|
Body Fluid Cell Count
|
Facility
|
OP
|
$76.00
|
|
| Hospital Charge Code |
2205028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: First Health Workers Compensation |
$29.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$68.40
|
| Rate for Payer: GEHA Commercial |
$60.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$68.40
|
| Rate for Payer: Humana ChoiceCare |
$19.76
|
| Rate for Payer: Multiplan All |
$69.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$45.60
|
| Rate for Payer: OMNI Networks Commercial |
$53.20
|
| Rate for Payer: One Health Plan PPO/POS |
$68.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$72.20
|
| Rate for Payer: Three Rivers Provider Network All |
$57.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.88
|
| Rate for Payer: United Healthcare Commercial |
$64.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$19.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$70.68
|
| Rate for Payer: Zelis Auto |
$30.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$38.00
|
| Rate for Payer: Zelis Worker's Compensation |
$20.75
|
|
|
BONE AGE STUDIES
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
8230046
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$330.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$208.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$295.80
|
| Rate for Payer: First Health Commercial |
$313.20
|
| Rate for Payer: First Health Workers Compensation |
$31.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$313.20
|
| Rate for Payer: GEHA Commercial |
$278.40
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$313.20
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$316.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$243.60
|
| Rate for Payer: One Health Plan PPO/POS |
$313.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$330.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$261.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$323.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$139.20
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$22.05
|
|
|
BONE AGE STUDIES
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
8230046
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$330.60 |
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$295.80
|
| Rate for Payer: First Health Commercial |
$313.20
|
| Rate for Payer: First Health Workers Compensation |
$31.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$313.20
|
| Rate for Payer: GEHA Commercial |
$243.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$313.20
|
| Rate for Payer: Multiplan All |
$316.68
|
| Rate for Payer: OMNI Networks Commercial |
$243.60
|
| Rate for Payer: One Health Plan PPO/POS |
$313.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$330.60
|
| Rate for Payer: Three Rivers Provider Network All |
$261.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$323.64
|
| Rate for Payer: Zelis Auto |
$139.20
|
| Rate for Payer: Zelis Worker's Compensation |
$22.05
|
|
|
BONE BIOPSY EXCISIONAL
|
Facility
|
OP
|
$1,012.23
|
|
|
Service Code
|
CPT 20245
|
| Hospital Charge Code |
6120245
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$276.34 |
| Max. Negotiated Rate |
$5,435.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$607.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,364.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,873.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,717.63
|
| Rate for Payer: Cash Price |
$607.34
|
| Rate for Payer: Cash Price |
$607.34
|
| Rate for Payer: Cigna Commercial |
$860.40
|
| Rate for Payer: First Health Commercial |
$911.01
|
| Rate for Payer: First Health Workers Compensation |
$390.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$911.01
|
| Rate for Payer: GEHA Commercial |
$809.78
|
| Rate for Payer: GEHA Medicare |
$2,717.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$911.01
|
| Rate for Payer: Humana ChoiceCare |
$2,989.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,717.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$4,565.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,911.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,717.63
|
| Rate for Payer: Multiplan All |
$921.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,619.97
|
| Rate for Payer: OMNI Networks Commercial |
$708.56
|
| Rate for Payer: One Health Plan PPO/POS |
$911.01
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,207.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,911.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,717.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$961.62
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,435.26
|
| Rate for Payer: Three Rivers Provider Network All |
$759.17
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,663.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,911.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,717.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$941.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,717.63
|
| Rate for Payer: Zelis Auto |
$404.89
|
| Rate for Payer: Zelis Medicare |
$2,309.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,261.16
|
| Rate for Payer: Zelis Worker's Compensation |
$276.34
|
|
|
BONE BIOPSY EXCISIONAL
|
Facility
|
IP
|
$1,012.23
|
|
|
Service Code
|
CPT 20245
|
| Hospital Charge Code |
6120245
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$276.34 |
