|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,439.00
|
|
|
Service Code
|
CPT 29882
|
| Hospital Charge Code |
6129882
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$392.85 |
| Max. Negotiated Rate |
$1,367.05 |
| Rate for Payer: Cash Price |
$863.40
|
| Rate for Payer: Cigna Commercial |
$1,223.15
|
| Rate for Payer: First Health Commercial |
$1,295.10
|
| Rate for Payer: First Health Workers Compensation |
$555.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,295.10
|
| Rate for Payer: GEHA Commercial |
$1,007.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,295.10
|
| Rate for Payer: Multiplan All |
$1,309.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,007.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,295.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,367.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,079.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,338.27
|
| Rate for Payer: Zelis Auto |
$575.60
|
| Rate for Payer: Zelis Worker's Compensation |
$392.85
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
CPT 29877
|
| Hospital Charge Code |
6129877
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$348.07 |
| 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 |
$765.00
|
| 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 |
$765.00
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,083.75
|
| Rate for Payer: First Health Commercial |
$1,147.50
|
| Rate for Payer: First Health Workers Compensation |
$492.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,147.50
|
| Rate for Payer: GEHA Commercial |
$1,020.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,147.50
|
| 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 |
$1,160.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$892.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,147.50
|
| 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 |
$1,211.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$956.25
|
| 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 |
$1,185.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$510.00
|
| 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 |
$348.07
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,351.00
|
|
|
Service Code
|
CPT 29876
|
| Hospital Charge Code |
6129876
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$368.82 |
| Max. Negotiated Rate |
$1,283.45 |
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cigna Commercial |
$1,148.35
|
| Rate for Payer: First Health Commercial |
$1,215.90
|
| Rate for Payer: First Health Workers Compensation |
$521.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,215.90
|
| Rate for Payer: GEHA Commercial |
$945.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,215.90
|
| Rate for Payer: Multiplan All |
$1,229.41
|
| Rate for Payer: OMNI Networks Commercial |
$945.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,215.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,283.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,013.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,256.43
|
| Rate for Payer: Zelis Auto |
$540.40
|
| Rate for Payer: Zelis Worker's Compensation |
$368.82
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,013.00
|
|
|
Service Code
|
CPT 29875
|
| Hospital Charge Code |
6129875
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$276.55 |
| 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 |
$607.80
|
| 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 |
$607.80
|
| Rate for Payer: Cash Price |
$607.80
|
| Rate for Payer: Cigna Commercial |
$861.05
|
| Rate for Payer: First Health Commercial |
$911.70
|
| Rate for Payer: First Health Workers Compensation |
$391.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$911.70
|
| Rate for Payer: GEHA Commercial |
$810.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$911.70
|
| 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 |
$921.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$709.10
|
| Rate for Payer: One Health Plan PPO/POS |
$911.70
|
| 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 |
$962.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$759.75
|
| 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 |
$942.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$405.20
|
| 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 |
$276.55
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,013.00
|
|
|
Service Code
|
CPT 29875
|
| Hospital Charge Code |
6129875
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$276.55 |
| Max. Negotiated Rate |
$962.35 |
| Rate for Payer: Cash Price |
$607.80
|
| Rate for Payer: Cigna Commercial |
$861.05
|
| Rate for Payer: First Health Commercial |
$911.70
|
| Rate for Payer: First Health Workers Compensation |
$391.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$911.70
|
| Rate for Payer: GEHA Commercial |
$709.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$911.70
|
| Rate for Payer: Multiplan All |
$921.83
|
| Rate for Payer: OMNI Networks Commercial |
$709.10
|
| Rate for Payer: One Health Plan PPO/POS |
$911.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$962.35
|
| Rate for Payer: Three Rivers Provider Network All |
$759.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$942.09
|
| Rate for Payer: Zelis Auto |
$405.20
|
| Rate for Payer: Zelis Worker's Compensation |
$276.55
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
CPT 29874
|
| Hospital Charge Code |
6129874
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$300.30 |
| 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 |
$660.00
|
| 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 |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cigna Commercial |
$935.00
|
| Rate for Payer: First Health Commercial |
$990.00
|
| Rate for Payer: First Health Workers Compensation |
$424.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$990.00
|
| Rate for Payer: GEHA Commercial |
$880.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$990.00
|
| 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 |
$1,001.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$770.00
|
| Rate for Payer: One Health Plan PPO/POS |
$990.00
|
| 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 |
$1,045.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$825.00
|
| 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 |
$1,023.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$440.00
|
| 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 |
$300.30
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
CPT 29874
|
| Hospital Charge Code |
6129874
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$300.30 |
| Max. Negotiated Rate |
$1,045.00 |
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cigna Commercial |
$935.00
|
| Rate for Payer: First Health Commercial |
$990.00
|
| Rate for Payer: First Health Workers Compensation |
