|
REVSC OPN/PRQ TIB/PERO STENT
|
Facility
|
OP
|
$931.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
6137234
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$242.06 |
| Max. Negotiated Rate |
$5,549.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,549.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$558.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,549.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,396.12
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cigna Commercial |
$791.35
|
| Rate for Payer: First Health Commercial |
$837.90
|
| Rate for Payer: First Health Workers Compensation |
$359.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$837.90
|
| Rate for Payer: GEHA Commercial |
$744.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$837.90
|
| Rate for Payer: Humana ChoiceCare |
$242.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,485.64
|
| Rate for Payer: Multiplan All |
$847.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$558.60
|
| Rate for Payer: OMNI Networks Commercial |
$651.70
|
| Rate for Payer: One Health Plan PPO/POS |
$837.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5,179.30
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,485.64
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$884.45
|
| Rate for Payer: Three Rivers Provider Network All |
$698.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$819.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,485.64
|
| Rate for Payer: United Payors & United Providers UP&UP |
$865.83
|
| Rate for Payer: Zelis Auto |
$372.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$465.50
|
| Rate for Payer: Zelis Worker's Compensation |
$254.16
|
|
|
REVSC OPN/PRQ TIB/PERO STENT
|
Facility
|
IP
|
$931.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
6137234
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$254.16 |
| Max. Negotiated Rate |
$884.45 |
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cigna Commercial |
$791.35
|
| Rate for Payer: First Health Commercial |
$837.90
|
| Rate for Payer: First Health Workers Compensation |
$359.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$837.90
|
| Rate for Payer: GEHA Commercial |
$651.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$837.90
|
| Rate for Payer: Multiplan All |
$847.21
|
| Rate for Payer: OMNI Networks Commercial |
$651.70
|
| Rate for Payer: One Health Plan PPO/POS |
$837.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$884.45
|
| Rate for Payer: Three Rivers Provider Network All |
$698.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$865.83
|
| Rate for Payer: Zelis Auto |
$372.40
|
| Rate for Payer: Zelis Worker's Compensation |
$254.16
|
|
|
RFB CORNEA W/O SLIT
|
Facility
|
OP
|
$408.00
|
|
| Hospital Charge Code |
8150048
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$326.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Humana ChoiceCare |
$106.08
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$244.80
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$359.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$204.00
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
RFB CORNEA W/O SLIT
|
Facility
|
IP
|
$408.00
|
|
| Hospital Charge Code |
8150048
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.38 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$285.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
RFB EMEBED CONJUCTIV
|
Facility
|
OP
|
$440.00
|
|
| Hospital Charge Code |
8150047
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$418.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$374.00
|
| Rate for Payer: First Health Commercial |
$396.00
|
| Rate for Payer: First Health Workers Compensation |
$169.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$396.00
|
| Rate for Payer: GEHA Commercial |
$352.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$396.00
|
| Rate for Payer: Humana ChoiceCare |
$114.40
|
| Rate for Payer: Multiplan All |
$400.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$264.00
|
| Rate for Payer: OMNI Networks Commercial |
$308.00
|
| Rate for Payer: One Health Plan PPO/POS |
$396.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$418.00
|
| Rate for Payer: Three Rivers Provider Network All |
$330.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$387.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$409.20
|
| Rate for Payer: Zelis Auto |
$176.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$220.00
|
| Rate for Payer: Zelis Worker's Compensation |
$120.12
|
|
|
RFB EMEBED CONJUCTIV
|
Facility
|
IP
|
$440.00
|
|
| Hospital Charge Code |
8150047
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$418.00 |
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$374.00
|
| Rate for Payer: First Health Commercial |
$396.00
|
| Rate for Payer: First Health Workers Compensation |
$169.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$396.00
|
| Rate for Payer: GEHA Commercial |
$308.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$396.00
|
| Rate for Payer: Multiplan All |
$400.40
|
| Rate for Payer: OMNI Networks Commercial |
$308.00
|
| Rate for Payer: One Health Plan PPO/POS |
$396.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$418.00
|
| Rate for Payer: Three Rivers Provider Network All |
$330.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$409.20
|
| Rate for Payer: Zelis Auto |
$176.00
|
| Rate for Payer: Zelis Worker's Compensation |
$120.12
|
|
|
RFB EYE CONJUTIVA
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
8150046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.04 |
| Max. Negotiated Rate |
$391.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$151.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$247.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$151.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$119.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cigna Commercial |
$350.20
|
| Rate for Payer: First Health Commercial |
$370.80
|
| Rate for Payer: First Health Workers Compensation |
$159.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$370.80
|
| Rate for Payer: GEHA Commercial |
$329.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$370.80
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$122.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$374.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$288.40
|
| Rate for Payer: One Health Plan PPO/POS |
$370.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$141.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$122.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$391.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$309.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$122.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$383.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$164.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$112.48
