|
ANKLE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,385.00
|
|
|
Service Code
|
CPT 29891
|
| Hospital Charge Code |
6129891
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$378.11 |
| Max. Negotiated Rate |
$1,315.75 |
| Rate for Payer: Cash Price |
$831.00
|
| Rate for Payer: Cigna Commercial |
$1,177.25
|
| Rate for Payer: First Health Commercial |
$1,246.50
|
| Rate for Payer: First Health Workers Compensation |
$534.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,246.50
|
| Rate for Payer: GEHA Commercial |
$969.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,246.50
|
| Rate for Payer: Multiplan All |
$1,260.35
|
| Rate for Payer: OMNI Networks Commercial |
$969.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,246.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,315.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,038.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,288.05
|
| Rate for Payer: Zelis Auto |
$554.00
|
| Rate for Payer: Zelis Worker's Compensation |
$378.11
|
|
|
ANKLE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$2,134.00
|
|
|
Service Code
|
CPT 29899
|
| Hospital Charge Code |
6129899
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$582.58 |
| Max. Negotiated Rate |
$2,027.30 |
| Rate for Payer: Cash Price |
$1,280.40
|
| Rate for Payer: Cigna Commercial |
$1,813.90
|
| Rate for Payer: First Health Commercial |
$1,920.60
|
| Rate for Payer: First Health Workers Compensation |
$823.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,920.60
|
| Rate for Payer: GEHA Commercial |
$1,493.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,920.60
|
| Rate for Payer: Multiplan All |
$1,941.94
|
| Rate for Payer: OMNI Networks Commercial |
$1,493.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,920.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,027.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,600.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,984.62
|
| Rate for Payer: Zelis Auto |
$853.60
|
| Rate for Payer: Zelis Worker's Compensation |
$582.58
|
|
|
ANKLE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$2,134.00
|
|
|
Service Code
|
CPT 29899
|
| Hospital Charge Code |
6129899
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$582.58 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,280.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,935.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,910.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,280.40
|
| Rate for Payer: Cash Price |
$1,280.40
|
| Rate for Payer: Cigna Commercial |
$1,813.90
|
| Rate for Payer: First Health Commercial |
$1,920.60
|
| Rate for Payer: First Health Workers Compensation |
$823.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,920.60
|
| Rate for Payer: GEHA Commercial |
$1,707.20
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,920.60
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,989.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,941.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,493.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,920.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,606.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,989.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,027.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,600.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,989.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,984.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$853.60
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$582.58
|
|
|
ANKLE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$977.00
|
|
|
Service Code
|
CPT 29895
|
| Hospital Charge Code |
6129895
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$266.72 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$586.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Cigna Commercial |
$830.45
|
| Rate for Payer: First Health Commercial |
$879.30
|
| Rate for Payer: First Health Workers Compensation |
$377.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$879.30
|
| Rate for Payer: GEHA Commercial |
$781.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$879.30
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$889.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$683.90
|
| Rate for Payer: One Health Plan PPO/POS |
$879.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$928.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$732.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$908.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$390.80
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$266.72
|
|
|
ANKLE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$977.00
|
|
|
Service Code
|
CPT 29895
|
| Hospital Charge Code |
6129895
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$266.72 |
| Max. Negotiated Rate |
$928.15 |
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Cigna Commercial |
$830.45
|
| Rate for Payer: First Health Commercial |
$879.30
|
| Rate for Payer: First Health Workers Compensation |
$377.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$879.30
|
| Rate for Payer: GEHA Commercial |
$683.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$879.30
|
| Rate for Payer: Multiplan All |
$889.07
|
| Rate for Payer: OMNI Networks Commercial |
$683.90
|
| Rate for Payer: One Health Plan PPO/POS |
$879.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$928.15
|
| Rate for Payer: Three Rivers Provider Network All |
$732.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$908.61
|
| Rate for Payer: Zelis Auto |
$390.80
|
| Rate for Payer: Zelis Worker's Compensation |
$266.72
|
|
|
ANKLE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,160.00
|
|
|
Service Code
|
CPT 29898
|
| Hospital Charge Code |
6129898
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$316.68 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$696.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$986.00
|
| Rate for Payer: First Health Commercial |
$1,044.00
|
| Rate for Payer: First Health Workers Compensation |
$447.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.00
|
| Rate for Payer: GEHA Commercial |
$928.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.00
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,055.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$812.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,102.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$870.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,078.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$464.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$316.68
