|
UC XR FOOT RIGHT 2VWS
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
21600396
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.03 |
| Max. Negotiated Rate |
$303.05 |
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cigna Commercial |
$271.15
|
| Rate for Payer: First Health Commercial |
$287.10
|
| Rate for Payer: First Health Workers Compensation |
$33.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$287.10
|
| Rate for Payer: GEHA Commercial |
$223.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$287.10
|
| Rate for Payer: Multiplan All |
$290.29
|
| Rate for Payer: OMNI Networks Commercial |
$223.30
|
| Rate for Payer: One Health Plan PPO/POS |
$287.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$303.05
|
| Rate for Payer: Three Rivers Provider Network All |
$239.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$296.67
|
| Rate for Payer: Zelis Auto |
$127.60
|
| Rate for Payer: Zelis Worker's Compensation |
$24.03
|
|
|
UC XR FOOT RIGHT 2VWS
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
21600396
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.03 |
| Max. Negotiated Rate |
$303.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$191.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cigna Commercial |
$271.15
|
| Rate for Payer: First Health Commercial |
$287.10
|
| Rate for Payer: First Health Workers Compensation |
$33.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$287.10
|
| Rate for Payer: GEHA Commercial |
$255.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$287.10
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$290.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$223.30
|
| Rate for Payer: One Health Plan PPO/POS |
$287.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$303.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$239.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$271.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$296.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$127.60
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$24.03
|
|
|
UC XR FOREARM
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
21600399
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$389.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$246.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cigna Commercial |
$348.50
|
| Rate for Payer: First Health Commercial |
$369.00
|
| Rate for Payer: First Health Workers Compensation |
$35.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$369.00
|
| Rate for Payer: GEHA Commercial |
$328.00
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$369.00
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$373.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$287.00
|
| Rate for Payer: One Health Plan PPO/POS |
$369.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$389.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$307.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$348.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$381.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$164.00
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$24.88
|
|
|
UC XR FOREARM
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
21600399
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$389.50 |
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cigna Commercial |
$348.50
|
| Rate for Payer: First Health Commercial |
$369.00
|
| Rate for Payer: First Health Workers Compensation |
$35.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$369.00
|
| Rate for Payer: GEHA Commercial |
$287.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$369.00
|
| Rate for Payer: Multiplan All |
$373.10
|
| Rate for Payer: OMNI Networks Commercial |
$287.00
|
| Rate for Payer: One Health Plan PPO/POS |
$369.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$389.50
|
| Rate for Payer: Three Rivers Provider Network All |
$307.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$381.30
|
| Rate for Payer: Zelis Auto |
$164.00
|
| Rate for Payer: Zelis Worker's Compensation |
$24.88
|
|
|
UC XR FOREARM RIGHT
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
21600400
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$389.50 |
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cigna Commercial |
$348.50
|
| Rate for Payer: First Health Commercial |
$369.00
|
| Rate for Payer: First Health Workers Compensation |
$35.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$369.00
|
| Rate for Payer: GEHA Commercial |
$287.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$369.00
|
| Rate for Payer: Multiplan All |
$373.10
|
| Rate for Payer: OMNI Networks Commercial |
$287.00
|
| Rate for Payer: One Health Plan PPO/POS |
$369.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$389.50
|
| Rate for Payer: Three Rivers Provider Network All |
$307.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$381.30
|
| Rate for Payer: Zelis Auto |
$164.00
|
| Rate for Payer: Zelis Worker's Compensation |
$24.88
|
|
|
UC XR FOREARM RIGHT
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
21600400
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$389.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$246.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cigna Commercial |
$348.50
|
| Rate for Payer: First Health Commercial |
$369.00
|
| Rate for Payer: First Health Workers Compensation |
$35.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$369.00
|
| Rate for Payer: GEHA Commercial |
$328.00
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$369.00
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$373.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$287.00
|
| Rate for Payer: One Health Plan PPO/POS |
$369.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$389.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$307.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$348.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$381.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$164.00
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$24.88
|
|
|
UC XR HAND 2 VWS
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
21600401
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.57 |
| Max. Negotiated Rate |
$304.95 |
| 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 |
$192.60
|
| 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 |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$272.85
|
| Rate for Payer: First Health Commercial |
$288.90
|
| Rate for Payer: First Health Workers Compensation |
$37.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$288.90
|
| Rate for Payer: GEHA Commercial |
