|
XR HUMERUS LEFT
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
8230019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$392.35 |
| 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 |
$247.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cigna Commercial |
$351.05
|
| Rate for Payer: First Health Commercial |
$371.70
|
| Rate for Payer: First Health Workers Compensation |
$38.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$371.70
|
| Rate for Payer: GEHA Commercial |
$330.40
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$371.70
|
| 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 |
$375.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$289.10
|
| Rate for Payer: One Health Plan PPO/POS |
$371.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$392.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$309.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$351.05
|
| 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 |
$384.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$165.20
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$27.42
|
|
|
XR HUMERUS LEFT
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
8230019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$392.35 |
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cigna Commercial |
$351.05
|
| Rate for Payer: First Health Commercial |
$371.70
|
| Rate for Payer: First Health Workers Compensation |
$38.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$371.70
|
| Rate for Payer: GEHA Commercial |
$289.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$371.70
|
| Rate for Payer: Multiplan All |
$375.83
|
| Rate for Payer: OMNI Networks Commercial |
$289.10
|
| Rate for Payer: One Health Plan PPO/POS |
$371.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$392.35
|
| Rate for Payer: Three Rivers Provider Network All |
$309.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$384.09
|
| Rate for Payer: Zelis Auto |
$165.20
|
| Rate for Payer: Zelis Worker's Compensation |
$27.42
|
|
|
XR HUMERUS RIGHT
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
8250005
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$392.35 |
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cigna Commercial |
$351.05
|
| Rate for Payer: First Health Commercial |
$371.70
|
| Rate for Payer: First Health Workers Compensation |
$38.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$371.70
|
| Rate for Payer: GEHA Commercial |
$289.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$371.70
|
| Rate for Payer: Multiplan All |
$375.83
|
| Rate for Payer: OMNI Networks Commercial |
$289.10
|
| Rate for Payer: One Health Plan PPO/POS |
$371.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$392.35
|
| Rate for Payer: Three Rivers Provider Network All |
$309.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$384.09
|
| Rate for Payer: Zelis Auto |
$165.20
|
| Rate for Payer: Zelis Worker's Compensation |
$27.42
|
|
|
XR HUMERUS RIGHT
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
8250005
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$392.35 |
| 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 |
$247.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cigna Commercial |
$351.05
|
| Rate for Payer: First Health Commercial |
$371.70
|
| Rate for Payer: First Health Workers Compensation |
$38.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$371.70
|
| Rate for Payer: GEHA Commercial |
$330.40
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$371.70
|
| 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 |
$375.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$289.10
|
| Rate for Payer: One Health Plan PPO/POS |
$371.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$392.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$309.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$351.05
|
| 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 |
$384.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$165.20
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$27.42
|
|
|
XR JOINT SURVEY SGL VEW
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
CPT 77077
|
| Hospital Charge Code |
2400002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.87 |
| Max. Negotiated Rate |
$459.80 |
| 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 |
$290.40
|
| 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 |
$290.40
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cigna Commercial |
$411.40
|
| Rate for Payer: First Health Commercial |
$435.60
|
| Rate for Payer: First Health Workers Compensation |
$56.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$435.60
|
| Rate for Payer: GEHA Commercial |
$387.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$435.60
|
| 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 |
$440.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$338.80
|
| Rate for Payer: One Health Plan PPO/POS |
$435.60
|
| 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 |
$459.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$363.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$411.40
|
| 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 |
$450.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$193.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$39.87
|
|
|
XR JOINT SURVEY SGL VEW
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
CPT 77077
|
| Hospital Charge Code |
2400002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.87 |
| Max. Negotiated Rate |
$459.80 |
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cigna Commercial |
$411.40
|
| Rate for Payer: First Health Commercial |
$435.60
|
| Rate for Payer: First Health Workers Compensation |
$56.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$435.60
|
| Rate for Payer: GEHA Commercial |
$338.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$435.60
|
| Rate for Payer: Multiplan All |
$440.44
|
| Rate for Payer: OMNI Networks Commercial |
$338.80
|
| Rate for Payer: One Health Plan PPO/POS |
$435.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$459.80
|
| Rate for Payer: Three Rivers Provider Network All |
$363.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$450.12
|
| Rate for Payer: Zelis Auto |
$193.60
|
| Rate for Payer: Zelis Worker's Compensation |
$39.87
|
|
|
XR KNEE 2V
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
