|
WRIST BRACE/FOREARM
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
8230083
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$145.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$145.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$145.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$114.97
|
| Rate for Payer: Cash Price |
$67.20
|
| 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 |
$89.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$100.80
|
| Rate for Payer: Humana ChoiceCare |
$29.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$117.31
|
| Rate for Payer: Multiplan All |
$101.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.20
|
| Rate for Payer: OMNI Networks Commercial |
$78.40
|
| Rate for Payer: One Health Plan PPO/POS |
$100.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$135.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$117.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$106.40
|
| Rate for Payer: Three Rivers Provider Network All |
$84.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$104.16
|
| Rate for Payer: Zelis Auto |
$44.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.00
|
|
|
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
|
|
|
WRIST BRACE/FOREARM
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
8800025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$145.12 |
| 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: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$145.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$145.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$114.97
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$100.80
|
| Rate for Payer: GEHA Commercial |
$89.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$100.80
|
| Rate for Payer: Humana ChoiceCare |
$29.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$117.31
|
| Rate for Payer: Multiplan All |
$101.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.20
|
| Rate for Payer: OMNI Networks Commercial |
$78.40
|
| Rate for Payer: One Health Plan PPO/POS |
$100.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$135.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$117.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$106.40
|
| Rate for Payer: Three Rivers Provider Network All |
$84.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$104.16
|
| Rate for Payer: Zelis Auto |
$44.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.00
|
|
|
WRIST HAND ORTHOSIS, WRIST EXTENSION CON
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
8503908
|
|
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
|
|
|
WRIST HAND ORTHOSIS, WRIST EXTENSION CON
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
8503908
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$145.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$145.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$145.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$114.97
|
| Rate for Payer: Cash Price |
$67.20
|
| 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 |
$89.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$100.80
|
| Rate for Payer: Humana ChoiceCare |
$29.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$117.31
|
| Rate for Payer: Multiplan All |
$101.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.20
|
| Rate for Payer: OMNI Networks Commercial |
$78.40
|
| Rate for Payer: One Health Plan PPO/POS |
$100.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$135.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$117.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$106.40
|
| Rate for Payer: Three Rivers Provider Network All |
$84.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$104.16
|
| Rate for Payer: Zelis Auto |
$44.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.00
|
|
|
WRIST REPLACEMENT
|
Facility
|
OP
|
$2,403.00
|
|
|
Service Code
|
CPT 25446
|
| Hospital Charge Code |
6125446
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$656.02 |
| Max. Negotiated Rate |
$35,639.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$12,008.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,441.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$12,008.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9,513.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17,819.59
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cigna Commercial |
$2,042.55
|
| Rate for Payer: First Health Commercial |
$2,162.70
|
| Rate for Payer: First Health Workers Compensation |
$927.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,162.70
|
| Rate for Payer: GEHA Commercial |
$1,922.40
|
| Rate for Payer: GEHA Medicare |
$17,819.59
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,162.70
|
| Rate for Payer: Humana ChoiceCare |
$19,601.55
|
| Rate for Payer: Humana Medicare Advantage |
$17,819.59
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29,936.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9,706.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,819.59
|
| Rate for Payer: Multiplan All |
$2,186.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30,293.30
|
| Rate for Payer: OMNI Networks Commercial |
$1,682.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,162.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11,207.85
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9,706.80
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17,819.59
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,282.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$35,639.18
|
| Rate for Payer: Three Rivers Provider Network All |
$1,802.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17,463.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9,706.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,819.59
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,234.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17,819.59
|
| Rate for Payer: Zelis Auto |
$961.20
|
| Rate for Payer: Zelis Medicare |
$15,146.65
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21,383.51
|
| Rate for Payer: Zelis Worker's Compensation |
$656.02
|
|
|
WRIST REPLACEMENT
|
Facility
|
IP
|
$2,403.00
|
|
|
Service Code
|
CPT 25446
|
| Hospital Charge Code |
