|
INSERT SUBQ CARDIAC RHYTHM MONITOR W/PRG
|
Facility
|
OP
|
$14,790.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
4210022
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,916.00 |
| Max. Negotiated Rate |
$15,716.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11,106.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,874.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11,106.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$8,798.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7,858.37
|
| Rate for Payer: Cash Price |
$8,874.00
|
| Rate for Payer: Cash Price |
$8,874.00
|
| Rate for Payer: Cigna Commercial |
$12,571.50
|
| Rate for Payer: First Health Commercial |
$13,311.00
|
| Rate for Payer: First Health Workers Compensation |
$10,113.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13,311.00
|
| Rate for Payer: GEHA Commercial |
$11,832.00
|
| Rate for Payer: GEHA Medicare |
$7,858.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13,311.00
|
| Rate for Payer: Humana ChoiceCare |
$8,644.21
|
| Rate for Payer: Humana Medicare Advantage |
$7,858.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13,202.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8,977.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7,858.37
|
| Rate for Payer: Multiplan All |
$13,458.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13,359.23
|
| Rate for Payer: OMNI Networks Commercial |
$10,353.00
|
| Rate for Payer: One Health Plan PPO/POS |
$13,311.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10,365.75
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8,977.48
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7,858.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14,050.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$15,716.74
|
| Rate for Payer: Three Rivers Provider Network All |
$11,092.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,701.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8,977.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,858.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,754.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7,858.37
|
| Rate for Payer: Zelis Auto |
$5,916.00
|
| Rate for Payer: Zelis Medicare |
$6,679.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9,430.04
|
| Rate for Payer: Zelis Worker's Compensation |
$7,151.12
|
|
|
INSERT SUBQ CARDIAC RHYTHM MONITOR W/PRG
|
Facility
|
OP
|
$14,790.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
8699248
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$4,037.67 |
| Max. Negotiated Rate |
$15,716.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11,106.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,874.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11,106.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$8,798.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7,858.37
|
| Rate for Payer: Cash Price |
$8,874.00
|
| Rate for Payer: Cash Price |
$8,874.00
|
| Rate for Payer: Cigna Commercial |
$12,571.50
|
| Rate for Payer: First Health Commercial |
$13,311.00
|
| Rate for Payer: First Health Workers Compensation |
$5,710.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13,311.00
|
| Rate for Payer: GEHA Commercial |
$11,832.00
|
| Rate for Payer: GEHA Medicare |
$7,858.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13,311.00
|
| Rate for Payer: Humana ChoiceCare |
$8,644.21
|
| Rate for Payer: Humana Medicare Advantage |
$7,858.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13,202.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8,977.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7,858.37
|
| Rate for Payer: Multiplan All |
$13,458.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13,359.23
|
| Rate for Payer: OMNI Networks Commercial |
$10,353.00
|
| Rate for Payer: One Health Plan PPO/POS |
$13,311.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10,365.75
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8,977.48
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7,858.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14,050.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$15,716.74
|
| Rate for Payer: Three Rivers Provider Network All |
$11,092.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,701.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8,977.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,858.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,754.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7,858.37
|
| Rate for Payer: Zelis Auto |
$5,916.00
|
| Rate for Payer: Zelis Medicare |
$6,679.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9,430.04
|
| Rate for Payer: Zelis Worker's Compensation |
$4,037.67
|
|
|
INSERT SUBQ CARDIAC RHYTHM MONITOR W/PRG
|
Facility
|
IP
|
$14,790.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
9000023
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$4,037.67 |
| Max. Negotiated Rate |
$14,050.50 |
| Rate for Payer: Cash Price |
$8,874.00
|
| Rate for Payer: Cigna Commercial |
$12,571.50
|
| Rate for Payer: First Health Commercial |
$13,311.00
|
| Rate for Payer: First Health Workers Compensation |
$5,710.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13,311.00
|
| Rate for Payer: GEHA Commercial |
$10,353.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13,311.00
|
| Rate for Payer: Multiplan All |
$13,458.90
|
| Rate for Payer: OMNI Networks Commercial |
$10,353.00
|
| Rate for Payer: One Health Plan PPO/POS |
$13,311.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14,050.50
|
| Rate for Payer: Three Rivers Provider Network All |
$11,092.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,754.70
|
| Rate for Payer: Zelis Auto |
$5,916.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4,037.67
|
|
|
INSERT SUBQ CARDIAC RHYTHM MONITOR W/PRG
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
6133285