2450083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$507.30 |
| 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 |
$320.40
|
| 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 |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cigna Commercial |
$453.90
|
| Rate for Payer: First Health Commercial |
$480.60
|
| Rate for Payer: First Health Workers Compensation |
$41.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$480.60
|
| Rate for Payer: GEHA Commercial |
$427.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$480.60
|
| 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 |
$485.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$373.80
|
| Rate for Payer: One Health Plan PPO/POS |
$480.60
|
| 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 |
$507.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$400.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$453.90
|
| 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 |
$496.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$213.60
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$29.12
|
|
|
XR KNEE 2V
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
2450083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$507.30 |
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cigna Commercial |
$453.90
|
| Rate for Payer: First Health Commercial |
$480.60
|
| Rate for Payer: First Health Workers Compensation |
$41.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$480.60
|
| Rate for Payer: GEHA Commercial |
$373.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$480.60
|
| Rate for Payer: Multiplan All |
$485.94
|
| Rate for Payer: OMNI Networks Commercial |
$373.80
|
| Rate for Payer: One Health Plan PPO/POS |
$480.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$507.30
|
| Rate for Payer: Three Rivers Provider Network All |
$400.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$496.62
|
| Rate for Payer: Zelis Auto |
$213.60
|
| Rate for Payer: Zelis Worker's Compensation |
$29.12
|
|
|
XR KNEE 3VWS
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
2450049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$619.40 |
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cigna Commercial |
$554.20
|
| Rate for Payer: First Health Commercial |
$586.80
|
| Rate for Payer: First Health Workers Compensation |
$48.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$586.80
|
| Rate for Payer: GEHA Commercial |
$456.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$586.80
|
| Rate for Payer: Multiplan All |
$593.32
|
| Rate for Payer: OMNI Networks Commercial |
$456.40
|
| Rate for Payer: One Health Plan PPO/POS |
$586.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$619.40
|
| Rate for Payer: Three Rivers Provider Network All |
$489.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$606.36
|
| Rate for Payer: Zelis Auto |
$260.80
|
| Rate for Payer: Zelis Worker's Compensation |
$34.50
|
|
|
XR KNEE 3VWS
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
2450049
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$619.40 |
| 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 |
$391.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cigna Commercial |
$554.20
|
| Rate for Payer: First Health Commercial |
$586.80
|
| Rate for Payer: First Health Workers Compensation |
$48.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$586.80
|
| Rate for Payer: GEHA Commercial |
$521.60
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$586.80
|
| 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 |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$593.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$456.40
|
| Rate for Payer: One Health Plan PPO/POS |
$586.80
|
| 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 |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$619.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$489.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$554.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$606.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$260.80
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$34.50
|
|
|
XR KNEE 3VWS LEFT
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
8230035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$634.60 |
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cigna Commercial |
$567.80
|
| Rate for Payer: First Health Commercial |
$601.20
|
| Rate for Payer: First Health Workers Compensation |
$48.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$601.20
|
| Rate for Payer: GEHA Commercial |
$467.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$601.20
|
| Rate for Payer: Multiplan All |
$607.88
|
| Rate for Payer: OMNI Networks Commercial |
$467.60
|
| Rate for Payer: One Health Plan PPO/POS |
$601.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$634.60
|
| Rate for Payer: Three Rivers Provider Network All |
$501.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$621.24
|
| Rate for Payer: Zelis Auto |
$267.20
|
| Rate for Payer: Zelis Worker's Compensation |
$34.50
|
|
|
XR KNEE 3VWS LEFT
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
8230035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$634.60 |
| 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 |
$400.80
|
| 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 |
$83.61
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cigna Commercial |
$567.80
|
| Rate for Payer: First Health Commercial |
$601.20
|
| Rate for Payer: First Health Workers Compensation |
$48.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$601.20
|
| Rate for Payer: GEHA Commercial |
$534.40
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$601.20
|
| 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 |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$607.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$467.60
|
| Rate for Payer: One Health Plan PPO/POS |
$601.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$634.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$501.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$567.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$621.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$267.20
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$34.50
|
|
|
XR KNEE 3VWS RIGHT
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
