|
UC XR L-SPINE COMP W/FL/EX
|
Facility
|
IP
|
$939.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
21600420
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.37 |
| Max. Negotiated Rate |
$892.05 |
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cigna Commercial |
$798.15
|
| Rate for Payer: First Health Commercial |
$845.10
|
| Rate for Payer: First Health Workers Compensation |
$75.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$845.10
|
| Rate for Payer: GEHA Commercial |
$657.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$845.10
|
| Rate for Payer: Multiplan All |
$854.49
|
| Rate for Payer: OMNI Networks Commercial |
$657.30
|
| Rate for Payer: One Health Plan PPO/POS |
$845.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$892.05
|
| Rate for Payer: Three Rivers Provider Network All |
$704.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$873.27
|
| Rate for Payer: Zelis Auto |
$375.60
|
| Rate for Payer: Zelis Worker's Compensation |
$53.37
|
|
|
UC XR L-SPINE COMP W/FL/EX
|
Facility
|
OP
|
$939.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
21600420
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.37 |
| Max. Negotiated Rate |
$892.05 |
| 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 |
$563.40
|
| 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 |
$103.04
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cigna Commercial |
$798.15
|
| Rate for Payer: First Health Commercial |
$845.10
|
| Rate for Payer: First Health Workers Compensation |
$75.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$845.10
|
| Rate for Payer: GEHA Commercial |
$751.20
|
| Rate for Payer: GEHA Medicare |
$103.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$845.10
|
| Rate for Payer: Humana ChoiceCare |
$113.34
|
| Rate for Payer: Humana Medicare Advantage |
$103.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$173.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$103.04
|
| Rate for Payer: Multiplan All |
$854.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.17
|
| Rate for Payer: OMNI Networks Commercial |
$657.30
|
| Rate for Payer: One Health Plan PPO/POS |
$845.10
|
| 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 |
$103.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$892.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$206.08
|
| Rate for Payer: Three Rivers Provider Network All |
$704.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.98
|
| Rate for Payer: United Healthcare Commercial |
$798.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$873.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$103.04
|
| Rate for Payer: Zelis Auto |
$375.60
|
| Rate for Payer: Zelis Medicare |
$87.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$123.65
|
| Rate for Payer: Zelis Worker's Compensation |
$53.37
|
|
|
UC XR L-SPINE FL/EX ONLY
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
21600423
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.06 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cigna Commercial |
$202.30
|
| Rate for Payer: First Health Commercial |
$214.20
|
| Rate for Payer: First Health Workers Compensation |
$52.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$214.20
|
| Rate for Payer: GEHA Commercial |
$166.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$214.20
|
| Rate for Payer: Multiplan All |
$216.58
|
| Rate for Payer: OMNI Networks Commercial |
$166.60
|
| Rate for Payer: One Health Plan PPO/POS |
$214.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$226.10
|
| Rate for Payer: Three Rivers Provider Network All |
$178.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$221.34
|
| Rate for Payer: Zelis Auto |
$95.20
|
| Rate for Payer: Zelis Worker's Compensation |
$37.06
|
|
|
UC XR L-SPINE FL/EX ONLY
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
21600423
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.06 |
| Max. Negotiated Rate |
$226.10 |
| 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 |
$142.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$103.04
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cigna Commercial |
$202.30
|
| Rate for Payer: First Health Commercial |
$214.20
|
| Rate for Payer: First Health Workers Compensation |
$52.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$214.20
|
| Rate for Payer: GEHA Commercial |
$190.40
|
| Rate for Payer: GEHA Medicare |
$103.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$214.20
|
| Rate for Payer: Humana ChoiceCare |
$113.34
|
| Rate for Payer: Humana Medicare Advantage |
$103.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$173.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$103.04
|
| Rate for Payer: Multiplan All |
$216.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.17
|
| Rate for Payer: OMNI Networks Commercial |
$166.60
|
| Rate for Payer: One Health Plan PPO/POS |
$214.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$103.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$226.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$206.08
|
| Rate for Payer: Three Rivers Provider Network All |
$178.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.98
|
| Rate for Payer: United Healthcare Commercial |
$202.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$221.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$103.04
|
| Rate for Payer: Zelis Auto |
$95.20
|
| Rate for Payer: Zelis Medicare |
$87.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$123.65
|
| Rate for Payer: Zelis Worker's Compensation |
$37.06
|
|
|
UC XR MANDIBLE 4+VWS
|
Facility
|
OP
|
$629.00
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
21600425
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.76 |
| Max. Negotiated Rate |
$597.55 |
| 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 |
$377.40
|
| 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 |
$103.04
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cigna Commercial |
$534.65
|
| Rate for Payer: First Health Commercial |
$566.10
|
| Rate for Payer: First Health Workers Compensation |
$51.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$566.10
|
| Rate for Payer: GEHA Commercial |
$503.20
|
| Rate for Payer: GEHA Medicare |
