|
XR HAND 2V
|
Facility
|
OP
|
$559.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
2450045
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.57 |
| Max. Negotiated Rate |
$531.05 |
| 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 |
$335.40
|
| 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 |
$100.97
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cigna Commercial |
$475.15
|
| Rate for Payer: First Health Commercial |
$503.10
|
| Rate for Payer: First Health Workers Compensation |
$37.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$503.10
|
| Rate for Payer: GEHA Commercial |
$447.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$503.10
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$508.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$391.30
|
| Rate for Payer: One Health Plan PPO/POS |
$503.10
|
| 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 |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$531.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$419.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$475.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$519.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$223.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$26.57
|
|
|
XR HAND AP LAT LEFT
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
8230026
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.57 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$272.85
|
| Rate for Payer: First Health Commercial |
$288.90
|
| Rate for Payer: First Health Workers Compensation |
$37.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$288.90
|
| Rate for Payer: GEHA Commercial |
$224.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$288.90
|
| Rate for Payer: Multiplan All |
$292.11
|
| Rate for Payer: OMNI Networks Commercial |
$224.70
|
| Rate for Payer: One Health Plan PPO/POS |
$288.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$304.95
|
| Rate for Payer: Three Rivers Provider Network All |
$240.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$298.53
|
| Rate for Payer: Zelis Auto |
$128.40
|
| Rate for Payer: Zelis Worker's Compensation |
$26.57
|
|
|
XR HAND AP LAT LEFT
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
8230026
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.57 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$192.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$272.85
|
| Rate for Payer: First Health Commercial |
$288.90
|
| Rate for Payer: First Health Workers Compensation |
$37.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$288.90
|
| Rate for Payer: GEHA Commercial |
$256.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$288.90
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$292.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$224.70
|
| Rate for Payer: One Health Plan PPO/POS |
$288.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$304.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$240.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$272.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$298.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$128.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$26.57
|
|
|
XR HAND AP LAT RIGHT
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
8250011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.57 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$192.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$272.85
|
| Rate for Payer: First Health Commercial |
$288.90
|
| Rate for Payer: First Health Workers Compensation |
$37.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$288.90
|
| Rate for Payer: GEHA Commercial |
$256.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$288.90
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$292.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$224.70
|
| Rate for Payer: One Health Plan PPO/POS |
$288.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$304.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$240.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$272.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$298.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$128.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$26.57
|
|
|
XR HAND AP LAT RIGHT
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
8250011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.57 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$272.85
|
| Rate for Payer: First Health Commercial |
$288.90
|
| Rate for Payer: First Health Workers Compensation |
$37.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$288.90
|
| Rate for Payer: GEHA Commercial |
$224.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$288.90
|
| Rate for Payer: Multiplan All |
$292.11
|
| Rate for Payer: OMNI Networks Commercial |
$224.70
|
| Rate for Payer: One Health Plan PPO/POS |
$288.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$304.95
|
| Rate for Payer: Three Rivers Provider Network All |
$240.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$298.53
|
| Rate for Payer: Zelis Auto |
$128.40
|
| Rate for Payer: Zelis Worker's Compensation |
$26.57
|
|
|
XR HAND COMP
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
2450081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.38 |
| Max. Negotiated Rate |
$585.20 |
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cigna Commercial |
$523.60
|
| Rate for Payer: First Health Commercial |
$554.40
|
| Rate for Payer: First Health Workers Compensation |
$44.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$554.40
|
| Rate for Payer: GEHA Commercial |
$431.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$554.40
|
| Rate for Payer: Multiplan All |
$560.56
|
| Rate for Payer: OMNI Networks Commercial |
$431.20
|
| Rate for Payer: One Health Plan PPO/POS |
$554.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$585.20
|
| Rate for Payer: Three Rivers Provider Network All |
$462.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$572.88
|
| Rate for Payer: Zelis Auto |
$246.40
|
| Rate for Payer: Zelis Worker's Compensation |
$31.38
|
|
|
XR HAND COMP
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
2450081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.38 |
| Max. Negotiated Rate |
$585.20 |
| 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 |
$369.60
|
| 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 |
$83.61
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cigna Commercial |
$523.60
|
| Rate for Payer: First Health Commercial |
$554.40
|
| Rate for Payer: First Health Workers Compensation |
$44.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$554.40
|
| Rate for Payer: GEHA Commercial |
$492.80
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$554.40
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$560.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$431.20
|
| Rate for Payer: One Health Plan PPO/POS |