8250017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$634.60 |
| 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 |
$400.80
|
| 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 |
$83.61
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cigna Commercial |
$567.80
|
| Rate for Payer: First Health Commercial |
$601.20
|
| Rate for Payer: First Health Workers Compensation |
$48.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$601.20
|
| Rate for Payer: GEHA Commercial |
$534.40
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$601.20
|
| 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 |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$607.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$467.60
|
| Rate for Payer: One Health Plan PPO/POS |
$601.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$634.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$501.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$567.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$621.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$267.20
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$34.50
|
|
|
XR KNEE 3VWS RIGHT
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
8250017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$634.60 |
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cigna Commercial |
$567.80
|
| Rate for Payer: First Health Commercial |
$601.20
|
| Rate for Payer: First Health Workers Compensation |
$48.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$601.20
|
| Rate for Payer: GEHA Commercial |
$467.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$601.20
|
| Rate for Payer: Multiplan All |
$607.88
|
| Rate for Payer: OMNI Networks Commercial |
$467.60
|
| Rate for Payer: One Health Plan PPO/POS |
$601.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$634.60
|
| Rate for Payer: Three Rivers Provider Network All |
$501.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$621.24
|
| Rate for Payer: Zelis Auto |
$267.20
|
| Rate for Payer: Zelis Worker's Compensation |
$34.50
|
|
|
XR KNEE AP LAT LEFT
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
8230034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$346.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$219.00
|
| 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 |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$310.25
|
| Rate for Payer: First Health Commercial |
$328.50
|
| Rate for Payer: First Health Workers Compensation |
$41.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$328.50
|
| Rate for Payer: GEHA Commercial |
$292.00
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$328.50
|
| 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 |
$332.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$255.50
|
| Rate for Payer: One Health Plan PPO/POS |
$328.50
|
| 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 |
$346.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$273.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$310.25
|
| 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 |
$339.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$146.00
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$29.12
|
|
|
XR KNEE AP LAT LEFT
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
8230034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$346.75 |
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$310.25
|
| Rate for Payer: First Health Commercial |
$328.50
|
| Rate for Payer: First Health Workers Compensation |
$41.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$328.50
|
| Rate for Payer: GEHA Commercial |
$255.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$328.50
|
| Rate for Payer: Multiplan All |
$332.15
|
| Rate for Payer: OMNI Networks Commercial |
$255.50
|
| Rate for Payer: One Health Plan PPO/POS |
$328.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$346.75
|
| Rate for Payer: Three Rivers Provider Network All |
$273.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$339.45
|
| Rate for Payer: Zelis Auto |
$146.00
|
| Rate for Payer: Zelis Worker's Compensation |
$29.12
|
|
|
XR KNEE AP LAT RIGHT
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
8250025
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$346.75 |
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$310.25
|
| Rate for Payer: First Health Commercial |
$328.50
|
| Rate for Payer: First Health Workers Compensation |
$41.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$328.50
|
| Rate for Payer: GEHA Commercial |
$255.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$328.50
|
| Rate for Payer: Multiplan All |
$332.15
|
| Rate for Payer: OMNI Networks Commercial |
$255.50
|
| Rate for Payer: One Health Plan PPO/POS |
$328.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$346.75
|
| Rate for Payer: Three Rivers Provider Network All |
$273.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$339.45
|
| Rate for Payer: Zelis Auto |
$146.00
|
| Rate for Payer: Zelis Worker's Compensation |
$29.12
|
|
|
XR KNEE AP LAT RIGHT
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
8250025
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$346.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$219.00
|
| 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 |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$310.25
|
| Rate for Payer: First Health Commercial |
$328.50
|
| Rate for Payer: First Health Workers Compensation |
$41.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$328.50
|
| Rate for Payer: GEHA Commercial |
$292.00
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$328.50
|
| 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 |
$332.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$255.50
|
| Rate for Payer: One Health Plan PPO/POS |
$328.50
|
| 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 |
$346.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$273.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$310.25
|
| 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 |
$339.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$146.00
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$29.12
|
|
|
XR KNEE COMPLETE 4/MORE VIEWS
|
Facility
|
IP
|
$764.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
2473564
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.59 |
| Max. Negotiated Rate |
