|
INS BIOMECH DVC TO INTERVERTEBRAL DISC S
|
Facility
|
OP
|
$1,523.00
|
|
|
Service Code
|
CPT 22859
|
| Hospital Charge Code |
6191086
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$380.75 |
| Max. Negotiated Rate |
$1,446.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$913.80
|
| Rate for Payer: Cash Price |
$913.80
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: First Health Commercial |
$1,370.70
|
| Rate for Payer: First Health Workers Compensation |
$588.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,370.70
|
| Rate for Payer: GEHA Commercial |
$1,218.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,370.70
|
| Rate for Payer: Humana ChoiceCare |
$395.98
|
| Rate for Payer: Multiplan All |
$1,385.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$913.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,066.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,370.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,446.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,142.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,340.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$380.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,416.39
|
| Rate for Payer: Zelis Auto |
$609.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$761.50
|
| Rate for Payer: Zelis Worker's Compensation |
$415.78
|
|
|
INS BIOMECH DVC TO INTERVERTEBRAL DISC S
|
Facility
|
OP
|
$1,523.00
|
|
|
Service Code
|
CPT 22853
|
| Hospital Charge Code |
6191084
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$380.75 |
| Max. Negotiated Rate |
$1,446.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$913.80
|
| Rate for Payer: Cash Price |
$913.80
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: First Health Commercial |
$1,370.70
|
| Rate for Payer: First Health Workers Compensation |
$588.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,370.70
|
| Rate for Payer: GEHA Commercial |
$1,218.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,370.70
|
| Rate for Payer: Humana ChoiceCare |
$395.98
|
| Rate for Payer: Multiplan All |
$1,385.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$913.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,066.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,370.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,446.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,142.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,340.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$380.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,416.39
|
| Rate for Payer: Zelis Auto |
$609.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$761.50
|
| Rate for Payer: Zelis Worker's Compensation |
$415.78
|
|
|
INS BIOMECH DVC TO INTERVERTEBRAL DISC S
|
Facility
|
IP
|
$1,523.00
|
|
|
Service Code
|
CPT 22859
|
| Hospital Charge Code |
6191086
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$415.78 |
| Max. Negotiated Rate |
$1,446.85 |
| Rate for Payer: Cash Price |
$913.80
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: First Health Commercial |
$1,370.70
|
| Rate for Payer: First Health Workers Compensation |
$588.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,370.70
|
| Rate for Payer: GEHA Commercial |
$1,066.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,370.70
|
| Rate for Payer: Multiplan All |
$1,385.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,066.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,370.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,446.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,142.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,416.39
|
| Rate for Payer: Zelis Auto |
$609.20
|
| Rate for Payer: Zelis Worker's Compensation |
$415.78
|
|
|
INS BIOMECH DVC TO VERTEBRAL CORPECTOMY
|
Facility
|
IP
|
$1,523.00
|
|
|
Service Code
|
CPT 22854
|
| Hospital Charge Code |
6191085
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$415.78 |
| Max. Negotiated Rate |
$1,446.85 |
| Rate for Payer: Cash Price |
$913.80
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: First Health Commercial |
$1,370.70
|
| Rate for Payer: First Health Workers Compensation |
$588.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,370.70
|
| Rate for Payer: GEHA Commercial |
$1,066.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,370.70
|
| Rate for Payer: Multiplan All |
$1,385.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,066.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,370.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,446.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,142.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,416.39
|
| Rate for Payer: Zelis Auto |
$609.20
|
| Rate for Payer: Zelis Worker's Compensation |
$415.78
|
|
|
INS BIOMECH DVC TO VERTEBRAL CORPECTOMY
|
Facility
|
OP
|
$1,523.00
|
|
|
Service Code
|
CPT 22854
|
| Hospital Charge Code |
6191085
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$380.75 |
| Max. Negotiated Rate |
$1,446.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$913.80
|
| Rate for Payer: Cash Price |
$913.80
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: First Health Commercial |
$1,370.70
|
| Rate for Payer: First Health Workers Compensation |
$588.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,370.70
|
| Rate for Payer: GEHA Commercial |
$1,218.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,370.70
|
| Rate for Payer: Humana ChoiceCare |
$395.98
|
| Rate for Payer: Multiplan All |
$1,385.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$913.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,066.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,370.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,446.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,142.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,340.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$380.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,416.39
|
| Rate for Payer: Zelis Auto |
$609.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$761.50
|
