|
CL- ROPIVACAINE INJ 1 MG
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
3350416
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$0.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
CLSD RED DISLOC SHOULD W/FX; W/MANIP
|
Facility
|
OP
|
$1,900.00
|
|
| Hospital Charge Code |
8123675
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$475.00 |
| Max. Negotiated Rate |
$1,805.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,140.00
|
| Rate for Payer: Cash Price |
$1,140.00
|
| Rate for Payer: Cigna Commercial |
$1,615.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: First Health Workers Compensation |
$733.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,710.00
|
| Rate for Payer: GEHA Commercial |
$1,520.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,710.00
|
| Rate for Payer: Humana ChoiceCare |
$494.00
|
| Rate for Payer: Multiplan All |
$1,729.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,140.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,330.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,710.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,805.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,425.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,672.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$475.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,767.00
|
| Rate for Payer: Zelis Auto |
$760.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$950.00
|
| Rate for Payer: Zelis Worker's Compensation |
$518.70
|
|
|
CLSD RED DISLOC SHOULD W/FX; W/MANIP
|
Facility
|
IP
|
$1,900.00
|
|
| Hospital Charge Code |
8123675
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$518.70 |
| Max. Negotiated Rate |
$1,805.00 |
| Rate for Payer: Cash Price |
$1,140.00
|
| Rate for Payer: Cigna Commercial |
$1,615.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: First Health Workers Compensation |
$733.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,710.00
|
| Rate for Payer: GEHA Commercial |
$1,330.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,710.00
|
| Rate for Payer: Multiplan All |
$1,729.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,330.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,710.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,805.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,425.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,767.00
|
| Rate for Payer: Zelis Auto |
$760.00
|
| Rate for Payer: Zelis Worker's Compensation |
$518.70
|
|
|
CLSD RED FX FINGER JOIN
|
Facility
|
IP
|
$4,180.00
|
|
| Hospital Charge Code |
8126742
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,141.14 |
| Max. Negotiated Rate |
$3,971.00 |
| Rate for Payer: Cash Price |
$2,508.00
|
| Rate for Payer: Cigna Commercial |
$3,553.00
|
| Rate for Payer: First Health Commercial |
$3,762.00
|
| Rate for Payer: First Health Workers Compensation |
$1,613.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,762.00
|
| Rate for Payer: GEHA Commercial |
$2,926.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,762.00
|
| Rate for Payer: Multiplan All |
$3,803.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,926.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,762.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,971.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,135.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,887.40
|
| Rate for Payer: Zelis Auto |
$1,672.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,141.14
|
|
|
CLSD RED FX FINGER JOIN
|
Facility
|
OP
|
$4,180.00
|
|
| Hospital Charge Code |
8126742
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,045.00 |
| Max. Negotiated Rate |
$3,971.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,508.00
|
| Rate for Payer: Cash Price |
$2,508.00
|
| Rate for Payer: Cigna Commercial |
$3,553.00
|
| Rate for Payer: First Health Commercial |
$3,762.00
|
| Rate for Payer: First Health Workers Compensation |
$1,613.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,762.00
|
| Rate for Payer: GEHA Commercial |
$3,344.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,762.00
|
| Rate for Payer: Humana ChoiceCare |
$1,086.80
|
| Rate for Payer: Multiplan All |
$3,803.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,508.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,926.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,762.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,971.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,135.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,678.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,045.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,887.40
|
| Rate for Payer: Zelis Auto |
$1,672.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,090.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,141.14
|
|
|
CLSD RED FX PHALANX GREAT TO
|
Facility
|
OP
|
$974.00
|
|
| Hospital Charge Code |
8128495
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$243.50 |
| Max. Negotiated Rate |
$925.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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 |
$376.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$876.60
|
| Rate for Payer: GEHA Commercial |
$779.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$876.60
|
| Rate for Payer: Humana ChoiceCare |
$253.24
|
| Rate for Payer: Multiplan All |
$886.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$584.40
|
| Rate for Payer: OMNI Networks Commercial |
$681.80
|
| Rate for Payer: One Health Plan PPO/POS |
$876.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$925.30
|
| Rate for Payer: Three Rivers Provider Network All |
