|
OSELTAMIVIR PHOSPHATE 75MG CAP
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
NDC 68180067711
|
| Hospital Charge Code |
3300678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.25 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$75.65
|
| Rate for Payer: First Health Commercial |
$80.10
|
| Rate for Payer: First Health Workers Compensation |
$34.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$80.10
|
| Rate for Payer: GEHA Commercial |
$71.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$80.10
|
| Rate for Payer: Humana ChoiceCare |
$23.14
|
| Rate for Payer: Multiplan All |
$80.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$53.40
|
| Rate for Payer: OMNI Networks Commercial |
$62.30
|
| Rate for Payer: One Health Plan PPO/POS |
$80.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$84.55
|
| Rate for Payer: Three Rivers Provider Network All |
$66.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$78.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$22.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$82.77
|
| Rate for Payer: Zelis Auto |
$35.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$44.50
|
| Rate for Payer: Zelis Worker's Compensation |
$24.30
|
|
|
osmolality 24hr urine REF003442
|
Facility
|
IP
|
$180.00
|
|
| Hospital Charge Code |
2233935
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$153.00
|
| Rate for Payer: First Health Commercial |
$162.00
|
| Rate for Payer: First Health Workers Compensation |
$69.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.00
|
| Rate for Payer: GEHA Commercial |
$126.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.00
|
| Rate for Payer: Multiplan All |
$163.80
|
| Rate for Payer: OMNI Networks Commercial |
$126.00
|
| Rate for Payer: One Health Plan PPO/POS |
$162.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.00
|
| Rate for Payer: Three Rivers Provider Network All |
$135.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$167.40
|
| Rate for Payer: Zelis Auto |
$72.00
|
| Rate for Payer: Zelis Worker's Compensation |
$49.14
|
|
|
osmolality 24hr urine REF003442
|
Facility
|
OP
|
$180.00
|
|
| Hospital Charge Code |
2233935
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$153.00
|
| Rate for Payer: First Health Commercial |
$162.00
|
| Rate for Payer: First Health Workers Compensation |
$69.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.00
|
| Rate for Payer: GEHA Commercial |
$144.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.00
|
| Rate for Payer: Humana ChoiceCare |
$46.80
|
| Rate for Payer: Multiplan All |
$163.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$108.00
|
| Rate for Payer: OMNI Networks Commercial |
$126.00
|
| Rate for Payer: One Health Plan PPO/POS |
$162.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.00
|
| Rate for Payer: Three Rivers Provider Network All |
$135.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$158.40
|
| Rate for Payer: United Healthcare Commercial |
$153.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$167.40
|
| Rate for Payer: Zelis Auto |
$72.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$90.00
|
| Rate for Payer: Zelis Worker's Compensation |
$49.14
|
|
|
osmolality serum/plasma REF002071
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
2233936
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$73.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.61
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: First Health Workers Compensation |
$11.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$97.60
|
| Rate for Payer: GEHA Medicare |
$6.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Humana ChoiceCare |
$7.27
|
| Rate for Payer: Humana Medicare Advantage |
$6.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.61
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.24
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13.22
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.48
|
| Rate for Payer: United Healthcare Commercial |
$103.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.61
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Medicare |
$5.62
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.93
|
| Rate for Payer: Zelis Worker's Compensation |
$8.22
|
|
|
osmolality serum/plasma REF002071
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
2233936
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.22 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$103.70
|
| Rate for Payer: First Health Commercial |
$109.80
|
| Rate for Payer: First Health Workers Compensation |
$11.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$109.80
|
| Rate for Payer: GEHA Commercial |
$85.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$109.80
|
| Rate for Payer: Multiplan All |
$111.02
|
| Rate for Payer: OMNI Networks Commercial |
$85.40
|
| Rate for Payer: One Health Plan PPO/POS |
$109.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$115.90
|
| Rate for Payer: Three Rivers Provider Network All |
$91.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$113.46
|
| Rate for Payer: Zelis Auto |
$48.80
|
| Rate for Payer: Zelis Worker's Compensation |
$8.22
|
|
|
osmolality urine random REF003442
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
2233930
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$12.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$108.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$12.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.82
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$153.00
|
| Rate for Payer: First Health Commercial |
$162.00
|
| Rate for Payer: First Health Workers Compensation |