| Rate for Payer: Zelis Worker's Compensation |
$415.78
|
|
|
INS CATH REN ART 1ST BILAT
|
Facility
|
IP
|
$1,171.00
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
6136252
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$319.68 |
| Max. Negotiated Rate |
$1,112.45 |
| Rate for Payer: Cash Price |
$702.60
|
| Rate for Payer: Cigna Commercial |
$995.35
|
| Rate for Payer: First Health Commercial |
$1,053.90
|
| Rate for Payer: First Health Workers Compensation |
$452.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,053.90
|
| Rate for Payer: GEHA Commercial |
$819.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,053.90
|
| Rate for Payer: Multiplan All |
$1,065.61
|
| Rate for Payer: OMNI Networks Commercial |
$819.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,053.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,112.45
|
| Rate for Payer: Three Rivers Provider Network All |
$878.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,089.03
|
| Rate for Payer: Zelis Auto |
$468.40
|
| Rate for Payer: Zelis Worker's Compensation |
$319.68
|
|
|
INS CATH REN ART 1ST BILAT
|
Facility
|
OP
|
$1,171.00
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
6136252
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$319.68 |
| Max. Negotiated Rate |
$5,977.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,013.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$702.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,013.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,387.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$702.60
|
| Rate for Payer: Cash Price |
$702.60
|
| Rate for Payer: Cigna Commercial |
$995.35
|
| Rate for Payer: First Health Commercial |
$1,053.90
|
| Rate for Payer: First Health Workers Compensation |
$452.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,053.90
|
| Rate for Payer: GEHA Commercial |
$936.80
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,053.90
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,435.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$1,065.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$819.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,053.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,812.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,435.73
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,112.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$878.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,435.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,089.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$468.40
|
| Rate for Payer: Zelis Medicare |
$2,540.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,586.42
|
| Rate for Payer: Zelis Worker's Compensation |
$319.68
|
|
|
INS CATH REN ART 1ST UNILAT
|
Facility
|
IP
|
$839.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
6136251
|
|
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
|
|
|
INS CATH REN ART 1ST UNILAT
|
Facility
|
OP
|
$839.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
6136251
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$229.05 |
| Max. Negotiated Rate |
$5,977.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,013.28
|
| 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 |
$3,013.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,387.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| 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 |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$755.10
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,435.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$763.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| 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 |
$2,812.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,435.73
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$797.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$629.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,435.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$780.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$335.60
|
| Rate for Payer: Zelis Medicare |
$2,540.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,586.42
|
| Rate for Payer: Zelis Worker's Compensation |
$229.05
|
|
|
INS CATH REN ART 2ND+ BILAT
|
Facility
|
IP
|
$1,354.00
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
6136254
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$369.64 |
| Max. Negotiated Rate |
$1,286.30 |
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cigna Commercial |
$1,150.90
|
| Rate for Payer: First Health Commercial |
$1,218.60
|
| Rate for Payer: First Health Workers Compensation |
$522.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,218.60
|
| Rate for Payer: GEHA Commercial |
$947.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,218.60
|
| Rate for Payer: Multiplan All |
$1,232.14
|
| Rate for Payer: OMNI Networks Commercial |
$947.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,218.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,286.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,015.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,259.22
|
| Rate for Payer: Zelis Auto |
$541.60
|
| Rate for Payer: Zelis Worker's Compensation |
$369.64
|
|
|
INS CATH REN ART 2ND+ BILAT
|
Facility
|
OP
|
$1,354.00
|
|
|
Service Code
|
CPT 36254
|
| Hospital Charge Code |
6136254
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$369.64 |
| Max. Negotiated Rate |
$5,977.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,013.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$812.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,013.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,387.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cigna Commercial |
$1,150.90
|
| Rate for Payer: First Health Commercial |
$1,218.60
|
| Rate for Payer: First Health Workers Compensation |
$522.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,218.60
|
| Rate for Payer: GEHA Commercial |
$1,083.20
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,218.60
