|
WIRE K STERILE .035X15CM
|
Facility
|
IP
|
$369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
90007213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$295.20
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$313.65
|
| Rate for Payer: First Health Commercial |
$332.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$332.10
|
| Rate for Payer: GEHA Commercial |
$258.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$332.10
|
| Rate for Payer: Multiplan All |
$335.79
|
| Rate for Payer: OMNI Networks Commercial |
$258.30
|
| Rate for Payer: One Health Plan PPO/POS |
$332.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$350.55
|
| Rate for Payer: Three Rivers Provider Network All |
$276.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$343.17
|
| Rate for Payer: Zelis Auto |
$147.60
|
|
|
WIRE K STERILE .035X15CM
|
Facility
|
OP
|
$369.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
90007213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$221.40
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$313.65
|
| Rate for Payer: First Health Commercial |
$332.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$332.10
|
| Rate for Payer: GEHA Commercial |
$295.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$332.10
|
| Rate for Payer: Humana ChoiceCare |
$95.94
|
| Rate for Payer: Multiplan All |
$335.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$221.40
|
| Rate for Payer: OMNI Networks Commercial |
$258.30
|
| Rate for Payer: One Health Plan PPO/POS |
$332.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$350.55
|
| Rate for Payer: Three Rivers Provider Network All |
$276.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$324.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$92.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$343.17
|
| Rate for Payer: Zelis Auto |
$147.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$184.50
|
|
|
WIRE K STERILE .035X15CM
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002973
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$79.20
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna Commercial |
$84.15
|
| Rate for Payer: First Health Commercial |
$89.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$89.10
|
| Rate for Payer: GEHA Commercial |
$69.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$89.10
|
| Rate for Payer: Multiplan All |
$90.09
|
| Rate for Payer: OMNI Networks Commercial |
$69.30
|
| Rate for Payer: One Health Plan PPO/POS |
$89.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$94.05
|
| Rate for Payer: Three Rivers Provider Network All |
$74.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$92.07
|
| Rate for Payer: Zelis Auto |
$39.60
|
|
|
WIRE K STERILE .035X15CM
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002973
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna Commercial |
$84.15
|
| Rate for Payer: First Health Commercial |
$89.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$89.10
|
| Rate for Payer: GEHA Commercial |
$79.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$89.10
|
| Rate for Payer: Humana ChoiceCare |
$25.74
|
| Rate for Payer: Multiplan All |
$90.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$59.40
|
| Rate for Payer: OMNI Networks Commercial |
$69.30
|
| Rate for Payer: One Health Plan PPO/POS |
$89.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$94.05
|
| Rate for Payer: Three Rivers Provider Network All |
$74.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$87.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$92.07
|
| Rate for Payer: Zelis Auto |
$39.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$49.50
|
|
|
WIRE-K TROCAR PT 1 END PLN
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
90033002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$192.80
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$168.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: Zelis Auto |
$96.40
|
|
|
WIRE-K TROCAR PT 1 END PLN
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
90033002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.25 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$192.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| Rate for Payer: Humana ChoiceCare |
$62.66
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$144.60
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$212.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: Zelis Auto |
$96.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$120.50
|
|
|
WOUND CLOSURE BY ADHESIVE
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT G0168
|
| Hospital Charge Code |
21600520
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$56.05 |
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$50.15
|
| Rate for Payer: First Health Commercial |
$53.10
|
| Rate for Payer: First Health Workers Compensation |
$22.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$53.10
|
| Rate for Payer: GEHA Commercial |
$41.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$53.10
|
| Rate for Payer: Multiplan All |
$53.69
|
| Rate for Payer: OMNI Networks Commercial |
$41.30
|
| Rate for Payer: One Health Plan PPO/POS |
$53.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$56.05
|
| Rate for Payer: Three Rivers Provider Network All |
$44.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$54.87
|
| Rate for Payer: Zelis Auto |
$23.60
|
| Rate for Payer: Zelis Worker's Compensation |
$16.11
|
|
|
WOUND CLOSURE BY ADHESIVE
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT G0168
|
| Hospital Charge Code |
21600520
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$14.75 |
| Max. Negotiated Rate |
$56.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$50.15
|
| Rate for Payer: First Health Commercial |
$53.10
|
| Rate for Payer: First Health Workers Compensation |