6125446
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$656.02 |
| Max. Negotiated Rate |
$2,282.85 |
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cigna Commercial |
$2,042.55
|
| Rate for Payer: First Health Commercial |
$2,162.70
|
| Rate for Payer: First Health Workers Compensation |
$927.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,162.70
|
| Rate for Payer: GEHA Commercial |
$1,682.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,162.70
|
| Rate for Payer: Multiplan All |
$2,186.73
|
| Rate for Payer: OMNI Networks Commercial |
$1,682.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,162.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,282.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,802.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,234.79
|
| Rate for Payer: Zelis Auto |
$961.20
|
| Rate for Payer: Zelis Worker's Compensation |
$656.02
|
|
|
XGEVA 120MG/1.7ML VIAL
|
Facility
|
OP
|
$7,368.00
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
3350161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.48 |
| Max. Negotiated Rate |
$6,999.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$22.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,420.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$22.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$29.38
|
| Rate for Payer: Cash Price |
$4,420.80
|
| Rate for Payer: Cash Price |
$4,420.80
|
| Rate for Payer: Cigna Commercial |
$6,262.80
|
| Rate for Payer: First Health Commercial |
$6,631.20
|
| Rate for Payer: First Health Workers Compensation |
$2,844.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,631.20
|
| Rate for Payer: GEHA Commercial |
$32.32
|
| Rate for Payer: GEHA Medicare |
$29.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,631.20
|
| Rate for Payer: Humana ChoiceCare |
$32.32
|
| Rate for Payer: Humana Medicare Advantage |
$29.38
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$49.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$29.38
|
| Rate for Payer: Multiplan All |
$6,704.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$49.95
|
| Rate for Payer: OMNI Networks Commercial |
$5,157.60
|
| Rate for Payer: One Health Plan PPO/POS |
$6,631.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$29.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,999.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$58.76
|
| Rate for Payer: Three Rivers Provider Network All |
$5,526.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$28.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,852.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$29.38
|
| Rate for Payer: Zelis Auto |
$2,947.20
|
| Rate for Payer: Zelis Medicare |
$24.97
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$35.26
|
| Rate for Payer: Zelis Worker's Compensation |
$2,011.46
|
|
|
XGEVA 120MG/1.7ML VIAL
|
Facility
|
IP
|
$7,368.00
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
3350161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,011.46 |
| Max. Negotiated Rate |
$6,999.60 |
| Rate for Payer: Cash Price |
$4,420.80
|
| Rate for Payer: Cigna Commercial |
$6,262.80
|
| Rate for Payer: First Health Commercial |
$6,631.20
|
| Rate for Payer: First Health Workers Compensation |
$2,844.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,631.20
|
| Rate for Payer: GEHA Commercial |
$5,157.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,631.20
|
| Rate for Payer: Multiplan All |
$6,704.88
|
| Rate for Payer: OMNI Networks Commercial |
$5,157.60
|
| Rate for Payer: One Health Plan PPO/POS |
$6,631.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,999.60
|
| Rate for Payer: Three Rivers Provider Network All |
$5,526.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,852.24
|
| Rate for Payer: Zelis Auto |
$2,947.20
|
| Rate for Payer: Zelis Worker's Compensation |
$2,011.46
|
|
|
XIAFLEX FOR INJ 0.9MG
|
Facility
|
OP
|
$10,905.00
|
|
|
Service Code
|
CPT J0775
|
| Hospital Charge Code |
3300204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.65 |
| Max. Negotiated Rate |
$10,359.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$57.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,543.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$57.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$45.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$75.91
|
| Rate for Payer: Cash Price |
$6,543.00
|
| Rate for Payer: Cash Price |
$6,543.00
|
| Rate for Payer: Cigna Commercial |
$9,269.25
|
| Rate for Payer: First Health Commercial |
$9,814.50
|
| Rate for Payer: First Health Workers Compensation |
$4,210.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,814.50
|
| Rate for Payer: GEHA Commercial |
$83.50
|
| Rate for Payer: GEHA Medicare |
$75.91
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,814.50
|
| Rate for Payer: Humana ChoiceCare |
$83.50
|
| Rate for Payer: Humana Medicare Advantage |
$75.91
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$127.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$46.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$75.91
|
| Rate for Payer: Multiplan All |
$9,923.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$129.05
|
| Rate for Payer: OMNI Networks Commercial |
$7,633.50
|
| Rate for Payer: One Health Plan PPO/POS |
$9,814.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$53.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$46.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$75.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,359.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$151.82
|
| Rate for Payer: Three Rivers Provider Network All |
$8,178.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$74.39
|
| Rate for Payer: United Healthcare Managed Medicaid |
$46.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,141.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$75.91
|
| Rate for Payer: Zelis Auto |
$4,362.00
|
| Rate for Payer: Zelis Medicare |
$64.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$91.09
|
| Rate for Payer: Zelis Worker's Compensation |
$2,977.07
|
|
|
XIAFLEX FOR INJ 0.9MG
|
Facility
|
IP
|
$10,905.00
|
|
|
Service Code
|
CPT J0775
|
| Hospital Charge Code |
