|
OPN TX DPRSD ZYGOMATIC ARCH
|
Facility
|
OP
|
$965.00
|
|
|
Service Code
|
CPT 21356
|
| Hospital Charge Code |
6121356
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$263.44 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$579.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$579.00
|
| Rate for Payer: Cash Price |
$579.00
|
| Rate for Payer: Cigna Commercial |
$820.25
|
| Rate for Payer: First Health Commercial |
$868.50
|
| Rate for Payer: First Health Workers Compensation |
$372.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$868.50
|
| Rate for Payer: GEHA Commercial |
$772.00
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$868.50
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$878.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$675.50
|
| Rate for Payer: One Health Plan PPO/POS |
$868.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$916.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$723.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$897.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$386.00
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$263.44
|
|
|
OPN TX DPRSD ZYGOMATIC ARCH
|
Facility
|
IP
|
$965.00
|
|
|
Service Code
|
CPT 21356
|
| Hospital Charge Code |
6121356
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$263.44 |
| Max. Negotiated Rate |
$916.75 |
| Rate for Payer: Cash Price |
$579.00
|
| Rate for Payer: Cigna Commercial |
$820.25
|
| Rate for Payer: First Health Commercial |
$868.50
|
| Rate for Payer: First Health Workers Compensation |
$372.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$868.50
|
| Rate for Payer: GEHA Commercial |
$675.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$868.50
|
| Rate for Payer: Multiplan All |
$878.15
|
| Rate for Payer: OMNI Networks Commercial |
$675.50
|
| Rate for Payer: One Health Plan PPO/POS |
$868.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$916.75
|
| Rate for Payer: Three Rivers Provider Network All |
$723.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$897.45
|
| Rate for Payer: Zelis Auto |
$386.00
|
| Rate for Payer: Zelis Worker's Compensation |
$263.44
|
|
|
OPN TX NASOMAX FX MULTPLE
|
Facility
|
IP
|
$2,308.00
|
|
|
Service Code
|
CPT 21347
|
| Hospital Charge Code |
6121347
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$630.08 |
| Max. Negotiated Rate |
$2,192.60 |
| Rate for Payer: Cash Price |
$1,384.80
|
| Rate for Payer: Cigna Commercial |
$1,961.80
|
| Rate for Payer: First Health Commercial |
$2,077.20
|
| Rate for Payer: First Health Workers Compensation |
$891.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,077.20
|
| Rate for Payer: GEHA Commercial |
$1,615.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,077.20
|
| Rate for Payer: Multiplan All |
$2,100.28
|
| Rate for Payer: OMNI Networks Commercial |
$1,615.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,077.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,192.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,731.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,146.44
|
| Rate for Payer: Zelis Auto |
$923.20
|
| Rate for Payer: Zelis Worker's Compensation |
$630.08
|
|
|
OPN TX NASOMAX FX MULTPLE
|
Facility
|
OP
|
$2,308.00
|
|
|
Service Code
|
CPT 21347
|
| Hospital Charge Code |
6121347
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$630.08 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,369.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,384.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,369.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6,630.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,384.80
|
| Rate for Payer: Cash Price |
$1,384.80
|
| Rate for Payer: Cigna Commercial |
$1,961.80
|
| Rate for Payer: First Health Commercial |
$2,077.20
|
| Rate for Payer: First Health Workers Compensation |
$891.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,077.20
|
| Rate for Payer: GEHA Commercial |
$1,846.40
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,077.20
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6,765.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$2,100.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,615.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,077.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7,811.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6,765.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,192.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,731.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6,765.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,146.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$923.20
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$630.08
|
|
|
OPN TX NASOMAX FX W/FIXJ
|
Facility
|
OP
|
$1,849.00
|
|
|
Service Code
|
CPT 21346
|
| Hospital Charge Code |
6121346
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$504.78 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,516.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,109.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,516.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,993.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,109.40
|
| Rate for Payer: Cash Price |
$1,109.40
|
| Rate for Payer: Cigna Commercial |
$1,571.65
|
| Rate for Payer: First Health Commercial |
$1,664.10
|
| Rate for Payer: First Health Workers Compensation |
$713.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,664.10
|
| Rate for Payer: GEHA Commercial |
$1,479.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,664.10
