|
MAM 3D UNILATERAL LEFT COMBO HD
|
Facility
|
IP
|
$199.50
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
2766919
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$189.53 |
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$169.57
|
| Rate for Payer: First Health Commercial |
$179.55
|
| Rate for Payer: First Health Workers Compensation |
$156.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$179.55
|
| Rate for Payer: GEHA Commercial |
$139.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$179.55
|
| Rate for Payer: Multiplan All |
$181.54
|
| Rate for Payer: OMNI Networks Commercial |
$139.65
|
| Rate for Payer: One Health Plan PPO/POS |
$179.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$189.53
|
| Rate for Payer: Three Rivers Provider Network All |
$149.62
|
| Rate for Payer: United Payors & United Providers UP&UP |
$185.53
|
| Rate for Payer: Zelis Auto |
$79.80
|
| Rate for Payer: Zelis Worker's Compensation |
$110.68
|
|
|
MAM 3D UNILATERAL RIGHT COMBO HD
|
Facility
|
OP
|
$199.50
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
2766918
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$49.88 |
| Max. Negotiated Rate |
$189.53 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$169.57
|
| Rate for Payer: First Health Commercial |
$179.55
|
| Rate for Payer: First Health Workers Compensation |
$156.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$179.55
|
| Rate for Payer: GEHA Commercial |
$159.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$179.55
|
| Rate for Payer: Humana ChoiceCare |
$51.87
|
| Rate for Payer: Multiplan All |
$181.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$119.70
|
| Rate for Payer: OMNI Networks Commercial |
$139.65
|
| Rate for Payer: One Health Plan PPO/POS |
$179.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$189.53
|
| Rate for Payer: Three Rivers Provider Network All |
$149.62
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$175.56
|
| Rate for Payer: United Healthcare Commercial |
$169.57
|
| Rate for Payer: United Healthcare Managed Medicaid |
$49.88
|
| Rate for Payer: United Payors & United Providers UP&UP |
$185.53
|
| Rate for Payer: Zelis Auto |
$79.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$99.75
|
| Rate for Payer: Zelis Worker's Compensation |
$110.68
|
|
|
MAM 3D UNILATERAL RIGHT COMBO HD
|
Facility
|
IP
|
$199.50
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
2766918
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$189.53 |
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$169.57
|
| Rate for Payer: First Health Commercial |
$179.55
|
| Rate for Payer: First Health Workers Compensation |
$156.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$179.55
|
| Rate for Payer: GEHA Commercial |
$139.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$179.55
|
| Rate for Payer: Multiplan All |
$181.54
|
| Rate for Payer: OMNI Networks Commercial |
$139.65
|
| Rate for Payer: One Health Plan PPO/POS |
$179.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$189.53
|
| Rate for Payer: Three Rivers Provider Network All |
$149.62
|
| Rate for Payer: United Payors & United Providers UP&UP |
$185.53
|
| Rate for Payer: Zelis Auto |
$79.80
|
| Rate for Payer: Zelis Worker's Compensation |
$110.68
|
|
|
MAM BREAST SURG-SPECIMEN
|
Facility
|
OP
|
$1,036.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
2700071
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.29 |
| Max. Negotiated Rate |
$1,041.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$566.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$621.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$566.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$448.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$520.63
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Cigna Commercial |
$880.60
|
| Rate for Payer: First Health Commercial |
$932.40
|
| Rate for Payer: First Health Workers Compensation |
$49.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$932.40
|
| Rate for Payer: GEHA Commercial |
$828.80
|
| Rate for Payer: GEHA Medicare |
$520.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$932.40
|
| Rate for Payer: Humana ChoiceCare |
$572.69
|
| Rate for Payer: Humana Medicare Advantage |
$520.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$874.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$457.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$520.63
|
| Rate for Payer: Multiplan All |
$942.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$885.07
|
| Rate for Payer: OMNI Networks Commercial |
$725.20
|
| Rate for Payer: One Health Plan PPO/POS |
$932.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$528.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$457.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$520.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$984.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,041.26
|
| Rate for Payer: Three Rivers Provider Network All |
$777.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$510.22
|
| Rate for Payer: United Healthcare Commercial |