|
|
|
ANKLE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT 29897
|
| Hospital Charge Code |
6129897
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$283.37 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$622.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: First Health Workers Compensation |
$400.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$830.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$415.20
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$283.37
|
|
|
ANKLE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,160.00
|
|
|
Service Code
|
CPT 29898
|
| Hospital Charge Code |
6129898
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$316.68 |
| Max. Negotiated Rate |
$1,102.00 |
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$986.00
|
| Rate for Payer: First Health Commercial |
$1,044.00
|
| Rate for Payer: First Health Workers Compensation |
$447.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.00
|
| Rate for Payer: GEHA Commercial |
$812.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.00
|
| Rate for Payer: Multiplan All |
$1,055.60
|
| Rate for Payer: OMNI Networks Commercial |
$812.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,102.00
|
| Rate for Payer: Three Rivers Provider Network All |
$870.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,078.80
|
| Rate for Payer: Zelis Auto |
$464.00
|
| Rate for Payer: Zelis Worker's Compensation |
$316.68
|
|
|
ANKLE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,027.00
|
|
|
Service Code
|
CPT 29894
|
| Hospital Charge Code |
6129894
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$280.37 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$616.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$616.20
|
| Rate for Payer: Cash Price |
$616.20
|
| Rate for Payer: Cigna Commercial |
$872.95
|
| Rate for Payer: First Health Commercial |
$924.30
|
| Rate for Payer: First Health Workers Compensation |
$396.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$924.30
|
| Rate for Payer: GEHA Commercial |
$821.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$924.30
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$934.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$718.90
|
| Rate for Payer: One Health Plan PPO/POS |
$924.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$975.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$770.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$955.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$410.80
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$280.37
|
|
|
ANKLE NEOPRENE SLEEVE
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT L1906
|
| Hospital Charge Code |
8230053
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.98 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$203.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$133.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$203.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$161.00
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cigna Commercial |
$189.55
|
| Rate for Payer: First Health Commercial |
$200.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$200.70
|
| Rate for Payer: GEHA Commercial |
$178.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$200.70
|
| Rate for Payer: Humana ChoiceCare |
$57.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$164.28
|
| Rate for Payer: Multiplan All |
$202.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$133.80
|
| Rate for Payer: OMNI Networks Commercial |
$156.10
|
| Rate for Payer: One Health Plan PPO/POS |
$200.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$189.69
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$164.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$211.85
|
| Rate for Payer: Three Rivers Provider Network All |
$167.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$196.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$164.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$207.39
|
| Rate for Payer: Zelis Auto |
$89.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$111.50
|
|
|
ANKLE NEOPRENE SLEEVE
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT L1906
|
| Hospital Charge Code |
8800009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.20 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cigna Commercial |
$189.55
|
| Rate for Payer: First Health Commercial |
$200.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$200.70
|
| Rate for Payer: GEHA Commercial |
$156.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$200.70
|
| Rate for Payer: Multiplan All |
$202.93
|
| Rate for Payer: OMNI Networks Commercial |
$156.10
|
| Rate for Payer: One Health Plan PPO/POS |
$200.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$211.85
|
| Rate for Payer: Three Rivers Provider Network All |
$167.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$207.39
|
| Rate for Payer: Zelis Auto |
$89.20
|
|
|
ANKLE NEOPRENE SLEEVE
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT L1906
|
| Hospital Charge Code |
8800009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.98 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$203.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$133.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$203.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$161.00
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cigna Commercial |
$189.55
|
| Rate for Payer: First Health Commercial |
$200.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$200.70
|
| Rate for Payer: GEHA Commercial |
$178.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$200.70
|
| Rate for Payer: Humana ChoiceCare |
$57.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$164.28
|
| Rate for Payer: Multiplan All |
$202.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$133.80
|
| Rate for Payer: OMNI Networks Commercial |
$156.10
|
| Rate for Payer: One Health Plan PPO/POS |
$200.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$189.69
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$164.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$211.85
|
| Rate for Payer: Three Rivers Provider Network All |
$167.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$196.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$164.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$207.39
|
| Rate for Payer: Zelis Auto |
$89.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$111.50
|
|
|
ANKLE NEOPRENE SLEEVE
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT L1906
|