| Max. Negotiated Rate |
$961.62 |
| Rate for Payer: Cash Price |
$607.34
|
| Rate for Payer: Cigna Commercial |
$860.40
|
| Rate for Payer: First Health Commercial |
$911.01
|
| Rate for Payer: First Health Workers Compensation |
$390.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$911.01
|
| Rate for Payer: GEHA Commercial |
$708.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$911.01
|
| Rate for Payer: Multiplan All |
$921.13
|
| Rate for Payer: OMNI Networks Commercial |
$708.56
|
| Rate for Payer: One Health Plan PPO/POS |
$911.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$961.62
|
| Rate for Payer: Three Rivers Provider Network All |
$759.17
|
| Rate for Payer: United Payors & United Providers UP&UP |
$941.37
|
| Rate for Payer: Zelis Auto |
$404.89
|
| Rate for Payer: Zelis Worker's Compensation |
$276.34
|
|
|
BONE BX VERTEBRAL,FE
|
Facility
|
IP
|
$1,879.00
|
|
| Hospital Charge Code |
2410068
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$512.97 |
| Max. Negotiated Rate |
$1,785.05 |
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$1,597.15
|
| Rate for Payer: First Health Commercial |
$1,691.10
|
| Rate for Payer: First Health Workers Compensation |
$725.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,691.10
|
| Rate for Payer: GEHA Commercial |
$1,315.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,691.10
|
| Rate for Payer: Multiplan All |
$1,709.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,315.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,691.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,785.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,409.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,747.47
|
| Rate for Payer: Zelis Auto |
$751.60
|
| Rate for Payer: Zelis Worker's Compensation |
$512.97
|
|
|
BONE BX VERTEBRAL,FE
|
Facility
|
OP
|
$1,879.00
|
|
| Hospital Charge Code |
2410068
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$469.75 |
| Max. Negotiated Rate |
$1,785.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,127.40
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$1,597.15
|
| Rate for Payer: First Health Commercial |
$1,691.10
|
| Rate for Payer: First Health Workers Compensation |
$725.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,691.10
|
| Rate for Payer: GEHA Commercial |
$1,503.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,691.10
|
| Rate for Payer: Humana ChoiceCare |
$488.54
|
| Rate for Payer: Multiplan All |
$1,709.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,127.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,315.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,691.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,785.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,409.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,653.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$469.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,747.47
|
| Rate for Payer: Zelis Auto |
$751.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$939.50
|
| Rate for Payer: Zelis Worker's Compensation |
$512.97
|
|
|
BONE LENGTH STUDIES/SCANO
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
8230047
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.16 |
| Max. Negotiated Rate |
$391.40 |
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cigna Commercial |
$350.20
|
| Rate for Payer: First Health Commercial |
$370.80
|
| Rate for Payer: First Health Workers Compensation |
$53.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$370.80
|
| Rate for Payer: GEHA Commercial |
$288.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$370.80
|
| Rate for Payer: Multiplan All |
$374.92
|
| Rate for Payer: OMNI Networks Commercial |
$288.40
|
| Rate for Payer: One Health Plan PPO/POS |
$370.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$391.40
|
| Rate for Payer: Three Rivers Provider Network All |
$309.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$383.16
|
| Rate for Payer: Zelis Auto |
$164.80
|
| Rate for Payer: Zelis Worker's Compensation |
$38.16
|
|
|
BONE LENGTH STUDIES/SCANO
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
8230047
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.16 |
| Max. Negotiated Rate |
$391.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$247.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cigna Commercial |
$350.20
|
| Rate for Payer: First Health Commercial |
$370.80
|
| Rate for Payer: First Health Workers Compensation |
$53.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$370.80
|
| Rate for Payer: GEHA Commercial |
$329.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$370.80
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$374.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$288.40
|
| Rate for Payer: One Health Plan PPO/POS |
$370.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$391.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$309.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$350.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$383.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$164.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$38.16
|
|
|
BONE MARROW ASPIR BONE GRFG
|
Facility
|
IP
|
$2,470.00
|
|
|
Service Code
|
CPT 20939
|
| Hospital Charge Code |
6169663
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$674.31 |
| Max. Negotiated Rate |
$2,346.50 |