|
|
|
RFB EYE CONJUTIVA
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
8150046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.48 |
| Max. Negotiated Rate |
$391.40 |
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cigna Commercial |
$350.20
|
| Rate for Payer: First Health Commercial |
$370.80
|
| Rate for Payer: First Health Workers Compensation |
$159.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$370.80
|
| Rate for Payer: GEHA Commercial |
$288.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$370.80
|
| Rate for Payer: Multiplan All |
$374.92
|
| Rate for Payer: OMNI Networks Commercial |
$288.40
|
| Rate for Payer: One Health Plan PPO/POS |
$370.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$391.40
|
| Rate for Payer: Three Rivers Provider Network All |
$309.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$383.16
|
| Rate for Payer: Zelis Auto |
$164.80
|
| Rate for Payer: Zelis Worker's Compensation |
$112.48
|
|
|
RFB EYELID EMBDED
|
Facility
|
OP
|
$1,029.00
|
|
| Hospital Charge Code |
8150049
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$257.25 |
| Max. Negotiated Rate |
$977.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$617.40
|
| Rate for Payer: Cash Price |
$617.40
|
| Rate for Payer: Cigna Commercial |
$874.65
|
| Rate for Payer: First Health Commercial |
$926.10
|
| Rate for Payer: First Health Workers Compensation |
$397.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$926.10
|
| Rate for Payer: GEHA Commercial |
$823.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$926.10
|
| Rate for Payer: Humana ChoiceCare |
$267.54
|
| Rate for Payer: Multiplan All |
$936.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$617.40
|
| Rate for Payer: OMNI Networks Commercial |
$720.30
|
| Rate for Payer: One Health Plan PPO/POS |
$926.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$977.55
|
| Rate for Payer: Three Rivers Provider Network All |
$771.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$905.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$257.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$956.97
|
| Rate for Payer: Zelis Auto |
$411.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$514.50
|
| Rate for Payer: Zelis Worker's Compensation |
$280.92
|
|
|
RFB EYELID EMBDED
|
Facility
|
IP
|
$1,029.00
|
|
| Hospital Charge Code |
8150049
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$280.92 |
| Max. Negotiated Rate |
$977.55 |
| Rate for Payer: Cash Price |
$617.40
|
| Rate for Payer: Cigna Commercial |
$874.65
|
| Rate for Payer: First Health Commercial |
$926.10
|
| Rate for Payer: First Health Workers Compensation |
$397.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$926.10
|
| Rate for Payer: GEHA Commercial |
$720.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$926.10
|
| Rate for Payer: Multiplan All |
$936.39
|
| Rate for Payer: OMNI Networks Commercial |
$720.30
|
| Rate for Payer: One Health Plan PPO/POS |
$926.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$977.55
|
| Rate for Payer: Three Rivers Provider Network All |
$771.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$956.97
|
| Rate for Payer: Zelis Auto |
$411.60
|
| Rate for Payer: Zelis Worker's Compensation |
$280.92
|
|
|
RHC TELEHEALTH VISITS
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT G2025
|
| Hospital Charge Code |
9502000
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: First Health Workers Compensation |
$108.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Worker's Compensation |
$76.44
|
|
|
RHC TELEHEALTH VISITS
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT G2025
|
| Hospital Charge Code |
9502025
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: First Health Workers Compensation |
$108.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Worker's Compensation |
$76.44
|
|
|
RHC TELEHEALTH VISITS
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT G2025
|
| Hospital Charge Code |
8500020
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: First Health Workers Compensation |
$108.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$224.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Humana ChoiceCare |
$72.80
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$168.00
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$246.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$70.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$140.00
|
| Rate for Payer: Zelis Worker's Compensation |
$76.44
|
|
|
RHC TELEHEALTH VISITS
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT G2025
|
| Hospital Charge Code |
8500020
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: First Health Workers Compensation |
$108.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Worker's Compensation |
$76.44
|
|
|
RHC TELEHEALTH VISITS
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT G2025
|
| Hospital Charge Code |
9502000
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: First Health Workers Compensation |
$108.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$224.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Humana ChoiceCare |
$72.80
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$168.00
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$246.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$70.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$140.00
|
| Rate for Payer: Zelis Worker's Compensation |
$76.44
|
|
|
RHC TELEHEALTH VISITS
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT G2025
|
| Hospital Charge Code |
9502025
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: First Health Workers Compensation |
$108.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$224.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Humana ChoiceCare |
$72.80
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$168.00
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$246.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$70.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$140.00
|
| Rate for Payer: Zelis Worker's Compensation |
$76.44
|
|
|
RHC TELEHEALTH VISITS
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT G2025
|
| Hospital Charge Code |
8502025
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: First Health Workers Compensation |
$108.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Worker's Compensation |
$76.44
|
|
|
RHC TELEHEALTH VISITS
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT G2025
|
| Hospital Charge Code |
8502025