$880.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$457.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$520.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$963.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$520.63
|
| Rate for Payer: Zelis Auto |
$414.40
|
| Rate for Payer: Zelis Medicare |
$442.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$624.76
|
| Rate for Payer: Zelis Worker's Compensation |
$35.29
|
|
|
MAM BREAST SURG-SPECIMEN
|
Facility
|
IP
|
$1,036.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
2700071
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.29 |
| Max. Negotiated Rate |
$984.20 |
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Cigna Commercial |
$880.60
|
| Rate for Payer: First Health Commercial |
$932.40
|
| Rate for Payer: First Health Workers Compensation |
$49.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$932.40
|
| Rate for Payer: GEHA Commercial |
$725.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$932.40
|
| Rate for Payer: Multiplan All |
$942.76
|
| Rate for Payer: OMNI Networks Commercial |
$725.20
|
| Rate for Payer: One Health Plan PPO/POS |
$932.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$984.20
|
| Rate for Payer: Three Rivers Provider Network All |
$777.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$963.48
|
| Rate for Payer: Zelis Auto |
$414.40
|
| Rate for Payer: Zelis Worker's Compensation |
$35.29
|
|
|
MAM DIAGNOSTIC BILATERAL CONVENTIONAL
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT 77066
|
| Hospital Charge Code |
2766911
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$144.68 |
| Max. Negotiated Rate |
$659.30 |
| Rate for Payer: Cash Price |
$416.40
|
| Rate for Payer: Cash Price |
$416.40
|
| Rate for Payer: Cigna Commercial |
$589.90
|
| Rate for Payer: First Health Commercial |
$624.60
|
| Rate for Payer: First Health Workers Compensation |
$204.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$624.60
|
| Rate for Payer: GEHA Commercial |
$485.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$624.60
|
| Rate for Payer: Multiplan All |
$631.54
|
| Rate for Payer: OMNI Networks Commercial |
$485.80
|
| Rate for Payer: One Health Plan PPO/POS |
$624.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$659.30
|
| Rate for Payer: Three Rivers Provider Network All |
$520.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$645.42
|
| Rate for Payer: Zelis Auto |
$277.60
|
| Rate for Payer: Zelis Worker's Compensation |
$144.68
|
|
|
MAM DIAGNOSTIC BILATERAL CONVENTIONAL
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT 77066
|
| Hospital Charge Code |
2766911
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$144.68 |
| Max. Negotiated Rate |
$659.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$237.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$416.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$237.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$188.45
|
| Rate for Payer: Cash Price |
$416.40
|
| Rate for Payer: Cash Price |
$416.40
|
| Rate for Payer: Cigna Commercial |
$589.90
|
| Rate for Payer: First Health Commercial |
$624.60
|
| Rate for Payer: First Health Workers Compensation |
$204.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$624.60
|
| Rate for Payer: GEHA Commercial |
$555.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$624.60
|
| Rate for Payer: Humana ChoiceCare |
$180.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$192.29
|
| Rate for Payer: Multiplan All |
$631.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$416.40
|
| Rate for Payer: OMNI Networks Commercial |
$485.80
|
| Rate for Payer: One Health Plan PPO/POS |
$624.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$222.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$192.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$659.30
|
| Rate for Payer: Three Rivers Provider Network All |
$520.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$610.72
|
| Rate for Payer: United Healthcare Commercial |
$589.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$192.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$645.42
|
| Rate for Payer: Zelis Auto |
$277.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$347.00
|
| Rate for Payer: Zelis Worker's Compensation |
$144.68
|
|
|
MAM NEEDLE LOC BREAST
|
Facility
|
IP
|
$1,693.00
|
|
| Hospital Charge Code |
2700072
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$462.19 |
| Max. Negotiated Rate |
$1,608.35 |
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$1,439.05
|
| Rate for Payer: First Health Commercial |
$1,523.70
|
| Rate for Payer: First Health Workers Compensation |
$653.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,523.70
|
| Rate for Payer: GEHA Commercial |
$1,185.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,523.70
|
| Rate for Payer: Multiplan All |
$1,540.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,185.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,523.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,608.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,269.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,574.49
|
| Rate for Payer: Zelis Auto |
$677.20
|
| Rate for Payer: Zelis Worker's Compensation |
$462.19
|
|
|
MAM NEEDLE LOC BREAST
|