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cigna Commercial |
$2,099.50
|
| Rate for Payer: First Health Commercial |
$2,223.00
|
| Rate for Payer: First Health Workers Compensation |
$953.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,223.00
|
| Rate for Payer: GEHA Commercial |
$1,729.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,223.00
|
| Rate for Payer: Multiplan All |
$2,247.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,729.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,223.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,346.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,852.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,297.10
|
| Rate for Payer: Zelis Auto |
$988.00
|
| Rate for Payer: Zelis Worker's Compensation |
$674.31
|
|
|
BONE MARROW ASPIR BONE GRFG
|
Facility
|
OP
|
$2,470.00
|
|
|
Service Code
|
CPT 20939
|
| Hospital Charge Code |
6169663
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$617.50 |
| Max. Negotiated Rate |
$2,346.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,482.00
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cigna Commercial |
$2,099.50
|
| Rate for Payer: First Health Commercial |
$2,223.00
|
| Rate for Payer: First Health Workers Compensation |
$953.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,223.00
|
| Rate for Payer: GEHA Commercial |
$1,976.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,223.00
|
| Rate for Payer: Humana ChoiceCare |
$642.20
|
| Rate for Payer: Multiplan All |
$2,247.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,482.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,729.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,223.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,346.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,852.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,173.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$617.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,297.10
|
| Rate for Payer: Zelis Auto |
$988.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,235.00
|
| Rate for Payer: Zelis Worker's Compensation |
$674.31
|
|
|
BONE MARROW HARVEST ALLOGEN
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
CPT 38230
|
| Hospital Charge Code |
6138230
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$140.32 |
| Max. Negotiated Rate |
$3,369.01 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,369.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$308.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,369.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,668.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,556.56
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cigna Commercial |
$436.90
|
| Rate for Payer: First Health Commercial |
$462.60
|
| Rate for Payer: First Health Workers Compensation |
$198.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$462.60
|
| Rate for Payer: GEHA Commercial |
$411.20
|
| Rate for Payer: GEHA Medicare |
$1,556.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$462.60
|
| Rate for Payer: Humana ChoiceCare |
$1,712.22
|
| Rate for Payer: Humana Medicare Advantage |
$1,556.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,615.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,723.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,556.56
|
| Rate for Payer: Multiplan All |
$467.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,646.15
|
| Rate for Payer: OMNI Networks Commercial |
$359.80
|
| Rate for Payer: One Health Plan PPO/POS |
$462.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,144.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,723.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,556.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$488.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,113.12
|
| Rate for Payer: Three Rivers Provider Network All |
$385.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,525.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,723.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,556.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,556.56
|
| Rate for Payer: Zelis Auto |
$205.60
|
| Rate for Payer: Zelis Medicare |
$1,323.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,867.87
|
| Rate for Payer: Zelis Worker's Compensation |
$140.32
|
|
|
BONE MARROW HARVEST ALLOGEN
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
CPT 38230
|
| Hospital Charge Code |
6138230
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$140.32 |
| Max. Negotiated Rate |
$488.30 |
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cigna Commercial |
$436.90
|
| Rate for Payer: First Health Commercial |
$462.60
|
| Rate for Payer: First Health Workers Compensation |
$198.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$462.60
|
| Rate for Payer: GEHA Commercial |
$359.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$462.60
|
| Rate for Payer: Multiplan All |
$467.74
|
| Rate for Payer: OMNI Networks Commercial |
$359.80
|
| Rate for Payer: One Health Plan PPO/POS |
$462.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$488.30
|
| Rate for Payer: Three Rivers Provider Network All |
$385.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.02
|
| Rate for Payer: Zelis Auto |
$205.60
|
| Rate for Payer: Zelis Worker's Compensation |
$140.32
|
|
|
BONE MARROW HARVEST AUTOLOG
|
Facility
|
IP
|
$512.00
|
|
|
Service Code
|
CPT 38232
|