$256.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$288.90
|
| 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 |
$292.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$224.70
|
| Rate for Payer: One Health Plan PPO/POS |
$288.90
|
| 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 |
$304.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$240.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$272.85
|
| 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 |
$298.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$128.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$26.57
|
|
|
UC XR HAND 2 VWS
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
21600401
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.57 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$272.85
|
| Rate for Payer: First Health Commercial |
$288.90
|
| Rate for Payer: First Health Workers Compensation |
$37.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$288.90
|
| Rate for Payer: GEHA Commercial |
$224.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$288.90
|
| Rate for Payer: Multiplan All |
$292.11
|
| Rate for Payer: OMNI Networks Commercial |
$224.70
|
| Rate for Payer: One Health Plan PPO/POS |
$288.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$304.95
|
| Rate for Payer: Three Rivers Provider Network All |
$240.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$298.53
|
| Rate for Payer: Zelis Auto |
$128.40
|
| Rate for Payer: Zelis Worker's Compensation |
$26.57
|
|
|
UC XR HAND COMP
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
21600403
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.38 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$254.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$360.40
|
| Rate for Payer: First Health Commercial |
$381.60
|
| Rate for Payer: First Health Workers Compensation |
$44.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$381.60
|
| Rate for Payer: GEHA Commercial |
$339.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$381.60
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$385.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$296.80
|
| Rate for Payer: One Health Plan PPO/POS |
$381.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$402.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$318.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$360.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$394.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$169.60
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$31.38
|
|
|
UC XR HAND COMP
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
21600403
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.38 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$360.40
|
| Rate for Payer: First Health Commercial |
$381.60
|
| Rate for Payer: First Health Workers Compensation |
$44.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$381.60
|
| Rate for Payer: GEHA Commercial |
$296.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$381.60
|
| Rate for Payer: Multiplan All |
$385.84
|
| Rate for Payer: OMNI Networks Commercial |
$296.80
|
| Rate for Payer: One Health Plan PPO/POS |
$381.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$402.80
|
| Rate for Payer: Three Rivers Provider Network All |
$318.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$394.32
|
| Rate for Payer: Zelis Auto |
$169.60
|
| Rate for Payer: Zelis Worker's Compensation |
$31.38
|
|
|
UC XR HAND COMP RIGHT
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
21600404
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.38 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$360.40
|
| Rate for Payer: First Health Commercial |
$381.60
|
| Rate for Payer: First Health Workers Compensation |
$44.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$381.60
|
| Rate for Payer: GEHA Commercial |
$296.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$381.60
|
| Rate for Payer: Multiplan All |
$385.84
|
| Rate for Payer: OMNI Networks Commercial |
$296.80
|
| Rate for Payer: One Health Plan PPO/POS |
$381.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$402.80
|
| Rate for Payer: Three Rivers Provider Network All |
$318.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$394.32
|
| Rate for Payer: Zelis Auto |
$169.60
|
| Rate for Payer: Zelis Worker's Compensation |
$31.38
|
|
|
UC XR HAND COMP RIGHT
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
21600404
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.38 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$254.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$360.40
|
| Rate for Payer: First Health Commercial |
$381.60
|
| Rate for Payer: First Health Workers Compensation |
$44.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$381.60
|
| Rate for Payer: GEHA Commercial |
$339.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$381.60
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$385.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$296.80
|
| Rate for Payer: One Health Plan PPO/POS |
$381.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$402.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$318.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$360.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$394.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$169.60
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$31.38
|
|
|
UC XR HAND RIGHT 2 VWS
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
21600402
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.57 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$272.85
|
| Rate for Payer: First Health Commercial |
$288.90
|
| Rate for Payer: First Health Workers Compensation |
$37.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$288.90
|
| Rate for Payer: GEHA Commercial |
$224.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$288.90
|
| Rate for Payer: Multiplan All |
$292.11
|
| Rate for Payer: OMNI Networks Commercial |
$224.70
|
| Rate for Payer: One Health Plan PPO/POS |
$288.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$304.95
|
| Rate for Payer: Three Rivers Provider Network All |
$240.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$298.53
|
| Rate for Payer: Zelis Auto |
$128.40
|
| Rate for Payer: Zelis Worker's Compensation |
$26.57
|
|
|
UC XR HAND RIGHT 2 VWS
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
21600402
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.57 |
| Max. Negotiated Rate |
$304.95 |
| 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 |
$192.60
|
| 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 |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$272.85