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$78.62 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cigna Commercial |
$244.80
|
| Rate for Payer: First Health Commercial |
$259.20
|
| Rate for Payer: First Health Workers Compensation |
$111.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$259.20
|
| Rate for Payer: GEHA Commercial |
$201.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$259.20
|
| Rate for Payer: Multiplan All |
$262.08
|
| Rate for Payer: OMNI Networks Commercial |
$201.60
|
| Rate for Payer: One Health Plan PPO/POS |
$259.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$273.60
|
| Rate for Payer: Three Rivers Provider Network All |
$216.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$267.84
|
| Rate for Payer: Zelis Auto |
$115.20
|
| Rate for Payer: Zelis Worker's Compensation |
$78.62
|
|
|
INSERT SUBQ CARDIAC RHYTHM MONITOR W/PRG
|
Facility
|
IP
|
$14,790.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
8699248
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$4,037.67 |
| Max. Negotiated Rate |
$14,050.50 |
| Rate for Payer: Cash Price |
$8,874.00
|
| Rate for Payer: Cigna Commercial |
$12,571.50
|
| Rate for Payer: First Health Commercial |
$13,311.00
|
| Rate for Payer: First Health Workers Compensation |
$5,710.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13,311.00
|
| Rate for Payer: GEHA Commercial |
$10,353.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13,311.00
|
| Rate for Payer: Multiplan All |
$13,458.90
|
| Rate for Payer: OMNI Networks Commercial |
$10,353.00
|
| Rate for Payer: One Health Plan PPO/POS |
$13,311.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14,050.50
|
| Rate for Payer: Three Rivers Provider Network All |
$11,092.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,754.70
|
| Rate for Payer: Zelis Auto |
$5,916.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4,037.67
|
|
|
INSERT SUBQ CARDIAC RHYTHM MONITOR W/PRG
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
6133285
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$78.62 |
| Max. Negotiated Rate |
$15,716.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11,106.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$172.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11,106.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$8,798.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7,858.37
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cigna Commercial |
$244.80
|
| Rate for Payer: First Health Commercial |
$259.20
|
| Rate for Payer: First Health Workers Compensation |
$111.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$259.20
|
| Rate for Payer: GEHA Commercial |
$230.40
|
| Rate for Payer: GEHA Medicare |
$7,858.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$259.20
|
| Rate for Payer: Humana ChoiceCare |
$8,644.21
|
| Rate for Payer: Humana Medicare Advantage |
$7,858.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13,202.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8,977.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7,858.37
|
| Rate for Payer: Multiplan All |
$262.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13,359.23
|
| Rate for Payer: OMNI Networks Commercial |
$201.60
|
| Rate for Payer: One Health Plan PPO/POS |
$259.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10,365.75
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8,977.48
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7,858.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$273.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$15,716.74
|
| Rate for Payer: Three Rivers Provider Network All |
$216.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,701.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8,977.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,858.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$267.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7,858.37
|
| Rate for Payer: Zelis Auto |
$115.20
|
| Rate for Payer: Zelis Medicare |
$6,679.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9,430.04
|
| Rate for Payer: Zelis Worker's Compensation |
$78.62
|
|
|
INSERT SUBQ CARDIAC RHYTHM MONITOR W/PRG
|
Facility
|
OP
|
$14,790.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
9000023
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$4,037.67 |
| Max. Negotiated Rate |
$15,716.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11,106.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,874.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11,106.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$8,798.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7,858.37
|
| Rate for Payer: Cash Price |
$8,874.00
|
| Rate for Payer: Cash Price |
$8,874.00
|
| Rate for Payer: Cigna Commercial |
$12,571.50
|
| Rate for Payer: First Health Commercial |
$13,311.00
|
| Rate for Payer: First Health Workers Compensation |
$5,710.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13,311.00
|
| Rate for Payer: GEHA Commercial |
$11,832.00
|
| Rate for Payer: GEHA Medicare |
$7,858.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13,311.00
|
| Rate for Payer: Humana ChoiceCare |
$8,644.21
|
| Rate for Payer: Humana Medicare Advantage |
$7,858.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13,202.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8,977.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7,858.37
|
| Rate for Payer: Multiplan All |
$13,458.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13,359.23
|
| Rate for Payer: OMNI Networks Commercial |
$10,353.00
|
| Rate for Payer: One Health Plan PPO/POS |
$13,311.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10,365.75
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8,977.48
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7,858.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14,050.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$15,716.74
