|
SCAN PROC CRANIAL EXTRA
|
Facility
|
IP
|
$553.00
|
|
|
Service Code
|
CPT 61782
|
| Hospital Charge Code |
6161782
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$150.97 |
| Max. Negotiated Rate |
$525.35 |
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cigna Commercial |
$470.05
|
| Rate for Payer: First Health Commercial |
$497.70
|
| Rate for Payer: First Health Workers Compensation |
$213.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$497.70
|
| Rate for Payer: GEHA Commercial |
$387.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$497.70
|
| Rate for Payer: Multiplan All |
$503.23
|
| Rate for Payer: OMNI Networks Commercial |
$387.10
|
| Rate for Payer: One Health Plan PPO/POS |
$497.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$525.35
|
| Rate for Payer: Three Rivers Provider Network All |
$414.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$514.29
|
| Rate for Payer: Zelis Auto |
$221.20
|
| Rate for Payer: Zelis Worker's Compensation |
$150.97
|
|
|
SCNDRY CLOSURE SURG WOUND/DEHSN EXT/COMP
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
CPT 13160
|
| Hospital Charge Code |
20300055
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$682.50 |
| Max. Negotiated Rate |
$2,375.00 |
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,125.00
|
| Rate for Payer: First Health Commercial |
$2,250.00
|
| Rate for Payer: First Health Workers Compensation |
$965.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,250.00
|
| Rate for Payer: GEHA Commercial |
$1,750.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,250.00
|
| Rate for Payer: Multiplan All |
$2,275.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,750.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,250.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,375.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,875.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,325.00
|
| Rate for Payer: Zelis Auto |
$1,000.00
|
| Rate for Payer: Zelis Worker's Compensation |
$682.50
|
|
|
SCNDRY CLOSURE SURG WOUND/DEHSN EXT/COMP
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
CPT 13160
|
| Hospital Charge Code |
6113160
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$682.50 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,125.00
|
| Rate for Payer: First Health Commercial |
$2,250.00
|
| Rate for Payer: First Health Workers Compensation |
$965.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,250.00
|
| Rate for Payer: GEHA Commercial |
$2,000.00
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,250.00
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$2,275.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,750.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,250.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,375.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,875.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,325.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$1,000.00
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$682.50
|
|
|
SCNDRY CLOSURE SURG WOUND/DEHSN EXT/COMP
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
CPT 13160
|
| Hospital Charge Code |
6113160
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$682.50 |
| Max. Negotiated Rate |
$2,375.00 |
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,125.00
|
| Rate for Payer: First Health Commercial |
$2,250.00
|
| Rate for Payer: First Health Workers Compensation |
$965.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,250.00
|
| Rate for Payer: GEHA Commercial |
$1,750.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,250.00
|
| Rate for Payer: Multiplan All |
$2,275.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,750.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,250.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,375.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,875.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,325.00
|
| Rate for Payer: Zelis Auto |
$1,000.00
|
| Rate for Payer: Zelis Worker's Compensation |
$682.50
|
|
|
SCNDRY CLOSURE SURG WOUND/DEHSN EXT/COMP
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
CPT 13160
|
| Hospital Charge Code |
20300055
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$682.50 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,500.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,125.00
|
| Rate for Payer: First Health Commercial |
$2,250.00
|
| Rate for Payer: First Health Workers Compensation |
$965.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,250.00
|
| Rate for Payer: GEHA Commercial |
$2,000.00
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,250.00
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$2,275.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,750.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,250.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,375.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,875.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,325.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$1,000.00
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$682.50
|
|
|
SCOPE PLANTAR FASCIOTOMY
|