$103.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$566.10
|
| Rate for Payer: Humana ChoiceCare |
$113.34
|
| Rate for Payer: Humana Medicare Advantage |
$103.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$173.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$103.04
|
| Rate for Payer: Multiplan All |
$572.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.17
|
| Rate for Payer: OMNI Networks Commercial |
$440.30
|
| Rate for Payer: One Health Plan PPO/POS |
$566.10
|
| 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 |
$103.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$597.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$206.08
|
| Rate for Payer: Three Rivers Provider Network All |
$471.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.98
|
| Rate for Payer: United Healthcare Commercial |
$534.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$584.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$103.04
|
| Rate for Payer: Zelis Auto |
$251.60
|
| Rate for Payer: Zelis Medicare |
$87.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$123.65
|
| Rate for Payer: Zelis Worker's Compensation |
$36.76
|
|
|
UC XR MANDIBLE 4+VWS
|
Facility
|
IP
|
$629.00
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
21600425
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.76 |
| Max. Negotiated Rate |
$597.55 |
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cigna Commercial |
$534.65
|
| Rate for Payer: First Health Commercial |
$566.10
|
| Rate for Payer: First Health Workers Compensation |
$51.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$566.10
|
| Rate for Payer: GEHA Commercial |
$440.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$566.10
|
| Rate for Payer: Multiplan All |
$572.39
|
| Rate for Payer: OMNI Networks Commercial |
$440.30
|
| Rate for Payer: One Health Plan PPO/POS |
$566.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$597.55
|
| Rate for Payer: Three Rivers Provider Network All |
$471.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$584.97
|
| Rate for Payer: Zelis Auto |
$251.60
|
| Rate for Payer: Zelis Worker's Compensation |
$36.76
|
|
|
UC XR MANDIBLE PARTIAL
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
21600426
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$194.75 |
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$174.25
|
| Rate for Payer: First Health Commercial |
$184.50
|
| Rate for Payer: First Health Workers Compensation |
$46.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$184.50
|
| Rate for Payer: GEHA Commercial |
$143.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$184.50
|
| Rate for Payer: Multiplan All |
$186.55
|
| Rate for Payer: OMNI Networks Commercial |
$143.50
|
| Rate for Payer: One Health Plan PPO/POS |
$184.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$194.75
|
| Rate for Payer: Three Rivers Provider Network All |
$153.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$190.65
|
| Rate for Payer: Zelis Auto |
$82.00
|
| Rate for Payer: Zelis Worker's Compensation |
$32.80
|
|
|
UC XR MANDIBLE PARTIAL
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
21600426
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$194.75 |
| 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 |
$123.00
|
| 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 |
$85.32
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$174.25
|
| Rate for Payer: First Health Commercial |
$184.50
|
| Rate for Payer: First Health Workers Compensation |
$46.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$184.50
|
| Rate for Payer: GEHA Commercial |
$164.00
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$184.50
|
| Rate for Payer: Humana ChoiceCare |
$93.85
|
| Rate for Payer: Humana Medicare Advantage |
$85.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$143.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$186.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$143.50
|
| Rate for Payer: One Health Plan PPO/POS |
$184.50
|
| 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 |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$194.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$153.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$174.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$190.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$82.00
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$32.80
|
|
|
UC XR MANDIBLE PARTIAL RT
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
21600427
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$194.75 |
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$174.25
|
| Rate for Payer: First Health Commercial |
$184.50
|
| Rate for Payer: First Health Workers Compensation |
$46.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$184.50
|
| Rate for Payer: GEHA Commercial |
$143.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$184.50
|
| Rate for Payer: Multiplan All |
$186.55
|
| Rate for Payer: OMNI Networks Commercial |
$143.50
|
| Rate for Payer: One Health Plan PPO/POS |
$184.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$194.75
|
| Rate for Payer: Three Rivers Provider Network All |
$153.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$190.65
|
| Rate for Payer: Zelis Auto |
$82.00
|
| Rate for Payer: Zelis Worker's Compensation |
$32.80
|
|
|
UC XR MANDIBLE PARTIAL RT
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
21600427
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$194.75 |
| 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 |
$123.00
|
| 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 |
$85.32
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$174.25
|
| Rate for Payer: First Health Commercial |
$184.50
|
| Rate for Payer: First Health Workers Compensation |
$46.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$184.50
|
| Rate for Payer: GEHA Commercial |
$164.00
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$184.50
|
| Rate for Payer: Humana ChoiceCare |
$93.85
|
| Rate for Payer: Humana Medicare Advantage |
$85.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$143.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$186.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$143.50