$725.80 |
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cigna Commercial |
$649.40
|
| Rate for Payer: First Health Commercial |
$687.60
|
| Rate for Payer: First Health Workers Compensation |
$55.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$687.60
|
| Rate for Payer: GEHA Commercial |
$534.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$687.60
|
| Rate for Payer: Multiplan All |
$695.24
|
| Rate for Payer: OMNI Networks Commercial |
$534.80
|
| Rate for Payer: One Health Plan PPO/POS |
$687.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$725.80
|
| Rate for Payer: Three Rivers Provider Network All |
$573.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$710.52
|
| Rate for Payer: Zelis Auto |
$305.60
|
| Rate for Payer: Zelis Worker's Compensation |
$39.59
|
|
|
XR KNEE COMPLETE 4/MORE VIEWS
|
Facility
|
OP
|
$764.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
2473564
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.59 |
| Max. Negotiated Rate |
$725.80 |
| 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 |
$458.40
|
| 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 |
$458.40
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cigna Commercial |
$649.40
|
| Rate for Payer: First Health Commercial |
$687.60
|
| Rate for Payer: First Health Workers Compensation |
$55.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$687.60
|
| Rate for Payer: GEHA Commercial |
$611.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$687.60
|
| 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 |
$695.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$534.80
|
| Rate for Payer: One Health Plan PPO/POS |
$687.60
|
| 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 |
$725.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$573.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$649.40
|
| 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 |
$710.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$305.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$39.59
|
|
|
XR KNEES BILAT STANDING AP
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
2400216
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.11 |
| Max. Negotiated Rate |
$444.60 |
| 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 |
$280.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$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 |
$48.24
|
| 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 |
$71.95
|
| 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 |
$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 |
$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 |
$71.95
|
| 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 |
$34.11
|
|
|
XR KNEES BILAT STANDING AP
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
2400216
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.11 |
| 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 |
$48.24
|
| 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 |
$34.11
|
|
|
XR L-SPINE 2/3 VWS
|
Facility
|
OP
|
$727.30
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
2400023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$690.93 |
| 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 |
$436.38
|
| 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 |
$436.38
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cigna Commercial |
$618.21
|
| Rate for Payer: First Health Commercial |
$654.57
|
| Rate for Payer: First Health Workers Compensation |
$47.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$654.57
|
| Rate for Payer: GEHA Commercial |
$581.84
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$654.57
|
| 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 |
$661.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$509.11
|
| Rate for Payer: One Health Plan PPO/POS |
$654.57
|
| 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 |
$690.93
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$545.48
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$618.21
|
| 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 |
$676.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$290.92
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$33.93
|
|
|
XR L-SPINE 2/3 VWS
|
Facility
|
IP
|
$727.30
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
2400023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$690.93 |
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cigna Commercial |
$618.21
|
| Rate for Payer: First Health Commercial |
$654.57
|
| Rate for Payer: First Health Workers Compensation |
$47.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$654.57
|
| Rate for Payer: GEHA Commercial |
$509.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$654.57
|
| Rate for Payer: Multiplan All |
$661.84
|
| Rate for Payer: OMNI Networks Commercial |
$509.11
|
| Rate for Payer: One Health Plan PPO/POS |
$654.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$690.93
|
| Rate for Payer: Three Rivers Provider Network All |
$545.48
|
| Rate for Payer: United Payors & United Providers UP&UP |
$676.39
|
| Rate for Payer: Zelis Auto |
$290.92
|
| Rate for Payer: Zelis Worker's Compensation |
$33.93
|
|
|
XR L-SPINE COMP
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
2400026
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$925.30 |
| 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 |
$584.40
|
| 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 |
$584.40
|
| Rate for Payer: Cash Price |
$584.40
|
| Rate for Payer: Cigna Commercial |
$827.90
|
| Rate for Payer: First Health Commercial |
$876.60
|
| Rate for Payer: First Health Workers Compensation |
$61.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$876.60
|
| Rate for Payer: GEHA Commercial |
$779.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$876.60
|
| 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 |
$886.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$681.80
|
| Rate for Payer: One Health Plan PPO/POS |
$876.60
|
| 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 |
$925.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$730.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$827.90
|
| 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 |
$905.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$389.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$43.55
|
|
