Rate for Payer: One Health Plan PPO/POS |
$81.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$85.50
|
| Rate for Payer: Three Rivers Provider Network All |
$67.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$83.70
|
| Rate for Payer: Zelis Auto |
$36.00
|
| Rate for Payer: Zelis Worker's Compensation |
$5.95
|
|
|
rbc potassium rbc REF202314
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
2200454
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.76
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$76.50
|
| Rate for Payer: First Health Commercial |
$81.00
|
| Rate for Payer: First Health Workers Compensation |
$8.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.00
|
| Rate for Payer: GEHA Commercial |
$72.00
|
| Rate for Payer: GEHA Medicare |
$4.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.00
|
| Rate for Payer: Humana ChoiceCare |
$5.24
|
| Rate for Payer: Humana Medicare Advantage |
$4.76
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.76
|
| Rate for Payer: Multiplan All |
$81.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.09
|
| Rate for Payer: OMNI Networks Commercial |
$63.00
|
| Rate for Payer: One Health Plan PPO/POS |
$81.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.76
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$85.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9.52
|
| Rate for Payer: Three Rivers Provider Network All |
$67.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.66
|
| Rate for Payer: United Healthcare Commercial |
$76.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$83.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.76
|
| Rate for Payer: Zelis Auto |
$36.00
|
| Rate for Payer: Zelis Medicare |
$4.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.71
|
| Rate for Payer: Zelis Worker's Compensation |
$5.95
|
|
|
READI-CAT
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
NDC 32909072301
|
| Hospital Charge Code |
3300089
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.25 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$31.45
|
| Rate for Payer: First Health Commercial |
$33.30
|
| Rate for Payer: First Health Workers Compensation |
$14.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$33.30
|
| Rate for Payer: GEHA Commercial |
$29.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$33.30
|
| Rate for Payer: Humana ChoiceCare |
$9.62
|
| Rate for Payer: Multiplan All |
$33.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.20
|
| Rate for Payer: OMNI Networks Commercial |
$25.90
|
| Rate for Payer: One Health Plan PPO/POS |
$33.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$35.15
|
| Rate for Payer: Three Rivers Provider Network All |
$27.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$32.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$34.41
|
| Rate for Payer: Zelis Auto |
$14.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.50
|
| Rate for Payer: Zelis Worker's Compensation |
$10.10
|
|
|
READI-CAT
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
NDC 32909072301
|
| Hospital Charge Code |
3300089
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$31.45
|
| Rate for Payer: First Health Commercial |
$33.30
|
| Rate for Payer: First Health Workers Compensation |
$14.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$33.30
|
| Rate for Payer: GEHA Commercial |
$25.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$33.30
|
| Rate for Payer: Multiplan All |
$33.67
|
| Rate for Payer: OMNI Networks Commercial |
$25.90
|
| Rate for Payer: One Health Plan PPO/POS |
$33.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$35.15
|
| Rate for Payer: Three Rivers Provider Network All |
$27.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$34.41
|
| Rate for Payer: Zelis Auto |
$14.80
|
| Rate for Payer: Zelis Worker's Compensation |
$10.10
|
|
|
REAGENT STRIP/BLOOD GLUCOSE
|
Facility
|
IP
|
$52.08
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
8582948
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$49.48 |
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cigna Commercial |
$44.27
|
| Rate for Payer: First Health Commercial |
$46.87
|
| Rate for Payer: First Health Workers Compensation |
$5.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$46.87
|
| Rate for Payer: GEHA Commercial |
$36.46
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$46.87
|
| Rate for Payer: Multiplan All |
$47.39
|
| Rate for Payer: OMNI Networks Commercial |
$36.46
|
| Rate for Payer: One Health Plan PPO/POS |
$46.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$49.48
|
| Rate for Payer: Three Rivers Provider Network All |
$39.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$48.43
|
| Rate for Payer: Zelis Auto |
$20.83
|
| Rate for Payer: Zelis Worker's Compensation |
$4.06
|
|
|
REAGENT STRIP/BLOOD GLUCOSE
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
21600326
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.04
|
| 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: First Health Workers Compensation |
$5.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$12.00
|
| Rate for Payer: GEHA Medicare |
$5.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Humana ChoiceCare |
$5.54
|
| Rate for Payer: Humana Medicare Advantage |
$5.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.04
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.57
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.47
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.34
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.08
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.94
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.04
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Medicare |
$4.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.05
|
| Rate for Payer: Zelis Worker's Compensation |
$4.06
|
|
|
REAGENT STRIP/BLOOD GLUCOSE
|
Facility
|
IP
|
$52.08
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
7282948
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$49.48 |
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cigna Commercial |