3300204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,977.07 |
| Max. Negotiated Rate |
$10,359.75 |
| Rate for Payer: Cash Price |
$6,543.00
|
| Rate for Payer: Cigna Commercial |
$9,269.25
|
| Rate for Payer: First Health Commercial |
$9,814.50
|
| Rate for Payer: First Health Workers Compensation |
$4,210.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9,814.50
|
| Rate for Payer: GEHA Commercial |
$7,633.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9,814.50
|
| Rate for Payer: Multiplan All |
$9,923.55
|
| Rate for Payer: OMNI Networks Commercial |
$7,633.50
|
| Rate for Payer: One Health Plan PPO/POS |
$9,814.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,359.75
|
| Rate for Payer: Three Rivers Provider Network All |
$8,178.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,141.65
|
| Rate for Payer: Zelis Auto |
$4,362.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2,977.07
|
|
|
XR ABD 1V
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
2400101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.31 |
| Max. Negotiated Rate |
$457.90 |
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$409.70
|
| Rate for Payer: First Health Commercial |
$433.80
|
| Rate for Payer: First Health Workers Compensation |
$37.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$433.80
|
| Rate for Payer: GEHA Commercial |
$337.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$433.80
|
| Rate for Payer: Multiplan All |
$438.62
|
| Rate for Payer: OMNI Networks Commercial |
$337.40
|
| Rate for Payer: One Health Plan PPO/POS |
$433.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$457.90
|
| Rate for Payer: Three Rivers Provider Network All |
$361.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$448.26
|
| Rate for Payer: Zelis Auto |
$192.80
|
| Rate for Payer: Zelis Worker's Compensation |
$26.31
|
|
|
XR ABD 1V
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
2400101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.31 |
| Max. Negotiated Rate |
$457.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$289.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$73.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$85.32
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$409.70
|
| Rate for Payer: First Health Commercial |
$433.80
|
| Rate for Payer: First Health Workers Compensation |
$37.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$433.80
|
| Rate for Payer: GEHA Commercial |
$385.60
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$433.80
|
| 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 |
$75.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$438.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$337.40
|
| Rate for Payer: One Health Plan PPO/POS |
$433.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$86.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$75.31
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$457.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$361.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$409.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$75.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$448.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$192.80
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$26.31
|
|
|
XR ABD 2V
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
CPT 74019
|
| Hospital Charge Code |
2400102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.39 |
| Max. Negotiated Rate |
$566.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$178.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$357.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$178.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$141.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$103.04
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cigna Commercial |
$506.60
|
| Rate for Payer: First Health Commercial |
$536.40
|
| Rate for Payer: First Health Workers Compensation |
$45.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$536.40
|
| Rate for Payer: GEHA Commercial |
$476.80
|
| Rate for Payer: GEHA Medicare |
$103.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$536.40
|
| 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 |
$143.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$103.04
|
| Rate for Payer: Multiplan All |
$542.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.17
|
| Rate for Payer: OMNI Networks Commercial |
$417.20
|
| Rate for Payer: One Health Plan PPO/POS |
$536.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$166.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$143.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$103.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$566.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$206.08
|
| Rate for Payer: Three Rivers Provider Network All |
$447.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.98
|
| Rate for Payer: United Healthcare Commercial |
$506.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$143.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$554.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$103.04
|
| Rate for Payer: Zelis Auto |
$238.40
|
| Rate for Payer: Zelis Medicare |
$87.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$123.65
|
| Rate for Payer: Zelis Worker's Compensation |
$32.39
|
|
|
XR ABD 2V
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
CPT 74019
|
| Hospital Charge Code |
2400102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.39 |
| Max. Negotiated Rate |
$566.20 |
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cigna Commercial |
$506.60
|
| Rate for Payer: First Health Commercial |
$536.40
|
| Rate for Payer: First Health Workers Compensation |
$45.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$536.40
|
| Rate for Payer: GEHA Commercial |
$417.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$536.40
|
| Rate for Payer: Multiplan All |
$542.36
|
| Rate for Payer: OMNI Networks Commercial |
$417.20
|
| Rate for Payer: One Health Plan PPO/POS |
$536.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$566.20
|
| Rate for Payer: Three Rivers Provider Network All |
$447.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$554.28
|
| Rate for Payer: Zelis Auto |
