|
UC XR TOE
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
21600461
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.87 |
| Max. Negotiated Rate |
$300.20 |
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cigna Commercial |
$268.60
|
| Rate for Payer: First Health Commercial |
$284.40
|
| Rate for Payer: First Health Workers Compensation |
$35.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$284.40
|
| Rate for Payer: GEHA Commercial |
$221.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$284.40
|
| Rate for Payer: Multiplan All |
$287.56
|
| Rate for Payer: OMNI Networks Commercial |
$221.20
|
| Rate for Payer: One Health Plan PPO/POS |
$284.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$300.20
|
| Rate for Payer: Three Rivers Provider Network All |
$237.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$293.88
|
| Rate for Payer: Zelis Auto |
$126.40
|
| Rate for Payer: Zelis Worker's Compensation |
$24.87
|
|
|
UC XR TOE RIGHT
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
21600462
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.87 |
| Max. Negotiated Rate |
$300.20 |
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cigna Commercial |
$268.60
|
| Rate for Payer: First Health Commercial |
$284.40
|
| Rate for Payer: First Health Workers Compensation |
$35.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$284.40
|
| Rate for Payer: GEHA Commercial |
$221.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$284.40
|
| Rate for Payer: Multiplan All |
$287.56
|
| Rate for Payer: OMNI Networks Commercial |
$221.20
|
| Rate for Payer: One Health Plan PPO/POS |
$284.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$300.20
|
| Rate for Payer: Three Rivers Provider Network All |
$237.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$293.88
|
| Rate for Payer: Zelis Auto |
$126.40
|
| Rate for Payer: Zelis Worker's Compensation |
$24.87
|
|
|
UC XR TOE RIGHT
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
21600462
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.87 |
| Max. Negotiated Rate |
$300.20 |
| 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 |
$189.60
|
| 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 |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cigna Commercial |
$268.60
|
| Rate for Payer: First Health Commercial |
$284.40
|
| Rate for Payer: First Health Workers Compensation |
$35.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$284.40
|
| Rate for Payer: GEHA Commercial |
$252.80
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$284.40
|
| 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 |
$287.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$221.20
|
| Rate for Payer: One Health Plan PPO/POS |
$284.40
|
| 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 |
$300.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$237.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$268.60
|
| 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 |
$293.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$126.40
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$24.87
|
|
|
UC XR T-SPINE 2V
|
Facility
|
IP
|
$597.00
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
21600454
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.99 |
| Max. Negotiated Rate |
$567.15 |
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cigna Commercial |
$507.45
|
| Rate for Payer: First Health Commercial |
$537.30
|
| Rate for Payer: First Health Workers Compensation |
$39.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$537.30
|
| Rate for Payer: GEHA Commercial |
$417.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$537.30
|
| Rate for Payer: Multiplan All |
$543.27
|
| Rate for Payer: OMNI Networks Commercial |
$417.90
|
| Rate for Payer: One Health Plan PPO/POS |
$537.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$567.15
|
| Rate for Payer: Three Rivers Provider Network All |
$447.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$555.21
|
| Rate for Payer: Zelis Auto |
$238.80
|
| Rate for Payer: Zelis Worker's Compensation |
$27.99
|
|
|
UC XR T-SPINE 2V
|
Facility
|
OP
|
$597.00
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
21600454
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.99 |
| Max. Negotiated Rate |
$567.15 |
| 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 |
$358.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$103.04
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cigna Commercial |
$507.45
|
| Rate for Payer: First Health Commercial |
$537.30
|
| Rate for Payer: First Health Workers Compensation |
$39.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$537.30
|
| Rate for Payer: GEHA Commercial |
$477.60
|
| Rate for Payer: GEHA Medicare |
$103.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$537.30
|
| 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 |
$543.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.17
|
| Rate for Payer: OMNI Networks Commercial |
$417.90
|
| Rate for Payer: One Health Plan PPO/POS |
$537.30
|
| 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 |
$567.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$206.08
|
| Rate for Payer: Three Rivers Provider Network All |
$447.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.98
|
| Rate for Payer: United Healthcare Commercial |
$507.45
|
| 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 |
$555.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$103.04
|
| Rate for Payer: Zelis Auto |
$238.80
|
| Rate for Payer: Zelis Medicare |
$87.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$123.65
|
| Rate for Payer: Zelis Worker's Compensation |
$27.99
|
|
|
UC XR WRIST 2V
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
21600463
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$274.55
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: First Health Workers Compensation |
$40.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$290.70
|
| Rate for Payer: GEHA Commercial |
$226.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$290.70
|
| Rate for Payer: Multiplan All |
$293.93
|
| Rate for Payer: OMNI Networks Commercial |
$226.10
|
| Rate for Payer: One Health Plan PPO/POS |