| Hospital Charge Code |
8230053
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.20 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cigna Commercial |
$189.55
|
| Rate for Payer: First Health Commercial |
$200.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$200.70
|
| Rate for Payer: GEHA Commercial |
$156.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$200.70
|
| Rate for Payer: Multiplan All |
$202.93
|
| Rate for Payer: OMNI Networks Commercial |
$156.10
|
| Rate for Payer: One Health Plan PPO/POS |
$200.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$211.85
|
| Rate for Payer: Three Rivers Provider Network All |
$167.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$207.39
|
| Rate for Payer: Zelis Auto |
$89.20
|
|
|
ANKLE W/SPEEDLACE
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT L1902
|
| Hospital Charge Code |
8230052
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$51.48 |
| Max. Negotiated Rate |
$263.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$263.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$118.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$263.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$208.72
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$158.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| Rate for Payer: Humana ChoiceCare |
$51.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$212.98
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$118.80
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$245.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$212.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$174.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$212.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: Zelis Auto |
$79.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$99.00
|
|
|
ANKLE W/SPEEDLACE
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT L1902
|
| Hospital Charge Code |
8800008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$51.48 |
| Max. Negotiated Rate |
$263.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$263.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$118.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$263.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$208.72
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$158.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| Rate for Payer: Humana ChoiceCare |
$51.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$212.98
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$118.80
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$245.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$212.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$174.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$212.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: Zelis Auto |
$79.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$99.00
|
|
|
ANKLE W/SPEEDLACE
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT L1902
|
| Hospital Charge Code |
8230052
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$138.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: Zelis Auto |
$79.20
|
|
|
ANKLE W/SPEEDLACE
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT L1902
|
| Hospital Charge Code |
8800008
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$138.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: Zelis Auto |
$79.20
|
|
|
ANL SP INF PMP W/MDREPRG&FIL
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 62370
|
| Hospital Charge Code |
6162370
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$39.86 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$124.10
|
| Rate for Payer: First Health Commercial |
$131.40
|
| Rate for Payer: First Health Workers Compensation |
$56.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$131.40
|
| Rate for Payer: GEHA Commercial |
$102.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$131.40
|
| Rate for Payer: Multiplan All |
$132.86
|
| Rate for Payer: OMNI Networks Commercial |
$102.20
|
| Rate for Payer: One Health Plan PPO/POS |
$131.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$138.70
|
| Rate for Payer: Three Rivers Provider Network All |
$109.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$135.78
|
| Rate for Payer: Zelis Auto |
$58.40
|
| Rate for Payer: Zelis Worker's Compensation |
$39.86
|
|
|
ANL SP INF PMP W/MDREPRG&FIL
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 62370
|
| Hospital Charge Code |
6162370
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$39.86 |
| Max. Negotiated Rate |
$569.56 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$241.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$87.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$241.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$191.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$284.78
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$124.10
|
| Rate for Payer: First Health Commercial |
$131.40
|
| Rate for Payer: First Health Workers Compensation |
$56.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$131.40
|
| Rate for Payer: GEHA Commercial |
$116.80
|
| Rate for Payer: GEHA Medicare |
$284.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$131.40
|
| Rate for Payer: Humana ChoiceCare |
$313.26
|
| Rate for Payer: Humana Medicare Advantage |
$284.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$478.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$195.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$284.78
|
| Rate for Payer: Multiplan All |
$132.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$484.13
|
| Rate for Payer: OMNI Networks Commercial |
$102.20
|
| Rate for Payer: One Health Plan PPO/POS |
$131.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$225.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$195.37
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$284.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$138.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$569.56
|
| Rate for Payer: Three Rivers Provider Network All |
$109.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$279.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$195.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$284.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$135.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$284.78
|
| Rate for Payer: Zelis Auto |
$58.40
|
| Rate for Payer: Zelis Medicare |
$242.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$341.74
|
| Rate for Payer: Zelis Worker's Compensation |
$39.86
|
|
|
ANNUAL ALCOHOL SCREEN 15 MIN