$22.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$53.10
|
| Rate for Payer: GEHA Commercial |
$47.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$53.10
|
| Rate for Payer: Humana ChoiceCare |
$15.34
|
| Rate for Payer: Multiplan All |
$53.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.40
|
| Rate for Payer: OMNI Networks Commercial |
$41.30
|
| Rate for Payer: One Health Plan PPO/POS |
$53.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$56.05
|
| Rate for Payer: Three Rivers Provider Network All |
$44.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$51.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$54.87
|
| Rate for Payer: Zelis Auto |
$23.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$29.50
|
| Rate for Payer: Zelis Worker's Compensation |
$16.11
|
|
|
WOUND CLOSURE BY ADHESIVE
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT G0168
|
| Hospital Charge Code |
8100168
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$56.05 |
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$50.15
|
| Rate for Payer: First Health Commercial |
$53.10
|
| Rate for Payer: First Health Workers Compensation |
$22.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$53.10
|
| Rate for Payer: GEHA Commercial |
$41.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$53.10
|
| Rate for Payer: Multiplan All |
$53.69
|
| Rate for Payer: OMNI Networks Commercial |
$41.30
|
| Rate for Payer: One Health Plan PPO/POS |
$53.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$56.05
|
| Rate for Payer: Three Rivers Provider Network All |
$44.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$54.87
|
| Rate for Payer: Zelis Auto |
$23.60
|
| Rate for Payer: Zelis Worker's Compensation |
$16.11
|
|
|
WOUND CLOSURE BY ADHESIVE
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT G0168
|
| Hospital Charge Code |
8100168
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.75 |
| Max. Negotiated Rate |
$56.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$50.15
|
| Rate for Payer: First Health Commercial |
$53.10
|
| Rate for Payer: First Health Workers Compensation |
$22.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$53.10
|
| Rate for Payer: GEHA Commercial |
$47.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$53.10
|
| Rate for Payer: Humana ChoiceCare |
$15.34
|
| Rate for Payer: Multiplan All |
$53.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.40
|
| Rate for Payer: OMNI Networks Commercial |
$41.30
|
| Rate for Payer: One Health Plan PPO/POS |
$53.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$56.05
|
| Rate for Payer: Three Rivers Provider Network All |
$44.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$51.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$54.87
|
| Rate for Payer: Zelis Auto |
$23.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$29.50
|
| Rate for Payer: Zelis Worker's Compensation |
$16.11
|
|
|
WOUND CLOS UTIL TISSUE ADHES ONL
|
Facility
|
OP
|
$264.87
|
|
|
Service Code
|
CPT G0168
|
| Hospital Charge Code |
8500168
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$66.22 |
| Max. Negotiated Rate |
$251.63 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$158.92
|
| Rate for Payer: Cash Price |
$158.92
|
| Rate for Payer: Cigna Commercial |
$225.14
|
| Rate for Payer: First Health Commercial |
$238.38
|
| Rate for Payer: First Health Workers Compensation |
$102.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$238.38
|
| Rate for Payer: GEHA Commercial |
$211.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$238.38
|
| Rate for Payer: Humana ChoiceCare |
$68.87
|
| Rate for Payer: Multiplan All |
$241.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$158.92
|
| Rate for Payer: OMNI Networks Commercial |
$185.41
|
| Rate for Payer: One Health Plan PPO/POS |
$238.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$251.63
|
| Rate for Payer: Three Rivers Provider Network All |
$198.65
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$233.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$66.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$246.33
|
| Rate for Payer: Zelis Auto |
$105.95
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$132.44
|
| Rate for Payer: Zelis Worker's Compensation |
$72.31
|
|
|
WOUND CLOS UTIL TISSUE ADHES ONL
|
Facility
|
IP
|
$264.87
|
|
|
Service Code
|
CPT G0168
|
| Hospital Charge Code |
8500168
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$72.31 |
| Max. Negotiated Rate |
$251.63 |
| Rate for Payer: Cash Price |
$158.92
|
| Rate for Payer: Cigna Commercial |
$225.14
|
| Rate for Payer: First Health Commercial |
$238.38
|
| Rate for Payer: First Health Workers Compensation |
$102.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$238.38
|
| Rate for Payer: GEHA Commercial |
$185.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$238.38
|
| Rate for Payer: Multiplan All |
$241.03
|
| Rate for Payer: OMNI Networks Commercial |
$185.41
|
| Rate for Payer: One Health Plan PPO/POS |
$238.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$251.63
|
| Rate for Payer: Three Rivers Provider Network All |
$198.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$246.33
|
| Rate for Payer: Zelis Auto |
$105.95
|
| Rate for Payer: Zelis Worker's Compensation |
$72.31
|
|
|
WOUND EXPLOR/DRESS CHANGE UNDER ANESTH
|
Facility
|
OP
|
$667.00
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
6117999
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$633.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$400.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cigna Commercial |
$566.95
|
| Rate for Payer: First Health Commercial |
$600.30
|
| Rate for Payer: First Health Workers Compensation |
$257.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$600.30
|