$12.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.00
|
| Rate for Payer: GEHA Commercial |
$144.00
|
| Rate for Payer: GEHA Medicare |
$6.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.00
|
| Rate for Payer: Humana ChoiceCare |
$7.50
|
| Rate for Payer: Humana Medicare Advantage |
$6.82
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.82
|
| Rate for Payer: Multiplan All |
$163.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.59
|
| Rate for Payer: OMNI Networks Commercial |
$126.00
|
| Rate for Payer: One Health Plan PPO/POS |
$162.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13.64
|
| Rate for Payer: Three Rivers Provider Network All |
$135.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.68
|
| Rate for Payer: United Healthcare Commercial |
$153.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$167.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.82
|
| Rate for Payer: Zelis Auto |
$72.00
|
| Rate for Payer: Zelis Medicare |
$5.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.18
|
| Rate for Payer: Zelis Worker's Compensation |
$8.71
|
|
|
osmolality urine random REF003442
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
2233930
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$153.00
|
| Rate for Payer: First Health Commercial |
$162.00
|
| Rate for Payer: First Health Workers Compensation |
$12.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$162.00
|
| Rate for Payer: GEHA Commercial |
$126.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$162.00
|
| Rate for Payer: Multiplan All |
$163.80
|
| Rate for Payer: OMNI Networks Commercial |
$126.00
|
| Rate for Payer: One Health Plan PPO/POS |
$162.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$171.00
|
| Rate for Payer: Three Rivers Provider Network All |
$135.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$167.40
|
| Rate for Payer: Zelis Auto |
$72.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.71
|
|
|
OSTECTOMY, CALCANEUS;
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 28118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,749.66 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| 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 |
$2,803.61
|
|
|
OSTECTOMY, CALCANEUS; FOR SPUR, WITH OR WITHOUT PLANTAR FASCIAL RELEASE
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 28119
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,749.66 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| 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 |
$2,803.61
|
|
|
OSTECTOMY, COMPLETE EXCISION; OTHER METATARSAL HEAD (SECOND, THIRD OR FOURTH)
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 28112
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,749.66 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| 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 |
$2,803.61
|
|
|
OSTECTOMY, PARTIAL EXCISION, FIFTH METATARSAL HEAD (BUNIONETTE) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 28110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,749.66 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| 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 |
$2,803.61
|
|
|
OSTECTOMY, PARTIAL, EXOSTECTOMY OR CONDYLECTOMY, METATARSAL HEAD, EACH METATARSAL HEAD
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 28288
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,749.66 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| 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 |
$2,803.61
|
|
|
OSTEOCHONDRAL KNEE ALLOGRAFT
|
Facility
|
OP
|
$2,829.00
|
|
|
Service Code
|
CPT 27415
|
| Hospital Charge Code |
6127415
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$772.32 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,697.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7,100.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Cigna Commercial |
$2,404.65
|
| Rate for Payer: First Health Commercial |
$2,546.10
|
| Rate for Payer: First Health Workers Compensation |
$1,092.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,546.10
|
| Rate for Payer: GEHA Commercial |
$2,263.20
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,546.10
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$2,574.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,980.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,546.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8,365.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7,245.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,687.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$2,121.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,630.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$1,131.60
|
| Rate for Payer: Zelis Medicare |
$10,384.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,661.07
|
| Rate for Payer: Zelis Worker's Compensation |
$772.32
|
|
|
OSTEOCHONDRAL KNEE ALLOGRAFT
|
Facility
|
IP
|
$2,829.00
|
|
|
Service Code
|
CPT 27415
|
| Hospital Charge Code |
6127415
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$772.32 |
| Max. Negotiated Rate |
$2,687.55 |
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Cigna Commercial |
$2,404.65
|
| Rate for Payer: First Health Commercial |
$2,546.10
|
| Rate for Payer: First Health Workers Compensation |
$1,092.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,546.10
|
| Rate for Payer: GEHA Commercial |
$1,980.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,546.10
|
| Rate for Payer: Multiplan All |
$2,574.39
|
| Rate for Payer: OMNI Networks Commercial |