| Hospital Charge Code |
6138232
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$139.78 |
| Max. Negotiated Rate |
$486.40 |
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cigna Commercial |
$435.20
|
| Rate for Payer: First Health Commercial |
$460.80
|
| Rate for Payer: First Health Workers Compensation |
$197.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$460.80
|
| Rate for Payer: GEHA Commercial |
$358.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$460.80
|
| Rate for Payer: Multiplan All |
$465.92
|
| Rate for Payer: OMNI Networks Commercial |
$358.40
|
| Rate for Payer: One Health Plan PPO/POS |
$460.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$486.40
|
| Rate for Payer: Three Rivers Provider Network All |
$384.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$476.16
|
| Rate for Payer: Zelis Auto |
$204.80
|
| Rate for Payer: Zelis Worker's Compensation |
$139.78
|
|
|
BONE MARROW HARVEST AUTOLOG
|
Facility
|
OP
|
$512.00
|
|
|
Service Code
|
CPT 38232
|
| Hospital Charge Code |
6138232
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$139.78 |
| Max. Negotiated Rate |
$8,897.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,294.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$307.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,294.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,610.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,448.76
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cigna Commercial |
$435.20
|
| Rate for Payer: First Health Commercial |
$460.80
|
| Rate for Payer: First Health Workers Compensation |
$197.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$460.80
|
| Rate for Payer: GEHA Commercial |
$409.60
|
| Rate for Payer: GEHA Medicare |
$4,448.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$460.80
|
| Rate for Payer: Humana ChoiceCare |
$4,893.64
|
| Rate for Payer: Humana Medicare Advantage |
$4,448.76
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,473.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,663.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,448.76
|
| Rate for Payer: Multiplan All |
$465.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,562.89
|
| Rate for Payer: OMNI Networks Commercial |
$358.40
|
| Rate for Payer: One Health Plan PPO/POS |
$460.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,075.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,663.39
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,448.76
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$486.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$8,897.52
|
| Rate for Payer: Three Rivers Provider Network All |
$384.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,359.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,663.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,448.76
|
| Rate for Payer: United Payors & United Providers UP&UP |
$476.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,448.76
|
| Rate for Payer: Zelis Auto |
$204.80
|
| Rate for Payer: Zelis Medicare |
$3,781.45
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,338.51
|
| Rate for Payer: Zelis Worker's Compensation |
$139.78
|
|
|
BONE MARROW SMEAR INTERPRETATION
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 85097
|
| Hospital Charge Code |
2200400
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.61 |
| Max. Negotiated Rate |
$606.10 |
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cigna Commercial |
$542.30
|
| Rate for Payer: First Health Commercial |
$574.20
|
| Rate for Payer: First Health Workers Compensation |
$92.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$574.20
|
| Rate for Payer: GEHA Commercial |
$446.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$574.20
|
| Rate for Payer: Multiplan All |
$580.58
|
| Rate for Payer: OMNI Networks Commercial |
$446.60
|
| Rate for Payer: One Health Plan PPO/POS |
$574.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$606.10
|
| Rate for Payer: Three Rivers Provider Network All |
$478.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$593.34
|
| Rate for Payer: Zelis Auto |
$255.20
|
| Rate for Payer: Zelis Worker's Compensation |
$65.61
|
|
|
BONE MARROW SMEAR INTERPRETATION
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 85097
|
| Hospital Charge Code |
2200400
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.61 |
| Max. Negotiated Rate |
$1,551.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$118.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$382.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$118.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$93.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$775.68
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cigna Commercial |
$542.30
|
| Rate for Payer: First Health Commercial |
$574.20
|
| Rate for Payer: First Health Workers Compensation |
$92.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$574.20
|
| Rate for Payer: GEHA Commercial |
$510.40
|
| Rate for Payer: GEHA Medicare |
$775.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$574.20
|
| Rate for Payer: Humana ChoiceCare |
$853.25
|
| Rate for Payer: Humana Medicare Advantage |
$775.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,303.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$95.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$775.68
|
| Rate for Payer: Multiplan All |