$290.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$306.85
|
| Rate for Payer: Three Rivers Provider Network All |
$242.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$300.39
|
| Rate for Payer: Zelis Auto |
$129.20
|
| Rate for Payer: Zelis Worker's Compensation |
$28.84
|
|
|
UC XR WRIST 2V
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
21600463
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$306.85 |
| 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 |
$193.80
|
| 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 |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$274.55
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: First Health Workers Compensation |
$40.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$290.70
|
| Rate for Payer: GEHA Commercial |
$258.40
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$290.70
|
| 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 |
$293.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$226.10
|
| Rate for Payer: One Health Plan PPO/POS |
$290.70
|
| 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 |
$306.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$242.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$274.55
|
| 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 |
$300.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$129.20
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$28.84
|
|
|
UC XR WRIST COMP
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
21600465
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.78 |
| Max. Negotiated Rate |
$419.90 |
| 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 |
$265.20
|
| 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 |
$265.20
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$375.70
|
| Rate for Payer: First Health Commercial |
$397.80
|
| Rate for Payer: First Health Workers Compensation |
$49.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$397.80
|
| Rate for Payer: GEHA Commercial |
$353.60
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$397.80
|
| 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 |
$402.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$309.40
|
| Rate for Payer: One Health Plan PPO/POS |
$397.80
|
| 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 |
$419.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$331.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$375.70
|
| 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 |
$411.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$176.80
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$34.78
|
|
|
UC XR WRIST COMP
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
21600465
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.78 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$375.70
|
| Rate for Payer: First Health Commercial |
$397.80
|
| Rate for Payer: First Health Workers Compensation |
$49.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$397.80
|
| Rate for Payer: GEHA Commercial |
$309.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$397.80
|
| Rate for Payer: Multiplan All |
$402.22
|
| Rate for Payer: OMNI Networks Commercial |
$309.40
|
| Rate for Payer: One Health Plan PPO/POS |
$397.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$419.90
|
| Rate for Payer: Three Rivers Provider Network All |
$331.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$411.06
|
| Rate for Payer: Zelis Auto |
$176.80
|
| Rate for Payer: Zelis Worker's Compensation |
$34.78
|
|
|
UC XR WRIST COMP RIGHT
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
21600466
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.78 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$375.70
|
| Rate for Payer: First Health Commercial |
$397.80
|
| Rate for Payer: First Health Workers Compensation |
$49.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$397.80
|
| Rate for Payer: GEHA Commercial |
$309.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$397.80
|
| Rate for Payer: Multiplan All |
$402.22
|
| Rate for Payer: OMNI Networks Commercial |
$309.40
|
| Rate for Payer: One Health Plan PPO/POS |
$397.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$419.90
|
| Rate for Payer: Three Rivers Provider Network All |
$331.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$411.06
|
| Rate for Payer: Zelis Auto |
$176.80
|
| Rate for Payer: Zelis Worker's Compensation |
$34.78
|
|
|
UC XR WRIST COMP RIGHT
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
21600466
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.78 |
| Max. Negotiated Rate |
$419.90 |
| 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 |
$265.20
|
| 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 |
$265.20
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$375.70
|
| Rate for Payer: First Health Commercial |
$397.80
|
| Rate for Payer: First Health Workers Compensation |
$49.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$397.80
|
| Rate for Payer: GEHA Commercial |
$353.60
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$397.80
|
| 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 |
$402.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$309.40
|
| Rate for Payer: One Health Plan PPO/POS |
$397.80
|
| 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 |
$419.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$331.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$375.70
|
| 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 |
$411.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$176.80
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$34.78
|
|
|
UC XR WRIST RIGHT 2V
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
21600464
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$306.85 |
| 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 |
$193.80
|
| 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 |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$274.55
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: First Health Workers Compensation |
$40.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$290.70
|
| Rate for Payer: GEHA Commercial |
$258.40
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$290.70
