|
RPR BLOOD VESSEL DIR INTRATHOR WO BYPASS
|
Facility
|
IP
|
$6,626.00
|
|
|
Service Code
|
CPT 35216
|
| Hospital Charge Code |
6135216
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,808.90 |
| Max. Negotiated Rate |
$6,294.70 |
| Rate for Payer: Cash Price |
$3,975.60
|
| Rate for Payer: Cigna Commercial |
$5,632.10
|
| Rate for Payer: First Health Commercial |
$5,963.40
|
| Rate for Payer: First Health Workers Compensation |
$2,558.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,963.40
|
| Rate for Payer: GEHA Commercial |
$4,638.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,963.40
|
| Rate for Payer: Multiplan All |
$6,029.66
|
| Rate for Payer: OMNI Networks Commercial |
$4,638.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,963.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,294.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4,969.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,162.18
|
| Rate for Payer: Zelis Auto |
$2,650.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,808.90
|
|
|
RPR BLOOD VESSEL DIR INTRATHOR WO BYPASS
|
Facility
|
OP
|
$6,626.00
|
|
|
Service Code
|
CPT 35216
|
| Hospital Charge Code |
6135216
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,656.50 |
| Max. Negotiated Rate |
$6,294.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,975.60
|
| Rate for Payer: Cash Price |
$3,975.60
|
| Rate for Payer: Cigna Commercial |
$5,632.10
|
| Rate for Payer: First Health Commercial |
$5,963.40
|
| Rate for Payer: First Health Workers Compensation |
$2,558.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,963.40
|
| Rate for Payer: GEHA Commercial |
$5,300.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,963.40
|
| Rate for Payer: Humana ChoiceCare |
$1,722.76
|
| Rate for Payer: Multiplan All |
$6,029.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,975.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,638.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,963.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,294.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4,969.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,830.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,656.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,162.18
|
| Rate for Payer: Zelis Auto |
$2,650.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,313.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,808.90
|
|
|
RPR CMX E/E/N/L 1.1\2.5
|
Facility
|
OP
|
$1,626.00
|
|
| Hospital Charge Code |
8150030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$406.50 |
| Max. Negotiated Rate |
$1,544.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$975.60
|
| Rate for Payer: Cash Price |
$975.60
|
| Rate for Payer: Cigna Commercial |
$1,382.10
|
| Rate for Payer: First Health Commercial |
$1,463.40
|
| Rate for Payer: First Health Workers Compensation |
$627.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,463.40
|
| Rate for Payer: GEHA Commercial |
$1,300.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,463.40
|
| Rate for Payer: Humana ChoiceCare |
$422.76
|
| Rate for Payer: Multiplan All |
$1,479.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$975.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,138.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,463.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,544.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,219.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,430.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$406.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,512.18
|
| Rate for Payer: Zelis Auto |
$650.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$813.00
|
| Rate for Payer: Zelis Worker's Compensation |
$443.90
|
|
|
RPR CMX E/E/N/L 1.1\2.5
|
Facility
|
IP
|
$1,626.00
|
|
| Hospital Charge Code |
8150030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$443.90 |
| Max. Negotiated Rate |
$1,544.70 |
| Rate for Payer: Cash Price |
$975.60
|
| Rate for Payer: Cigna Commercial |
$1,382.10
|
| Rate for Payer: First Health Commercial |
$1,463.40
|
| Rate for Payer: First Health Workers Compensation |
$627.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,463.40
|
| Rate for Payer: GEHA Commercial |
$1,138.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,463.40
|
| Rate for Payer: Multiplan All |
$1,479.66
|
| Rate for Payer: OMNI Networks Commercial |
$1,138.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,463.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,544.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,219.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,512.18
|
| Rate for Payer: Zelis Auto |
$650.40
|
| Rate for Payer: Zelis Worker's Compensation |
$443.90
|
|
|
RPR CMX E/E/N/L 2.6 7.5
|
Facility
|
OP
|
$1,785.00
|
|
| Hospital Charge Code |
8150031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$446.25 |
| Max. Negotiated Rate |
$1,695.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,071.00
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Cigna Commercial |
$1,517.25
|
| Rate for Payer: First Health Commercial |
$1,606.50
|
| Rate for Payer: First Health Workers Compensation |
$689.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,606.50
|
| Rate for Payer: GEHA Commercial |
$1,428.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,606.50
|
| Rate for Payer: Humana ChoiceCare |
$464.10
|
| Rate for Payer: Multiplan All |
$1,624.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,071.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,249.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,606.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,695.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,338.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,570.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$446.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,660.05