$730.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$857.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$243.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$905.82
|
| Rate for Payer: Zelis Auto |
$389.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$487.00
|
| Rate for Payer: Zelis Worker's Compensation |
$265.90
|
|
|
CLSD RED FX PHALANX GREAT TO
|
Facility
|
IP
|
$974.00
|
|
| Hospital Charge Code |
8128495
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$265.90 |
| Max. Negotiated Rate |
$925.30 |
| 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 |
$376.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$876.60
|
| Rate for Payer: GEHA Commercial |
$681.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$876.60
|
| Rate for Payer: Multiplan All |
$886.34
|
| Rate for Payer: OMNI Networks Commercial |
$681.80
|
| Rate for Payer: One Health Plan PPO/POS |
$876.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$925.30
|
| Rate for Payer: Three Rivers Provider Network All |
$730.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$905.82
|
| Rate for Payer: Zelis Auto |
$389.60
|
| Rate for Payer: Zelis Worker's Compensation |
$265.90
|
|
|
CLSD RED FX PHALANX OTHER TOE EAC
|
Facility
|
OP
|
$1,152.00
|
|
| Hospital Charge Code |
8128515
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: First Health Workers Compensation |
$444.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$921.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Humana ChoiceCare |
$299.52
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$691.20
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,013.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$288.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$576.00
|
| Rate for Payer: Zelis Worker's Compensation |
$314.50
|
|
|
CLSD RED FX PHALANX OTHER TOE EAC
|
Facility
|
IP
|
$1,152.00
|
|
| Hospital Charge Code |
8128515
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$314.50 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$979.20
|
| Rate for Payer: First Health Commercial |
$1,036.80
|
| Rate for Payer: First Health Workers Compensation |
$444.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,036.80
|
| Rate for Payer: GEHA Commercial |
$806.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,036.80
|
| Rate for Payer: Multiplan All |
$1,048.32
|
| Rate for Payer: OMNI Networks Commercial |
$806.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,036.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,094.40
|
| Rate for Payer: Three Rivers Provider Network All |
$864.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,071.36
|
| Rate for Payer: Zelis Auto |
$460.80
|
| Rate for Payer: Zelis Worker's Compensation |
$314.50
|
|
|
CLSD RED SHOULD DISLOC W/MANIP W/ANESTH
|
Facility
|
IP
|
$4,584.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
8123655
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,251.43 |
| Max. Negotiated Rate |
$4,354.80 |
| Rate for Payer: Cash Price |
$2,750.40
|
| Rate for Payer: Cigna Commercial |
$3,896.40
|
| Rate for Payer: First Health Commercial |
$4,125.60
|
| Rate for Payer: First Health Workers Compensation |
$1,769.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,125.60
|
| Rate for Payer: GEHA Commercial |
$3,208.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,125.60
|
| Rate for Payer: Multiplan All |
$4,171.44
|
| Rate for Payer: OMNI Networks Commercial |
$3,208.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,125.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,354.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3,438.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,263.12
|
| Rate for Payer: Zelis Auto |
$1,833.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,251.43
|
|
|
CLSD RED SHOULD DISLOC W/MANIP W/ANESTH
|
Facility
|
OP
|
$4,584.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
8123655
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,224.89 |
| Max. Negotiated Rate |
$4,354.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,750.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,224.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$2,750.40
|
| Rate for Payer: Cash Price |
$2,750.40
|
| Rate for Payer: Cigna Commercial |
$3,896.40
|
| Rate for Payer: First Health Commercial |
$4,125.60
|
| Rate for Payer: First Health Workers Compensation |
$1,769.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,125.60
|
| Rate for Payer: GEHA Commercial |
$3,667.20
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,125.60
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,249.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$4,171.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$3,208.80
|
| Rate for Payer: One Health Plan PPO/POS |
$4,125.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,443.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,249.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,354.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,438.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,249.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,263.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$1,833.60
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$1,251.43
|
|
|
CLSD TRTMNT OF HIP DSLCTN, TRAU / ANESTH
|
Facility
|
IP
|
$4,178.94
|
|
|
Service Code
|
CPT 27252
|
| Hospital Charge Code |
8127252
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,140.85 |
| Max. Negotiated Rate |
$3,969.99 |
| Rate for Payer: Cash Price |
$2,507.36
|
| Rate for Payer: Cigna Commercial |
$3,552.10
|
| Rate for Payer: First Health Commercial |
$3,761.05
|