|
| 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 |
$293.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$226.10
|
| Rate for Payer: One Health Plan PPO/POS |
$290.70
|
| 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 |
$306.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$242.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$274.55
|
| 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 |
$300.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$129.20
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$28.84
|
|
|
UC XR WRIST RIGHT 2V
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
21600464
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$274.55
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: First Health Workers Compensation |
$40.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$290.70
|
| Rate for Payer: GEHA Commercial |
$226.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$290.70
|
| Rate for Payer: Multiplan All |
$293.93
|
| Rate for Payer: OMNI Networks Commercial |
$226.10
|
| Rate for Payer: One Health Plan PPO/POS |
$290.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$306.85
|
| Rate for Payer: Three Rivers Provider Network All |
$242.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$300.39
|
| Rate for Payer: Zelis Auto |
$129.20
|
| Rate for Payer: Zelis Worker's Compensation |
$28.84
|
|
|
ugt1a1 irinotecan toxicity REF511200
|
Facility
|
OP
|
$855.00
|
|
|
Service Code
|
CPT 81350
|
| Hospital Charge Code |
22006623
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$187.12 |
| Max. Negotiated Rate |
$812.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$351.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$513.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$351.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$278.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$234.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna Commercial |
$726.75
|
| Rate for Payer: First Health Commercial |
$769.50
|
| Rate for Payer: First Health Workers Compensation |
$264.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$769.50
|
| Rate for Payer: GEHA Commercial |
$684.00
|
| Rate for Payer: GEHA Medicare |
$234.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$769.50
|
| Rate for Payer: Humana ChoiceCare |
$257.40
|
| Rate for Payer: Humana Medicare Advantage |
$234.00
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$393.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$283.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$234.00
|
| Rate for Payer: Multiplan All |
$778.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$397.80
|
| Rate for Payer: OMNI Networks Commercial |
$598.50
|
| Rate for Payer: One Health Plan PPO/POS |
$769.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$327.60
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$283.73
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$234.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$812.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$468.00
|
| Rate for Payer: Three Rivers Provider Network All |
$641.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.32
|
| Rate for Payer: United Healthcare Commercial |
$726.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$283.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$795.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$234.00
|
| Rate for Payer: Zelis Auto |
$342.00
|
| Rate for Payer: Zelis Medicare |
$198.90
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$280.80
|
| Rate for Payer: Zelis Worker's Compensation |
$187.12
|
|
|
ugt1a1 irinotecan toxicity REF511200
|
Facility
|
IP
|
$855.00
|
|
|
Service Code
|
CPT 81350
|
| Hospital Charge Code |
22006623
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$187.12 |
| Max. Negotiated Rate |
$812.25 |
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna Commercial |
$726.75
|
| Rate for Payer: First Health Commercial |
$769.50
|
| Rate for Payer: First Health Workers Compensation |
$264.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$769.50
|
| Rate for Payer: GEHA Commercial |
$598.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$769.50
|
| Rate for Payer: Multiplan All |
$778.05
|
| Rate for Payer: OMNI Networks Commercial |
$598.50
|
| Rate for Payer: One Health Plan PPO/POS |
$769.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$812.25
|
| Rate for Payer: Three Rivers Provider Network All |
$641.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$795.15
|
| Rate for Payer: Zelis Auto |
$342.00
|
| Rate for Payer: Zelis Worker's Compensation |
$187.12
|
|
|
UMBILICAL VEIN CATHETER NEWBORN
|
Facility
|
OP
|
$174.00
|
|
| Hospital Charge Code |
8136510
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$165.30 |
| Rate for Payer: One Health Plan PPO/POS |
$156.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$165.30
|
| Rate for Payer: Three Rivers Provider Network All |
$130.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$153.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$43.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$161.82
|
| Rate for Payer: Zelis Auto |
$69.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$87.00
|
| Rate for Payer: Zelis Worker's Compensation |
$47.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$147.90
|
| Rate for Payer: First Health Commercial |
$156.60
|
| Rate for Payer: First Health Workers Compensation |
$67.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$156.60
|
| Rate for Payer: GEHA Commercial |
$139.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$156.60
|
| Rate for Payer: Humana ChoiceCare |
$45.24
|
| Rate for Payer: Multiplan All |
$158.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$104.40
|
| Rate for Payer: OMNI Networks Commercial |
$121.80
|
|
|
UMBILICAL VEIN CATHETER NEWBORN
|
Facility
|
IP
|
$174.00
|
|
| Hospital Charge Code |
8136510
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$165.30 |
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$147.90
|
| Rate for Payer: First Health Commercial |
$156.60
|
| Rate for Payer: First Health Workers Compensation |
$67.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$156.60