Facility
|
OP
|
$867.00
|
|
|
Service Code
|
CPT 29893
|
| Hospital Charge Code |
6129893
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.69 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$520.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cigna Commercial |
$736.95
|
| Rate for Payer: First Health Commercial |
$780.30
|
| Rate for Payer: First Health Workers Compensation |
$334.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$780.30
|
| Rate for Payer: GEHA Commercial |
$693.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$780.30
|
| 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 |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$788.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$606.90
|
| Rate for Payer: One Health Plan PPO/POS |
$780.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$823.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$650.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$806.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$346.80
|
| 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 |
$236.69
|
|
|
SCOPE PLANTAR FASCIOTOMY
|
Facility
|
IP
|
$867.00
|
|
|
Service Code
|
CPT 29893
|
| Hospital Charge Code |
6129893
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.69 |
| Max. Negotiated Rate |
$823.65 |
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cigna Commercial |
$736.95
|
| Rate for Payer: First Health Commercial |
$780.30
|
| Rate for Payer: First Health Workers Compensation |
$334.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$780.30
|
| Rate for Payer: GEHA Commercial |
$606.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$780.30
|
| Rate for Payer: Multiplan All |
$788.97
|
| Rate for Payer: OMNI Networks Commercial |
$606.90
|
| Rate for Payer: One Health Plan PPO/POS |
$780.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$823.65
|
| Rate for Payer: Three Rivers Provider Network All |
$650.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$806.31
|
| Rate for Payer: Zelis Auto |
$346.80
|
| Rate for Payer: Zelis Worker's Compensation |
$236.69
|
|
|
SCOPOLAMINE TD PATCH 72HR 1MG
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3300814
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$93.50
|
| Rate for Payer: First Health Commercial |
$99.00
|
| Rate for Payer: First Health Workers Compensation |
$42.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.00
|
| Rate for Payer: GEHA Commercial |
$77.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.00
|
| Rate for Payer: Multiplan All |
$100.10
|
| Rate for Payer: OMNI Networks Commercial |
$77.00
|
| Rate for Payer: One Health Plan PPO/POS |
$99.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$104.50
|
| Rate for Payer: Three Rivers Provider Network All |
$82.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$102.30
|
| Rate for Payer: Zelis Auto |
$44.00
|
| Rate for Payer: Zelis Worker's Compensation |
$30.03
|
|
|
SCOPOLAMINE TD PATCH 72HR 1MG
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
3300814
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$93.50
|
| Rate for Payer: First Health Commercial |
$99.00
|
| Rate for Payer: First Health Workers Compensation |
$42.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.00
|
| Rate for Payer: GEHA Commercial |
$88.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.00
|
| Rate for Payer: Humana ChoiceCare |
$28.60
|
| Rate for Payer: Multiplan All |
$100.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$66.00
|
| Rate for Payer: OMNI Networks Commercial |
$77.00
|
| Rate for Payer: One Health Plan PPO/POS |
$99.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$104.50
|
| Rate for Payer: Three Rivers Provider Network All |
$82.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$96.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$27.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$102.30
|
| Rate for Payer: Zelis Auto |
$44.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$55.00
|
| Rate for Payer: Zelis Worker's Compensation |
$30.03
|
|
|
SCR CERV/VAG THIN LAY PHYS INTERP
|
Facility
|
IP
|
$68.67
|
|
|
Service Code
|
CPT G0124
|
| Hospital Charge Code |
8500124
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$65.24 |
| Rate for Payer: Cash Price |
$41.20
|
| Rate for Payer: Cigna Commercial |
$58.37
|
| Rate for Payer: First Health Commercial |
$61.80
|
| Rate for Payer: First Health Workers Compensation |
$26.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$61.80
|
| Rate for Payer: GEHA Commercial |
$48.07
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$61.80
|
| Rate for Payer: Multiplan All |
$62.49
|
| Rate for Payer: OMNI Networks Commercial |
$48.07
|
| Rate for Payer: One Health Plan PPO/POS |
$61.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$65.24
|
| Rate for Payer: Three Rivers Provider Network All |
$51.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$63.86
|
| Rate for Payer: Zelis Auto |
$27.47
|
| Rate for Payer: Zelis Worker's Compensation |
$18.75
|
|
|
SCR CERV/VAG THIN LAY PHYS INTERP
|
Facility
|
OP
|
$68.67
|
|
|
Service Code
|
CPT G0124
|
| Hospital Charge Code |
8500124