$554.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$585.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$462.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$523.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$572.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$246.40
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$31.38
|
|
|
XR HAND COMP LEFT
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
8230027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.38 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$360.40
|
| Rate for Payer: First Health Commercial |
$381.60
|
| Rate for Payer: First Health Workers Compensation |
$44.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$381.60
|
| Rate for Payer: GEHA Commercial |
$296.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$381.60
|
| Rate for Payer: Multiplan All |
$385.84
|
| Rate for Payer: OMNI Networks Commercial |
$296.80
|
| Rate for Payer: One Health Plan PPO/POS |
$381.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$402.80
|
| Rate for Payer: Three Rivers Provider Network All |
$318.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$394.32
|
| Rate for Payer: Zelis Auto |
$169.60
|
| Rate for Payer: Zelis Worker's Compensation |
$31.38
|
|
|
XR HAND COMP LEFT
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
8230027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.38 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$254.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$360.40
|
| Rate for Payer: First Health Commercial |
$381.60
|
| Rate for Payer: First Health Workers Compensation |
$44.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$381.60
|
| Rate for Payer: GEHA Commercial |
$339.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$381.60
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$385.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$296.80
|
| Rate for Payer: One Health Plan PPO/POS |
$381.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$402.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$318.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$360.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$394.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$169.60
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$31.38
|
|
|
XR HAND COMP RIGHT
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
8250012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.38 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$360.40
|
| Rate for Payer: First Health Commercial |
$381.60
|
| Rate for Payer: First Health Workers Compensation |
$44.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$381.60
|
| Rate for Payer: GEHA Commercial |
$296.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$381.60
|
| Rate for Payer: Multiplan All |
$385.84
|
| Rate for Payer: OMNI Networks Commercial |
$296.80
|
| Rate for Payer: One Health Plan PPO/POS |
$381.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$402.80
|
| Rate for Payer: Three Rivers Provider Network All |
$318.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$394.32
|
| Rate for Payer: Zelis Auto |
$169.60
|
| Rate for Payer: Zelis Worker's Compensation |
$31.38
|
|
|
XR HAND COMP RIGHT
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
8250012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.38 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$254.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$360.40
|
| Rate for Payer: First Health Commercial |
$381.60
|
| Rate for Payer: First Health Workers Compensation |
$44.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$381.60
|
| Rate for Payer: GEHA Commercial |
$339.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$381.60
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$385.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$296.80
|
| Rate for Payer: One Health Plan PPO/POS |
$381.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$402.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$318.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$360.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$394.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$169.60
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$31.38
|
|
|
XR HIP 1V
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
2410084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.81 |
| Max. Negotiated Rate |
$444.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$280.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$72.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cigna Commercial |
$397.80
|
| Rate for Payer: First Health Commercial |
$421.20
|
| Rate for Payer: First Health Workers Compensation |
$46.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$421.20
|
| Rate for Payer: GEHA Commercial |
$374.40
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$421.20
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$73.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$425.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$327.60
|
| Rate for Payer: One Health Plan PPO/POS |
$421.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$85.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$73.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$444.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$351.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$397.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$73.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$435.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$187.20
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$32.81
|
|
|
XR HIP 1V
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
2410084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.81 |
| Max. Negotiated Rate |
$444.60 |
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cigna Commercial |
$397.80
|
| Rate for Payer: First Health Commercial |
$421.20
|
| Rate for Payer: First Health Workers Compensation |
$46.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$421.20
|
| Rate for Payer: GEHA Commercial |
$327.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$421.20
|
| Rate for Payer: Multiplan All |
$425.88
|
| Rate for Payer: OMNI Networks Commercial |
$327.60
|
| Rate for Payer: One Health Plan PPO/POS |
$421.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$444.60
|
| Rate for Payer: Three Rivers Provider Network All |
$351.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$435.24
|
| Rate for Payer: Zelis Auto |
$187.20
|
| Rate for Payer: Zelis Worker's Compensation |
$32.81
|
|
|
XR HIP 2 or 3 VW
|
Facility
|
IP
|
$587.00
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
2410085
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.31 |
| Max. Negotiated Rate |
$557.65 |
| Rate for Payer: Cash Price |
$352.20
|
| Rate for Payer: Cash Price |
$352.20
|
| Rate for Payer: Cigna Commercial |
$498.95
|
| Rate for Payer: First Health Commercial |
$528.30
|
| Rate for Payer: First Health Workers Compensation |
$64.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$528.30
|