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,435.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$1,232.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$947.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,218.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,812.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,435.73
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,286.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$1,015.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,435.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,259.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$541.60
|
| Rate for Payer: Zelis Medicare |
$2,540.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,586.42
|
| Rate for Payer: Zelis Worker's Compensation |
$369.64
|
|
|
INS CATH REN ART 2ND+ UNILAT
|
Facility
|
OP
|
$1,140.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
6136253
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$311.22 |
| Max. Negotiated Rate |
$10,265.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,013.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$684.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,013.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,387.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,132.93
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cigna Commercial |
$969.00
|
| Rate for Payer: First Health Commercial |
$1,026.00
|
| Rate for Payer: First Health Workers Compensation |
$440.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,026.00
|
| Rate for Payer: GEHA Commercial |
$912.00
|
| Rate for Payer: GEHA Medicare |
$5,132.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,026.00
|
| Rate for Payer: Humana ChoiceCare |
$5,646.22
|
| Rate for Payer: Humana Medicare Advantage |
$5,132.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,623.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,435.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,132.93
|
| Rate for Payer: Multiplan All |
$1,037.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,725.98
|
| Rate for Payer: OMNI Networks Commercial |
$798.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,026.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,812.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,435.73
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,132.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,083.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10,265.86
|
| Rate for Payer: Three Rivers Provider Network All |
$855.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,030.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,435.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,132.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,060.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,132.93
|
| Rate for Payer: Zelis Auto |
$456.00
|
| Rate for Payer: Zelis Medicare |
$4,362.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,159.52
|
| Rate for Payer: Zelis Worker's Compensation |
$311.22
|
|
|
INS CATH REN ART 2ND+ UNILAT
|
Facility
|
IP
|
$1,140.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
6136253
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$311.22 |
| Max. Negotiated Rate |
$1,083.00 |
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cigna Commercial |
$969.00
|
| Rate for Payer: First Health Commercial |
$1,026.00
|
| Rate for Payer: First Health Workers Compensation |
$440.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,026.00
|
| Rate for Payer: GEHA Commercial |
$798.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,026.00
|
| Rate for Payer: Multiplan All |
$1,037.40
|
| Rate for Payer: OMNI Networks Commercial |
$798.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,026.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,083.00
|
| Rate for Payer: Three Rivers Provider Network All |
$855.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,060.20
|
| Rate for Payer: Zelis Auto |
$456.00
|
| Rate for Payer: Zelis Worker's Compensation |
$311.22
|
|
|
INS DEVICE FOR RT GUIDE OPEN
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 49412
|
| Hospital Charge Code |
6149412
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$72.34 |
| Max. Negotiated Rate |
$251.75 |
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$225.25
|
| Rate for Payer: First Health Commercial |
$238.50
|
| Rate for Payer: First Health Workers Compensation |
$102.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$238.50
|
| Rate for Payer: GEHA Commercial |
$185.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$238.50
|
| Rate for Payer: Multiplan All |
$241.15
|
| Rate for Payer: OMNI Networks Commercial |
$185.50
|
| Rate for Payer: One Health Plan PPO/POS |
$238.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$251.75
|
| Rate for Payer: Three Rivers Provider Network All |
$198.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$246.45
|
| Rate for Payer: Zelis Auto |
$106.00
|
| Rate for Payer: Zelis Worker's Compensation |
$72.34
|
|
|
INS DEVICE FOR RT GUIDE OPEN
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT 49412
|
| Hospital Charge Code |
6149412
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$66.25 |
| Max. Negotiated Rate |
$251.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$159.00
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$225.25
|
| Rate for Payer: First Health Commercial |
$238.50
|
| Rate for Payer: First Health Workers Compensation |
$102.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$238.50
|
| Rate for Payer: GEHA Commercial |
$212.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$238.50
|
| Rate for Payer: Humana ChoiceCare |
$68.90
|
| Rate for Payer: Multiplan All |
$241.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$159.00
|
| Rate for Payer: OMNI Networks Commercial |
$185.50
|
| Rate for Payer: One Health Plan PPO/POS |
$238.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$251.75
|
| Rate for Payer: Three Rivers Provider Network All |