|
| Rate for Payer: One Health Plan PPO/POS |
$184.50
|
| 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 |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$194.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$153.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$174.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$190.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$82.00
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$32.80
|
|
|
UC XR MASTOID 3+ VWS
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
21600428
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.16 |
| Max. Negotiated Rate |
$585.20 |
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cigna Commercial |
$523.60
|
| Rate for Payer: First Health Commercial |
$554.40
|
| Rate for Payer: First Health Workers Compensation |
$75.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$554.40
|
| Rate for Payer: GEHA Commercial |
$431.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$554.40
|
| Rate for Payer: Multiplan All |
$560.56
|
| Rate for Payer: OMNI Networks Commercial |
$431.20
|
| Rate for Payer: One Health Plan PPO/POS |
$554.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$585.20
|
| Rate for Payer: Three Rivers Provider Network All |
$462.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$572.88
|
| Rate for Payer: Zelis Auto |
$246.40
|
| Rate for Payer: Zelis Worker's Compensation |
$53.16
|
|
|
UC XR MASTOID 3+ VWS
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
21600428
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.16 |
| Max. Negotiated Rate |
$585.20 |
| 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 |
$369.60
|
| 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 |
$103.04
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cigna Commercial |
$523.60
|
| Rate for Payer: First Health Commercial |
$554.40
|
| Rate for Payer: First Health Workers Compensation |
$75.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$554.40
|
| Rate for Payer: GEHA Commercial |
$492.80
|
| Rate for Payer: GEHA Medicare |
$103.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$554.40
|
| Rate for Payer: Humana ChoiceCare |
$113.34
|
| Rate for Payer: Humana Medicare Advantage |
$103.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$173.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$103.04
|
| Rate for Payer: Multiplan All |
$560.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.17
|
| Rate for Payer: OMNI Networks Commercial |
$431.20
|
| Rate for Payer: One Health Plan PPO/POS |
$554.40
|
| 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 |
$103.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$585.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$206.08
|
| Rate for Payer: Three Rivers Provider Network All |
$462.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.98
|
| Rate for Payer: United Healthcare Commercial |
$523.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$572.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$103.04
|
| Rate for Payer: Zelis Auto |
$246.40
|
| Rate for Payer: Zelis Medicare |
$87.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$123.65
|
| Rate for Payer: Zelis Worker's Compensation |
$53.16
|
|
|
UC XR MASTOIDS <3VWS
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
21600429
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$451.25 |
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cigna Commercial |
$403.75
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: First Health Workers Compensation |
$46.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$427.50
|
| Rate for Payer: GEHA Commercial |
$332.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$427.50
|
| Rate for Payer: Multiplan All |
$432.25
|
| Rate for Payer: OMNI Networks Commercial |
$332.50
|
| Rate for Payer: One Health Plan PPO/POS |
$427.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$451.25
|
| Rate for Payer: Three Rivers Provider Network All |
$356.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$441.75
|
| Rate for Payer: Zelis Auto |
$190.00
|
| Rate for Payer: Zelis Worker's Compensation |
$32.80
|
|
|
UC XR MASTOIDS <3VWS
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
21600429
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$451.25 |
| 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 |
$285.00
|
| 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 |
$103.04
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cigna Commercial |
$403.75
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: First Health Workers Compensation |
$46.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$427.50
|
| Rate for Payer: GEHA Commercial |
$380.00
|
| Rate for Payer: GEHA Medicare |
$103.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$427.50
|
| Rate for Payer: Humana ChoiceCare |
$113.34
|
| Rate for Payer: Humana Medicare Advantage |
$103.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$173.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$103.04
|
| Rate for Payer: Multiplan All |
$432.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.17
|
| Rate for Payer: OMNI Networks Commercial |
$332.50
|
| Rate for Payer: One Health Plan PPO/POS |
$427.50
|
| 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 |
$103.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$451.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$206.08
|
| Rate for Payer: Three Rivers Provider Network All |
$356.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.98
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$441.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$103.04
|
| Rate for Payer: Zelis Auto |
$190.00
|
| Rate for Payer: Zelis Medicare |
$87.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$123.65
|
| Rate for Payer: Zelis Worker's Compensation |
$32.80
|
|
|
UC XR NASAL BONES COMP
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
21600431
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.52 |
| Max. Negotiated Rate |
$478.80 |
| 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 |
$302.40
|
| 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 |
$85.32