$580.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,318.66
|
| Rate for Payer: OMNI Networks Commercial |
$446.60
|
| Rate for Payer: One Health Plan PPO/POS |
$574.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$110.61
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$95.80
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$775.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$606.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,551.36
|
| Rate for Payer: Three Rivers Provider Network All |
$478.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$760.17
|
| Rate for Payer: United Healthcare Commercial |
$542.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$95.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$775.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$593.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$775.68
|
| Rate for Payer: Zelis Auto |
$255.20
|
| Rate for Payer: Zelis Medicare |
$659.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$930.82
|
| Rate for Payer: Zelis Worker's Compensation |
$65.61
|
|
|
BONE/SKIN GRAFT GREAT TOE
|
Facility
|
IP
|
$5,480.00
|
|
|
Service Code
|
CPT 20973
|
| Hospital Charge Code |
6120973
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,496.04 |
| Max. Negotiated Rate |
$5,206.00 |
| Rate for Payer: Cash Price |
$3,288.00
|
| Rate for Payer: Cigna Commercial |
$4,658.00
|
| Rate for Payer: First Health Commercial |
$4,932.00
|
| Rate for Payer: First Health Workers Compensation |
$2,115.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,932.00
|
| Rate for Payer: GEHA Commercial |
$3,836.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,932.00
|
| Rate for Payer: Multiplan All |
$4,986.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,836.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,932.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,206.00
|
| Rate for Payer: Three Rivers Provider Network All |
$4,110.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,096.40
|
| Rate for Payer: Zelis Auto |
$2,192.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,496.04
|
|
|
BONE/SKIN GRAFT GREAT TOE
|
Facility
|
OP
|
$5,480.00
|
|
|
Service Code
|
CPT 20973
|
| Hospital Charge Code |
6120973
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,496.04 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,288.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,207.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$3,288.00
|
| Rate for Payer: Cash Price |
$3,288.00
|
| Rate for Payer: Cigna Commercial |
$4,658.00
|
| Rate for Payer: First Health Commercial |
$4,932.00
|
| Rate for Payer: First Health Workers Compensation |
$2,115.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,932.00
|
| Rate for Payer: GEHA Commercial |
$4,384.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,932.00
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,292.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$4,986.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$3,836.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,932.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,956.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,292.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,206.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$4,110.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,292.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,096.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$2,192.00
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$1,496.04
|
|
|
BONE/SKIN GRAFT ILIAC CREST
|
Facility
|
OP
|
$6,102.00
|
|
|
Service Code
|
CPT 20970
|
| Hospital Charge Code |
6120970
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,525.50 |
| Max. Negotiated Rate |
$5,796.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,661.20
|
| Rate for Payer: Cash Price |
$3,661.20
|
| Rate for Payer: Cigna Commercial |
$5,186.70
|
| Rate for Payer: First Health Commercial |
$5,491.80
|
| Rate for Payer: First Health Workers Compensation |
$2,355.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,491.80
|
| Rate for Payer: GEHA Commercial |
$4,881.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,491.80
|
| Rate for Payer: Humana ChoiceCare |
$1,586.52
|
| Rate for Payer: Multiplan All |
$5,552.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,661.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,271.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,491.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,796.90
|
| Rate for Payer: Three Rivers Provider Network All |
$4,576.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,369.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,525.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,674.86
|
| Rate for Payer: Zelis Auto |
$2,440.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,051.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,665.85
|
|
|
BONE/SKIN GRAFT ILIAC CREST
|
Facility
|
IP
|
$6,102.00
|
|
|
Service Code
|
CPT 20970
|
| Hospital Charge Code |
6120970
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,665.85 |
| Max. Negotiated Rate |
$5,796.90 |
| Rate for Payer: Cash Price |
$3,661.20
|
| Rate for Payer: Cigna Commercial |
$5,186.70
|
| Rate for Payer: First Health Commercial |
$5,491.80
|
| Rate for Payer: First Health Workers Compensation |
$2,355.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,491.80
|