$424.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$990.00
|
| Rate for Payer: GEHA Commercial |
$770.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$990.00
|
| Rate for Payer: Multiplan All |
$1,001.00
|
| Rate for Payer: OMNI Networks Commercial |
$770.00
|
| Rate for Payer: One Health Plan PPO/POS |
$990.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,045.00
|
| Rate for Payer: Three Rivers Provider Network All |
$825.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,023.00
|
| Rate for Payer: Zelis Auto |
$440.00
|
| Rate for Payer: Zelis Worker's Compensation |
$300.30
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
CPT 29880
|
| Hospital Charge Code |
6129880
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$313.95 |
| Max. Negotiated Rate |
$1,092.50 |
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$977.50
|
| Rate for Payer: First Health Commercial |
$1,035.00
|
| Rate for Payer: First Health Workers Compensation |
$444.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,035.00
|
| Rate for Payer: GEHA Commercial |
$805.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,035.00
|
| Rate for Payer: Multiplan All |
$1,046.50
|
| Rate for Payer: OMNI Networks Commercial |
$805.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,035.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,092.50
|
| Rate for Payer: Three Rivers Provider Network All |
$862.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,069.50
|
| Rate for Payer: Zelis Auto |
$460.00
|
| Rate for Payer: Zelis Worker's Compensation |
$313.95
|
|
|
KNEE SLEEVE
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT L1820
|
| Hospital Charge Code |
8230073
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$224.40
|
| Rate for Payer: First Health Commercial |
$237.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$184.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: OMNI Networks Commercial |
$184.80
|
| Rate for Payer: One Health Plan PPO/POS |
$237.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: Zelis Auto |
$105.60
|
|
|
KNEE SLEEVE
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT L1820
|
| Hospital Charge Code |
8800015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$243.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$158.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$243.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$192.61
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$224.40
|
| Rate for Payer: First Health Commercial |
$237.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$211.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Humana ChoiceCare |
$68.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$196.53
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$158.40
|
| Rate for Payer: OMNI Networks Commercial |
$184.80
|
| Rate for Payer: One Health Plan PPO/POS |
$237.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$226.93
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$196.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$232.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$196.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$132.00
|
|
|
KNEE SLEEVE
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT L1820
|
| Hospital Charge Code |
8800015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$224.40
|
| Rate for Payer: First Health Commercial |
$237.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$184.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: OMNI Networks Commercial |
$184.80
|
| Rate for Payer: One Health Plan PPO/POS |
$237.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: Zelis Auto |
$105.60
|
|
|
KNEE SLEEVE
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT L1820
|
| Hospital Charge Code |
8230073
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$243.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$158.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$243.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$192.61
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$224.40
|
| Rate for Payer: First Health Commercial |
$237.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$211.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Humana ChoiceCare |
$68.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$196.53
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$158.40
|
| Rate for Payer: OMNI Networks Commercial |
$184.80
|
| Rate for Payer: One Health Plan PPO/POS |
$237.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$226.93
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$196.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$232.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$196.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$132.00
|
|
|
KO ELAST W/JNT PREFAB INCL FIT&ADJ
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT L1810
|
| Hospital Charge Code |
8230051
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$51.48 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$180.74
|
| 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 |
$180.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$143.18
|
| 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 |
$146.09
|
| 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 |
$168.69
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$146.09
|
| 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 |
$146.09
|
| 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
|
|
|
KO ELAST W/JNT PREFAB INCL FIT&ADJ
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT L1810
|
| Hospital Charge Code |
8230051
|
|
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
|
|
|
K-WIRE .062
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.60 |
| Max. Negotiated Rate |
$379.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$319.20
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cigna Commercial |
$339.15
|
| Rate for Payer: First Health Commercial |
$359.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$359.10
|
| Rate for Payer: GEHA Commercial |
$279.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$359.10
|
| Rate for Payer: Multiplan All |
$363.09
|
| Rate for Payer: OMNI Networks Commercial |
$279.30
|
| Rate for Payer: One Health Plan PPO/POS |
$359.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$379.05
|
| Rate for Payer: Three Rivers Provider Network All |
$299.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$371.07
|
| Rate for Payer: Zelis Auto |
$159.60
|
|
|
K-WIRE .062
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$379.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$239.40
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cigna Commercial |
$339.15
|
| Rate for Payer: First Health Commercial |
$359.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$359.10
|
| Rate for Payer: GEHA Commercial |