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$17.17 |
| Max. Negotiated Rate |
$65.24 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$41.20
|
| Rate for Payer: Cash Price |
$41.20
|
| Rate for Payer: Cigna Commercial |
$58.37
|
| Rate for Payer: First Health Commercial |
$61.80
|
| Rate for Payer: First Health Workers Compensation |
$26.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$61.80
|
| Rate for Payer: GEHA Commercial |
$54.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$61.80
|
| Rate for Payer: Humana ChoiceCare |
$17.85
|
| Rate for Payer: Multiplan All |
$62.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$41.20
|
| Rate for Payer: OMNI Networks Commercial |
$48.07
|
| Rate for Payer: One Health Plan PPO/POS |
$61.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$65.24
|
| Rate for Payer: Three Rivers Provider Network All |
$51.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$60.43
|
| Rate for Payer: United Healthcare Commercial |
$58.37
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.17
|
| Rate for Payer: United Payors & United Providers UP&UP |
$63.86
|
| Rate for Payer: Zelis Auto |
$27.47
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$34.34
|
| Rate for Payer: Zelis Worker's Compensation |
$18.75
|
|
|
SCREENING TEST VISUAL ACUITY QUANTITATIV
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
21600226
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$197.93 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$197.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$197.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$156.80
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$34.85
|
| Rate for Payer: First Health Commercial |
$36.90
|
| Rate for Payer: First Health Workers Compensation |
$15.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.90
|
| Rate for Payer: GEHA Commercial |
$32.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.90
|
| Rate for Payer: Humana ChoiceCare |
$10.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$159.99
|
| Rate for Payer: Multiplan All |
$37.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.60
|
| Rate for Payer: OMNI Networks Commercial |
$28.70
|
| Rate for Payer: One Health Plan PPO/POS |
$36.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$184.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$159.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.95
|
| Rate for Payer: Three Rivers Provider Network All |
$30.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$36.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$159.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$38.13
|
| Rate for Payer: Zelis Auto |
$16.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.50
|
| Rate for Payer: Zelis Worker's Compensation |
$11.19
|
|
|
SCREENING TEST VISUAL ACUITY QUANTITATIV
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
21600226
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$38.95 |
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$34.85
|
| Rate for Payer: First Health Commercial |
$36.90
|
| Rate for Payer: First Health Workers Compensation |
$15.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.90
|
| Rate for Payer: GEHA Commercial |
$28.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.90
|
| Rate for Payer: Multiplan All |
$37.31
|
| Rate for Payer: OMNI Networks Commercial |
$28.70
|
| Rate for Payer: One Health Plan PPO/POS |
$36.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.95
|
| Rate for Payer: Three Rivers Provider Network All |
$30.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$38.13
|
| Rate for Payer: Zelis Auto |
$16.40
|
| Rate for Payer: Zelis Worker's Compensation |
$11.19
|
|
|
SCREW CAGE ECLIPSE
|
Facility
|
IP
|
$13,275.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,310.00 |
| Max. Negotiated Rate |
$12,611.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$10,620.00
|
| Rate for Payer: Cash Price |
$7,965.00
|
| Rate for Payer: Cash Price |
$7,965.00
|
| Rate for Payer: Cigna Commercial |
$11,283.75
|
| Rate for Payer: First Health Commercial |
$11,947.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$11,947.50
|
| Rate for Payer: GEHA Commercial |
$9,292.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$11,947.50
|
| Rate for Payer: Multiplan All |
$12,080.25
|
| Rate for Payer: OMNI Networks Commercial |
$9,292.50
|
| Rate for Payer: One Health Plan PPO/POS |
$11,947.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$12,611.25
|
| Rate for Payer: Three Rivers Provider Network All |
$9,956.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$12,345.75
|
| Rate for Payer: Zelis Auto |
$5,310.00
|
|
|
SCREW CAGE ECLIPSE
|
Facility
|
OP
|
$13,275.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,318.75 |
| Max. Negotiated Rate |
$12,611.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7,965.00
|
| Rate for Payer: Cash Price |
$7,965.00
|
| Rate for Payer: Cash Price |
$7,965.00
|
| Rate for Payer: Cigna Commercial |
$11,283.75
|
| Rate for Payer: First Health Commercial |
$11,947.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$11,947.50
|
| Rate for Payer: GEHA Commercial |