| Rate for Payer: First Health Workers Compensation |
$1,613.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,761.05
|
| Rate for Payer: GEHA Commercial |
$2,925.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,761.05
|
| Rate for Payer: Multiplan All |
$3,802.84
|
| Rate for Payer: OMNI Networks Commercial |
$2,925.26
|
| Rate for Payer: One Health Plan PPO/POS |
$3,761.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,969.99
|
| Rate for Payer: Three Rivers Provider Network All |
$3,134.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,886.41
|
| Rate for Payer: Zelis Auto |
$1,671.58
|
| Rate for Payer: Zelis Worker's Compensation |
$1,140.85
|
|
|
CLSD TRTMNT OF HIP DSLCTN, TRAU / ANESTH
|
Facility
|
OP
|
$4,178.94
|
|
|
Service Code
|
CPT 27252
|
| Hospital Charge Code |
8127252
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,140.85 |
| Max. Negotiated Rate |
$3,969.99 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,507.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,224.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$2,507.36
|
| Rate for Payer: Cash Price |
$2,507.36
|
| Rate for Payer: Cigna Commercial |
$3,552.10
|
| Rate for Payer: First Health Commercial |
$3,761.05
|
| Rate for Payer: First Health Workers Compensation |
$1,613.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,761.05
|
| Rate for Payer: GEHA Commercial |
$3,343.15
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,761.05
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,249.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$3,802.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$2,925.26
|
| Rate for Payer: One Health Plan PPO/POS |
$3,761.05
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,443.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,249.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,969.99
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,134.20
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,249.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,886.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$1,671.58
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$1,140.85
|
|
|
CLSD TRTMNT OF ULNAR FX, PROX W/ MANIPUL
|
Facility
|
IP
|
$4,583.00
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
8124675
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,251.16 |
| Max. Negotiated Rate |
$4,353.85 |
| Rate for Payer: Cash Price |
$2,749.80
|
| Rate for Payer: Cigna Commercial |
$3,895.55
|
| Rate for Payer: First Health Commercial |
$4,124.70
|
| Rate for Payer: First Health Workers Compensation |
$1,769.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,124.70
|
| Rate for Payer: GEHA Commercial |
$3,208.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,124.70
|
| Rate for Payer: Multiplan All |
$4,170.53
|
| Rate for Payer: OMNI Networks Commercial |
$3,208.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,124.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,353.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,437.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,262.19
|
| Rate for Payer: Zelis Auto |
$1,833.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,251.16
|
|
|
CLSD TRTMNT OF ULNAR FX, PROX W/ MANIPUL
|
Facility
|
OP
|
$4,583.00
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
8124675
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.77 |
| Max. Negotiated Rate |
$4,353.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,749.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$167.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$132.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$2,749.80
|
| Rate for Payer: Cash Price |
$2,749.80
|
| Rate for Payer: Cigna Commercial |
$3,895.55
|
| Rate for Payer: First Health Commercial |
$4,124.70
|
| Rate for Payer: First Health Workers Compensation |
$1,769.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,124.70
|
| Rate for Payer: GEHA Commercial |
$3,666.40
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,124.70
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$135.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$4,170.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$3,208.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,124.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$156.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$135.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,353.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$3,437.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$135.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,262.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$1,833.20
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$1,251.16
|
|
|
CLSD TX CLAVICULAR FRACTURE W/MANIPULATI
|
Facility
|
OP
|
$839.00
|
|
|
Service Code
|
CPT 23505
|
| Hospital Charge Code |
6123505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$229.05 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,860.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$503.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,860.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,473.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Cigna Commercial |
$713.15
|
| Rate for Payer: First Health Commercial |
$755.10
|
| Rate for Payer: First Health Workers Compensation |
$323.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$755.10
|
| Rate for Payer: GEHA Commercial |
$671.20
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$755.10
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,503.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$763.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$587.30