| Rate for Payer: GEHA Commercial |
$4,271.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,491.80
|
| Rate for Payer: Multiplan All |
$5,552.82
|
| Rate for Payer: OMNI Networks Commercial |
$4,271.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,491.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,796.90
|
| Rate for Payer: Three Rivers Provider Network All |
$4,576.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,674.86
|
| Rate for Payer: Zelis Auto |
$2,440.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,665.85
|
|
|
BONE/SKIN GRAFT METATARSAL
|
Facility
|
IP
|
$4,898.00
|
|
|
Service Code
|
CPT 20972
|
| Hospital Charge Code |
6120972
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,337.15 |
| Max. Negotiated Rate |
$4,653.10 |
| Rate for Payer: Cash Price |
$2,938.80
|
| Rate for Payer: Cigna Commercial |
$4,163.30
|
| Rate for Payer: First Health Commercial |
$4,408.20
|
| Rate for Payer: First Health Workers Compensation |
$1,891.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,408.20
|
| Rate for Payer: GEHA Commercial |
$3,428.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,408.20
|
| Rate for Payer: Multiplan All |
$4,457.18
|
| Rate for Payer: OMNI Networks Commercial |
$3,428.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,408.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,653.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,673.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,555.14
|
| Rate for Payer: Zelis Auto |
$1,959.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,337.15
|
|
|
BONE/SKIN GRAFT METATARSAL
|
Facility
|
OP
|
$4,898.00
|
|
|
Service Code
|
CPT 20972
|
| Hospital Charge Code |
6120972
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,337.15 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,938.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,207.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$2,938.80
|
| Rate for Payer: Cash Price |
$2,938.80
|
| Rate for Payer: Cigna Commercial |
$4,163.30
|
| Rate for Payer: First Health Commercial |
$4,408.20
|
| Rate for Payer: First Health Workers Compensation |
$1,891.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,408.20
|
| Rate for Payer: GEHA Commercial |
$3,918.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,408.20
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,292.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$4,457.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$3,428.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,408.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,956.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,292.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,653.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$3,673.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,292.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,555.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$1,959.20
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$1,337.15
|
|
|
BONE/SKIN GRAFT MICROVASC
|
Facility
|
IP
|
$5,736.00
|
|
|
Service Code
|
CPT 20969
|
| Hospital Charge Code |
6120969
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,565.93 |
| Max. Negotiated Rate |
$5,449.20 |
| Rate for Payer: Cash Price |
$3,441.60
|
| Rate for Payer: Cigna Commercial |
$4,875.60
|
| Rate for Payer: First Health Commercial |
$5,162.40
|
| Rate for Payer: First Health Workers Compensation |
$2,214.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,162.40
|
| Rate for Payer: GEHA Commercial |
$4,015.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,162.40
|
| Rate for Payer: Multiplan All |
$5,219.76
|
| Rate for Payer: OMNI Networks Commercial |
$4,015.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,162.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,449.20
|
| Rate for Payer: Three Rivers Provider Network All |
$4,302.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,334.48
|
| Rate for Payer: Zelis Auto |
$2,294.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,565.93
|
|
|
BONE/SKIN GRAFT MICROVASC
|
Facility
|
OP
|
$5,736.00
|
|
|
Service Code
|
CPT 20969
|
| Hospital Charge Code |
6120969
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,434.00 |
| Max. Negotiated Rate |
$5,449.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,441.60
|
| Rate for Payer: Cash Price |
$3,441.60
|
| Rate for Payer: Cigna Commercial |
$4,875.60
|
| Rate for Payer: First Health Commercial |
$5,162.40
|
| Rate for Payer: First Health Workers Compensation |
$2,214.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,162.40
|
| Rate for Payer: GEHA Commercial |
$4,588.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,162.40
|
| Rate for Payer: Humana ChoiceCare |
$1,491.36
|
| Rate for Payer: Multiplan All |
$5,219.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,441.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,015.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,162.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,449.20
|
| Rate for Payer: Three Rivers Provider Network All |
$4,302.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,047.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,434.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,334.48
|
| Rate for Payer: Zelis Auto |
$2,294.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,868.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,565.93
|
|