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,034.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,682.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,294.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,664.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,348.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,034.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,756.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,386.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,034.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,719.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$739.60
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$504.78
|
|
|
OPN TX NASOMAX FX W/FIXJ
|
Facility
|
IP
|
$1,849.00
|
|
|
Service Code
|
CPT 21346
|
| Hospital Charge Code |
6121346
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$504.78 |
| Max. Negotiated Rate |
$1,756.55 |
| Rate for Payer: Cash Price |
$1,109.40
|
| Rate for Payer: Cigna Commercial |
$1,571.65
|
| Rate for Payer: First Health Commercial |
$1,664.10
|
| Rate for Payer: First Health Workers Compensation |
$713.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,664.10
|
| Rate for Payer: GEHA Commercial |
$1,294.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,664.10
|
| Rate for Payer: Multiplan All |
$1,682.59
|
| Rate for Payer: OMNI Networks Commercial |
$1,294.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,664.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,756.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,386.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,719.57
|
| Rate for Payer: Zelis Auto |
$739.60
|
| Rate for Payer: Zelis Worker's Compensation |
$504.78
|
|
|
OPN TX NASOMAX FX W/GRAFT
|
Facility
|
OP
|
$2,479.00
|
|
|
Service Code
|
CPT 21348
|
| Hospital Charge Code |
6121348
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$619.75 |
| Max. Negotiated Rate |
$2,355.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,487.40
|
| Rate for Payer: Cash Price |
$1,487.40
|
| Rate for Payer: Cigna Commercial |
$2,107.15
|
| Rate for Payer: First Health Commercial |
$2,231.10
|
| Rate for Payer: First Health Workers Compensation |
$957.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,231.10
|
| Rate for Payer: GEHA Commercial |
$1,983.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,231.10
|
| Rate for Payer: Humana ChoiceCare |
$644.54
|
| Rate for Payer: Multiplan All |
$2,255.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,487.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,735.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,231.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,355.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,859.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,181.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$619.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,305.47
|
| Rate for Payer: Zelis Auto |
$991.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,239.50
|
| Rate for Payer: Zelis Worker's Compensation |
$676.77
|
|
|
OPN TX NASOMAX FX W/GRAFT
|
Facility
|
IP
|
$2,479.00
|
|
|
Service Code
|
CPT 21348
|
| Hospital Charge Code |
6121348
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$676.77 |
| Max. Negotiated Rate |
$2,355.05 |
| Rate for Payer: Cash Price |
$1,487.40
|
| Rate for Payer: Cigna Commercial |
$2,107.15
|
| Rate for Payer: First Health Commercial |
$2,231.10
|
| Rate for Payer: First Health Workers Compensation |
$957.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,231.10
|
| Rate for Payer: GEHA Commercial |
$1,735.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,231.10
|
| Rate for Payer: Multiplan All |
$2,255.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,735.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,231.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,355.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,859.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,305.47
|
| Rate for Payer: Zelis Auto |
$991.60
|
| Rate for Payer: Zelis Worker's Compensation |
$676.77
|
|
|
OPN TX ORBIT FX COMBINED
|
Facility
|
OP
|
$1,458.00
|
|
|
Service Code
|
CPT 21387
|
| Hospital Charge Code |
6121387
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$398.03 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$874.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$1,239.30
|
| Rate for Payer: First Health Commercial |
$1,312.20
|
| Rate for Payer: First Health Workers Compensation |
$562.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,312.20
|
| Rate for Payer: GEHA Commercial |
$1,166.40
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,312.20
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,326.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,020.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,312.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,385.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,093.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,355.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$583.20
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$398.03
|
|
|
OPN TX ORBIT FX COMBINED
|
Facility
|
IP
|
$1,458.00
|
|
|
Service Code
|
CPT 21387
|
| Hospital Charge Code |
6121387
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$398.03 |
| Max. Negotiated Rate |
$1,385.10 |
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$1,239.30
|
| Rate for Payer: First Health Commercial |
$1,312.20
|
| Rate for Payer: First Health Workers Compensation |
$562.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,312.20
|
| Rate for Payer: GEHA Commercial |
$1,020.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,312.20