|
| Rate for Payer: One Health Plan PPO/POS |
$755.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,736.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,503.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$797.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$629.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,503.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$780.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$335.60
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$229.05
|
|
|
CLSD TX CLAVICULAR FRACTURE W/MANIPULATI
|
Facility
|
IP
|
$839.00
|
|
|
Service Code
|
CPT 23505
|
| Hospital Charge Code |
6123505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$229.05 |
| Max. Negotiated Rate |
$797.05 |
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Cigna Commercial |
$713.15
|
| Rate for Payer: First Health Commercial |
$755.10
|
| Rate for Payer: First Health Workers Compensation |
$323.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$755.10
|
| Rate for Payer: GEHA Commercial |
$587.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$755.10
|
| Rate for Payer: Multiplan All |
$763.49
|
| Rate for Payer: OMNI Networks Commercial |
$587.30
|
| Rate for Payer: One Health Plan PPO/POS |
$755.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$797.05
|
| Rate for Payer: Three Rivers Provider Network All |
$629.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$780.27
|
| Rate for Payer: Zelis Auto |
$335.60
|
| Rate for Payer: Zelis Worker's Compensation |
$229.05
|
|
|
CLSD TX CLAVICULAR FRACTURE W/MANIPULATI
|
Facility
|
IP
|
$3,504.00
|
|
|
Service Code
|
CPT 23505
|
| Hospital Charge Code |
8123505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$956.59 |
| Max. Negotiated Rate |
$3,328.80 |
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cigna Commercial |
$2,978.40
|
| Rate for Payer: First Health Commercial |
$3,153.60
|
| Rate for Payer: First Health Workers Compensation |
$1,352.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,153.60
|
| Rate for Payer: GEHA Commercial |
$2,452.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,153.60
|
| Rate for Payer: Multiplan All |
$3,188.64
|
| Rate for Payer: OMNI Networks Commercial |
$2,452.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,153.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,328.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,628.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,258.72
|
| Rate for Payer: Zelis Auto |
$1,401.60
|
| Rate for Payer: Zelis Worker's Compensation |
$956.59
|
|
|
CLSD TX CLAVICULAR FRACTURE W/MANIPULATI
|
Facility
|
OP
|
$3,504.00
|
|
|
Service Code
|
CPT 23505
|
| Hospital Charge Code |
8123505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$956.59 |
| Max. Negotiated Rate |
$3,328.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,860.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,102.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,860.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,473.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cigna Commercial |
$2,978.40
|
| Rate for Payer: First Health Commercial |
$3,153.60
|
| Rate for Payer: First Health Workers Compensation |
$1,352.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,153.60
|
| Rate for Payer: GEHA Commercial |
$2,803.20
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,153.60
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,503.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$3,188.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$2,452.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,153.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,736.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,503.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,328.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,628.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,503.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,258.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$1,401.60
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$956.59
|
|
|
CLSD TX DIST HUMERUS FX; W/MANIPUL
|
Facility
|
OP
|
$3,111.00
|
|
| Hospital Charge Code |
8124535
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$777.75 |
| Max. Negotiated Rate |
$2,955.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,866.60
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$2,644.35
|
| Rate for Payer: First Health Commercial |
$2,799.90
|
| Rate for Payer: First Health Workers Compensation |
$1,201.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,799.90
|
| Rate for Payer: GEHA Commercial |
$2,488.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,799.90
|
| Rate for Payer: Humana ChoiceCare |
$808.86
|
| Rate for Payer: Multiplan All |
$2,831.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,866.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,177.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,799.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,955.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,333.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,737.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$777.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,893.23
|
| Rate for Payer: Zelis Auto |
$1,244.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,555.50
|
| Rate for Payer: Zelis Worker's Compensation |
$849.30
|
|
|
CLSD TX DIST HUMERUS FX; W/MANIPUL
|
Facility
|
IP
|
$3,111.00
|
|
| Hospital Charge Code |
8124535
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$849.30 |
| Max. Negotiated Rate |
$2,955.45 |