Facility
|
OP
|
$1,693.00
|
|
| Hospital Charge Code |
2700072
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$423.25 |
| Max. Negotiated Rate |
$1,608.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$1,439.05
|
| Rate for Payer: First Health Commercial |
$1,523.70
|
| Rate for Payer: First Health Workers Compensation |
$653.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,523.70
|
| Rate for Payer: GEHA Commercial |
$1,354.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,523.70
|
| Rate for Payer: Humana ChoiceCare |
$440.18
|
| Rate for Payer: Multiplan All |
$1,540.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,015.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,185.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,523.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,608.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,269.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,574.49
|
| Rate for Payer: Zelis Auto |
$677.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$846.50
|
| Rate for Payer: Zelis Worker's Compensation |
$462.19
|
|
|
MAM SCREEN BILATERAL CONVENTIONAL
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
CPT 77067
|
| Hospital Charge Code |
2766910
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$116.58 |
| Max. Negotiated Rate |
$451.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$191.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$285.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$191.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$151.64
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cigna Commercial |
$403.75
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: First Health Workers Compensation |
$164.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$427.50
|
| Rate for Payer: GEHA Commercial |
$380.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$427.50
|
| Rate for Payer: Humana ChoiceCare |
$123.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$154.73
|
| Rate for Payer: Multiplan All |
$432.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$285.00
|
| Rate for Payer: OMNI Networks Commercial |
$332.50
|
| Rate for Payer: One Health Plan PPO/POS |
$427.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$178.65
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$154.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$451.25
|
| Rate for Payer: Three Rivers Provider Network All |
$356.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$418.00
|
| Rate for Payer: United Healthcare Commercial |
$403.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$154.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$441.75
|
| Rate for Payer: Zelis Auto |
$190.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$237.50
|
| Rate for Payer: Zelis Worker's Compensation |
$116.58
|
|
|
MAM SCREEN BILATERAL CONVENTIONAL
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
CPT 77067
|
| Hospital Charge Code |
2766910
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$116.58 |
| Max. Negotiated Rate |
$451.25 |
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cigna Commercial |
$403.75
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: First Health Workers Compensation |
$164.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$427.50
|
| Rate for Payer: GEHA Commercial |
$332.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$427.50
|
| Rate for Payer: Multiplan All |
$432.25
|
| Rate for Payer: OMNI Networks Commercial |
$332.50
|
| Rate for Payer: One Health Plan PPO/POS |
$427.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$451.25
|
| Rate for Payer: Three Rivers Provider Network All |
$356.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$441.75
|
| Rate for Payer: Zelis Auto |
$190.00
|
| Rate for Payer: Zelis Worker's Compensation |
$116.58
|
|
|
MAM UNILATERAL LEFT CONVENTIONAL
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
2766913
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$114.48 |
| Max. Negotiated Rate |
$514.90 |
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$460.70
|
| Rate for Payer: First Health Commercial |
$487.80
|
| Rate for Payer: First Health Workers Compensation |
$161.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$487.80
|
| Rate for Payer: GEHA Commercial |
$379.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$487.80
|
| Rate for Payer: Multiplan All |
$493.22
|
| Rate for Payer: OMNI Networks Commercial |
$379.40
|
| Rate for Payer: One Health Plan PPO/POS |
$487.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$514.90
|
| Rate for Payer: Three Rivers Provider Network All |
$406.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.06
|
| Rate for Payer: Zelis Auto |
$216.80
|
| Rate for Payer: Zelis Worker's Compensation |
$114.48
|
|
|
MAM UNILATERAL LEFT CONVENTIONAL
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
2766913
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$114.48 |
| Max. Negotiated Rate |
$514.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$188.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$325.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$188.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$149.24