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$428.40
|
| Rate for Payer: First Health Commercial |
$453.60
|
| Rate for Payer: First Health Workers Compensation |
$45.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$453.60
|
| Rate for Payer: GEHA Commercial |
$403.20
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$453.60
|
| Rate for Payer: Humana ChoiceCare |
$93.85
|
| Rate for Payer: Humana Medicare Advantage |
$85.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$143.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$458.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$352.80
|
| Rate for Payer: One Health Plan PPO/POS |
$453.60
|
| 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 |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$478.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$378.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$428.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$468.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$201.60
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$32.52
|
|
|
UC XR NASAL BONES COMP
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
21600431
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.52 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$428.40
|
| Rate for Payer: First Health Commercial |
$453.60
|
| Rate for Payer: First Health Workers Compensation |
$45.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$453.60
|
| Rate for Payer: GEHA Commercial |
$352.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$453.60
|
| Rate for Payer: Multiplan All |
$458.64
|
| Rate for Payer: OMNI Networks Commercial |
$352.80
|
| Rate for Payer: One Health Plan PPO/POS |
$453.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$478.80
|
| Rate for Payer: Three Rivers Provider Network All |
$378.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$468.72
|
| Rate for Payer: Zelis Auto |
$201.60
|
| Rate for Payer: Zelis Worker's Compensation |
$32.52
|
|
|
UC XR OPTIC FORAMINA
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
21600433
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$302.10 |
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Cigna Commercial |
$270.30
|
| Rate for Payer: First Health Commercial |
$286.20
|
| Rate for Payer: First Health Workers Compensation |
$45.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$286.20
|
| Rate for Payer: GEHA Commercial |
$222.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$286.20
|
| Rate for Payer: Multiplan All |
$289.38
|
| Rate for Payer: OMNI Networks Commercial |
$222.60
|
| Rate for Payer: One Health Plan PPO/POS |
$286.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$302.10
|
| Rate for Payer: Three Rivers Provider Network All |
$238.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$295.74
|
| Rate for Payer: Zelis Auto |
$127.20
|
| Rate for Payer: Zelis Worker's Compensation |
$32.40
|
|
|
UC XR OPTIC FORAMINA
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
21600433
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$302.10 |
| 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 |
$190.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$85.32
|
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Cigna Commercial |
$270.30
|
| Rate for Payer: First Health Commercial |
$286.20
|
| Rate for Payer: First Health Workers Compensation |
$45.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$286.20
|
| Rate for Payer: GEHA Commercial |
$254.40
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$286.20
|
| Rate for Payer: Humana ChoiceCare |
$93.85
|
| Rate for Payer: Humana Medicare Advantage |
$85.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$143.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$289.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$222.60
|
| Rate for Payer: One Health Plan PPO/POS |
$286.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$302.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$238.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$270.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$295.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$127.20
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$32.40
|
|
|
UC XR ORBITS
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
21600434
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.76 |
| Max. Negotiated Rate |
$441.75 |
| 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 |
$279.00
|
| 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 |
$103.04
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna Commercial |
$395.25
|
| Rate for Payer: First Health Commercial |
$418.50
|
| Rate for Payer: First Health Workers Compensation |
$57.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$418.50
|
| Rate for Payer: GEHA Commercial |
$372.00
|
| Rate for Payer: GEHA Medicare |
$103.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$418.50
|
| Rate for Payer: Humana ChoiceCare |
$113.34
|
| Rate for Payer: Humana Medicare Advantage |
$103.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$173.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$103.04
|
| Rate for Payer: Multiplan All |
$423.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.17
|
| Rate for Payer: OMNI Networks Commercial |
$325.50
|
| Rate for Payer: One Health Plan PPO/POS |
$418.50
|
| 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 |
$103.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$441.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$206.08
|
| Rate for Payer: Three Rivers Provider Network All |
$348.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.98
|
| Rate for Payer: United Healthcare Commercial |
$395.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$432.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$103.04
|
| Rate for Payer: Zelis Auto |
$186.00
|
| Rate for Payer: Zelis Medicare |
$87.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$123.65
|
| Rate for Payer: Zelis Worker's Compensation |
$40.76
|
|
|
UC XR ORBITS
|
Facility
|
IP
|
$465.00
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
21600434
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.76 |
| Max. Negotiated Rate |
$441.75 |