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT G0442
|
| Hospital Charge Code |
9199537
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$63.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$49.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$63.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$50.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$28.29
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$74.70
|
| Rate for Payer: First Health Workers Compensation |
$32.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$74.70
|
| Rate for Payer: GEHA Commercial |
$66.40
|
| Rate for Payer: GEHA Medicare |
$28.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$74.70
|
| Rate for Payer: Humana ChoiceCare |
$31.12
|
| Rate for Payer: Humana Medicare Advantage |
$28.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$47.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$51.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$28.29
|
| Rate for Payer: Multiplan All |
$75.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.09
|
| Rate for Payer: OMNI Networks Commercial |
$58.10
|
| Rate for Payer: One Health Plan PPO/POS |
$74.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$59.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$51.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$28.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$78.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$56.58
|
| Rate for Payer: Three Rivers Provider Network All |
$62.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$51.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$77.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$28.29
|
| Rate for Payer: Zelis Auto |
$33.20
|
| Rate for Payer: Zelis Medicare |
$24.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.95
|
| Rate for Payer: Zelis Worker's Compensation |
$22.66
|
|
|
ANNUAL ALCOHOL SCREEN 15 MIN
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT G0442
|
| Hospital Charge Code |
9199537
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$74.70
|
| Rate for Payer: First Health Workers Compensation |
$32.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$74.70
|
| Rate for Payer: GEHA Commercial |
$58.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$74.70
|
| Rate for Payer: Multiplan All |
$75.53
|
| Rate for Payer: OMNI Networks Commercial |
$58.10
|
| Rate for Payer: One Health Plan PPO/POS |
$74.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$78.85
|
| Rate for Payer: Three Rivers Provider Network All |
$62.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$77.19
|
| Rate for Payer: Zelis Auto |
$33.20
|
| Rate for Payer: Zelis Worker's Compensation |
$22.66
|
|
|
ANNUAL SPORTS PHYSICAL
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
8500440
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: First Health Commercial |
$22.50
|
| Rate for Payer: First Health Workers Compensation |
$9.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$22.50
|
| Rate for Payer: GEHA Commercial |
$20.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$22.50
|
| Rate for Payer: Humana ChoiceCare |
$6.50
|
| Rate for Payer: Multiplan All |
$22.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.00
|
| Rate for Payer: OMNI Networks Commercial |
$17.50
|
| Rate for Payer: One Health Plan PPO/POS |
$22.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$23.75
|
| Rate for Payer: Three Rivers Provider Network All |
$18.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$22.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$23.25
|
| Rate for Payer: Zelis Auto |
$10.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.50
|
| Rate for Payer: Zelis Worker's Compensation |
$6.83
|
|
|
ANNUAL SPORTS PHYSICAL
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
25500013
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: First Health Commercial |
$22.50
|
| Rate for Payer: First Health Workers Compensation |
$9.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$22.50
|
| Rate for Payer: GEHA Commercial |
$20.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$22.50
|
| Rate for Payer: Humana ChoiceCare |
$6.50
|
| Rate for Payer: Multiplan All |
$22.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.00
|
| Rate for Payer: OMNI Networks Commercial |
$17.50
|
| Rate for Payer: One Health Plan PPO/POS |
$22.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$23.75
|
| Rate for Payer: Three Rivers Provider Network All |
$18.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$22.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$23.25
|
| Rate for Payer: Zelis Auto |
$10.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.50
|
| Rate for Payer: Zelis Worker's Compensation |
$6.83
|
|
|
ANNUAL SPORTS PHYSICAL
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
930213
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: First Health Commercial |
$22.50
|
| Rate for Payer: First Health Workers Compensation |
$9.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$22.50
|
| Rate for Payer: GEHA Commercial |
$17.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$22.50
|
| Rate for Payer: Multiplan All |
$22.75
|
| Rate for Payer: OMNI Networks Commercial |
$17.50
|
| Rate for Payer: One Health Plan PPO/POS |
$22.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$23.75
|
| Rate for Payer: Three Rivers Provider Network All |
$18.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$23.25
|
| Rate for Payer: Zelis Auto |
$10.00
|
| Rate for Payer: Zelis Worker's Compensation |
$6.83
|
|
|
ANNUAL SPORTS PHYSICAL
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
21600013
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$21.25
|
| Rate for Payer: First Health Commercial |
$22.50
|
| Rate for Payer: First Health Workers Compensation |
$9.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$22.50
|
| Rate for Payer: GEHA Commercial |
$20.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$22.50
|
| Rate for Payer: Humana ChoiceCare |
$6.50
|
| Rate for Payer: Multiplan All |
$22.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.00
|
| Rate for Payer: OMNI Networks Commercial |
$17.50
|
| Rate for Payer: One Health Plan PPO/POS |
$22.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$23.75
|
| Rate for Payer: Three Rivers Provider Network All |
$18.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$22.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$23.25
|
| Rate for Payer: Zelis Auto |
$10.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.50
|
| Rate for Payer: Zelis Worker's Compensation |
$6.83
|
|