| Rate for Payer: GEHA Commercial |
$533.60
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$600.30
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$606.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$466.90
|
| Rate for Payer: One Health Plan PPO/POS |
$600.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$633.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$500.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$620.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$266.80
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$182.09
|
|
|
WOUND EXPLOR/DRESS CHANGE UNDER ANESTH
|
Facility
|
IP
|
$667.00
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
6117999
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$182.09 |
| Max. Negotiated Rate |
$633.65 |
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cigna Commercial |
$566.95
|
| Rate for Payer: First Health Commercial |
$600.30
|
| Rate for Payer: First Health Workers Compensation |
$257.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$600.30
|
| Rate for Payer: GEHA Commercial |
$466.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$600.30
|
| Rate for Payer: Multiplan All |
$606.97
|
| Rate for Payer: OMNI Networks Commercial |
$466.90
|
| Rate for Payer: One Health Plan PPO/POS |
$600.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$633.65
|
| Rate for Payer: Three Rivers Provider Network All |
$500.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$620.31
|
| Rate for Payer: Zelis Auto |
$266.80
|
| Rate for Payer: Zelis Worker's Compensation |
$182.09
|
|
|
WOUN DRES COLLAGEN
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
NDC 11701016116
|
| Hospital Charge Code |
3301127
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.75 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$83.30
|
| Rate for Payer: First Health Commercial |
$88.20
|
| Rate for Payer: First Health Workers Compensation |
$37.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.20
|
| Rate for Payer: GEHA Commercial |
$68.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.20
|
| Rate for Payer: Multiplan All |
$89.18
|
| Rate for Payer: OMNI Networks Commercial |
$68.60
|
| Rate for Payer: One Health Plan PPO/POS |
$88.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$93.10
|
| Rate for Payer: Three Rivers Provider Network All |
$73.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$91.14
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Worker's Compensation |
$26.75
|
|
|
WOUN DRES COLLAGEN
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
NDC 11701016116
|
| Hospital Charge Code |
3301127
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$83.30
|
| Rate for Payer: First Health Commercial |
$88.20
|
| Rate for Payer: First Health Workers Compensation |
$37.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.20
|
| Rate for Payer: GEHA Commercial |
$78.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.20
|
| Rate for Payer: Humana ChoiceCare |
$25.48
|
| Rate for Payer: Multiplan All |
$89.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$58.80
|
| Rate for Payer: OMNI Networks Commercial |
$68.60
|
| Rate for Payer: One Health Plan PPO/POS |
$88.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$93.10
|
| Rate for Payer: Three Rivers Provider Network All |
$73.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$91.14
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$49.00
|
| Rate for Payer: Zelis Worker's Compensation |
$26.75
|
|
|
WRAP AROUND KNEE BRACE
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT L1820
|
| Hospital Charge Code |
8800016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$224.40
|
| Rate for Payer: First Health Commercial |
$237.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$184.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: OMNI Networks Commercial |
$184.80
|
| Rate for Payer: One Health Plan PPO/POS |
$237.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: Zelis Auto |
$105.60
|
|
|
WRAP AROUND KNEE BRACE
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT L1820
|
| Hospital Charge Code |
8230074
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$224.40
|
| Rate for Payer: First Health Commercial |
$237.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$184.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: OMNI Networks Commercial |
$184.80
|
| Rate for Payer: One Health Plan PPO/POS |
$237.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: Zelis Auto |
$105.60
|
|
|
WRAP AROUND KNEE BRACE
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT L1820
|
| Hospital Charge Code |
8800016
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$243.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$158.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$243.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$192.61
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$224.40
|
| Rate for Payer: First Health Commercial |
$237.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$211.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Humana ChoiceCare |
$68.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$196.53
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$158.40
|
| Rate for Payer: OMNI Networks Commercial |
$184.80
|
| Rate for Payer: One Health Plan PPO/POS |
$237.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$226.93
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$196.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$232.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$196.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$132.00
|
|
|
WRAP AROUND KNEE BRACE
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT L1820
|
| Hospital Charge Code |
8230074
