|
SIMPLE REPAIR S/N/A/G/T 2.5CM/<
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
20300100
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.89 |
| Max. Negotiated Rate |
$385.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$226.95
|
| Rate for Payer: First Health Commercial |
$240.30
|
| Rate for Payer: First Health Workers Compensation |
$103.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.30
|
| Rate for Payer: GEHA Commercial |
$213.60
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.30
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$242.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| Rate for Payer: OMNI Networks Commercial |
$186.90
|
| Rate for Payer: One Health Plan PPO/POS |
$240.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$200.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$106.80
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$72.89
|
|
|
SIMPLE REPAIR S/N/A/G/T 2.5CM/<
|
Facility
|
IP
|
$492.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
8150001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.32 |
| Max. Negotiated Rate |
$467.40 |
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cigna Commercial |
$418.20
|
| Rate for Payer: First Health Commercial |
$442.80
|
| Rate for Payer: First Health Workers Compensation |
$189.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$442.80
|
| Rate for Payer: GEHA Commercial |
$344.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$442.80
|
| Rate for Payer: Multiplan All |
$447.72
|
| Rate for Payer: OMNI Networks Commercial |
$344.40
|
| Rate for Payer: One Health Plan PPO/POS |
$442.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$467.40
|
| Rate for Payer: Three Rivers Provider Network All |
$369.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$457.56
|
| Rate for Payer: Zelis Auto |
$196.80
|
| Rate for Payer: Zelis Worker's Compensation |
$134.32
|
|
|
SIMPLE REPAIR S/N/A/G/T 2.5CM/<
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
6112001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$385.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$84.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$119.00
|
| Rate for Payer: First Health Commercial |
$126.00
|
| Rate for Payer: First Health Workers Compensation |
$54.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$126.00
|
| Rate for Payer: GEHA Commercial |
$112.00
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$126.00
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$127.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| Rate for Payer: OMNI Networks Commercial |
$98.00
|
| Rate for Payer: One Health Plan PPO/POS |
$126.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$133.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$105.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$130.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$56.00
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$38.22
|
|
|
SIMPLE REPAIR S/N/A/G/T 2.5CM/<
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
21600099
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$385.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$84.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$119.00
|
| Rate for Payer: First Health Commercial |
$126.00
|
| Rate for Payer: First Health Workers Compensation |
$54.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$126.00
|
| Rate for Payer: GEHA Commercial |
$112.00
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$126.00
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$127.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| Rate for Payer: OMNI Networks Commercial |
$98.00
|
| Rate for Payer: One Health Plan PPO/POS |
$126.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$133.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$105.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$130.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$56.00
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$38.22
|
|
|
SIMPLE REPAIR S/N/A/G/T 2.5CM/<
|
Facility
|
OP
|
$260.07
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
7212001
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$71.00 |
| Max. Negotiated Rate |
$385.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$156.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cigna Commercial |
$221.06
|
| Rate for Payer: First Health Commercial |
$234.06
|
| Rate for Payer: First Health Workers Compensation |
$100.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.06
|
| Rate for Payer: GEHA Commercial |
$208.06
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.06
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$236.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| Rate for Payer: OMNI Networks Commercial |
$182.05
|
| Rate for Payer: One Health Plan PPO/POS |
$234.06
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$247.07
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$195.05
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$241.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$104.03
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$71.00
|
|
|
SIMPLE REPAIR S/N/A/G/T 2.5CM/<
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
6112001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$119.00
|
| Rate for Payer: First Health Commercial |
$126.00
|
| Rate for Payer: First Health Workers Compensation |
$54.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$126.00
|
| Rate for Payer: GEHA Commercial |
$98.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$126.00
|
| Rate for Payer: Multiplan All |
$127.40
|
| Rate for Payer: OMNI Networks Commercial |
$98.00
|
| Rate for Payer: One Health Plan PPO/POS |
$126.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$133.00
|
| Rate for Payer: Three Rivers Provider Network All |
$105.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$130.20
|
| Rate for Payer: Zelis Auto |
$56.00
|
| Rate for Payer: Zelis Worker's Compensation |
$38.22
|
|
|
SIMPLE REPAIR S/N/A/G/T 2.5CM/<
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