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$460.70
|
| Rate for Payer: First Health Commercial |
$487.80
|
| Rate for Payer: First Health Workers Compensation |
$161.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$487.80
|
| Rate for Payer: GEHA Commercial |
$433.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$487.80
|
| Rate for Payer: Humana ChoiceCare |
$140.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$152.28
|
| Rate for Payer: Multiplan All |
$493.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$325.20
|
| Rate for Payer: OMNI Networks Commercial |
$379.40
|
| Rate for Payer: One Health Plan PPO/POS |
$487.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$175.83
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$152.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$514.90
|
| Rate for Payer: Three Rivers Provider Network All |
$406.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$476.96
|
| Rate for Payer: United Healthcare Commercial |
$460.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$152.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.06
|
| Rate for Payer: Zelis Auto |
$216.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$271.00
|
| Rate for Payer: Zelis Worker's Compensation |
$114.48
|
|
|
MAM UNILATERAL RIGHT CONVENTIONAL
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
2766912
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$114.48 |
| Max. Negotiated Rate |
$514.90 |
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$460.70
|
| Rate for Payer: First Health Commercial |
$487.80
|
| Rate for Payer: First Health Workers Compensation |
$161.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$487.80
|
| Rate for Payer: GEHA Commercial |
$379.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$487.80
|
| Rate for Payer: Multiplan All |
$493.22
|
| Rate for Payer: OMNI Networks Commercial |
$379.40
|
| Rate for Payer: One Health Plan PPO/POS |
$487.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$514.90
|
| Rate for Payer: Three Rivers Provider Network All |
$406.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.06
|
| Rate for Payer: Zelis Auto |
$216.80
|
| Rate for Payer: Zelis Worker's Compensation |
$114.48
|
|
|
MAM UNILATERAL RIGHT CONVENTIONAL
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
2766912
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$114.48 |
| Max. Negotiated Rate |
$514.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$188.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$325.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$188.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$149.24
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$460.70
|
| Rate for Payer: First Health Commercial |
$487.80
|
| Rate for Payer: First Health Workers Compensation |
$161.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$487.80
|
| Rate for Payer: GEHA Commercial |
$433.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$487.80
|
| Rate for Payer: Humana ChoiceCare |
$140.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$152.28
|
| Rate for Payer: Multiplan All |
$493.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$325.20
|
| Rate for Payer: OMNI Networks Commercial |
$379.40
|
| Rate for Payer: One Health Plan PPO/POS |
$487.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$175.83
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$152.28
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$514.90
|
| Rate for Payer: Three Rivers Provider Network All |
$406.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$476.96
|
| Rate for Payer: United Healthcare Commercial |
$460.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$152.28
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.06
|
| Rate for Payer: Zelis Auto |
$216.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$271.00
|
| Rate for Payer: Zelis Worker's Compensation |
$114.48
|
|
|
MANIPULATE ELBOW W/ANESTH
|
Facility
|
OP
|
$835.00
|
|
|
Service Code
|
CPT 24300
|
| Hospital Charge Code |
6124300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$227.96 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$501.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,224.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$501.00
|
| Rate for Payer: Cash Price |
$501.00
|
| Rate for Payer: Cigna Commercial |
$709.75
|
| Rate for Payer: First Health Commercial |
$751.50
|
| Rate for Payer: First Health Workers Compensation |
$322.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$751.50
|
| Rate for Payer: GEHA Commercial |
$668.00
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$751.50
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,249.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$759.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$584.50
|
| Rate for Payer: One Health Plan PPO/POS |
$751.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,443.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,249.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$793.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$626.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,249.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$776.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$334.00