$44.27
|
| Rate for Payer: First Health Commercial |
$46.87
|
| Rate for Payer: First Health Workers Compensation |
$5.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$46.87
|
| Rate for Payer: GEHA Commercial |
$36.46
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$46.87
|
| Rate for Payer: Multiplan All |
$47.39
|
| Rate for Payer: OMNI Networks Commercial |
$36.46
|
| Rate for Payer: One Health Plan PPO/POS |
$46.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$49.48
|
| Rate for Payer: Three Rivers Provider Network All |
$39.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$48.43
|
| Rate for Payer: Zelis Auto |
$20.83
|
| Rate for Payer: Zelis Worker's Compensation |
$4.06
|
|
|
REAGENT STRIP/BLOOD GLUCOSE
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
21600326
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$4.06 |
| 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: First Health Workers Compensation |
$5.74
|
| 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
|
| Rate for Payer: Zelis Worker's Compensation |
$4.06
|
|
|
REAGENT STRIP/BLOOD GLUCOSE
|
Facility
|
OP
|
$52.08
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
8582948
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$49.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$31.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.04
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cigna Commercial |
$44.27
|
| Rate for Payer: First Health Commercial |
$46.87
|
| Rate for Payer: First Health Workers Compensation |
$5.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$46.87
|
| Rate for Payer: GEHA Commercial |
$41.66
|
| Rate for Payer: GEHA Medicare |
$5.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$46.87
|
| Rate for Payer: Humana ChoiceCare |
$5.54
|
| Rate for Payer: Humana Medicare Advantage |
$5.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.04
|
| Rate for Payer: Multiplan All |
$47.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.57
|
| Rate for Payer: OMNI Networks Commercial |
$36.46
|
| Rate for Payer: One Health Plan PPO/POS |
$46.87
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.47
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.34
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$49.48
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.08
|
| Rate for Payer: Three Rivers Provider Network All |
$39.06
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.94
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$48.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.04
|
| Rate for Payer: Zelis Auto |
$20.83
|
| Rate for Payer: Zelis Medicare |
$4.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.05
|
| Rate for Payer: Zelis Worker's Compensation |
$4.06
|
|
|
REAGENT STRIP/BLOOD GLUCOSE
|
Facility
|
OP
|
$52.08
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
7282948
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$49.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$31.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.04
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cigna Commercial |
$44.27
|
| Rate for Payer: First Health Commercial |
$46.87
|
| Rate for Payer: First Health Workers Compensation |
$5.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$46.87
|
| Rate for Payer: GEHA Commercial |
$41.66
|
| Rate for Payer: GEHA Medicare |
$5.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$46.87
|
| Rate for Payer: Humana ChoiceCare |
$5.54
|
| Rate for Payer: Humana Medicare Advantage |
$5.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.04
|
| Rate for Payer: Multiplan All |
$47.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.57
|
| Rate for Payer: OMNI Networks Commercial |
$36.46
|
| Rate for Payer: One Health Plan PPO/POS |
$46.87
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.47
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.34
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$49.48
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.08
|
| Rate for Payer: Three Rivers Provider Network All |
$39.06
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.94
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$48.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.04
|
| Rate for Payer: Zelis Auto |
$20.83
|
| Rate for Payer: Zelis Medicare |
$4.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.05
|
| Rate for Payer: Zelis Worker's Compensation |
$4.06
|
|
|
REALIGNMENT OF HAND
|
Facility
|
OP
|
$1,660.00
|
|
|
Service Code
|
CPT 25335
|
| Hospital Charge Code |
6125335
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$453.18 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$996.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$996.00
|
| Rate for Payer: Cash Price |
$996.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,494.00
|
| Rate for Payer: First Health Workers Compensation |
$640.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,494.00
|
| Rate for Payer: GEHA Commercial |
$1,328.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,494.00
|
| 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 |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,510.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,162.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,494.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,577.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,245.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,543.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$664.00
|
| 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 |
$453.18
|
|
|
REALIGNMENT OF HAND
|
Facility
|
IP
|
$1,660.00
|
|
|
Service Code
|
CPT 25335
|
| Hospital Charge Code |
6125335
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$453.18 |
| Max. Negotiated Rate |
$1,577.00 |
| Rate for Payer: Cash Price |
$996.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,494.00
|
| Rate for Payer: First Health Workers Compensation |
$640.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,494.00
|