|
| Rate for Payer: First Health Commercial |
$288.90
|
| Rate for Payer: First Health Workers Compensation |
$37.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$288.90
|
| Rate for Payer: GEHA Commercial |
$256.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$288.90
|
| 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 |
$292.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$224.70
|
| Rate for Payer: One Health Plan PPO/POS |
$288.90
|
| 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 |
$304.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$240.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$272.85
|
| 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 |
$298.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$128.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$26.57
|
|
|
UC XR HIP 1V
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
21600405
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.81 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$237.15
|
| Rate for Payer: First Health Commercial |
$251.10
|
| Rate for Payer: First Health Workers Compensation |
$46.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$251.10
|
| Rate for Payer: GEHA Commercial |
$195.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$251.10
|
| Rate for Payer: Multiplan All |
$253.89
|
| Rate for Payer: OMNI Networks Commercial |
$195.30
|
| Rate for Payer: One Health Plan PPO/POS |
$251.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$265.05
|
| Rate for Payer: Three Rivers Provider Network All |
$209.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$259.47
|
| Rate for Payer: Zelis Auto |
$111.60
|
| Rate for Payer: Zelis Worker's Compensation |
$32.81
|
|
|
UC XR HIP 1V
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
21600405
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.81 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$167.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$72.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$237.15
|
| Rate for Payer: First Health Commercial |
$251.10
|
| Rate for Payer: First Health Workers Compensation |
$46.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$251.10
|
| Rate for Payer: GEHA Commercial |
$223.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$251.10
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$73.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$253.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$195.30
|
| Rate for Payer: One Health Plan PPO/POS |
$251.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$85.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$73.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$265.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$209.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$237.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$73.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$259.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$111.60
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$32.81
|
|
|
UC XR HIP 2/3 VW
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
21600407
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.31 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$167.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$72.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$237.15
|
| Rate for Payer: First Health Commercial |
$251.10
|
| Rate for Payer: First Health Workers Compensation |
$64.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$251.10
|
| Rate for Payer: GEHA Commercial |
$223.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$251.10
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$73.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$253.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$195.30
|
| Rate for Payer: One Health Plan PPO/POS |
$251.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$85.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$73.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$265.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$209.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$237.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$73.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$259.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$111.60
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$45.31
|
|
|
UC XR HIP 2/3 VW
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
21600407
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.31 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$237.15
|
| Rate for Payer: First Health Commercial |
$251.10
|
| Rate for Payer: First Health Workers Compensation |
$64.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$251.10
|
| Rate for Payer: GEHA Commercial |
$195.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$251.10
|
| Rate for Payer: Multiplan All |
$253.89
|
| Rate for Payer: OMNI Networks Commercial |
$195.30
|
| Rate for Payer: One Health Plan PPO/POS |
$251.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$265.05
|
| Rate for Payer: Three Rivers Provider Network All |
$209.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$259.47
|
| Rate for Payer: Zelis Auto |
$111.60
|
| Rate for Payer: Zelis Worker's Compensation |
$45.31
|
|
|
UC XR HIPS BILAT 2 VWS
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
21600411
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$385.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$151.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$243.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$151.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$119.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$345.10
|
| Rate for Payer: First Health Commercial |
$365.40
|
| Rate for Payer: First Health Workers Compensation |
$61.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$365.40
|
| Rate for Payer: GEHA Commercial |
$324.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$365.40
|
| 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 |
$122.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$369.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$284.20
|
| Rate for Payer: One Health Plan PPO/POS |
$365.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$140.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$122.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$385.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$304.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$345.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$122.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$377.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$162.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$43.75