$198.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$233.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$66.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$246.45
|
| Rate for Payer: Zelis Auto |
$106.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$132.50
|
| Rate for Payer: Zelis Worker's Compensation |
$72.34
|
|
|
INS ENDOVAS VENA CAVA FILTR
|
Facility
|
OP
|
$716.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
6137191
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$195.47 |
| Max. Negotiated Rate |
$10,265.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,467.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$429.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,467.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,538.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,132.93
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cigna Commercial |
$608.60
|
| Rate for Payer: First Health Commercial |
$644.40
|
| Rate for Payer: First Health Workers Compensation |
$276.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$644.40
|
| Rate for Payer: GEHA Commercial |
$572.80
|
| Rate for Payer: GEHA Medicare |
$5,132.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$644.40
|
| Rate for Payer: Humana ChoiceCare |
$5,646.22
|
| Rate for Payer: Humana Medicare Advantage |
$5,132.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,623.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,610.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,132.93
|
| Rate for Payer: Multiplan All |
$651.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,725.98
|
| Rate for Payer: OMNI Networks Commercial |
$501.20
|
| Rate for Payer: One Health Plan PPO/POS |
$644.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,169.23
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,610.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,132.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$680.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10,265.86
|
| Rate for Payer: Three Rivers Provider Network All |
$537.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,030.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,610.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,132.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$665.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,132.93
|
| Rate for Payer: Zelis Auto |
$286.40
|
| Rate for Payer: Zelis Medicare |
$4,362.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,159.52
|
| Rate for Payer: Zelis Worker's Compensation |
$195.47
|
|
|
INS ENDOVAS VENA CAVA FILTR
|
Facility
|
IP
|
$716.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
6137191
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$195.47 |
| Max. Negotiated Rate |
$680.20 |
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cigna Commercial |
$608.60
|
| Rate for Payer: First Health Commercial |
$644.40
|
| Rate for Payer: First Health Workers Compensation |
$276.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$644.40
|
| Rate for Payer: GEHA Commercial |
$501.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$644.40
|
| Rate for Payer: Multiplan All |
$651.56
|
| Rate for Payer: OMNI Networks Commercial |
$501.20
|
| Rate for Payer: One Health Plan PPO/POS |
$644.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$680.20
|
| Rate for Payer: Three Rivers Provider Network All |
$537.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$665.88
|
| Rate for Payer: Zelis Auto |
$286.40
|
| Rate for Payer: Zelis Worker's Compensation |
$195.47
|
|
|
INSERT ABDOMEN-VENOUS DRAIN
|
Facility
|
OP
|
$1,534.00
|
|
|
Service Code
|
CPT 49425
|
| Hospital Charge Code |
6149425
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$383.50 |
| Max. Negotiated Rate |
$1,457.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$920.40
|
| Rate for Payer: Cash Price |
$920.40
|
| Rate for Payer: Cigna Commercial |
$1,303.90
|
| Rate for Payer: First Health Commercial |
$1,380.60
|
| Rate for Payer: First Health Workers Compensation |
$592.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,380.60
|
| Rate for Payer: GEHA Commercial |
$1,227.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,380.60
|
| Rate for Payer: Humana ChoiceCare |
$398.84
|
| Rate for Payer: Multiplan All |
$1,395.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$920.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,073.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,380.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,457.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,150.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,349.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$383.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,426.62
|
| Rate for Payer: Zelis Auto |
$613.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$767.00
|
| Rate for Payer: Zelis Worker's Compensation |
$418.78
|
|
|
INSERT ABDOMEN-VENOUS DRAIN
|
Facility
|
IP
|
$1,534.00
|
|
|
Service Code
|
CPT 49425
|
| Hospital Charge Code |
6149425
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$418.78 |
| Max. Negotiated Rate |
$1,457.30 |
| Rate for Payer: Cash Price |
$920.40
|
| Rate for Payer: Cigna Commercial |
$1,303.90
|
| Rate for Payer: First Health Commercial |
$1,380.60
|
| Rate for Payer: First Health Workers Compensation |
$592.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,380.60
|
| Rate for Payer: GEHA Commercial |
$1,073.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,380.60
|
| Rate for Payer: Multiplan All |
$1,395.94
|
| Rate for Payer: OMNI Networks Commercial |
$1,073.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,380.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,457.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,150.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,426.62
|
| Rate for Payer: Zelis Auto |
$613.60
|
| Rate for Payer: Zelis Worker's Compensation |
$418.78
|
|
|
INSERT AND REMOVE BONE PIN
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 20650
|
| Hospital Charge Code |
