|
CB XR FEMUR
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
2900040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.55 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$259.25
|
| Rate for Payer: First Health Commercial |
$274.50
|
| Rate for Payer: First Health Workers Compensation |
$50.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$274.50
|
| Rate for Payer: GEHA Commercial |
$213.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$274.50
|
| Rate for Payer: Multiplan All |
$277.55
|
| Rate for Payer: OMNI Networks Commercial |
$213.50
|
| Rate for Payer: One Health Plan PPO/POS |
$274.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$289.75
|
| Rate for Payer: Three Rivers Provider Network All |
$228.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$283.65
|
| Rate for Payer: Zelis Auto |
$122.00
|
| Rate for Payer: Zelis Worker's Compensation |
$35.55
|
|
|
CB XR FEMUR 1V
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
2900038
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$429.40 |
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cigna Commercial |
$384.20
|
| Rate for Payer: First Health Commercial |
$406.80
|
| Rate for Payer: First Health Workers Compensation |
$43.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$406.80
|
| Rate for Payer: GEHA Commercial |
$316.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$406.80
|
| Rate for Payer: Multiplan All |
$411.32
|
| Rate for Payer: OMNI Networks Commercial |
$316.40
|
| Rate for Payer: One Health Plan PPO/POS |
$406.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$429.40
|
| Rate for Payer: Three Rivers Provider Network All |
$339.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$420.36
|
| Rate for Payer: Zelis Auto |
$180.80
|
| Rate for Payer: Zelis Worker's Compensation |
$30.46
|
|
|
CB XR FEMUR 1V
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
2900038
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$429.40 |
| 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 |
$271.20
|
| 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 |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cigna Commercial |
$384.20
|
| Rate for Payer: First Health Commercial |
$406.80
|
| Rate for Payer: First Health Workers Compensation |
$43.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$406.80
|
| Rate for Payer: GEHA Commercial |
$361.60
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$406.80
|
| 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 |
$73.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$411.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$316.40
|
| Rate for Payer: One Health Plan PPO/POS |
$406.80
|
| 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 |
$429.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$339.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$384.20
|
| 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 |
$420.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$180.80
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$30.46
|
|
|
CB XR FINGER
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
2900042
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.23 |
| Max. Negotiated Rate |
$446.50 |
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$399.50
|
| Rate for Payer: First Health Commercial |
$423.00
|
| Rate for Payer: First Health Workers Compensation |
$45.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$423.00
|
| Rate for Payer: GEHA Commercial |
$329.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$423.00
|
| Rate for Payer: Multiplan All |
$427.70
|
| Rate for Payer: OMNI Networks Commercial |
$329.00
|
| Rate for Payer: One Health Plan PPO/POS |
$423.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$446.50
|
| Rate for Payer: Three Rivers Provider Network All |
$352.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$437.10
|
| Rate for Payer: Zelis Auto |
$188.00
|
| Rate for Payer: Zelis Worker's Compensation |
$32.23
|
|
|
CB XR FINGER
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
2900042
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.23 |
| Max. Negotiated Rate |
$446.50 |
| 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 |
$282.00
|
| 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 |
$282.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$399.50
|
| Rate for Payer: First Health Commercial |
$423.00
|
| Rate for Payer: First Health Workers Compensation |
$45.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$423.00
|
| Rate for Payer: GEHA Commercial |
$376.00
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$423.00
|
| 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 |
$427.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$329.00
|
| Rate for Payer: One Health Plan PPO/POS |
$423.00
|
| 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 |
$446.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$352.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$399.50
|
| 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 |
$437.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$188.00
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$32.23
|
|
|
CB XR FOOT 2V
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
2900044
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.03 |
| Max. Negotiated Rate |
$303.05 |
| 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 |
$191.40
|
| 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 |
$191.40
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cigna Commercial |
$271.15
|
| Rate for Payer: First Health Commercial |
$287.10
|
| Rate for Payer: First Health Workers Compensation |
$33.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$287.10
|
| Rate for Payer: GEHA Commercial |
$255.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$287.10
|
| 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 |
$290.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$223.30
|
| Rate for Payer: One Health Plan PPO/POS |
$287.10
|
| 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 |
$303.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$239.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$271.15
|
| 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 |
$296.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$127.60
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$24.03
|
|
|
CB XR FOOT 2V
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
2900044
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.03 |
| Max. Negotiated Rate |
$303.05 |
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cigna Commercial |
$271.15
|
| Rate for Payer: First Health Commercial |
$287.10
|
| Rate for Payer: First Health Workers Compensation |
$33.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$287.10
|
| Rate for Payer: GEHA Commercial |
$223.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$287.10
|
| Rate for Payer: Multiplan All |
$290.29
|
| Rate for Payer: OMNI Networks Commercial |
$223.30
|
| Rate for Payer: One Health Plan PPO/POS |
$287.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$303.05
|
| Rate for Payer: Three Rivers Provider Network All |
$239.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$296.67
|
| Rate for Payer: Zelis Auto |
$127.60
|
| Rate for Payer: Zelis Worker's Compensation |
$24.03
|
|
|
CB XR FOOT COMP
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
2900046
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$416.10 |
| 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 |
$262.80
|
| 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 |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna Commercial |
$372.30
|
| Rate for Payer: First Health Commercial |
$394.20
|
| Rate for Payer: First Health Workers Compensation |