$1,980.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,546.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,687.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,121.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,630.97
|
| Rate for Payer: Zelis Auto |
$1,131.60
|
| Rate for Payer: Zelis Worker's Compensation |
$772.32
|
|
|
OSTEOCHONDRAL KNEE AUTOGRAFT
|
Facility
|
OP
|
$2,016.00
|
|
|
Service Code
|
CPT 27416
|
| Hospital Charge Code |
6127416
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$550.37 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,209.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Cigna Commercial |
$1,713.60
|
| Rate for Payer: First Health Commercial |
$1,814.40
|
| Rate for Payer: First Health Workers Compensation |
$778.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,814.40
|
| Rate for Payer: GEHA Commercial |
$1,612.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,814.40
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,834.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,411.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,814.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,915.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,512.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,874.88
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$806.40
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$550.37
|
|
|
OSTEOCHONDRAL KNEE AUTOGRAFT
|
Facility
|
IP
|
$2,016.00
|
|
|
Service Code
|
CPT 27416
|
| Hospital Charge Code |
6127416
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$550.37 |
| Max. Negotiated Rate |
$1,915.20 |
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Cigna Commercial |
$1,713.60
|
| Rate for Payer: First Health Commercial |
$1,814.40
|
| Rate for Payer: First Health Workers Compensation |
$778.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,814.40
|
| Rate for Payer: GEHA Commercial |
$1,411.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,814.40
|
| Rate for Payer: Multiplan All |
$1,834.56
|
| Rate for Payer: OMNI Networks Commercial |
$1,411.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,814.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,915.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,512.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,874.88
|
| Rate for Payer: Zelis Auto |
$806.40
|
| Rate for Payer: Zelis Worker's Compensation |
$550.37
|
|
|
OSTEOCHONDRAL TALUS AUTOGRFT
|
Facility
|
IP
|
$2,497.00
|
|
|
Service Code
|
CPT 28446
|
| Hospital Charge Code |
6128446
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$681.68 |
| Max. Negotiated Rate |
$2,372.15 |
| Rate for Payer: Cash Price |
$1,498.20
|
| Rate for Payer: Cigna Commercial |
$2,122.45
|
| Rate for Payer: First Health Commercial |
$2,247.30
|
| Rate for Payer: First Health Workers Compensation |
$964.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,247.30
|
| Rate for Payer: GEHA Commercial |
$1,747.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,247.30
|
| Rate for Payer: Multiplan All |
$2,272.27
|
| Rate for Payer: OMNI Networks Commercial |
$1,747.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,247.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,372.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,872.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,322.21
|
| Rate for Payer: Zelis Auto |
$998.80
|
| Rate for Payer: Zelis Worker's Compensation |
$681.68
|
|
|
OSTEOCHONDRAL TALUS AUTOGRFT
|
Facility
|
OP
|
$2,497.00
|
|
|
Service Code
|
CPT 28446
|
| Hospital Charge Code |
6128446
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$681.68 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,498.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,207.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,498.20
|
| Rate for Payer: Cash Price |
$1,498.20
|
| Rate for Payer: Cigna Commercial |
$2,122.45
|
| Rate for Payer: First Health Commercial |
$2,247.30
|
| Rate for Payer: First Health Workers Compensation |
$964.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,247.30
|
| Rate for Payer: GEHA Commercial |
$1,997.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,247.30
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,292.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$2,272.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,747.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,247.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,956.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,292.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,372.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,872.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,292.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,322.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$998.80
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$681.68
|
|
|
OSTEOTOMY; CALCANEUS (EG, DWYER OR CHAMBERS TYPE PROCEDURE), WITH OR WITHOUT INTERNAL FIXATION
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 28300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,207.24 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,310.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,207.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,292.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,956.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,292.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,292.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$6,172.77
|
|
|
OSTEOTOMY; FIBULA
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 27707
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,763.37 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| 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 |
$2,803.61