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$227.96
|
|
|
MANIPULATE ELBOW W/ANESTH
|
Facility
|
IP
|
$835.00
|
|
|
Service Code
|
CPT 24300
|
| Hospital Charge Code |
6124300
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$227.96 |
| Max. Negotiated Rate |
$793.25 |
| Rate for Payer: Cash Price |
$501.00
|
| Rate for Payer: Cigna Commercial |
$709.75
|
| Rate for Payer: First Health Commercial |
$751.50
|
| Rate for Payer: First Health Workers Compensation |
$322.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$751.50
|
| Rate for Payer: GEHA Commercial |
$584.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$751.50
|
| Rate for Payer: Multiplan All |
$759.85
|
| Rate for Payer: OMNI Networks Commercial |
$584.50
|
| Rate for Payer: One Health Plan PPO/POS |
$751.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$793.25
|
| Rate for Payer: Three Rivers Provider Network All |
$626.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$776.55
|
| Rate for Payer: Zelis Auto |
$334.00
|
| Rate for Payer: Zelis Worker's Compensation |
$227.96
|
|
|
MANIPULATE FINGER W/ANESTH
|
Facility
|
OP
|
$826.00
|
|
|
Service Code
|
CPT 26340
|
| Hospital Charge Code |
6126340
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$225.50 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$484.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$495.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$484.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$384.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$495.60
|
| Rate for Payer: Cash Price |
$495.60
|
| Rate for Payer: Cigna Commercial |
$702.10
|
| Rate for Payer: First Health Commercial |
$743.40
|
| Rate for Payer: First Health Workers Compensation |
$318.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$743.40
|
| Rate for Payer: GEHA Commercial |
$660.80
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$743.40
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$391.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$751.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$578.20
|
| Rate for Payer: One Health Plan PPO/POS |
$743.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$452.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$391.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$784.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$619.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$391.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$768.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$330.40
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$225.50
|
|
|
MANIPULATE FINGER W/ANESTH
|
Facility
|
IP
|
$826.00
|
|
|
Service Code
|
CPT 26340
|
| Hospital Charge Code |
6126340
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$225.50 |
| Max. Negotiated Rate |
$784.70 |
| Rate for Payer: Cash Price |
$495.60
|
| Rate for Payer: Cigna Commercial |
$702.10
|
| Rate for Payer: First Health Commercial |
$743.40
|
| Rate for Payer: First Health Workers Compensation |
$318.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$743.40
|
| Rate for Payer: GEHA Commercial |
$578.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$743.40
|
| Rate for Payer: Multiplan All |
$751.66
|
| Rate for Payer: OMNI Networks Commercial |
$578.20
|
| Rate for Payer: One Health Plan PPO/POS |
$743.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$784.70
|
| Rate for Payer: Three Rivers Provider Network All |
$619.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$768.18
|
| Rate for Payer: Zelis Auto |
$330.40
|
| Rate for Payer: Zelis Worker's Compensation |
$225.50
|
|
|
MANIPULATE WRIST W/ANESTHES
|
Facility
|
IP
|
$829.00
|
|
|
Service Code
|
CPT 25259
|
| Hospital Charge Code |
6125259
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$226.32 |
| Max. Negotiated Rate |
$787.55 |
| Rate for Payer: Cash Price |
$497.40
|
| Rate for Payer: Cigna Commercial |
$704.65
|
| Rate for Payer: First Health Commercial |
$746.10
|
| Rate for Payer: First Health Workers Compensation |
$320.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$746.10
|
| Rate for Payer: GEHA Commercial |
$580.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$746.10
|
| Rate for Payer: Multiplan All |
$754.39
|
| Rate for Payer: OMNI Networks Commercial |
$580.30
|
| Rate for Payer: One Health Plan PPO/POS |
$746.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$787.55
|
| Rate for Payer: Three Rivers Provider Network All |
$621.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$770.97
|
| Rate for Payer: Zelis Auto |
$331.60
|
| Rate for Payer: Zelis Worker's Compensation |
$226.32
|
|
|
MANIPULATE WRIST W/ANESTHES
|
Facility
|
OP
|
$829.00
|
|
|
Service Code
|
CPT 25259
|
| Hospital Charge Code |
6125259
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$226.32 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,860.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$497.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,860.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,473.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$497.40