$238.40
|
| Rate for Payer: Zelis Worker's Compensation |
$32.39
|
|
|
XR ABD 3V
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
CPT 74021
|
| Hospital Charge Code |
2400103
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.71 |
| Max. Negotiated Rate |
$665.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$178.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$420.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$178.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$141.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$103.04
|
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Cigna Commercial |
$595.85
|
| Rate for Payer: First Health Commercial |
$630.90
|
| Rate for Payer: First Health Workers Compensation |
$53.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$630.90
|
| Rate for Payer: GEHA Commercial |
$560.80
|
| Rate for Payer: GEHA Medicare |
$103.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$630.90
|
| 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 |
$143.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$103.04
|
| Rate for Payer: Multiplan All |
$637.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.17
|
| Rate for Payer: OMNI Networks Commercial |
$490.70
|
| Rate for Payer: One Health Plan PPO/POS |
$630.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$166.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$143.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$103.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$665.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$206.08
|
| Rate for Payer: Three Rivers Provider Network All |
$525.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.98
|
| Rate for Payer: United Healthcare Commercial |
$595.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$143.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$651.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$103.04
|
| Rate for Payer: Zelis Auto |
$280.40
|
| Rate for Payer: Zelis Medicare |
$87.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$123.65
|
| Rate for Payer: Zelis Worker's Compensation |
$37.71
|
|
|
XR ABD 3V
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
CPT 74021
|
| Hospital Charge Code |
2400103
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.71 |
| Max. Negotiated Rate |
$665.95 |
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Cash Price |
$420.60
|
| Rate for Payer: Cigna Commercial |
$595.85
|
| Rate for Payer: First Health Commercial |
$630.90
|
| Rate for Payer: First Health Workers Compensation |
$53.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$630.90
|
| Rate for Payer: GEHA Commercial |
$490.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$630.90
|
| Rate for Payer: Multiplan All |
$637.91
|
| Rate for Payer: OMNI Networks Commercial |
$490.70
|
| Rate for Payer: One Health Plan PPO/POS |
$630.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$665.95
|
| Rate for Payer: Three Rivers Provider Network All |
$525.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$651.93
|
| Rate for Payer: Zelis Auto |
$280.40
|
| Rate for Payer: Zelis Worker's Compensation |
$37.71
|
|
|
XR ABD W/CHEST
|
Facility
|
OP
|
$853.00
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
2400032
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.41 |
| Max. Negotiated Rate |
$810.35 |
| 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 |
$511.80
|
| 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 |
$511.80
|
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cigna Commercial |
$725.05
|
| Rate for Payer: First Health Commercial |
$767.70
|
| Rate for Payer: First Health Workers Compensation |
$59.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$767.70
|
| Rate for Payer: GEHA Commercial |
$682.40
|
| Rate for Payer: GEHA Medicare |
$103.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$767.70
|
| 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 |
$776.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.17
|
| Rate for Payer: OMNI Networks Commercial |
$597.10
|
| Rate for Payer: One Health Plan PPO/POS |
$767.70
|
| 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 |
$810.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$206.08
|
| Rate for Payer: Three Rivers Provider Network All |
$639.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.98
|
| Rate for Payer: United Healthcare Commercial |
$725.05
|
| 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 |
$793.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$103.04
|
| Rate for Payer: Zelis Auto |
$341.20
|
| Rate for Payer: Zelis Medicare |
$87.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$123.65
|
| Rate for Payer: Zelis Worker's Compensation |
$42.41
|
|
|
XR ABD W/CHEST
|
Facility
|
IP
|
$853.00
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
2400032
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.41 |
| Max. Negotiated Rate |
$810.35 |
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cigna Commercial |
$725.05
|
| Rate for Payer: First Health Commercial |
$767.70
|
| Rate for Payer: First Health Workers Compensation |
$59.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$767.70
|
| Rate for Payer: GEHA Commercial |
$597.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$767.70
|
| Rate for Payer: Multiplan All |
$776.23
|
| Rate for Payer: OMNI Networks Commercial |
$597.10
|
| Rate for Payer: One Health Plan PPO/POS |
$767.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$810.35
|
| Rate for Payer: Three Rivers Provider Network All |
$639.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$793.29
|
| Rate for Payer: Zelis Auto |
$341.20
|
| Rate for Payer: Zelis Worker's Compensation |
$42.41
|
|
|
XR A/C JNTS BILAT
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
2400038
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.56 |
| Max. Negotiated Rate |
$550.05 |
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$492.15
|
| Rate for Payer: First Health Commercial |
$521.10
|
| Rate for Payer: First Health Workers Compensation |
$43.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$521.10
|
| Rate for Payer: GEHA Commercial |
$405.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$521.10