$10,620.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$11,947.50
|
| Rate for Payer: Humana ChoiceCare |
$3,451.50
|
| Rate for Payer: Multiplan All |
$12,080.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,965.00
|
| Rate for Payer: OMNI Networks Commercial |
$9,292.50
|
| Rate for Payer: One Health Plan PPO/POS |
$11,947.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$12,611.25
|
| Rate for Payer: Three Rivers Provider Network All |
$9,956.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,682.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,318.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$12,345.75
|
| Rate for Payer: Zelis Auto |
$5,310.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,637.50
|
|
|
SCREW,CANCELLOUS 40X4.0MM
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$313.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$264.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cigna Commercial |
$280.50
|
| Rate for Payer: First Health Commercial |
$297.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$297.00
|
| Rate for Payer: GEHA Commercial |
$231.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$297.00
|
| Rate for Payer: Multiplan All |
$300.30
|
| Rate for Payer: OMNI Networks Commercial |
$231.00
|
| Rate for Payer: One Health Plan PPO/POS |
$297.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$313.50
|
| Rate for Payer: Three Rivers Provider Network All |
$247.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$306.90
|
| Rate for Payer: Zelis Auto |
$132.00
|
|
|
SCREW,CANCELLOUS 40X4.0MM
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$313.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cigna Commercial |
$280.50
|
| Rate for Payer: First Health Commercial |
$297.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$297.00
|
| Rate for Payer: GEHA Commercial |
$264.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$297.00
|
| Rate for Payer: Humana ChoiceCare |
$85.80
|
| Rate for Payer: Multiplan All |
$300.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$198.00
|
| Rate for Payer: OMNI Networks Commercial |
$231.00
|
| Rate for Payer: One Health Plan PPO/POS |
$297.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$313.50
|
| Rate for Payer: Three Rivers Provider Network All |
$247.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$290.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$82.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$306.90
|
| Rate for Payer: Zelis Auto |
$132.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$165.00
|
|
|
SCREW,CANCELLOUS 4.0X60MM
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$279.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$249.90
|
| Rate for Payer: First Health Commercial |
$264.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$264.60
|
| Rate for Payer: GEHA Commercial |
$235.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$264.60
|
| Rate for Payer: Humana ChoiceCare |
$76.44
|
| Rate for Payer: Multiplan All |
$267.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$176.40
|
| Rate for Payer: OMNI Networks Commercial |
$205.80
|
| Rate for Payer: One Health Plan PPO/POS |
$264.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$279.30
|
| Rate for Payer: Three Rivers Provider Network All |
$220.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$258.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$73.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$273.42
|
| Rate for Payer: Zelis Auto |
$117.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$147.00
|
|
|
SCREW,CANCELLOUS 4.0X60MM
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001385
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$59.75 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$203.15
|
| Rate for Payer: First Health Commercial |
$215.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$215.10
|
| Rate for Payer: GEHA Commercial |
$191.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$215.10
|
| Rate for Payer: Humana ChoiceCare |
$62.14
|
| Rate for Payer: Multiplan All |
$217.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$143.40
|
| Rate for Payer: OMNI Networks Commercial |
$167.30
|
| Rate for Payer: One Health Plan PPO/POS |
$215.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$227.05
|
| Rate for Payer: Three Rivers Provider Network All |
$179.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$210.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$59.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$222.27
|
| Rate for Payer: Zelis Auto |
$95.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$119.50
|
|
|
SCREW,CANCELLOUS 4.0X60MM
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$279.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$235.20
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$249.90
|
| Rate for Payer: First Health Commercial |
$264.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$264.60
|
| Rate for Payer: GEHA Commercial |
$205.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$264.60
|
| Rate for Payer: Multiplan All |
$267.54
|
| Rate for Payer: OMNI Networks Commercial |
$205.80
|