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$2,644.35
|
| Rate for Payer: First Health Commercial |
$2,799.90
|
| Rate for Payer: First Health Workers Compensation |
$1,201.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,799.90
|
| Rate for Payer: GEHA Commercial |
$2,177.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,799.90
|
| Rate for Payer: Multiplan All |
$2,831.01
|
| Rate for Payer: OMNI Networks Commercial |
$2,177.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,799.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,955.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,333.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,893.23
|
| Rate for Payer: Zelis Auto |
$1,244.40
|
| Rate for Payer: Zelis Worker's Compensation |
$849.30
|
|
|
CLSD TX FX ANKLE TRIMALLEOLA
|
Facility
|
IP
|
$1,441.00
|
|
| Hospital Charge Code |
8127816
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.39 |
| Max. Negotiated Rate |
$1,368.95 |
| Rate for Payer: Cash Price |
$864.60
|
| Rate for Payer: Cigna Commercial |
$1,224.85
|
| Rate for Payer: First Health Commercial |
$1,296.90
|
| Rate for Payer: First Health Workers Compensation |
$556.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,296.90
|
| Rate for Payer: GEHA Commercial |
$1,008.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,296.90
|
| Rate for Payer: Multiplan All |
$1,311.31
|
| Rate for Payer: OMNI Networks Commercial |
$1,008.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,296.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,368.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,080.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,340.13
|
| Rate for Payer: Zelis Auto |
$576.40
|
| Rate for Payer: Zelis Worker's Compensation |
$393.39
|
|
|
CLSD TX FX ANKLE TRIMALLEOLA
|
Facility
|
OP
|
$1,441.00
|
|
| Hospital Charge Code |
8127816
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$360.25 |
| Max. Negotiated Rate |
$1,368.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$864.60
|
| Rate for Payer: Cash Price |
$864.60
|
| Rate for Payer: Cigna Commercial |
$1,224.85
|
| Rate for Payer: First Health Commercial |
$1,296.90
|
| Rate for Payer: First Health Workers Compensation |
$556.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,296.90
|
| Rate for Payer: GEHA Commercial |
$1,152.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,296.90
|
| Rate for Payer: Humana ChoiceCare |
$374.66
|
| Rate for Payer: Multiplan All |
$1,311.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$864.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,008.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,296.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,368.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,080.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,268.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$360.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,340.13
|
| Rate for Payer: Zelis Auto |
$576.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$720.50
|
| Rate for Payer: Zelis Worker's Compensation |
$393.39
|
|
|
CLSD TX FX DISTAL RADIUS
|
Facility
|
IP
|
$1,939.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
8125605
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$529.35 |
| Max. Negotiated Rate |
$1,842.05 |
| Rate for Payer: Cash Price |
$1,163.40
|
| Rate for Payer: Cigna Commercial |
$1,648.15
|
| Rate for Payer: First Health Commercial |
$1,745.10
|
| Rate for Payer: First Health Workers Compensation |
$748.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,745.10
|
| Rate for Payer: GEHA Commercial |
$1,357.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,745.10
|
| Rate for Payer: Multiplan All |
$1,764.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,357.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,745.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,842.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,454.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,803.27
|
| Rate for Payer: Zelis Auto |
$775.60
|
| Rate for Payer: Zelis Worker's Compensation |
$529.35
|
|
|
CLSD TX FX DISTAL RADIUS
|
Facility
|
OP
|
$1,939.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
8125605
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$384.03 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$484.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,163.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$484.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$384.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$1,163.40
|
| Rate for Payer: Cash Price |
$1,163.40
|
| Rate for Payer: Cigna Commercial |
$1,648.15
|
| Rate for Payer: First Health Commercial |
$1,745.10
|
| Rate for Payer: First Health Workers Compensation |
$748.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,745.10
|
| Rate for Payer: GEHA Commercial |
$1,551.20
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,745.10
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$391.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$1,764.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$1,357.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,745.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$452.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$391.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,842.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,454.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$391.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,803.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$775.60
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$529.35
|
|