8212001
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$72.89 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$226.95
|
| Rate for Payer: First Health Commercial |
$240.30
|
| Rate for Payer: First Health Workers Compensation |
$103.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.30
|
| Rate for Payer: GEHA Commercial |
$186.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.30
|
| Rate for Payer: Multiplan All |
$242.97
|
| Rate for Payer: OMNI Networks Commercial |
$186.90
|
| Rate for Payer: One Health Plan PPO/POS |
$240.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.65
|
| Rate for Payer: Three Rivers Provider Network All |
$200.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.31
|
| Rate for Payer: Zelis Auto |
$106.80
|
| Rate for Payer: Zelis Worker's Compensation |
$72.89
|
|
|
SIMPLE REPAIR S/N/A/G/T 2.5CM/<
|
Facility
|
IP
|
$260.07
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
8512001
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$71.00 |
| Max. Negotiated Rate |
$247.07 |
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cigna Commercial |
$221.06
|
| Rate for Payer: First Health Commercial |
$234.06
|
| Rate for Payer: First Health Workers Compensation |
$100.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.06
|
| Rate for Payer: GEHA Commercial |
$182.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.06
|
| Rate for Payer: Multiplan All |
$236.66
|
| Rate for Payer: OMNI Networks Commercial |
$182.05
|
| Rate for Payer: One Health Plan PPO/POS |
$234.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$247.07
|
| Rate for Payer: Three Rivers Provider Network All |
$195.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$241.87
|
| Rate for Payer: Zelis Auto |
$104.03
|
| Rate for Payer: Zelis Worker's Compensation |
$71.00
|
|
|
SIMPLE REPAIR S/N/A/G/T 2.5CM/<
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
8212001
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$72.89 |
| Max. Negotiated Rate |
$385.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$226.95
|
| Rate for Payer: First Health Commercial |
$240.30
|
| Rate for Payer: First Health Workers Compensation |
$103.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.30
|
| Rate for Payer: GEHA Commercial |
$213.60
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.30
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$242.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| Rate for Payer: OMNI Networks Commercial |
$186.90
|
| Rate for Payer: One Health Plan PPO/POS |
$240.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$200.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$106.80
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$72.89
|
|
|
SIMPLE REPAIR S/N/A/G/T 2.5CM/<
|
Facility
|
OP
|
$260.07
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
8512001
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$71.00 |
| Max. Negotiated Rate |
$385.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$156.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cigna Commercial |
$221.06
|
| Rate for Payer: First Health Commercial |
$234.06
|
| Rate for Payer: First Health Workers Compensation |
$100.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.06
|
| Rate for Payer: GEHA Commercial |
$208.06
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.06
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$236.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| Rate for Payer: OMNI Networks Commercial |
$182.05
|
| Rate for Payer: One Health Plan PPO/POS |
$234.06
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$247.07
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$195.05
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$241.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$104.03
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$71.00
|
|
|
SIMPLE REPAIR S/N/A/G/T 2.5CM/<
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
21600099
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$119.00
|
| Rate for Payer: First Health Commercial |
$126.00
|
| Rate for Payer: First Health Workers Compensation |
$54.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$126.00
|
| Rate for Payer: GEHA Commercial |
$98.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$126.00
|
| Rate for Payer: Multiplan All |
$127.40
|
| Rate for Payer: OMNI Networks Commercial |
$98.00
|
| Rate for Payer: One Health Plan PPO/POS |
$126.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$133.00
|
| Rate for Payer: Three Rivers Provider Network All |
$105.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$130.20
|
| Rate for Payer: Zelis Auto |
$56.00
|
| Rate for Payer: Zelis Worker's Compensation |
$38.22
|
|
|
SIMPLE REPAIR S/N/A/G/T 2.5CM/<
|
Facility
|
OP
|
$821.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
1912001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$779.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$492.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cigna Commercial |
$697.85
|
| Rate for Payer: First Health Commercial |
$738.90
|
| Rate for Payer: First Health Workers Compensation |
$316.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$738.90
|
| Rate for Payer: GEHA Commercial |
$656.80
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$738.90
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$747.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| Rate for Payer: OMNI Networks Commercial |
$574.70
|
| Rate for Payer: One Health Plan PPO/POS |
$738.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$779.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$615.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$763.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$328.40
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$224.13
|
|
|
SIMPLE RPR S/N/A/G/T 7.6-12.5CM
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
8150003
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$166.26 |
| Max. Negotiated Rate |
$578.55 |
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$517.65
|
| Rate for Payer: First Health Commercial |