|
| Rate for Payer: Three Rivers Provider Network All |
$11,092.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,701.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8,977.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,858.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,754.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7,858.37
|
| Rate for Payer: Zelis Auto |
$5,916.00
|
| Rate for Payer: Zelis Medicare |
$6,679.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9,430.04
|
| Rate for Payer: Zelis Worker's Compensation |
$4,037.67
|
|
|
INSERT SUBQ EXTEN TO IP CATH
|
Facility
|
IP
|
$386.00
|
|
|
Service Code
|
CPT 49435
|
| Hospital Charge Code |
6149435
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$105.38 |
| Max. Negotiated Rate |
$366.70 |
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cigna Commercial |
$328.10
|
| Rate for Payer: First Health Commercial |
$347.40
|
| Rate for Payer: First Health Workers Compensation |
$149.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$347.40
|
| Rate for Payer: GEHA Commercial |
$270.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$347.40
|
| Rate for Payer: Multiplan All |
$351.26
|
| Rate for Payer: OMNI Networks Commercial |
$270.20
|
| Rate for Payer: One Health Plan PPO/POS |
$347.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$366.70
|
| Rate for Payer: Three Rivers Provider Network All |
$289.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$358.98
|
| Rate for Payer: Zelis Auto |
$154.40
|
| Rate for Payer: Zelis Worker's Compensation |
$105.38
|
|
|
INSERT SUBQ EXTEN TO IP CATH
|
Facility
|
OP
|
$386.00
|
|
|
Service Code
|
CPT 49435
|
| Hospital Charge Code |
6149435
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$100.36 |
| Max. Negotiated Rate |
$1,548.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,548.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$231.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,548.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,226.34
|
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cash Price |
$231.60
|
| Rate for Payer: Cigna Commercial |
$328.10
|
| Rate for Payer: First Health Commercial |
$347.40
|
| Rate for Payer: First Health Workers Compensation |
$149.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$347.40
|
| Rate for Payer: GEHA Commercial |
$308.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$347.40
|
| Rate for Payer: Humana ChoiceCare |
$100.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,251.31
|
| Rate for Payer: Multiplan All |
$351.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$231.60
|
| Rate for Payer: OMNI Networks Commercial |
$270.20
|
| Rate for Payer: One Health Plan PPO/POS |
$347.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,444.81
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,251.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$366.70
|
| Rate for Payer: Three Rivers Provider Network All |
$289.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$339.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,251.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$358.98
|
| Rate for Payer: Zelis Auto |
$154.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$193.00
|
| Rate for Payer: Zelis Worker's Compensation |
$105.38
|
|
|
INSERT TANDEM CUFF
|
Facility
|
OP
|
$1,632.00
|
|
|
Service Code
|
CPT 53444
|
| Hospital Charge Code |
6153444
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$445.54 |
| Max. Negotiated Rate |
$38,225.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9,917.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$979.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9,917.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7,856.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$19,112.87
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Cigna Commercial |
$1,387.20
|
| Rate for Payer: First Health Commercial |
$1,468.80
|
| Rate for Payer: First Health Workers Compensation |
$630.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,468.80
|
| Rate for Payer: GEHA Commercial |
$1,305.60
|
| Rate for Payer: GEHA Medicare |
$19,112.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,468.80
|
| Rate for Payer: Humana ChoiceCare |
$21,024.16
|
| Rate for Payer: Humana Medicare Advantage |
$19,112.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$32,109.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8,016.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19,112.87
|
| Rate for Payer: Multiplan All |
$1,485.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$32,491.88
|
| Rate for Payer: OMNI Networks Commercial |
$1,142.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,468.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9,256.28
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8,016.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$19,112.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,550.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$38,225.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,224.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18,730.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8,016.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,112.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,517.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$19,112.87
|
| Rate for Payer: Zelis Auto |
$652.80
|
| Rate for Payer: Zelis Medicare |
$16,245.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22,935.44
|
| Rate for Payer: Zelis Worker's Compensation |
$445.54
|
|
|
INSERT TANDEM CUFF
|
Facility
|
IP
|
$1,632.00
|
|
|
Service Code
|
CPT 53444
|
| Hospital Charge Code |
6153444
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$445.54 |
| Max. Negotiated Rate |
$1,550.40 |
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Cigna Commercial |
$1,387.20
|