|
| Rate for Payer: Multiplan All |
$1,326.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,020.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,312.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,385.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,093.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,355.94
|
| Rate for Payer: Zelis Auto |
$583.20
|
| Rate for Payer: Zelis Worker's Compensation |
$398.03
|
|
|
OPN TX ORBIT FX PERIORBITAL
|
Facility
|
IP
|
$1,420.00
|
|
|
Service Code
|
CPT 21386
|
| Hospital Charge Code |
6121386
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$387.66 |
| Max. Negotiated Rate |
$1,349.00 |
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Cigna Commercial |
$1,207.00
|
| Rate for Payer: First Health Commercial |
$1,278.00
|
| Rate for Payer: First Health Workers Compensation |
$548.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,278.00
|
| Rate for Payer: GEHA Commercial |
$994.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,278.00
|
| Rate for Payer: Multiplan All |
$1,292.20
|
| Rate for Payer: OMNI Networks Commercial |
$994.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,278.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,349.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,065.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,320.60
|
| Rate for Payer: Zelis Auto |
$568.00
|
| Rate for Payer: Zelis Worker's Compensation |
$387.66
|
|
|
OPN TX ORBIT FX PERIORBITAL
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
CPT 21386
|
| Hospital Charge Code |
6121386
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$387.66 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$852.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Cigna Commercial |
$1,207.00
|
| Rate for Payer: First Health Commercial |
$1,278.00
|
| Rate for Payer: First Health Workers Compensation |
$548.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,278.00
|
| Rate for Payer: GEHA Commercial |
$1,136.00
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,278.00
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,292.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$994.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,278.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,349.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,065.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,320.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$568.00
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$387.66
|
|
|
OPN TX ORBIT FX TRANSANTRAL
|
Facility
|
OP
|
$1,393.00
|
|
|
Service Code
|
CPT 21385
|
| Hospital Charge Code |
6121385
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$380.29 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$835.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$835.80
|
| Rate for Payer: Cash Price |
$835.80
|
| Rate for Payer: Cigna Commercial |
$1,184.05
|
| Rate for Payer: First Health Commercial |
$1,253.70
|
| Rate for Payer: First Health Workers Compensation |
$537.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,253.70
|
| Rate for Payer: GEHA Commercial |
$1,114.40
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,253.70
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,267.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$975.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,253.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,323.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,044.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,295.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$557.20
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$380.29
|
|
|
OPN TX ORBIT FX TRANSANTRAL
|
Facility
|
IP
|
$1,393.00
|
|
|
Service Code
|
CPT 21385
|
| Hospital Charge Code |
6121385
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$380.29 |
| Max. Negotiated Rate |
$1,323.35 |
| Rate for Payer: Cash Price |
$835.80
|
| Rate for Payer: Cigna Commercial |
$1,184.05
|
| Rate for Payer: First Health Commercial |
$1,253.70
|
| Rate for Payer: First Health Workers Compensation |
$537.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,253.70
|
| Rate for Payer: GEHA Commercial |
$975.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,253.70
|
| Rate for Payer: Multiplan All |
$1,267.63
|
| Rate for Payer: OMNI Networks Commercial |
$975.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,253.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,323.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,044.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,295.49
|
| Rate for Payer: Zelis Auto |
$557.20
|
| Rate for Payer: Zelis Worker's Compensation |
$380.29
|
|
|
OPN TX ORBIT FX W/BONE GRFT
|
Facility
|
OP
|
$1,797.00
|
|
|
Service Code
|
CPT 21408
|
| Hospital Charge Code |
6121408
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$490.58 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,078.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,078.20
|
| Rate for Payer: Cash Price |
$1,078.20
|
| Rate for Payer: Cigna Commercial |
$1,527.45
|
| Rate for Payer: First Health Commercial |
$1,617.30
|
| Rate for Payer: First Health Workers Compensation |
$693.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,617.30
|
| Rate for Payer: GEHA Commercial |
$1,437.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,617.30
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,635.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,257.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,617.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,707.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,347.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,671.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$718.80