$548.10
|
| Rate for Payer: First Health Workers Compensation |
$235.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$548.10
|
| Rate for Payer: GEHA Commercial |
$426.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$548.10
|
| Rate for Payer: Multiplan All |
$554.19
|
| Rate for Payer: OMNI Networks Commercial |
$426.30
|
| Rate for Payer: One Health Plan PPO/POS |
$548.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$578.55
|
| Rate for Payer: Three Rivers Provider Network All |
$456.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$566.37
|
| Rate for Payer: Zelis Auto |
$243.60
|
| Rate for Payer: Zelis Worker's Compensation |
$166.26
|
|
|
SIMPLE RPR S/N/A/G/T 7.6-12.5CM
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
8150003
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$578.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$365.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$517.65
|
| Rate for Payer: First Health Commercial |
$548.10
|
| Rate for Payer: First Health Workers Compensation |
$235.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$548.10
|
| Rate for Payer: GEHA Commercial |
$487.20
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$548.10
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$554.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| Rate for Payer: OMNI Networks Commercial |
$426.30
|
| Rate for Payer: One Health Plan PPO/POS |
$548.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$578.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$456.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$566.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$243.60
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$166.26
|
|
|
SIMPLE RPR S/N/A/G/T 7.6-12.5CM
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
6112004
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$62.24 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$88.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$159.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Worker's Compensation |
$62.24
|
|
|
SIMPLE RPR S/N/A/G/T 7.6-12.5CM
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
21600169
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$62.24 |
| Max. Negotiated Rate |
$385.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$88.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$182.40
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$62.24
|
|
|
SIMPLE RPR S/N/A/G/T 7.6-12.5CM
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
21600169
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$62.24 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$88.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$159.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Worker's Compensation |
$62.24
|
|
|
SIMPLE RPR S/N/A/G/T 7.6-12.5CM
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
6112004
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$62.24 |
| Max. Negotiated Rate |
$385.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$88.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$182.40
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$62.24
|
|
|
SINCALIDE FOR INJ 5MCG
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
CPT J2805
|
| Hospital Charge Code |
3300830
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$135.70 |
| Max. Negotiated Rate |
$601.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$379.80
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cigna Commercial |
$538.05
|
| Rate for Payer: First Health Commercial |
$569.70
|
| Rate for Payer: First Health Workers Compensation |
$244.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$569.70
|
| Rate for Payer: GEHA Commercial |
$135.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$569.70
|
| Rate for Payer: Humana ChoiceCare |
$164.58
|
| Rate for Payer: Multiplan All |
$576.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$379.80
|
| Rate for Payer: OMNI Networks Commercial |
$443.10
|
| Rate for Payer: One Health Plan PPO/POS |
$569.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$601.35
|
| Rate for Payer: Three Rivers Provider Network All |
$474.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$557.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$158.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$588.69
|
| Rate for Payer: Zelis Auto |
$253.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$316.50
|
| Rate for Payer: Zelis Worker's Compensation |
$172.81
|
|
|
SINCALIDE FOR INJ 5MCG
|
Facility
|
IP
|
$633.00
|
|
|
Service Code
|
CPT J2805
|
| Hospital Charge Code |
3300830
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$172.81 |
| Max. Negotiated Rate |
$601.35 |
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cigna Commercial |
$538.05
|
| Rate for Payer: First Health Commercial |
$569.70
|
| Rate for Payer: First Health Workers Compensation |
$244.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$569.70
|
| Rate for Payer: GEHA Commercial |
$443.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$569.70
|
| Rate for Payer: Multiplan All |
$576.03
|
| Rate for Payer: OMNI Networks Commercial |
$443.10
|
| Rate for Payer: One Health Plan PPO/POS |
$569.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$601.35
|
| Rate for Payer: Three Rivers Provider Network All |
$474.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$588.69
|
| Rate for Payer: Zelis Auto |
$253.20
|
| Rate for Payer: Zelis Worker's Compensation |
$172.81
|
|
|
SINGLE TRANSFER TOE-HAND
|
Facility
|
OP
|
$6,738.00
|
|
|
Service Code
|
CPT 26553
|
| Hospital Charge Code |
6126553
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,684.50 |
| Max. Negotiated Rate |
$6,401.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,042.80
|
| Rate for Payer: Cash Price |
$4,042.80
|
| Rate for Payer: Cigna Commercial |
$5,727.30
|
| Rate for Payer: First Health Commercial |
$6,064.20
|
| Rate for Payer: First Health Workers Compensation |
$2,601.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,064.20
|
| Rate for Payer: GEHA Commercial |