$41.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$394.20
|
| Rate for Payer: GEHA Commercial |
$350.40
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$394.20
|
| 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 |
$398.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$306.60
|
| Rate for Payer: One Health Plan PPO/POS |
$394.20
|
| 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 |
$416.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$328.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$372.30
|
| 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 |
$407.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$175.20
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$29.12
|
|
|
CB XR FOOT COMP
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
2900046
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$416.10 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna Commercial |
$372.30
|
| Rate for Payer: First Health Commercial |
$394.20
|
| Rate for Payer: First Health Workers Compensation |
$41.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$394.20
|
| Rate for Payer: GEHA Commercial |
$306.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$394.20
|
| Rate for Payer: Multiplan All |
$398.58
|
| Rate for Payer: OMNI Networks Commercial |
$306.60
|
| Rate for Payer: One Health Plan PPO/POS |
$394.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$416.10
|
| Rate for Payer: Three Rivers Provider Network All |
$328.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$407.34
|
| Rate for Payer: Zelis Auto |
$175.20
|
| Rate for Payer: Zelis Worker's Compensation |
$29.12
|
|
|
CB XR FOREARM
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
2900048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$522.50 |
| 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 |
$330.00
|
| 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 |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$467.50
|
| Rate for Payer: First Health Commercial |
$495.00
|
| Rate for Payer: First Health Workers Compensation |
$35.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$495.00
|
| Rate for Payer: GEHA Commercial |
$440.00
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$495.00
|
| 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 |
$500.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$385.00
|
| Rate for Payer: One Health Plan PPO/POS |
$495.00
|
| 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 |
$522.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$412.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$467.50
|
| 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 |
$511.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$220.00
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$24.88
|
|
|
CB XR FOREARM
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
2900048
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$522.50 |
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$467.50
|
| Rate for Payer: First Health Commercial |
$495.00
|
| Rate for Payer: First Health Workers Compensation |
$35.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$495.00
|
| Rate for Payer: GEHA Commercial |
$385.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$495.00
|
| Rate for Payer: Multiplan All |
$500.50
|
| Rate for Payer: OMNI Networks Commercial |
$385.00
|
| Rate for Payer: One Health Plan PPO/POS |
$495.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$522.50
|
| Rate for Payer: Three Rivers Provider Network All |
$412.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$511.50
|
| Rate for Payer: Zelis Auto |
$220.00
|
| Rate for Payer: Zelis Worker's Compensation |
$24.88
|
|
|
CB XR HAND 2V
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
2900052
|
|
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
|
|
|
CB XR HAND 2V
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
2900052
|
|
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
|
|
|
CB XR HAND COMP
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
2900054
|
|
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
|
|
|
CB XR HAND COMP
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
2900054
|
|
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
|
|
|
CB XR HIP 1V
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
2900058
|
|
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
|
|
|
CB XR HIP 1V
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
2900058
|
|
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
|
|
|
CB XR HIP 2/3 VW
|
Facility
|
IP
|
$587.00
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
2900060
|
|
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
|
|
|
CB XR HIP 2/3 VW
|
Facility
|
OP
|
$587.00
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
2900060
|
|
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
|
|
|
CB XR HIP 4+ VWS
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT 73503
|
| Hospital Charge Code |
2900062
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$56.64 |
| Max. Negotiated Rate |
$385.70 |
| 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 |
$243.60
|
| 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 |
$243.60
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$345.10
|
| Rate for Payer: First Health Commercial |
$365.40
|
| Rate for Payer: First Health Workers Compensation |
$80.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$365.40
|
| Rate for Payer: GEHA Commercial |
$324.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$365.40
|
| 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 |
$369.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$284.20
|
| Rate for Payer: One Health Plan PPO/POS |
$365.40
|
| 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 |
$385.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$304.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$345.10
|
| 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 |
$377.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$162.40
|
| 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
|
|
|
CB XR HIP 4+ VWS
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 73503
|
| Hospital Charge Code |
2900062
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$56.64 |
| Max. Negotiated Rate |
$385.70 |
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$345.10
|
| Rate for Payer: First Health Commercial |
$365.40
|
| Rate for Payer: First Health Workers Compensation |
$80.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$365.40
|
| Rate for Payer: GEHA Commercial |
$284.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$365.40
|
| Rate for Payer: Multiplan All |
$369.46
|
| Rate for Payer: OMNI Networks Commercial |
$284.20
|
| Rate for Payer: One Health Plan PPO/POS |
$365.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$385.70
|
| Rate for Payer: Three Rivers Provider Network All |
$304.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$377.58
|
| Rate for Payer: Zelis Auto |
$162.40
|
| Rate for Payer: Zelis Worker's Compensation |
$56.64
|
|
|
CB XR HIPS BILAT 2 VWS
|
Facility
|
OP
|
$722.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
2900064
|
|
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
|
|
|
CB XR HIPS BILAT 2 VWS
|
Facility
|
IP
|
$722.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
2900064
|
|
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
|
|
|
CB XR HIPS BILAT 3-4 VWS
|
Facility
|
OP
|
$822.00
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
2900065
|
|
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
|
|
|
CB XR HIPS BILAT 3-4 VWS
|
Facility
|
IP
|
$822.00
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
2900065
|
|
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
|
|