| Rate for Payer: First Health Commercial |
$1,468.80
|
| Rate for Payer: First Health Workers Compensation |
$630.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,468.80
|
| Rate for Payer: GEHA Commercial |
$1,142.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,468.80
|
| Rate for Payer: Multiplan All |
$1,485.12
|
| Rate for Payer: OMNI Networks Commercial |
$1,142.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,468.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,550.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,224.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,517.76
|
| Rate for Payer: Zelis Auto |
$652.80
|
| Rate for Payer: Zelis Worker's Compensation |
$445.54
|
|
|
INSERT TIBIAL 10MM SIZE 5
|
Facility
|
IP
|
$4,415.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,766.00 |
| Max. Negotiated Rate |
$4,194.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,532.00
|
| Rate for Payer: Cash Price |
$2,649.00
|
| Rate for Payer: Cash Price |
$2,649.00
|
| Rate for Payer: Cigna Commercial |
$3,752.75
|
| Rate for Payer: First Health Commercial |
$3,973.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,973.50
|
| Rate for Payer: GEHA Commercial |
$3,090.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,973.50
|
| Rate for Payer: Multiplan All |
$4,017.65
|
| Rate for Payer: OMNI Networks Commercial |
$3,090.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,973.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,194.25
|
| Rate for Payer: Three Rivers Provider Network All |
$3,311.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,105.95
|
| Rate for Payer: Zelis Auto |
$1,766.00
|
|
|
INSERT TIBIAL 10MM SIZE 5
|
Facility
|
OP
|
$4,415.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,103.75 |
| Max. Negotiated Rate |
$4,194.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,649.00
|
| Rate for Payer: Cash Price |
$2,649.00
|
| Rate for Payer: Cash Price |
$2,649.00
|
| Rate for Payer: Cigna Commercial |
$3,752.75
|
| Rate for Payer: First Health Commercial |
$3,973.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,973.50
|
| Rate for Payer: GEHA Commercial |
$3,532.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,973.50
|
| Rate for Payer: Humana ChoiceCare |
$1,147.90
|
| Rate for Payer: Multiplan All |
$4,017.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,649.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,090.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,973.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,194.25
|
| Rate for Payer: Three Rivers Provider Network All |
$3,311.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,885.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,103.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,105.95
|
| Rate for Payer: Zelis Auto |
$1,766.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,207.50
|
|
|
INSERT TIBIAL#3 10MM
|
Facility
|
OP
|
$4,068.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,017.00 |
| Max. Negotiated Rate |
$3,864.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,440.80
|
| Rate for Payer: Cash Price |
$2,440.80
|
| Rate for Payer: Cash Price |
$2,440.80
|
| Rate for Payer: Cigna Commercial |
$3,457.80
|
| Rate for Payer: First Health Commercial |
$3,661.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,661.20
|
| Rate for Payer: GEHA Commercial |
$3,254.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,661.20
|
| Rate for Payer: Humana ChoiceCare |
$1,057.68
|
| Rate for Payer: Multiplan All |
$3,701.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,440.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,847.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,661.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,864.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,051.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,579.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,017.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,783.24
|
| Rate for Payer: Zelis Auto |
$1,627.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,034.00
|
|
|
INSERT TIBIAL#3 10MM
|
Facility
|
IP
|
$4,068.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,627.20 |
| Max. Negotiated Rate |
$3,864.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,254.40
|
| Rate for Payer: Cash Price |
$2,440.80
|
| Rate for Payer: Cash Price |
$2,440.80
|
| Rate for Payer: Cigna Commercial |
$3,457.80
|
| Rate for Payer: First Health Commercial |
$3,661.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,661.20
|
| Rate for Payer: GEHA Commercial |
$2,847.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,661.20
|
| Rate for Payer: Multiplan All |
$3,701.88
|
| Rate for Payer: OMNI Networks Commercial |
$2,847.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,661.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,864.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,051.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,783.24
|
| Rate for Payer: Zelis Auto |
$1,627.20
|
|
|
INSERT TIBIAL 8MM SZ3
|
Facility
|
OP
|
$4,050.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.50 |
| Max. Negotiated Rate |
$3,847.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,430.00
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$3,442.50
|
| Rate for Payer: First Health Commercial |
$3,645.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,645.00
|
| Rate for Payer: GEHA Commercial |
$3,240.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,645.00
|
| Rate for Payer: Humana ChoiceCare |
$1,053.00
|
| Rate for Payer: Multiplan All |
$3,685.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,430.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,835.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,645.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,847.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,037.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,564.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,012.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,766.50