$5,390.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,064.20
|
| Rate for Payer: Humana ChoiceCare |
$1,751.88
|
| Rate for Payer: Multiplan All |
$6,131.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,042.80
|
| Rate for Payer: OMNI Networks Commercial |
$4,716.60
|
| Rate for Payer: One Health Plan PPO/POS |
$6,064.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,401.10
|
| Rate for Payer: Three Rivers Provider Network All |
$5,053.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,929.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,684.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,266.34
|
| Rate for Payer: Zelis Auto |
$2,695.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,369.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,839.47
|
|
|
SINGLE TRANSFER TOE-HAND
|
Facility
|
IP
|
$6,738.00
|
|
|
Service Code
|
CPT 26553
|
| Hospital Charge Code |
6126553
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,839.47 |
| Max. Negotiated Rate |
$6,401.10 |
| Rate for Payer: Cash Price |
$4,042.80
|
| Rate for Payer: Cigna Commercial |
$5,727.30
|
| Rate for Payer: First Health Commercial |
$6,064.20
|
| Rate for Payer: First Health Workers Compensation |
$2,601.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,064.20
|
| Rate for Payer: GEHA Commercial |
$4,716.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,064.20
|
| Rate for Payer: Multiplan All |
$6,131.58
|
| Rate for Payer: OMNI Networks Commercial |
$4,716.60
|
| Rate for Payer: One Health Plan PPO/POS |
$6,064.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,401.10
|
| Rate for Payer: Three Rivers Provider Network All |
$5,053.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,266.34
|
| Rate for Payer: Zelis Auto |
$2,695.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,839.47
|
|
|
SINUS ENDOSCOPY SURGICAL
|
Facility
|
OP
|
$1,049.00
|
|
|
Service Code
|
CPT 31276
|
| Hospital Charge Code |
6131276
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$286.38 |
| Max. Negotiated Rate |
$13,415.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,959.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$629.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,959.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,344.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,707.73
|
| Rate for Payer: Cash Price |
$629.40
|
| Rate for Payer: Cash Price |
$629.40
|
| Rate for Payer: Cigna Commercial |
$891.65
|
| Rate for Payer: First Health Commercial |
$944.10
|
| Rate for Payer: First Health Workers Compensation |
$405.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$944.10
|
| Rate for Payer: GEHA Commercial |
$839.20
|
| Rate for Payer: GEHA Medicare |
$6,707.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$944.10
|
| Rate for Payer: Humana ChoiceCare |
$7,378.50
|
| Rate for Payer: Humana Medicare Advantage |
$6,707.73
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,268.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,392.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,707.73
|
| Rate for Payer: Multiplan All |
$954.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,403.14
|
| Rate for Payer: OMNI Networks Commercial |
$734.30
|
| Rate for Payer: One Health Plan PPO/POS |
$944.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,762.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,392.37
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,707.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$996.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,415.46
|
| Rate for Payer: Three Rivers Provider Network All |
$786.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,573.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,392.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,707.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$975.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,707.73
|
| Rate for Payer: Zelis Auto |
$419.60
|
| Rate for Payer: Zelis Medicare |
$5,701.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,049.28
|
| Rate for Payer: Zelis Worker's Compensation |
$286.38
|
|
|
SINUS ENDOSCOPY SURGICAL
|
Facility
|
IP
|
$1,049.00
|
|
|
Service Code
|
CPT 31276
|
| Hospital Charge Code |
6131276
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$286.38 |
| Max. Negotiated Rate |
$996.55 |
| Rate for Payer: Cash Price |
$629.40
|
| Rate for Payer: Cigna Commercial |
$891.65
|
| Rate for Payer: First Health Commercial |
$944.10
|
| Rate for Payer: First Health Workers Compensation |
$405.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$944.10
|
| Rate for Payer: GEHA Commercial |
$734.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$944.10
|
| Rate for Payer: Multiplan All |
$954.59
|
| Rate for Payer: OMNI Networks Commercial |
$734.30
|
| Rate for Payer: One Health Plan PPO/POS |
$944.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$996.55
|
| Rate for Payer: Three Rivers Provider Network All |
$786.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$975.57
|
| Rate for Payer: Zelis Auto |
$419.60
|
| Rate for Payer: Zelis Worker's Compensation |
$286.38
|
|
|
sirolimus whole blood REF716712
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
22990785
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.22 |
| Max. Negotiated Rate |
$201.40 |
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cigna Commercial |
$180.20
|
| Rate for Payer: First Health Commercial |
$190.80
|
| Rate for Payer: First Health Workers Compensation |
$24.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$190.80
|
| Rate for Payer: GEHA Commercial |
$148.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$190.80
|
| Rate for Payer: Multiplan All |
$192.92
|
| Rate for Payer: OMNI Networks Commercial |
$148.40
|
| Rate for Payer: One Health Plan PPO/POS |
$190.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$201.40
|
| Rate for Payer: Three Rivers Provider Network All |
$159.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$197.16
|
| Rate for Payer: Zelis Auto |
$84.80
|
| Rate for Payer: Zelis Worker's Compensation |
$17.22
|
|