| Rate for Payer: GEHA Commercial |
$410.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$528.30
|
| Rate for Payer: Multiplan All |
$534.17
|
| Rate for Payer: OMNI Networks Commercial |
$410.90
|
| Rate for Payer: One Health Plan PPO/POS |
$528.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$557.65
|
| Rate for Payer: Three Rivers Provider Network All |
$440.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$545.91
|
| Rate for Payer: Zelis Auto |
$234.80
|
| Rate for Payer: Zelis Worker's Compensation |
$45.31
|
|
|
XR HIP 2 or 3 VW
|
Facility
|
OP
|
$587.00
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
2410085
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.31 |
| Max. Negotiated Rate |
$557.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$352.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$72.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$352.20
|
| Rate for Payer: Cash Price |
$352.20
|
| Rate for Payer: Cigna Commercial |
$498.95
|
| Rate for Payer: First Health Commercial |
$528.30
|
| Rate for Payer: First Health Workers Compensation |
$64.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$528.30
|
| Rate for Payer: GEHA Commercial |
$469.60
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$528.30
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$73.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$534.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$410.90
|
| Rate for Payer: One Health Plan PPO/POS |
$528.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$85.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$73.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$557.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$440.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$498.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$73.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$545.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$234.80
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$45.31
|
|
|
XR HIP 4+ VWS
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT 73503
|
| Hospital Charge Code |
2410086
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$56.64 |
| Max. Negotiated Rate |
$732.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$151.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$462.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$151.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$119.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cigna Commercial |
$655.35
|
| Rate for Payer: First Health Commercial |
$693.90
|
| Rate for Payer: First Health Workers Compensation |
$80.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$693.90
|
| Rate for Payer: GEHA Commercial |
$616.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$693.90
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$122.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$701.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$539.70
|
| Rate for Payer: One Health Plan PPO/POS |
$693.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$140.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$122.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$732.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$578.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$655.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$122.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$717.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$308.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$56.64
|
|
|
XR HIP 4+ VWS
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
CPT 73503
|
| Hospital Charge Code |
2410086
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$56.64 |
| Max. Negotiated Rate |
$732.45 |
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cigna Commercial |
$655.35
|
| Rate for Payer: First Health Commercial |
$693.90
|
| Rate for Payer: First Health Workers Compensation |
$80.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$693.90
|
| Rate for Payer: GEHA Commercial |
$539.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$693.90
|
| Rate for Payer: Multiplan All |
$701.61
|
| Rate for Payer: OMNI Networks Commercial |
$539.70
|
| Rate for Payer: One Health Plan PPO/POS |
$693.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$732.45
|
| Rate for Payer: Three Rivers Provider Network All |
$578.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$717.03
|
| Rate for Payer: Zelis Auto |
$308.40
|
| Rate for Payer: Zelis Worker's Compensation |
$56.64
|
|
|
XR HIPS BILAT 2 VWS
|
Facility
|
IP
|
$722.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
2408003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$685.90 |
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cigna Commercial |
$613.70
|
| Rate for Payer: First Health Commercial |
$649.80
|
| Rate for Payer: First Health Workers Compensation |
$61.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$649.80
|
| Rate for Payer: GEHA Commercial |
$505.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$649.80
|
| Rate for Payer: Multiplan All |
$657.02
|
| Rate for Payer: OMNI Networks Commercial |
$505.40
|
| Rate for Payer: One Health Plan PPO/POS |
$649.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$685.90
|
| Rate for Payer: Three Rivers Provider Network All |
$541.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$671.46
|
| Rate for Payer: Zelis Auto |
$288.80
|
| Rate for Payer: Zelis Worker's Compensation |
$43.75
|
|
|
XR HIPS BILAT 2 VWS
|
Facility
|
OP
|
$722.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
2408003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$685.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$151.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$433.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$151.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$119.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cigna Commercial |
$613.70
|
| Rate for Payer: First Health Commercial |
$649.80
|
| Rate for Payer: First Health Workers Compensation |
$61.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$649.80
|
| Rate for Payer: GEHA Commercial |
$577.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$649.80
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$122.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$657.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$505.40
|
| Rate for Payer: One Health Plan PPO/POS |
$649.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$140.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$122.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$685.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$541.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$613.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$122.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$671.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$288.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$43.75
|
|
|
XR HIPS BILAT 3/4 VWS
|
Facility
|
OP
|
$822.00