|
| Rate for Payer: GEHA Commercial |
$121.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$156.60
|
| Rate for Payer: Multiplan All |
$158.34
|
| Rate for Payer: OMNI Networks Commercial |
$121.80
|
| Rate for Payer: One Health Plan PPO/POS |
$156.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$165.30
|
| Rate for Payer: Three Rivers Provider Network All |
$130.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$161.82
|
| Rate for Payer: Zelis Auto |
$69.60
|
| Rate for Payer: Zelis Worker's Compensation |
$47.50
|
|
|
UNIVERS VAULTLOCK GLENOID LRG
|
Facility
|
IP
|
$4,725.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,890.00 |
| Max. Negotiated Rate |
$4,488.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,780.00
|
| Rate for Payer: Cash Price |
$2,835.00
|
| Rate for Payer: Cash Price |
$2,835.00
|
| Rate for Payer: Cigna Commercial |
$4,016.25
|
| Rate for Payer: First Health Commercial |
$4,252.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,252.50
|
| Rate for Payer: GEHA Commercial |
$3,307.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,252.50
|
| Rate for Payer: Multiplan All |
$4,299.75
|
| Rate for Payer: OMNI Networks Commercial |
$3,307.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,252.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,488.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,543.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,394.25
|
| Rate for Payer: Zelis Auto |
$1,890.00
|
|
|
UNIVERS VAULTLOCK GLENOID LRG
|
Facility
|
OP
|
$4,725.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.25 |
| Max. Negotiated Rate |
$4,488.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,835.00
|
| Rate for Payer: Cash Price |
$2,835.00
|
| Rate for Payer: Cash Price |
$2,835.00
|
| Rate for Payer: Cigna Commercial |
$4,016.25
|
| Rate for Payer: First Health Commercial |
$4,252.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,252.50
|
| Rate for Payer: GEHA Commercial |
$3,780.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,252.50
|
| Rate for Payer: Humana ChoiceCare |
$1,228.50
|
| Rate for Payer: Multiplan All |
$4,299.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,835.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,307.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,252.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,488.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3,543.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,158.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,181.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,394.25
|
| Rate for Payer: Zelis Auto |
$1,890.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,362.50
|
|
|
UNLIS LAPAROSCOPIC PROCEDURE LIVER
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
CPT 47379
|
| Hospital Charge Code |
20300154
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.16 |
| Max. Negotiated Rate |
$543.40 |
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$486.20
|
| Rate for Payer: First Health Commercial |
$514.80
|
| Rate for Payer: First Health Workers Compensation |
$220.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$514.80
|
| Rate for Payer: GEHA Commercial |
$400.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$514.80
|
| Rate for Payer: Multiplan All |
$520.52
|
| Rate for Payer: OMNI Networks Commercial |
$400.40
|
| Rate for Payer: One Health Plan PPO/POS |
$514.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$543.40
|
| Rate for Payer: Three Rivers Provider Network All |
$429.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.96
|
| Rate for Payer: Zelis Auto |
$228.80
|
| Rate for Payer: Zelis Worker's Compensation |
$156.16
|
|
|
UNLIS LAPAROSCOPIC PROCEDURE LIVER
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
CPT 47379
|
| Hospital Charge Code |
6147379
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$156.16 |
| Max. Negotiated Rate |
$11,306.76 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,847.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$343.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,847.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,048.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,653.38
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$486.20
|
| Rate for Payer: First Health Commercial |
$514.80
|
| Rate for Payer: First Health Workers Compensation |
$220.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$514.80
|
| Rate for Payer: GEHA Commercial |
$457.60
|
| Rate for Payer: GEHA Medicare |
$5,653.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$514.80
|
| Rate for Payer: Humana ChoiceCare |
$6,218.72
|
| Rate for Payer: Humana Medicare Advantage |
$5,653.38
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,497.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,110.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,653.38
|
| Rate for Payer: Multiplan All |
$520.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,610.75
|
| Rate for Payer: OMNI Networks Commercial |
$400.40
|
| Rate for Payer: One Health Plan PPO/POS |
$514.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,591.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,110.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,653.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$543.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,306.76
|
| Rate for Payer: Three Rivers Provider Network All |
$429.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,540.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,110.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,653.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,653.38
|
| Rate for Payer: Zelis Auto |
$228.80
|
| Rate for Payer: Zelis Medicare |
$4,805.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,784.06
|
| Rate for Payer: Zelis Worker's Compensation |
$156.16
|
|
|
UNLIS LAPAROSCOPIC PROCEDURE LIVER
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
CPT 47379
|
| Hospital Charge Code |
20300154
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.16 |
| Max. Negotiated Rate |