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$238.00
|
| Rate for Payer: First Health Commercial |
$252.00
|
| Rate for Payer: First Health Workers Compensation |
$108.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.00
|
| Rate for Payer: GEHA Commercial |
$224.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.00
|
| Rate for Payer: Humana ChoiceCare |
$72.80
|
| Rate for Payer: Multiplan All |
$254.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$168.00
|
| Rate for Payer: OMNI Networks Commercial |
$196.00
|
| Rate for Payer: One Health Plan PPO/POS |
$252.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.00
|
| Rate for Payer: Three Rivers Provider Network All |
$210.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$246.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$70.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$260.40
|
| Rate for Payer: Zelis Auto |
$112.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$140.00
|
| Rate for Payer: Zelis Worker's Compensation |
$76.44
|
|
|
RHEUMATOID FACTOR IGG REF
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2300101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$20.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: GEHA Medicare |
$17.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$19.00
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.27
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29.36
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$29.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34.54
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.92
|
| Rate for Payer: United Healthcare Commercial |
$211.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.27
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Medicare |
$14.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.72
|
| Rate for Payer: Zelis Worker's Compensation |
$14.31
|
|
|
RHEUMATOID FACTOR IGG REF
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2300101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$20.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Worker's Compensation |
$14.31
|
|
|
RHEUMATOID FACTOR QL AGH
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 86430
|
| Hospital Charge Code |
2204233
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$45.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$8.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.14
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: First Health Workers Compensation |
$11.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$68.40
|
| Rate for Payer: GEHA Commercial |
$60.80
|
| Rate for Payer: GEHA Medicare |
$6.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$68.40
|
| Rate for Payer: Humana ChoiceCare |
$6.75
|
| Rate for Payer: Humana Medicare Advantage |
$6.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.14
|
| Rate for Payer: Multiplan All |
$69.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10.44
|
| Rate for Payer: OMNI Networks Commercial |
$53.20
|
| Rate for Payer: One Health Plan PPO/POS |
$68.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$72.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12.28
|
| Rate for Payer: Three Rivers Provider Network All |
$57.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.02
|
| Rate for Payer: United Healthcare Commercial |
$64.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$70.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.14
|
| Rate for Payer: Zelis Auto |
$30.40
|
| Rate for Payer: Zelis Medicare |
$5.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.37
|
| Rate for Payer: Zelis Worker's Compensation |
$7.97
|
|
|
RHEUMATOID FACTOR QL AGH
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 86430
|
| Hospital Charge Code |
2204233
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: First Health Workers Compensation |
$11.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$68.40
|
| Rate for Payer: GEHA Commercial |
$53.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$68.40
|
| Rate for Payer: Multiplan All |
$69.16
|
| Rate for Payer: OMNI Networks Commercial |
$53.20
|
| Rate for Payer: One Health Plan PPO/POS |
$68.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$72.20
|
| Rate for Payer: Three Rivers Provider Network All |
$57.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$70.68
|
| Rate for Payer: Zelis Auto |
$30.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.97
|
|
|
rheumatoid factor quant REF 006502
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
2200141
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$12.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Worker's Compensation |
$8.71
|
|
|
rheumatoid factor quant REF 006502
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
2200141
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$8.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.67
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$12.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: GEHA Medicare |
$5.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$6.24
|
| Rate for Payer: Humana Medicare Advantage |
$5.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.67
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.64
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.24
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11.34
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.56
|
| Rate for Payer: United Healthcare Commercial |
$211.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.67
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Medicare |
$4.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.80
|
| Rate for Payer: Zelis Worker's Compensation |
$8.71
|
|
|
RHOGAM 300 MCG INJ PFS
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
CPT J2790
|
| Hospital Charge Code |
3303035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$205.02 |
| Max. Negotiated Rate |
$713.45 |
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Cigna Commercial |
$638.35
|
| Rate for Payer: First Health Commercial |
$675.90
|
| Rate for Payer: First Health Workers Compensation |
$289.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$675.90
|
| Rate for Payer: GEHA Commercial |
$525.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$675.90
|
| Rate for Payer: Multiplan All |
$683.41
|
| Rate for Payer: OMNI Networks Commercial |
$525.70
|
| Rate for Payer: One Health Plan PPO/POS |
$675.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$713.45
|
| Rate for Payer: Three Rivers Provider Network All |
$563.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$698.43
|
| Rate for Payer: Zelis Auto |
$300.40
|
| Rate for Payer: Zelis Worker's Compensation |
$205.02
|
|