|
| Rate for Payer: Multiplan All |
$526.89
|
| Rate for Payer: OMNI Networks Commercial |
$405.30
|
| Rate for Payer: One Health Plan PPO/POS |
$521.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$550.05
|
| Rate for Payer: Three Rivers Provider Network All |
$434.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$538.47
|
| Rate for Payer: Zelis Auto |
$231.60
|
| Rate for Payer: Zelis Worker's Compensation |
$30.56
|
|
|
XR A/C JNTS BILAT
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
2400038
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.56 |
| Max. Negotiated Rate |
$550.05 |
| 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 |
$347.40
|
| 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 |
$85.32
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$492.15
|
| Rate for Payer: First Health Commercial |
$521.10
|
| Rate for Payer: First Health Workers Compensation |
$43.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$521.10
|
| Rate for Payer: GEHA Commercial |
$463.20
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$521.10
|
| 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 |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$526.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$405.30
|
| Rate for Payer: One Health Plan PPO/POS |
$521.10
|
| 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 |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$550.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$434.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$492.15
|
| 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 |
$538.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$231.60
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$30.56
|
|
|
XR A/C JOINTS BILATERAL
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
8230018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.56 |
| Max. Negotiated Rate |
$493.05 |
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cigna Commercial |
$441.15
|
| Rate for Payer: First Health Commercial |
$467.10
|
| Rate for Payer: First Health Workers Compensation |
$43.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$467.10
|
| Rate for Payer: GEHA Commercial |
$363.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$467.10
|
| Rate for Payer: Multiplan All |
$472.29
|
| Rate for Payer: OMNI Networks Commercial |
$363.30
|
| Rate for Payer: One Health Plan PPO/POS |
$467.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$493.05
|
| Rate for Payer: Three Rivers Provider Network All |
$389.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$482.67
|
| Rate for Payer: Zelis Auto |
$207.60
|
| Rate for Payer: Zelis Worker's Compensation |
$30.56
|
|
|
XR A/C JOINTS BILATERAL
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
8230018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.56 |
| Max. Negotiated Rate |
$493.05 |
| 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 |
$311.40
|
| 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 |
$85.32
|
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cigna Commercial |
$441.15
|
| Rate for Payer: First Health Commercial |
$467.10
|
| Rate for Payer: First Health Workers Compensation |
$43.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$467.10
|
| Rate for Payer: GEHA Commercial |
$415.20
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$467.10
|
| 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 |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$472.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$363.30
|
| Rate for Payer: One Health Plan PPO/POS |
$467.10
|
| 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 |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$493.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$389.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$441.15
|
| 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 |
$482.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$207.60
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$30.56
|
|
|
XR ANKLE 2V
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
2450084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$483.55 |
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cigna Commercial |
$432.65
|
| Rate for Payer: First Health Commercial |
$458.10
|
| Rate for Payer: First Health Workers Compensation |
$39.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$458.10
|
| Rate for Payer: GEHA Commercial |
$356.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$458.10
|
| Rate for Payer: Multiplan All |
$463.19
|
| Rate for Payer: OMNI Networks Commercial |
$356.30
|
| Rate for Payer: One Health Plan PPO/POS |
$458.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$483.55
|
| Rate for Payer: Three Rivers Provider Network All |
$381.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$473.37
|
| Rate for Payer: Zelis Auto |
$203.60
|
| Rate for Payer: Zelis Worker's Compensation |
$27.71
|
|
|
XR ANKLE 2V
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
2450084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$483.55 |
| 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 |
$305.40
|
| 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 |
$85.32
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cigna Commercial |
$432.65
|
| Rate for Payer: First Health Commercial |
$458.10
|
| Rate for Payer: First Health Workers Compensation |
$39.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$458.10
|
| Rate for Payer: GEHA Commercial |
$407.20
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$458.10
|
| 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 |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$463.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$356.30
|
| Rate for Payer: One Health Plan PPO/POS |
$458.10
|
| 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 |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$483.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$381.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$432.65
|
| 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 |
$473.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$203.60
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$27.71
|
|