|
| Rate for Payer: Cash Price |
$497.40
|
| Rate for Payer: Cigna Commercial |
$704.65
|
| Rate for Payer: First Health Commercial |
$746.10
|
| Rate for Payer: First Health Workers Compensation |
$320.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$746.10
|
| Rate for Payer: GEHA Commercial |
$663.20
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$746.10
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,503.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$754.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$580.30
|
| Rate for Payer: One Health Plan PPO/POS |
$746.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,736.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,503.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$787.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$621.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,503.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$770.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$331.60
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$226.32
|
|
|
MANIPULATION OF HIP JOINT
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
CPT 27275
|
| Hospital Charge Code |
6127275
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$151.24 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$332.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,224.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$332.40
|
| Rate for Payer: Cash Price |
$332.40
|
| Rate for Payer: Cigna Commercial |
$470.90
|
| Rate for Payer: First Health Commercial |
$498.60
|
| Rate for Payer: First Health Workers Compensation |
$213.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$498.60
|
| Rate for Payer: GEHA Commercial |
$443.20
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$498.60
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,249.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$504.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$387.80
|
| Rate for Payer: One Health Plan PPO/POS |
$498.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,443.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,249.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$526.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$415.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,249.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$515.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$221.60
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$151.24
|
|
|
MANIPULATION OF HIP JOINT
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
CPT 27275
|
| Hospital Charge Code |
6127275
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$151.24 |
| Max. Negotiated Rate |
$526.30 |
| Rate for Payer: Cash Price |
$332.40
|
| Rate for Payer: Cigna Commercial |
$470.90
|
| Rate for Payer: First Health Commercial |
$498.60
|
| Rate for Payer: First Health Workers Compensation |
$213.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$498.60
|
| Rate for Payer: GEHA Commercial |
$387.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$498.60
|
| Rate for Payer: Multiplan All |
$504.14
|
| Rate for Payer: OMNI Networks Commercial |
$387.80
|
| Rate for Payer: One Health Plan PPO/POS |
$498.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$526.30
|
| Rate for Payer: Three Rivers Provider Network All |
$415.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$515.22
|
| Rate for Payer: Zelis Auto |
$221.60
|
| Rate for Payer: Zelis Worker's Compensation |
$151.24
|
|
|
MANIPULATION OF KNEE JOINT UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRACTION OR OTHER FIXATION DEVICES)
|
Facility
|
OP
|
$3,039.30
|
|
|
Service Code
|
CPT 27570
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,224.89 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,224.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: First Health Workers Compensation |
$1,955.79
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,249.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,443.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,249.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,249.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$1,382.88
|
|
|
MANIPULATION OF SPINE
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
CPT 22505
|
| Hospital Charge Code |
6122505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$108.11 |
| Max. Negotiated Rate |
$376.20 |
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$336.60
|
| Rate for Payer: First Health Commercial |
$356.40
|
| Rate for Payer: First Health Workers Compensation |
$152.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$356.40
|
| Rate for Payer: GEHA Commercial |
$277.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$356.40
|
| Rate for Payer: Multiplan All |
$360.36
|
| Rate for Payer: OMNI Networks Commercial |
$277.20
|
| Rate for Payer: One Health Plan PPO/POS |
$356.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$376.20
|
| Rate for Payer: Three Rivers Provider Network All |
$297.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$368.28
|
| Rate for Payer: Zelis Auto |
$158.40
|
| Rate for Payer: Zelis Worker's Compensation |
$108.11
|
|