|
|
|
OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, METATARSAL; OTHER THAN FIRST METATARSAL, EACH
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 28308
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,749.66 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| 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 |
$2,803.61
|
|
|
OTA ADL TRNG
|
Facility
|
OP
|
$436.00
|
|
|
Service Code
|
CPT 97535 GO,CO
|
| Hospital Charge Code |
4597535
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$43.42 |
| Max. Negotiated Rate |
$414.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$68.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$261.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$68.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$54.51
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$370.60
|
| Rate for Payer: First Health Commercial |
$392.40
|
| Rate for Payer: First Health Workers Compensation |
$61.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$392.40
|
| Rate for Payer: GEHA Commercial |
$348.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$392.40
|
| Rate for Payer: Humana ChoiceCare |
$113.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$55.62
|
| Rate for Payer: Multiplan All |
$396.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$261.60
|
| Rate for Payer: OMNI Networks Commercial |
$305.20
|
| Rate for Payer: One Health Plan PPO/POS |
$392.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$64.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$55.62
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$414.20
|
| Rate for Payer: Three Rivers Provider Network All |
$327.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$383.68
|
| Rate for Payer: United Healthcare Commercial |
$370.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$55.62
|
| Rate for Payer: United Payors & United Providers UP&UP |
$405.48
|
| Rate for Payer: Zelis Auto |
$174.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$218.00
|
| Rate for Payer: Zelis Worker's Compensation |
$43.42
|
|
|
OTA ADL TRNG
|
Facility
|
IP
|
$436.00
|
|
|
Service Code
|
CPT 97535 GO,CO
|
| Hospital Charge Code |
4597535
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$119.03 |
| Max. Negotiated Rate |
$414.20 |
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$370.60
|
| Rate for Payer: First Health Commercial |
$392.40
|
| Rate for Payer: First Health Workers Compensation |
$168.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$392.40
|
| Rate for Payer: GEHA Commercial |
$305.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$392.40
|
| Rate for Payer: Multiplan All |
$396.76
|
| Rate for Payer: OMNI Networks Commercial |
$305.20
|
| Rate for Payer: One Health Plan PPO/POS |
$392.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$414.20
|
| Rate for Payer: Three Rivers Provider Network All |
$327.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$405.48
|
| Rate for Payer: Zelis Auto |
$174.40
|
| Rate for Payer: Zelis Worker's Compensation |
$119.03
|
|
|
OTA AQUATIC THERAPY WITH THERAPEUTIC EXE
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 97113 GO,CO
|
| Hospital Charge Code |
4597815
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$49.96 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$155.55
|
| Rate for Payer: First Health Commercial |
$164.70
|
| Rate for Payer: First Health Workers Compensation |
$70.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$164.70
|
| Rate for Payer: GEHA Commercial |
$128.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$164.70
|
| Rate for Payer: Multiplan All |
$166.53
|
| Rate for Payer: OMNI Networks Commercial |
$128.10
|
| Rate for Payer: One Health Plan PPO/POS |
$164.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$173.85
|
| Rate for Payer: Three Rivers Provider Network All |
$137.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$170.19
|
| Rate for Payer: Zelis Auto |
$73.20
|
| Rate for Payer: Zelis Worker's Compensation |
$49.96
|
|
|
OTA AQUATIC THERAPY WITH THERAPEUTIC EXE
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 97113 GO,CO
|
| Hospital Charge Code |
4597815
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$77.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$109.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$77.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$61.03
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$155.55
|
| Rate for Payer: First Health Commercial |
$164.70
|
| Rate for Payer: First Health Workers Compensation |
$69.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$164.70
|
| Rate for Payer: GEHA Commercial |
$146.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$164.70
|
| Rate for Payer: Humana ChoiceCare |
$47.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$62.27
|
| Rate for Payer: Multiplan All |
$166.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$109.80
|
| Rate for Payer: OMNI Networks Commercial |
$128.10
|
| Rate for Payer: One Health Plan PPO/POS |
$164.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$71.90
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$62.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$173.85
|
| Rate for Payer: Three Rivers Provider Network All |
$137.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$161.04
|
| Rate for Payer: United Healthcare Commercial |
$155.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$62.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$170.19
|
| Rate for Payer: Zelis Auto |
$73.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$91.50
|
| Rate for Payer: Zelis Worker's Compensation |
$49.03
|
|