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$490.58
|
|
|
OPN TX ORBIT FX W/BONE GRFT
|
Facility
|
IP
|
$1,797.00
|
|
|
Service Code
|
CPT 21408
|
| Hospital Charge Code |
6121408
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$490.58 |
| Max. Negotiated Rate |
$1,707.15 |
| Rate for Payer: Cash Price |
$1,078.20
|
| Rate for Payer: Cigna Commercial |
$1,527.45
|
| Rate for Payer: First Health Commercial |
$1,617.30
|
| Rate for Payer: First Health Workers Compensation |
$693.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,617.30
|
| Rate for Payer: GEHA Commercial |
$1,257.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,617.30
|
| Rate for Payer: Multiplan All |
$1,635.27
|
| Rate for Payer: OMNI Networks Commercial |
$1,257.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,617.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,707.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,347.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,671.21
|
| Rate for Payer: Zelis Auto |
$718.80
|
| Rate for Payer: Zelis Worker's Compensation |
$490.58
|
|
|
OPN TX ORBIT FX W/IMPLANT
|
Facility
|
OP
|
$1,317.00
|
|
|
Service Code
|
CPT 21407
|
| Hospital Charge Code |
6121407
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$359.54 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$790.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Cigna Commercial |
$1,119.45
|
| Rate for Payer: First Health Commercial |
$1,185.30
|
| Rate for Payer: First Health Workers Compensation |
$508.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,185.30
|
| Rate for Payer: GEHA Commercial |
$1,053.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,185.30
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,198.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$921.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,185.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,251.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$987.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,224.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$526.80
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$359.54
|
|
|
OPN TX ORBIT FX W/IMPLANT
|
Facility
|
IP
|
$1,317.00
|
|
|
Service Code
|
CPT 21407
|
| Hospital Charge Code |
6121407
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$359.54 |
| Max. Negotiated Rate |
$1,251.15 |
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Cigna Commercial |
$1,119.45
|
| Rate for Payer: First Health Commercial |
$1,185.30
|
| Rate for Payer: First Health Workers Compensation |
$508.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,185.30
|
| Rate for Payer: GEHA Commercial |
$921.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,185.30
|
| Rate for Payer: Multiplan All |
$1,198.47
|
| Rate for Payer: OMNI Networks Commercial |
$921.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,185.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,251.15
|
| Rate for Payer: Three Rivers Provider Network All |
$987.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,224.81
|
| Rate for Payer: Zelis Auto |
$526.80
|
| Rate for Payer: Zelis Worker's Compensation |
$359.54
|
|
|
OPN TX ORBIT FX W/O IMPLANT
|
Facility
|
IP
|
$1,063.00
|
|
|
Service Code
|
CPT 21406
|
| Hospital Charge Code |
6121406
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$290.20 |
| Max. Negotiated Rate |
$1,009.85 |
| Rate for Payer: Cash Price |
$637.80
|
| Rate for Payer: Cigna Commercial |
$903.55
|
| Rate for Payer: First Health Commercial |
$956.70
|
| Rate for Payer: First Health Workers Compensation |
$410.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$956.70
|
| Rate for Payer: GEHA Commercial |
$744.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$956.70
|
| Rate for Payer: Multiplan All |
$967.33
|
| Rate for Payer: OMNI Networks Commercial |
$744.10
|
| Rate for Payer: One Health Plan PPO/POS |
$956.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,009.85
|
| Rate for Payer: Three Rivers Provider Network All |
$797.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$988.59
|
| Rate for Payer: Zelis Auto |
$425.20
|
| Rate for Payer: Zelis Worker's Compensation |
$290.20
|
|
|
OPN TX ORBIT FX W/O IMPLANT
|
Facility
|
OP
|
$1,063.00
|
|
|
Service Code
|
CPT 21406
|
| Hospital Charge Code |
6121406
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$290.20 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$637.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$637.80
|
| Rate for Payer: Cash Price |
$637.80
|
| Rate for Payer: Cigna Commercial |
$903.55
|
| Rate for Payer: First Health Commercial |
$956.70
|
| Rate for Payer: First Health Workers Compensation |
$410.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$956.70
|
| Rate for Payer: GEHA Commercial |
$850.40
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$956.70
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$967.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$744.10
|
| Rate for Payer: One Health Plan PPO/POS |
$956.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,009.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$797.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$988.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$425.20
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$290.20
|
|
|
OPN TX ORBIT PERIORBTL IMPLT
|
Facility
|
IP
|
$1,619.00
|
|
|
Service Code
|
CPT 21390
|
| Hospital Charge Code |
6121390