|
|
|
UC XR HIPS BILAT 2 VWS
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
21600411
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$385.70 |
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$345.10
|
| Rate for Payer: First Health Commercial |
$365.40
|
| Rate for Payer: First Health Workers Compensation |
$61.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$365.40
|
| Rate for Payer: GEHA Commercial |
$284.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$365.40
|
| Rate for Payer: Multiplan All |
$369.46
|
| Rate for Payer: OMNI Networks Commercial |
$284.20
|
| Rate for Payer: One Health Plan PPO/POS |
$365.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$385.70
|
| Rate for Payer: Three Rivers Provider Network All |
$304.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$377.58
|
| Rate for Payer: Zelis Auto |
$162.40
|
| Rate for Payer: Zelis Worker's Compensation |
$43.75
|
|
|
UC XR HIPS BILAT 3-4 VWS
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
21600412
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.52 |
| Max. Negotiated Rate |
$385.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$151.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$243.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$151.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$119.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$345.10
|
| Rate for Payer: First Health Commercial |
$365.40
|
| Rate for Payer: First Health Workers Compensation |
$75.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$365.40
|
| Rate for Payer: GEHA Commercial |
$324.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$365.40
|
| 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 |
$122.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$369.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$284.20
|
| Rate for Payer: One Health Plan PPO/POS |
$365.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$140.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$122.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$385.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$304.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$345.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$122.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$377.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$162.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$53.52
|
|
|
UC XR HIPS BILAT 3-4 VWS
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
21600412
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.52 |
| Max. Negotiated Rate |
$385.70 |
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$345.10
|
| Rate for Payer: First Health Commercial |
$365.40
|
| Rate for Payer: First Health Workers Compensation |
$75.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$365.40
|
| Rate for Payer: GEHA Commercial |
$284.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$365.40
|
| Rate for Payer: Multiplan All |
$369.46
|
| Rate for Payer: OMNI Networks Commercial |
$284.20
|
| Rate for Payer: One Health Plan PPO/POS |
$365.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$385.70
|
| Rate for Payer: Three Rivers Provider Network All |
$304.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$377.58
|
| Rate for Payer: Zelis Auto |
$162.40
|
| Rate for Payer: Zelis Worker's Compensation |
$53.52
|
|
|
UC XR HIP UNI 1 VW RT
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
21600406
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.81 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$237.15
|
| Rate for Payer: First Health Commercial |
$251.10
|
| Rate for Payer: First Health Workers Compensation |
$46.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$251.10
|
| Rate for Payer: GEHA Commercial |
$195.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$251.10
|
| Rate for Payer: Multiplan All |
$253.89
|
| Rate for Payer: OMNI Networks Commercial |
$195.30
|
| Rate for Payer: One Health Plan PPO/POS |
$251.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$265.05
|
| Rate for Payer: Three Rivers Provider Network All |
$209.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$259.47
|
| Rate for Payer: Zelis Auto |
$111.60
|
| Rate for Payer: Zelis Worker's Compensation |
$32.81
|
|
|
UC XR HIP UNI 1 VW RT
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
21600406
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.81 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$167.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$72.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$237.15
|
| Rate for Payer: First Health Commercial |
$251.10
|
| Rate for Payer: First Health Workers Compensation |
$46.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$251.10
|
| Rate for Payer: GEHA Commercial |
$223.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$251.10
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$73.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$253.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$195.30
|
| Rate for Payer: One Health Plan PPO/POS |
$251.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$85.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$73.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$265.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$209.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$237.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$73.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$259.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$111.60
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$32.81
|
|
|
UC XR HIP UNI 2-3 VW RT
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
21620039
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.31 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$237.15
|
| Rate for Payer: First Health Commercial |
$251.10
|
| Rate for Payer: First Health Workers Compensation |
$64.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$251.10
|
| Rate for Payer: GEHA Commercial |
$195.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$251.10
|
| Rate for Payer: Multiplan All |
$253.89
|
| Rate for Payer: OMNI Networks Commercial |
$195.30
|
| Rate for Payer: One Health Plan PPO/POS |
$251.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$265.05
|
| Rate for Payer: Three Rivers Provider Network All |
$209.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$259.47
|
| Rate for Payer: Zelis Auto |
$111.60
|
| Rate for Payer: Zelis Worker's Compensation |
$45.31
|
|