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$243.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$158.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$243.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$192.61
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$224.40
|
| Rate for Payer: First Health Commercial |
$237.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$211.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Humana ChoiceCare |
$68.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$196.53
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$158.40
|
| Rate for Payer: OMNI Networks Commercial |
$184.80
|
| Rate for Payer: One Health Plan PPO/POS |
$237.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$226.93
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$196.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$232.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$196.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$132.00
|
|
|
WRIST ARTHROSCOPY
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
CPT 29840
|
| Hospital Charge Code |
6129840
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$252.25 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$554.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cigna Commercial |
$785.40
|
| Rate for Payer: First Health Commercial |
$831.60
|
| Rate for Payer: First Health Workers Compensation |
$356.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$831.60
|
| Rate for Payer: GEHA Commercial |
$739.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$831.60
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$840.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$646.80
|
| Rate for Payer: One Health Plan PPO/POS |
$831.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$877.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$693.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$859.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$369.60
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$252.25
|
|
|
WRIST ARTHROSCOPY
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
CPT 29840
|
| Hospital Charge Code |
6129840
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$252.25 |
| Max. Negotiated Rate |
$877.80 |
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cigna Commercial |
$785.40
|
| Rate for Payer: First Health Commercial |
$831.60
|
| Rate for Payer: First Health Workers Compensation |
$356.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$831.60
|
| Rate for Payer: GEHA Commercial |
$646.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$831.60
|
| Rate for Payer: Multiplan All |
$840.84
|
| Rate for Payer: OMNI Networks Commercial |
$646.80
|
| Rate for Payer: One Health Plan PPO/POS |
$831.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$877.80
|
| Rate for Payer: Three Rivers Provider Network All |
$693.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$859.32
|
| Rate for Payer: Zelis Auto |
$369.60
|
| Rate for Payer: Zelis Worker's Compensation |
$252.25
|
|
|
WRIST ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,059.00
|
|
|
Service Code
|
CPT 29846
|
| Hospital Charge Code |
6129846
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$289.11 |
| Max. Negotiated Rate |
$1,006.05 |
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cigna Commercial |
$900.15
|
| Rate for Payer: First Health Commercial |
$953.10
|
| Rate for Payer: First Health Workers Compensation |
$408.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$953.10
|
| Rate for Payer: GEHA Commercial |
$741.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$953.10
|
| Rate for Payer: Multiplan All |
$963.69
|
| Rate for Payer: OMNI Networks Commercial |
$741.30
|
| Rate for Payer: One Health Plan PPO/POS |
$953.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,006.05
|
| Rate for Payer: Three Rivers Provider Network All |
$794.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$984.87
|
| Rate for Payer: Zelis Auto |
$423.60
|
| Rate for Payer: Zelis Worker's Compensation |
$289.11
|
|
|
WRIST ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,059.00
|
|
|
Service Code
|
CPT 29846
|
| Hospital Charge Code |
6129846
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$289.11 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$635.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cigna Commercial |
$900.15
|
| Rate for Payer: First Health Commercial |
$953.10
|
| Rate for Payer: First Health Workers Compensation |
$408.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$953.10
|
| Rate for Payer: GEHA Commercial |
$847.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$953.10
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$963.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$741.30
|
| Rate for Payer: One Health Plan PPO/POS |
$953.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,006.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$794.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$984.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$423.60
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$289.11
|
|
|
WRIST BRACE/FOREARM
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
8230083
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$95.20
|
| Rate for Payer: First Health Commercial |
$100.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$100.80
|
| Rate for Payer: GEHA Commercial |
$78.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$100.80
|
| Rate for Payer: Multiplan All |
$101.92
|
| Rate for Payer: OMNI Networks Commercial |
$78.40
|
| Rate for Payer: One Health Plan PPO/POS |
$100.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$106.40
|
| Rate for Payer: Three Rivers Provider Network All |
$84.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$104.16
|
| Rate for Payer: Zelis Auto |
$44.80
|
|