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
2408004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.52 |
| Max. Negotiated Rate |
$780.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$151.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$493.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$151.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$119.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cigna Commercial |
$698.70
|
| Rate for Payer: First Health Commercial |
$739.80
|
| Rate for Payer: First Health Workers Compensation |
$75.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$739.80
|
| Rate for Payer: GEHA Commercial |
$657.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$739.80
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$122.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$748.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$575.40
|
| Rate for Payer: One Health Plan PPO/POS |
$739.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$140.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$122.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$780.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$616.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$698.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$122.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$764.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$328.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$53.52
|
|
|
XR HIPS BILAT 3/4 VWS
|
Facility
|
IP
|
$822.00
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
2408004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.52 |
| Max. Negotiated Rate |
$780.90 |
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cigna Commercial |
$698.70
|
| Rate for Payer: First Health Commercial |
$739.80
|
| Rate for Payer: First Health Workers Compensation |
$75.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$739.80
|
| Rate for Payer: GEHA Commercial |
$575.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$739.80
|
| Rate for Payer: Multiplan All |
$748.02
|
| Rate for Payer: OMNI Networks Commercial |
$575.40
|
| Rate for Payer: One Health Plan PPO/POS |
$739.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$780.90
|
| Rate for Payer: Three Rivers Provider Network All |
$616.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$764.46
|
| Rate for Payer: Zelis Auto |
$328.80
|
| Rate for Payer: Zelis Worker's Compensation |
$53.52
|
|
|
XR HIPS BILAT 5+ VWS
|
Facility
|
OP
|
$999.00
|
|
|
Service Code
|
CPT 73523
|
| Hospital Charge Code |
2408005
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$949.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$287.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$599.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$287.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$228.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$599.40
|
| Rate for Payer: Cash Price |
$599.40
|
| Rate for Payer: Cigna Commercial |
$849.15
|
| Rate for Payer: First Health Commercial |
$899.10
|
| Rate for Payer: First Health Workers Compensation |
$87.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$899.10
|
| Rate for Payer: GEHA Commercial |
$799.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$899.10
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$232.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$909.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$699.30
|
| Rate for Payer: One Health Plan PPO/POS |
$899.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$268.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$232.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$949.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$749.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$849.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$232.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$929.07
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$399.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$62.10
|
|
|
XR HIPS BILAT 5+ VWS
|
Facility
|
IP
|
$999.00
|
|
|
Service Code
|
CPT 73523
|
| Hospital Charge Code |
2408005
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$949.05 |
| Rate for Payer: Cash Price |
$599.40
|
| Rate for Payer: Cash Price |
$599.40
|
| Rate for Payer: Cigna Commercial |
$849.15
|
| Rate for Payer: First Health Commercial |
$899.10
|
| Rate for Payer: First Health Workers Compensation |
$87.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$899.10
|
| Rate for Payer: GEHA Commercial |
$699.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$899.10
|
| Rate for Payer: Multiplan All |
$909.09
|
| Rate for Payer: OMNI Networks Commercial |
$699.30
|
| Rate for Payer: One Health Plan PPO/POS |
$899.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$949.05
|
| Rate for Payer: Three Rivers Provider Network All |
$749.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$929.07
|
| Rate for Payer: Zelis Auto |
$399.60
|
| Rate for Payer: Zelis Worker's Compensation |
$62.10
|
|
|
XR HUMERUS
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
2450039
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$527.25 |
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna Commercial |
$471.75
|
| Rate for Payer: First Health Commercial |
$499.50
|
| Rate for Payer: First Health Workers Compensation |
$38.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$499.50
|
| Rate for Payer: GEHA Commercial |
$388.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$499.50
|
| Rate for Payer: Multiplan All |
$505.05
|
| Rate for Payer: OMNI Networks Commercial |
$388.50
|
| Rate for Payer: One Health Plan PPO/POS |
$499.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$527.25
|
| Rate for Payer: Three Rivers Provider Network All |
$416.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$516.15
|
| Rate for Payer: Zelis Auto |
$222.00
|
| Rate for Payer: Zelis Worker's Compensation |
$27.42
|
|
|
XR HUMERUS
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
2450039
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$527.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$333.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna Commercial |
$471.75
|
| Rate for Payer: First Health Commercial |
$499.50
|
| Rate for Payer: First Health Workers Compensation |
$38.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$499.50
|
| Rate for Payer: GEHA Commercial |
$444.00
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$499.50
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$505.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$388.50
|
| Rate for Payer: One Health Plan PPO/POS |
$499.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$527.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$416.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$471.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$516.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$222.00
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$27.42
|
|