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna Commercial |
$395.25
|
| Rate for Payer: First Health Commercial |
$418.50
|
| Rate for Payer: First Health Workers Compensation |
$57.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$418.50
|
| Rate for Payer: GEHA Commercial |
$325.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$418.50
|
| Rate for Payer: Multiplan All |
$423.15
|
| Rate for Payer: OMNI Networks Commercial |
$325.50
|
| Rate for Payer: One Health Plan PPO/POS |
$418.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$441.75
|
| Rate for Payer: Three Rivers Provider Network All |
$348.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$432.45
|
| Rate for Payer: Zelis Auto |
$186.00
|
| Rate for Payer: Zelis Worker's Compensation |
$40.76
|
|
|
UC XR OS CALCIS
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
21600435
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$388.55 |
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$347.65
|
| Rate for Payer: First Health Commercial |
$368.10
|
| Rate for Payer: First Health Workers Compensation |
$34.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$368.10
|
| Rate for Payer: GEHA Commercial |
$286.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$368.10
|
| Rate for Payer: Multiplan All |
$372.19
|
| Rate for Payer: OMNI Networks Commercial |
$286.30
|
| Rate for Payer: One Health Plan PPO/POS |
$368.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$388.55
|
| Rate for Payer: Three Rivers Provider Network All |
$306.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$380.37
|
| Rate for Payer: Zelis Auto |
$163.60
|
| Rate for Payer: Zelis Worker's Compensation |
$24.31
|
|
|
UC XR OS CALCIS
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
21600435
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$388.55 |
| 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 |
$245.40
|
| 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 |
$85.32
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$347.65
|
| Rate for Payer: First Health Commercial |
$368.10
|
| Rate for Payer: First Health Workers Compensation |
$34.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$368.10
|
| Rate for Payer: GEHA Commercial |
$327.20
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$368.10
|
| Rate for Payer: Humana ChoiceCare |
$93.85
|
| Rate for Payer: Humana Medicare Advantage |
$85.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$143.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$372.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$286.30
|
| Rate for Payer: One Health Plan PPO/POS |
$368.10
|
| 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 |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$388.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$306.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$347.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$380.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$163.60
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$24.31
|
|
|
UC XR OS CALCIS RIGHT
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
21600436
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$388.55 |
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$347.65
|
| Rate for Payer: First Health Commercial |
$368.10
|
| Rate for Payer: First Health Workers Compensation |
$34.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$368.10
|
| Rate for Payer: GEHA Commercial |
$286.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$368.10
|
| Rate for Payer: Multiplan All |
$372.19
|
| Rate for Payer: OMNI Networks Commercial |
$286.30
|
| Rate for Payer: One Health Plan PPO/POS |
$368.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$388.55
|
| Rate for Payer: Three Rivers Provider Network All |
$306.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$380.37
|
| Rate for Payer: Zelis Auto |
$163.60
|
| Rate for Payer: Zelis Worker's Compensation |
$24.31
|
|
|
UC XR OS CALCIS RIGHT
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
21600436
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$388.55 |
| 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 |
$245.40
|
| 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 |
$85.32
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$347.65
|
| Rate for Payer: First Health Commercial |
$368.10
|
| Rate for Payer: First Health Workers Compensation |
$34.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$368.10
|
| Rate for Payer: GEHA Commercial |
$327.20
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$368.10
|
| Rate for Payer: Humana ChoiceCare |
$93.85
|
| Rate for Payer: Humana Medicare Advantage |
$85.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$143.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$372.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$286.30
|
| Rate for Payer: One Health Plan PPO/POS |
$368.10
|
| 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 |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$388.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$306.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$347.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$380.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$163.60
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$24.31
|
|
|
UC XR PELVIS 1/2 VWS
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
21600437
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.07 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$265.20
|
| Rate for Payer: First Health Commercial |
$280.80
|
| Rate for Payer: First Health Workers Compensation |
$38.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$280.80
|
| Rate for Payer: GEHA Commercial |
$218.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$280.80
|
| Rate for Payer: Multiplan All |
$283.92
|
| Rate for Payer: OMNI Networks Commercial |
$218.40
|
| Rate for Payer: One Health Plan PPO/POS |
$280.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$296.40
|
| Rate for Payer: Three Rivers Provider Network All |
$234.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$290.16
|
| Rate for Payer: Zelis Auto |
$124.80
|
| Rate for Payer: Zelis Worker's Compensation |
$27.07
|
|