|
| Rate for Payer: Zelis Auto |
$1,620.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,025.00
|
|
|
INSERT TIBIAL 8MM SZ3
|
Facility
|
IP
|
$4,050.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,620.00 |
| Max. Negotiated Rate |
$3,847.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,240.00
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$3,442.50
|
| Rate for Payer: First Health Commercial |
$3,645.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,645.00
|
| Rate for Payer: GEHA Commercial |
$2,835.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,645.00
|
| Rate for Payer: Multiplan All |
$3,685.50
|
| Rate for Payer: OMNI Networks Commercial |
$2,835.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,645.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,847.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,037.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,766.50
|
| Rate for Payer: Zelis Auto |
$1,620.00
|
|
|
INSERT TIBIAL BEARING SIZE 5 11M
|
Facility
|
OP
|
$3,654.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002224
|
|
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 TIBIAL BEARING SIZE 5 11M
|
Facility
|
IP
|
$3,654.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002224
|
|
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 TIBIAL BEARING SIZE7
|
Facility
|
IP
|
$3,654.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002223
|
|
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 TIBIAL BEARING SIZE7
|
Facility
|
OP
|
$3,654.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002223
|
|
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 TIBIAL LARGE 10MM
|
Facility
|
OP
|
$7,475.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,868.75 |
| Max. Negotiated Rate |
$7,101.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,485.00
|
| Rate for Payer: Cash Price |
$4,485.00
|
| Rate for Payer: Cash Price |
$4,485.00
|
| Rate for Payer: Cigna Commercial |
$6,353.75
|
| Rate for Payer: First Health Commercial |
$6,727.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,727.50
|
| Rate for Payer: GEHA Commercial |
$5,980.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,727.50
|
| Rate for Payer: Humana ChoiceCare |
$1,943.50
|
| Rate for Payer: Multiplan All |
$6,802.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,485.00
|
| Rate for Payer: OMNI Networks Commercial |
$5,232.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,727.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,101.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,606.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,578.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,868.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,951.75
|
| Rate for Payer: Zelis Auto |
$2,990.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,737.50
|
|
|
INSERT TIBIAL LARGE 10MM
|
Facility
|
IP
|
$7,475.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,990.00 |
| Max. Negotiated Rate |
$7,101.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,980.00
|
| Rate for Payer: Cash Price |
$4,485.00
|
| Rate for Payer: Cash Price |
$4,485.00
|
| Rate for Payer: Cigna Commercial |
$6,353.75
|
| Rate for Payer: First Health Commercial |
$6,727.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,727.50
|
| Rate for Payer: GEHA Commercial |
$5,232.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,727.50
|
| Rate for Payer: Multiplan All |
$6,802.25
|
| Rate for Payer: OMNI Networks Commercial |
$5,232.50
|
| Rate for Payer: One Health Plan PPO/POS |
$6,727.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,101.25
|
| Rate for Payer: Three Rivers Provider Network All |
$5,606.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,951.75
|
| Rate for Payer: Zelis Auto |
$2,990.00
|
|
|
INSERT TIBIAL LM/RL SZ3 8MM
|
Facility
|
IP
|
$4,050.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,620.00 |
| Max. Negotiated Rate |
$3,847.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,240.00
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$3,442.50
|
| Rate for Payer: First Health Commercial |
$3,645.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,645.00
|
| Rate for Payer: GEHA Commercial |
$2,835.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,645.00
|
| Rate for Payer: Multiplan All |
$3,685.50
|
| Rate for Payer: OMNI Networks Commercial |
$2,835.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,645.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,847.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,037.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,766.50
|
| Rate for Payer: Zelis Auto |
$1,620.00
|
|
|
INSERT TIBIAL LM/RL SZ3 8MM
|
Facility
|
OP
|
$4,050.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.50 |
| Max. Negotiated Rate |
$3,847.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,430.00
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$3,442.50
|
| Rate for Payer: First Health Commercial |
$3,645.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,645.00
|
| Rate for Payer: GEHA Commercial |
$3,240.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,645.00
|
| Rate for Payer: Humana ChoiceCare |
$1,053.00
|
| Rate for Payer: Multiplan All |
$3,685.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,430.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,835.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,645.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,847.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,037.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,564.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,012.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,766.50
|
| Rate for Payer: Zelis Auto |
$1,620.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,025.00
|
|