| Rate for Payer: One Health Plan PPO/POS |
$264.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$279.30
|
| Rate for Payer: Three Rivers Provider Network All |
$220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$273.42
|
| Rate for Payer: Zelis Auto |
$117.60
|
|
|
SCREW,CANCELLOUS 4.0X60MM
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001385
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$191.20
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$203.15
|
| Rate for Payer: First Health Commercial |
$215.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$215.10
|
| Rate for Payer: GEHA Commercial |
$167.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$215.10
|
| Rate for Payer: Multiplan All |
$217.49
|
| Rate for Payer: OMNI Networks Commercial |
$167.30
|
| Rate for Payer: One Health Plan PPO/POS |
$215.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$227.05
|
| Rate for Payer: Three Rivers Provider Network All |
$179.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$222.27
|
| Rate for Payer: Zelis Auto |
$95.60
|
|
|
SCREW,CANCELLOUS 6.5X70MM
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$381.25 |
| Max. Negotiated Rate |
$1,448.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$915.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cigna Commercial |
$1,296.25
|
| Rate for Payer: First Health Commercial |
$1,372.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,372.50
|
| Rate for Payer: GEHA Commercial |
$1,220.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,372.50
|
| Rate for Payer: Humana ChoiceCare |
$396.50
|
| Rate for Payer: Multiplan All |
$1,387.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$915.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,067.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,372.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,448.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,143.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,342.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$381.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,418.25
|
| Rate for Payer: Zelis Auto |
$610.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$762.50
|
|
|
SCREW,CANCELLOUS 6.5X70MM
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.00 |
| Max. Negotiated Rate |
$1,448.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,220.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cigna Commercial |
$1,296.25
|
| Rate for Payer: First Health Commercial |
$1,372.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,372.50
|
| Rate for Payer: GEHA Commercial |
$1,067.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,372.50
|
| Rate for Payer: Multiplan All |
$1,387.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,067.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,372.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,448.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,143.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,418.25
|
| Rate for Payer: Zelis Auto |
$610.00
|
|
|
SCREW INTERFERENCE 8X23MM
|
Facility
|
IP
|
$1,618.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.20 |
| Max. Negotiated Rate |
$1,537.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,294.40
|
| Rate for Payer: Cash Price |
$970.80
|
| Rate for Payer: Cash Price |
$970.80
|
| Rate for Payer: Cigna Commercial |
$1,375.30
|
| Rate for Payer: First Health Commercial |
$1,456.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,456.20
|
| Rate for Payer: GEHA Commercial |
$1,132.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,456.20
|
| Rate for Payer: Multiplan All |
$1,472.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,132.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,456.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,537.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,213.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,504.74
|
| Rate for Payer: Zelis Auto |
$647.20
|
|
|
SCREW INTERFERENCE 8X23MM
|
Facility
|
OP
|
$1,618.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.50 |
| Max. Negotiated Rate |
$1,537.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$970.80
|
| Rate for Payer: Cash Price |
$970.80
|
| Rate for Payer: Cash Price |
$970.80
|
| Rate for Payer: Cigna Commercial |
$1,375.30
|
| Rate for Payer: First Health Commercial |
$1,456.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,456.20
|
| Rate for Payer: GEHA Commercial |
$1,294.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,456.20
|
| Rate for Payer: Humana ChoiceCare |
$420.68
|
| Rate for Payer: Multiplan All |
$1,472.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$970.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,132.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,456.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,537.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,213.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,423.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$404.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,504.74
|
| Rate for Payer: Zelis Auto |
$647.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$809.00
|
|