$11,306.76 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,847.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$343.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,847.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,048.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,653.38
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$486.20
|
| Rate for Payer: First Health Commercial |
$514.80
|
| Rate for Payer: First Health Workers Compensation |
$220.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$514.80
|
| Rate for Payer: GEHA Commercial |
$457.60
|
| Rate for Payer: GEHA Medicare |
$5,653.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$514.80
|
| Rate for Payer: Humana ChoiceCare |
$6,218.72
|
| Rate for Payer: Humana Medicare Advantage |
$5,653.38
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,497.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,110.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,653.38
|
| Rate for Payer: Multiplan All |
$520.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,610.75
|
| Rate for Payer: OMNI Networks Commercial |
$400.40
|
| Rate for Payer: One Health Plan PPO/POS |
$514.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,591.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,110.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,653.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$543.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,306.76
|
| Rate for Payer: Three Rivers Provider Network All |
$429.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,540.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,110.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,653.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,653.38
|
| Rate for Payer: Zelis Auto |
$228.80
|
| Rate for Payer: Zelis Medicare |
$4,805.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,784.06
|
| Rate for Payer: Zelis Worker's Compensation |
$156.16
|
|
|
UNLIS LAPAROSCOPIC PROCEDURE LIVER
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
CPT 47379
|
| Hospital Charge Code |
6147379
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$156.16 |
| Max. Negotiated Rate |
$543.40 |
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$486.20
|
| Rate for Payer: First Health Commercial |
$514.80
|
| Rate for Payer: First Health Workers Compensation |
$220.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$514.80
|
| Rate for Payer: GEHA Commercial |
$400.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$514.80
|
| Rate for Payer: Multiplan All |
$520.52
|
| Rate for Payer: OMNI Networks Commercial |
$400.40
|
| Rate for Payer: One Health Plan PPO/POS |
$514.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$543.40
|
| Rate for Payer: Three Rivers Provider Network All |
$429.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.96
|
| Rate for Payer: Zelis Auto |
$228.80
|
| Rate for Payer: Zelis Worker's Compensation |
$156.16
|
|
|
UNLIS LAPS PX HRNAP HERNIORRHAPHY HERNIO
|
Facility
|
OP
|
$1,764.27
|
|
|
Service Code
|
CPT 49659
|
| Hospital Charge Code |
6149659
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$481.65 |
| Max. Negotiated Rate |
$11,306.76 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,847.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,058.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,847.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,048.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,653.38
|
| Rate for Payer: Cash Price |
$1,058.56
|
| Rate for Payer: Cash Price |
$1,058.56
|
| Rate for Payer: Cigna Commercial |
$1,499.63
|
| Rate for Payer: First Health Commercial |
$1,587.84
|
| Rate for Payer: First Health Workers Compensation |
$681.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,587.84
|
| Rate for Payer: GEHA Commercial |
$1,411.42
|
| Rate for Payer: GEHA Medicare |
$5,653.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,587.84
|
| Rate for Payer: Humana ChoiceCare |
$6,218.72
|
| Rate for Payer: Humana Medicare Advantage |
$5,653.38
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,497.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,110.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,653.38
|
| Rate for Payer: Multiplan All |
$1,605.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,610.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,234.99
|
| Rate for Payer: One Health Plan PPO/POS |
$1,587.84
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,591.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,110.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,653.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,676.06
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,306.76
|
| Rate for Payer: Three Rivers Provider Network All |
$1,323.20
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,540.31
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,110.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,653.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,640.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,653.38
|
| Rate for Payer: Zelis Auto |
$705.71
|
| Rate for Payer: Zelis Medicare |
$4,805.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,784.06
|
| Rate for Payer: Zelis Worker's Compensation |
$481.65
|
|
|
UNLIS LAPS PX HRNAP HERNIORRHAPHY HERNIO
|
Facility
|
IP
|
$1,764.27
|
|
|
Service Code
|
CPT 49659
|
| Hospital Charge Code |
6149659
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$481.65 |
| Max. Negotiated Rate |
$1,676.06 |
| Rate for Payer: Cash Price |
$1,058.56
|
| Rate for Payer: Cigna Commercial |
$1,499.63
|
| Rate for Payer: First Health Commercial |
$1,587.84
|
| Rate for Payer: First Health Workers Compensation |
$681.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,587.84
|
| Rate for Payer: GEHA Commercial |
$1,234.99
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,587.84
|
| Rate for Payer: Multiplan All |
$1,605.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,234.99
|
| Rate for Payer: One Health Plan PPO/POS |
$1,587.84
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,676.06
|
| Rate for Payer: Three Rivers Provider Network All |
$1,323.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,640.77
|
| Rate for Payer: Zelis Auto |
$705.71
|
| Rate for Payer: Zelis Worker's Compensation |
$481.65
|
|