|
| Rate for Payer: Zelis Auto |
$714.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$892.50
|
| Rate for Payer: Zelis Worker's Compensation |
$487.31
|
|
|
RPR CMX E/E/N/L 2.6 7.5
|
Facility
|
IP
|
$1,785.00
|
|
| Hospital Charge Code |
8150031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$487.31 |
| Max. Negotiated Rate |
$1,695.75 |
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Cigna Commercial |
$1,517.25
|
| Rate for Payer: First Health Commercial |
$1,606.50
|
| Rate for Payer: First Health Workers Compensation |
$689.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,606.50
|
| Rate for Payer: GEHA Commercial |
$1,249.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,606.50
|
| Rate for Payer: Multiplan All |
$1,624.35
|
| Rate for Payer: OMNI Networks Commercial |
$1,249.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,606.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,695.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,338.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,660.05
|
| Rate for Payer: Zelis Auto |
$714.00
|
| Rate for Payer: Zelis Worker's Compensation |
$487.31
|
|
|
RPR CMX E/E/N/L E/A 5CM
|
Facility
|
IP
|
$935.00
|
|
| Hospital Charge Code |
8150032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$255.25 |
| Max. Negotiated Rate |
$888.25 |
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cigna Commercial |
$794.75
|
| Rate for Payer: First Health Commercial |
$841.50
|
| Rate for Payer: First Health Workers Compensation |
$361.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$841.50
|
| Rate for Payer: GEHA Commercial |
$654.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$841.50
|
| Rate for Payer: Multiplan All |
$850.85
|
| Rate for Payer: OMNI Networks Commercial |
$654.50
|
| Rate for Payer: One Health Plan PPO/POS |
$841.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$888.25
|
| Rate for Payer: Three Rivers Provider Network All |
$701.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$869.55
|
| Rate for Payer: Zelis Auto |
$374.00
|
| Rate for Payer: Zelis Worker's Compensation |
$255.25
|
|
|
RPR CMX E/E/N/L E/A 5CM
|
Facility
|
OP
|
$935.00
|
|
| Hospital Charge Code |
8150032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.75 |
| Max. Negotiated Rate |
$888.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cigna Commercial |
$794.75
|
| Rate for Payer: First Health Commercial |
$841.50
|
| Rate for Payer: First Health Workers Compensation |
$361.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$841.50
|
| Rate for Payer: GEHA Commercial |
$748.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$841.50
|
| Rate for Payer: Humana ChoiceCare |
$243.10
|
| Rate for Payer: Multiplan All |
$850.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$561.00
|
| Rate for Payer: OMNI Networks Commercial |
$654.50
|
| Rate for Payer: One Health Plan PPO/POS |
$841.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$888.25
|
| Rate for Payer: Three Rivers Provider Network All |
$701.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$822.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$233.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$869.55
|
| Rate for Payer: Zelis Auto |
$374.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$467.50
|
| Rate for Payer: Zelis Worker's Compensation |
$255.25
|
|
|
RPR CMX F/C/M/N/A/G/H/F E/A 5CM
|
Facility
|
IP
|
$854.00
|
|
| Hospital Charge Code |
8150028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.14 |
| Max. Negotiated Rate |
$811.30 |
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$725.90
|
| Rate for Payer: First Health Commercial |
$768.60
|
| Rate for Payer: First Health Workers Compensation |
$329.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$768.60
|
| Rate for Payer: GEHA Commercial |
$597.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$768.60
|
| Rate for Payer: Multiplan All |
$777.14
|
| Rate for Payer: OMNI Networks Commercial |
$597.80
|
| Rate for Payer: One Health Plan PPO/POS |
$768.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$811.30
|
| Rate for Payer: Three Rivers Provider Network All |
$640.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$794.22
|
| Rate for Payer: Zelis Auto |
$341.60
|
| Rate for Payer: Zelis Worker's Compensation |
$233.14
|
|
|
RPR CMX F/C/M/N/A/G/H/F E/A 5CM
|
Facility
|
OP
|
$854.00
|
|
| Hospital Charge Code |
8150028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$213.50 |
| Max. Negotiated Rate |
$811.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$512.40
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$725.90
|
| Rate for Payer: First Health Commercial |
$768.60
|
| Rate for Payer: First Health Workers Compensation |
$329.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$768.60
|
| Rate for Payer: GEHA Commercial |
$683.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$768.60
|
| Rate for Payer: Humana ChoiceCare |
$222.04
|
| Rate for Payer: Multiplan All |
$777.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$512.40
|
| Rate for Payer: OMNI Networks Commercial |
$597.80
|
| Rate for Payer: One Health Plan PPO/POS |
$768.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$811.30
|
| Rate for Payer: Three Rivers Provider Network All |
$640.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$751.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$213.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$794.22
|
| Rate for Payer: Zelis Auto |
$341.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$427.00
|
| Rate for Payer: Zelis Worker's Compensation |
$233.14
|
|
|
RPR CMX TRNK 1.1\2.5
|
Facility
|
IP
|
$3,395.00
|
|
| Hospital Charge Code |
8150033