| Rate for Payer: GEHA Commercial |
$1,162.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,494.00
|
| Rate for Payer: Multiplan All |
$1,510.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,162.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,494.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,577.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,245.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,543.80
|
| Rate for Payer: Zelis Auto |
$664.00
|
| Rate for Payer: Zelis Worker's Compensation |
$453.18
|
|
|
REALIGNMENT OF KNEE
|
Facility
|
IP
|
$1,937.00
|
|
|
Service Code
|
CPT 27455
|
| Hospital Charge Code |
6127455
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$528.80 |
| Max. Negotiated Rate |
$1,840.15 |
| Rate for Payer: Cash Price |
$1,162.20
|
| Rate for Payer: Cigna Commercial |
$1,646.45
|
| Rate for Payer: First Health Commercial |
$1,743.30
|
| Rate for Payer: First Health Workers Compensation |
$747.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,743.30
|
| Rate for Payer: GEHA Commercial |
$1,355.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,743.30
|
| Rate for Payer: Multiplan All |
$1,762.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,355.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,743.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,840.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,452.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,801.41
|
| Rate for Payer: Zelis Auto |
$774.80
|
| Rate for Payer: Zelis Worker's Compensation |
$528.80
|
|
|
REALIGNMENT OF KNEE
|
Facility
|
IP
|
$1,949.00
|
|
|
Service Code
|
CPT 27457
|
| Hospital Charge Code |
6127457
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$532.08 |
| Max. Negotiated Rate |
$1,851.55 |
| Rate for Payer: Cash Price |
$1,169.40
|
| Rate for Payer: Cigna Commercial |
$1,656.65
|
| Rate for Payer: First Health Commercial |
$1,754.10
|
| Rate for Payer: First Health Workers Compensation |
$752.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,754.10
|
| Rate for Payer: GEHA Commercial |
$1,364.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,754.10
|
| Rate for Payer: Multiplan All |
$1,773.59
|
| Rate for Payer: OMNI Networks Commercial |
$1,364.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,754.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,851.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,461.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,812.57
|
| Rate for Payer: Zelis Auto |
$779.60
|
| Rate for Payer: Zelis Worker's Compensation |
$532.08
|
|
|
REALIGNMENT OF KNEE
|
Facility
|
OP
|
$1,937.00
|
|
|
Service Code
|
CPT 27455
|
| Hospital Charge Code |
6127455
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$484.25 |
| Max. Negotiated Rate |
$1,840.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,162.20
|
| Rate for Payer: Cash Price |
$1,162.20
|
| Rate for Payer: Cigna Commercial |
$1,646.45
|
| Rate for Payer: First Health Commercial |
$1,743.30
|
| Rate for Payer: First Health Workers Compensation |
$747.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,743.30
|
| Rate for Payer: GEHA Commercial |
$1,549.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,743.30
|
| Rate for Payer: Humana ChoiceCare |
$503.62
|
| Rate for Payer: Multiplan All |
$1,762.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,162.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,355.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,743.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,840.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,452.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,704.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$484.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,801.41
|
| Rate for Payer: Zelis Auto |
$774.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$968.50
|
| Rate for Payer: Zelis Worker's Compensation |
$528.80
|
|
|
REALIGNMENT OF KNEE
|
Facility
|
OP
|
$1,949.00
|
|
|
Service Code
|
CPT 27457
|
| Hospital Charge Code |
6127457
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$487.25 |
| Max. Negotiated Rate |
$1,851.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,169.40
|
| Rate for Payer: Cash Price |
$1,169.40
|
| Rate for Payer: Cigna Commercial |
$1,656.65
|
| Rate for Payer: First Health Commercial |
$1,754.10
|
| Rate for Payer: First Health Workers Compensation |
$752.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,754.10
|
| Rate for Payer: GEHA Commercial |
$1,559.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,754.10
|
| Rate for Payer: Humana ChoiceCare |
$506.74
|
| Rate for Payer: Multiplan All |
$1,773.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,169.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,364.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,754.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,851.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,461.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,715.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$487.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,812.57
|
| Rate for Payer: Zelis Auto |
$779.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$974.50
|
| Rate for Payer: Zelis Worker's Compensation |
$532.08
|
|
|
REALIGNMENT OF LOWER LEG
|
Facility
|
IP
|
$2,268.00
|
|
|
Service Code
|
CPT 27712
|
| Hospital Charge Code |
6127712
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$619.16 |
| Max. Negotiated Rate |
$2,154.60 |
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cigna Commercial |
$1,927.80
|
| Rate for Payer: First Health Commercial |
$2,041.20
|
| Rate for Payer: First Health Workers Compensation |
$875.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,041.20
|
| Rate for Payer: GEHA Commercial |
$1,587.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,041.20
|
| Rate for Payer: Multiplan All |
$2,063.88
|
| Rate for Payer: OMNI Networks Commercial |