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$441.99 |
| Max. Negotiated Rate |
$1,538.05 |
| Rate for Payer: Cash Price |
$971.40
|
| Rate for Payer: Cigna Commercial |
$1,376.15
|
| Rate for Payer: First Health Commercial |
$1,457.10
|
| Rate for Payer: First Health Workers Compensation |
$625.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,457.10
|
| Rate for Payer: GEHA Commercial |
$1,133.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,457.10
|
| Rate for Payer: Multiplan All |
$1,473.29
|
| Rate for Payer: OMNI Networks Commercial |
$1,133.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,457.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,538.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,214.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,505.67
|
| Rate for Payer: Zelis Auto |
$647.60
|
| Rate for Payer: Zelis Worker's Compensation |
$441.99
|
|
|
OPN TX ORBIT PERIORBTL IMPLT
|
Facility
|
OP
|
$1,619.00
|
|
|
Service Code
|
CPT 21390
|
| Hospital Charge Code |
6121390
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$441.99 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$971.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$971.40
|
| Rate for Payer: Cash Price |
$971.40
|
| Rate for Payer: Cigna Commercial |
$1,376.15
|
| Rate for Payer: First Health Commercial |
$1,457.10
|
| Rate for Payer: First Health Workers Compensation |
$625.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,457.10
|
| Rate for Payer: GEHA Commercial |
$1,295.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,457.10
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,473.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,133.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,457.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,538.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,214.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,505.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$647.60
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$441.99
|
|
|
OPN TX ORBIT PERIORBT W/GRFT
|
Facility
|
OP
|
$2,057.00
|
|
|
Service Code
|
CPT 21395
|
| Hospital Charge Code |
6121395
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$561.56 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,518.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,234.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,518.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,579.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,234.20
|
| Rate for Payer: Cash Price |
$1,234.20
|
| Rate for Payer: Cigna Commercial |
$1,748.45
|
| Rate for Payer: First Health Commercial |
$1,851.30
|
| Rate for Payer: First Health Workers Compensation |
$794.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,851.30
|
| Rate for Payer: GEHA Commercial |
$1,645.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,851.30
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,652.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,871.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,439.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,851.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,217.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,652.50
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,954.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,542.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,652.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,913.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$822.80
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$561.56
|
|
|
OPN TX ORBIT PERIORBT W/GRFT
|
Facility
|
IP
|
$2,057.00
|
|
|
Service Code
|
CPT 21395
|
| Hospital Charge Code |
6121395
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$561.56 |
| Max. Negotiated Rate |
$1,954.15 |
| Rate for Payer: Cash Price |
$1,234.20
|
| Rate for Payer: Cigna Commercial |
$1,748.45
|
| Rate for Payer: First Health Commercial |
$1,851.30
|
| Rate for Payer: First Health Workers Compensation |
$794.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,851.30
|
| Rate for Payer: GEHA Commercial |
$1,439.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,851.30
|
| Rate for Payer: Multiplan All |
$1,871.87
|
| Rate for Payer: OMNI Networks Commercial |
$1,439.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,851.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,954.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,542.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,913.01
|
| Rate for Payer: Zelis Auto |
$822.80
|
| Rate for Payer: Zelis Worker's Compensation |
$561.56
|
|
|
OPTX MEDIAL ANKLE FX
|
Facility
|
IP
|
$1,246.00
|
|
|
Service Code
|
CPT 27766
|
| Hospital Charge Code |
6127766
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$340.16 |
| Max. Negotiated Rate |
$1,183.70 |
| Rate for Payer: Cash Price |
$747.60
|
| Rate for Payer: Cigna Commercial |
$1,059.10
|
| Rate for Payer: First Health Commercial |
$1,121.40
|
| Rate for Payer: First Health Workers Compensation |
$481.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,121.40
|
| Rate for Payer: GEHA Commercial |
$872.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,121.40
|
| Rate for Payer: Multiplan All |
$1,133.86
|
| Rate for Payer: OMNI Networks Commercial |
$872.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,121.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,183.70
|
| Rate for Payer: Three Rivers Provider Network All |
$934.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,158.78
|
| Rate for Payer: Zelis Auto |
$498.40
|
| Rate for Payer: Zelis Worker's Compensation |
$340.16
|
|