$319.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$359.10
|
| Rate for Payer: Humana ChoiceCare |
$103.74
|
| Rate for Payer: Multiplan All |
$363.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$239.40
|
| Rate for Payer: OMNI Networks Commercial |
$279.30
|
| Rate for Payer: One Health Plan PPO/POS |
$359.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$379.05
|
| Rate for Payer: Three Rivers Provider Network All |
$299.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$351.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$99.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$371.07
|
| Rate for Payer: Zelis Auto |
$159.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$199.50
|
|
|
K-WIRE 1.6MM ZPFX BOX OF 5
|
Facility
|
OP
|
$545.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.25 |
| Max. Negotiated Rate |
$517.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$327.00
|
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Cigna Commercial |
$463.25
|
| Rate for Payer: First Health Commercial |
$490.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$490.50
|
| Rate for Payer: GEHA Commercial |
$436.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$490.50
|
| Rate for Payer: Humana ChoiceCare |
$141.70
|
| Rate for Payer: Multiplan All |
$495.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.00
|
| Rate for Payer: OMNI Networks Commercial |
$381.50
|
| Rate for Payer: One Health Plan PPO/POS |
$490.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$517.75
|
| Rate for Payer: Three Rivers Provider Network All |
$408.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$479.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$136.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$506.85
|
| Rate for Payer: Zelis Auto |
$218.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$272.50
|
|
|
K-WIRE 1.6MM ZPFX BOX OF 5
|
Facility
|
IP
|
$545.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7001112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$218.00 |
| Max. Negotiated Rate |
$517.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$436.00
|
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Cigna Commercial |
$463.25
|
| Rate for Payer: First Health Commercial |
$490.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$490.50
|
| Rate for Payer: GEHA Commercial |
$381.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$490.50
|
| Rate for Payer: Multiplan All |
$495.95
|
| Rate for Payer: OMNI Networks Commercial |
$381.50
|
| Rate for Payer: One Health Plan PPO/POS |
$490.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$517.75
|
| Rate for Payer: Three Rivers Provider Network All |
$408.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$506.85
|
| Rate for Payer: Zelis Auto |
$218.00
|
|
|
K-WIRE DBL TROC .028X4"
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002944
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$21.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
|
|
K-WIRE DBL TROC .028X4"
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002944
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$24.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Humana ChoiceCare |
$7.80
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.00
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$26.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.00
|
|
|
K-WIRE DBL TROC .028X6"
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002945
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$29.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$26.35
|
| Rate for Payer: First Health Commercial |
$27.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.90
|
| Rate for Payer: GEHA Commercial |
$24.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.90
|
| Rate for Payer: Humana ChoiceCare |
$8.06
|
| Rate for Payer: Multiplan All |
$28.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.60
|
| Rate for Payer: OMNI Networks Commercial |
$21.70
|
| Rate for Payer: One Health Plan PPO/POS |
$27.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$29.45
|
| Rate for Payer: Three Rivers Provider Network All |
$23.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$28.83
|
| Rate for Payer: Zelis Auto |
$12.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.50
|
|
|
K-WIRE DBL TROC .028X6"
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002945
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$29.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24.80
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$26.35
|
| Rate for Payer: First Health Commercial |
$27.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.90
|
| Rate for Payer: GEHA Commercial |
$21.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.90
|
| Rate for Payer: Multiplan All |
$28.21
|
| Rate for Payer: OMNI Networks Commercial |
$21.70
|
| Rate for Payer: One Health Plan PPO/POS |
$27.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$29.45
|
| Rate for Payer: Three Rivers Provider Network All |
$23.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$28.83
|
| Rate for Payer: Zelis Auto |
$12.40
|
|
|
K-WIRE DBL TROC .028X9"
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$25.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$27.20
|
| Rate for Payer: First Health Commercial |
$28.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$28.80
|
| Rate for Payer: GEHA Commercial |
$22.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$28.80
|
| Rate for Payer: Multiplan All |
$29.12
|
| Rate for Payer: OMNI Networks Commercial |
$22.40
|
| Rate for Payer: One Health Plan PPO/POS |
$28.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$30.40
|
| Rate for Payer: Three Rivers Provider Network All |
$24.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$29.76
|
| Rate for Payer: Zelis Auto |
$12.80
|
|
|
K-WIRE DBL TROC .028X9"
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$27.20
|
| Rate for Payer: First Health Commercial |
$28.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$28.80
|
| Rate for Payer: GEHA Commercial |
$25.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$28.80
|
| Rate for Payer: Humana ChoiceCare |
$8.32
|
| Rate for Payer: Multiplan All |
$29.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.20
|
| Rate for Payer: OMNI Networks Commercial |
$22.40
|
| Rate for Payer: One Health Plan PPO/POS |
$28.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$30.40
|
| Rate for Payer: Three Rivers Provider Network All |
$24.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$28.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$29.76
|
| Rate for Payer: Zelis Auto |
$12.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.00
|
|
|
K-WIRE DBL TROC .035X4"
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$21.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
|