$1,587.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,041.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,154.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,701.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,109.24
|
| Rate for Payer: Zelis Auto |
$907.20
|
| Rate for Payer: Zelis Worker's Compensation |
$619.16
|
|
|
REALIGNMENT OF LOWER LEG
|
Facility
|
OP
|
$2,268.00
|
|
|
Service Code
|
CPT 27712
|
| Hospital Charge Code |
6127712
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$567.00 |
| Max. Negotiated Rate |
$2,154.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cigna Commercial |
$1,927.80
|
| Rate for Payer: First Health Commercial |
$2,041.20
|
| Rate for Payer: First Health Workers Compensation |
$875.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,041.20
|
| Rate for Payer: GEHA Commercial |
$1,814.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,041.20
|
| Rate for Payer: Humana ChoiceCare |
$589.68
|
| Rate for Payer: Multiplan All |
$2,063.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,360.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,587.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,041.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,154.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,701.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,995.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$567.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,109.24
|
| Rate for Payer: Zelis Auto |
$907.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,134.00
|
| Rate for Payer: Zelis Worker's Compensation |
$619.16
|
|
|
REALIGNMENT OF TENDONS
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
CPT 26437
|
| Hospital Charge Code |
6126437
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$334.43 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$735.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cigna Commercial |
$1,041.25
|
| Rate for Payer: First Health Commercial |
$1,102.50
|
| Rate for Payer: First Health Workers Compensation |
$472.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,102.50
|
| Rate for Payer: GEHA Commercial |
$980.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,102.50
|
| 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 |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,114.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$857.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,102.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,163.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$918.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,139.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$490.00
|
| 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 |
$334.43
|
|
|
REALIGNMENT OF TENDONS
|
Facility
|
IP
|
$1,225.00
|
|
|
Service Code
|
CPT 26437
|
| Hospital Charge Code |
6126437
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$334.43 |
| Max. Negotiated Rate |
$1,163.75 |
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cigna Commercial |
$1,041.25
|
| Rate for Payer: First Health Commercial |
$1,102.50
|
| Rate for Payer: First Health Workers Compensation |
$472.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,102.50
|
| Rate for Payer: GEHA Commercial |
$857.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,102.50
|
| Rate for Payer: Multiplan All |
$1,114.75
|
| Rate for Payer: OMNI Networks Commercial |
$857.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,102.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,163.75
|
| Rate for Payer: Three Rivers Provider Network All |
$918.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,139.25
|
| Rate for Payer: Zelis Auto |
$490.00
|
| Rate for Payer: Zelis Worker's Compensation |
$334.43
|
|
|
REALIGNMENT OF THIGH BONE
|
Facility
|
OP
|
$2,688.00
|
|
|
Service Code
|
CPT 27454
|
| Hospital Charge Code |
6127454
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$672.00 |
| Max. Negotiated Rate |
$2,553.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,612.80
|
| Rate for Payer: Cash Price |
$1,612.80
|
| Rate for Payer: Cigna Commercial |
$2,284.80
|
| Rate for Payer: First Health Commercial |
$2,419.20
|
| Rate for Payer: First Health Workers Compensation |
$1,037.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,419.20
|
| Rate for Payer: GEHA Commercial |
$2,150.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,419.20
|
| Rate for Payer: Humana ChoiceCare |
$698.88
|
| Rate for Payer: Multiplan All |
$2,446.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,612.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,881.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,419.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,553.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,016.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,365.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$672.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,499.84
|
| Rate for Payer: Zelis Auto |
$1,075.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,344.00
|
| Rate for Payer: Zelis Worker's Compensation |
$733.82
|
|
|
REALIGNMENT OF THIGH BONE
|
Facility
|
IP
|
$2,688.00
|
|
|
Service Code
|
CPT 27454
|
| Hospital Charge Code |
6127454
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$733.82 |
| Max. Negotiated Rate |
$2,553.60 |
| Rate for Payer: Cash Price |
$1,612.80
|
| Rate for Payer: Cigna Commercial |
$2,284.80
|
| Rate for Payer: First Health Commercial |
$2,419.20
|
| Rate for Payer: First Health Workers Compensation |
$1,037.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,419.20
|
| Rate for Payer: GEHA Commercial |
$1,881.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,419.20
|
| Rate for Payer: Multiplan All |
$2,446.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,881.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,419.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,553.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,016.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,499.84
|
| Rate for Payer: Zelis Auto |
$1,075.20
|
| Rate for Payer: Zelis Worker's Compensation |
$733.82
|
|