6120650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$130.77 |
| Max. Negotiated Rate |
$455.05 |
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cigna Commercial |
$407.15
|
| Rate for Payer: First Health Commercial |
$431.10
|
| Rate for Payer: First Health Workers Compensation |
$184.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$431.10
|
| Rate for Payer: GEHA Commercial |
$335.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$431.10
|
| Rate for Payer: Multiplan All |
$435.89
|
| Rate for Payer: OMNI Networks Commercial |
$335.30
|
| Rate for Payer: One Health Plan PPO/POS |
$431.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$455.05
|
| Rate for Payer: Three Rivers Provider Network All |
$359.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$445.47
|
| Rate for Payer: Zelis Auto |
$191.60
|
| Rate for Payer: Zelis Worker's Compensation |
$130.77
|
|
|
INSERT AND REMOVE BONE PIN
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 20650
|
| Hospital Charge Code |
6120650
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$130.77 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$287.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cigna Commercial |
$407.15
|
| Rate for Payer: First Health Commercial |
$431.10
|
| Rate for Payer: First Health Workers Compensation |
$184.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$431.10
|
| Rate for Payer: GEHA Commercial |
$383.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$431.10
|
| 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 |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$435.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$335.30
|
| Rate for Payer: One Health Plan PPO/POS |
$431.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$455.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$359.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$445.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$191.60
|
| 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 |
$130.77
|
|
|
INSERT BEARING TIBIAL - CS SIZE 7X11MM
|
Facility
|
IP
|
$3,654.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,461.60 |
| Max. Negotiated Rate |
$3,471.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,923.20
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cigna Commercial |
$3,105.90
|
| Rate for Payer: First Health Commercial |
$3,288.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,288.60
|
| Rate for Payer: GEHA Commercial |
$2,557.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,288.60
|
| Rate for Payer: Multiplan All |
$3,325.14
|
| Rate for Payer: OMNI Networks Commercial |
$2,557.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,288.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,471.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,740.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,398.22
|
| Rate for Payer: Zelis Auto |
$1,461.60
|
|
|
INSERT BEARING TIBIAL - CS SIZE 7X11MM
|
Facility
|
OP
|
$3,654.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.50 |
| Max. Negotiated Rate |
$3,471.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cigna Commercial |
$3,105.90
|
| Rate for Payer: First Health Commercial |
$3,288.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,288.60
|
| Rate for Payer: GEHA Commercial |
$2,923.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,288.60
|
| Rate for Payer: Humana ChoiceCare |
$950.04
|
| Rate for Payer: Multiplan All |
$3,325.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,192.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,557.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,288.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,471.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,740.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,215.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$913.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,398.22
|
| Rate for Payer: Zelis Auto |
$1,461.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,827.00
|
|
|
INSERT BEARING TIBIAL - CS SIZE 7X11MM
|
Facility
|
OP
|
$3,654.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.50 |
| Max. Negotiated Rate |
$3,471.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cigna Commercial |
$3,105.90
|
| Rate for Payer: First Health Commercial |
$3,288.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,288.60
|
| Rate for Payer: GEHA Commercial |
$2,923.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,288.60
|
| Rate for Payer: Humana ChoiceCare |
$950.04
|
| Rate for Payer: Multiplan All |
$3,325.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,192.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,557.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,288.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,471.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,740.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,215.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$913.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,398.22
|
| Rate for Payer: Zelis Auto |
$1,461.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,827.00
|
|
|
INSERT BEARING TIBIAL - CS SIZE 7X11MM
|
Facility
|
IP
|
$3,654.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,461.60 |
| Max. Negotiated Rate |
$3,471.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,923.20
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cash Price |
$2,192.40
|
| Rate for Payer: Cigna Commercial |
$3,105.90
|
| Rate for Payer: First Health Commercial |
$3,288.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,288.60
|
| Rate for Payer: GEHA Commercial |
$2,557.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,288.60
|
| Rate for Payer: Multiplan All |
$3,325.14
|
| Rate for Payer: OMNI Networks Commercial |
$2,557.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,288.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,471.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,740.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,398.22
|
| Rate for Payer: Zelis Auto |
$1,461.60
|
|