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$926.84 |
| Max. Negotiated Rate |
$3,225.25 |
| Rate for Payer: Cash Price |
$2,037.00
|
| Rate for Payer: Cigna Commercial |
$2,885.75
|
| Rate for Payer: First Health Commercial |
$3,055.50
|
| Rate for Payer: First Health Workers Compensation |
$1,310.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,055.50
|
| Rate for Payer: GEHA Commercial |
$2,376.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,055.50
|
| Rate for Payer: Multiplan All |
$3,089.45
|
| Rate for Payer: OMNI Networks Commercial |
$2,376.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,055.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,225.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,546.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,157.35
|
| Rate for Payer: Zelis Auto |
$1,358.00
|
| Rate for Payer: Zelis Worker's Compensation |
$926.84
|
|
|
RPR CMX TRNK 1.1\2.5
|
Facility
|
OP
|
$3,395.00
|
|
| Hospital Charge Code |
8150033
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$848.75 |
| Max. Negotiated Rate |
$3,225.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,037.00
|
| Rate for Payer: Cash Price |
$2,037.00
|
| Rate for Payer: Cigna Commercial |
$2,885.75
|
| Rate for Payer: First Health Commercial |
$3,055.50
|
| Rate for Payer: First Health Workers Compensation |
$1,310.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,055.50
|
| Rate for Payer: GEHA Commercial |
$2,716.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,055.50
|
| Rate for Payer: Humana ChoiceCare |
$882.70
|
| Rate for Payer: Multiplan All |
$3,089.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,037.00
|
| Rate for Payer: OMNI Networks Commercial |
$2,376.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,055.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,225.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,546.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,987.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$848.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,157.35
|
| Rate for Payer: Zelis Auto |
$1,358.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,697.50
|
| Rate for Payer: Zelis Worker's Compensation |
$926.84
|
|
|
RPR CMX TRNK 2.6\7.5
|
Facility
|
OP
|
$1,536.00
|
|
| Hospital Charge Code |
8150034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$384.00 |
| Max. Negotiated Rate |
$1,459.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$921.60
|
| Rate for Payer: Cash Price |
$921.60
|
| Rate for Payer: Cigna Commercial |
$1,305.60
|
| Rate for Payer: First Health Commercial |
$1,382.40
|
| Rate for Payer: First Health Workers Compensation |
$593.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,382.40
|
| Rate for Payer: GEHA Commercial |
$1,228.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,382.40
|
| Rate for Payer: Humana ChoiceCare |
$399.36
|
| Rate for Payer: Multiplan All |
$1,397.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$921.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,075.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,382.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,459.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,152.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,351.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$384.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,428.48
|
| Rate for Payer: Zelis Auto |
$614.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$768.00
|
| Rate for Payer: Zelis Worker's Compensation |
$419.33
|
|
|
RPR CMX TRNK 2.6\7.5
|
Facility
|
IP
|
$1,536.00
|
|
| Hospital Charge Code |
8150034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$419.33 |
| Max. Negotiated Rate |
$1,459.20 |
| Rate for Payer: Cash Price |
$921.60
|
| Rate for Payer: Cigna Commercial |
$1,305.60
|
| Rate for Payer: First Health Commercial |
$1,382.40
|
| Rate for Payer: First Health Workers Compensation |
$593.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,382.40
|
| Rate for Payer: GEHA Commercial |
$1,075.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,382.40
|
| Rate for Payer: Multiplan All |
$1,397.76
|
| Rate for Payer: OMNI Networks Commercial |
$1,075.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,382.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,459.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,152.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,428.48
|
| Rate for Payer: Zelis Auto |
$614.40
|
| Rate for Payer: Zelis Worker's Compensation |
$419.33
|
|
|
RPR CMX TRNK E/A 5CM
|
Facility
|
IP
|
$485.00
|
|
| Hospital Charge Code |
8150035
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.41 |
| Max. Negotiated Rate |
$460.75 |
| Rate for Payer: Cash Price |
$291.00
|
| Rate for Payer: Cigna Commercial |
$412.25
|
| Rate for Payer: First Health Commercial |
$436.50
|
| Rate for Payer: First Health Workers Compensation |
$187.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$436.50
|
| Rate for Payer: GEHA Commercial |
$339.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$436.50
|
| Rate for Payer: Multiplan All |
$441.35
|
| Rate for Payer: OMNI Networks Commercial |
$339.50
|
| Rate for Payer: One Health Plan PPO/POS |
$436.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$460.75
|
| Rate for Payer: Three Rivers Provider Network All |
$363.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$451.05
|
| Rate for Payer: Zelis Auto |
$194.00
|
| Rate for Payer: Zelis Worker's Compensation |
$132.41
|
|
|
RPR CMX TRNK E/A 5CM
|
Facility
|
OP
|
$485.00
|
|
| Hospital Charge Code |
8150035
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.25 |
| Max. Negotiated Rate |
$460.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$291.00
|
| Rate for Payer: Cash Price |
$291.00
|
| Rate for Payer: Cigna Commercial |
$412.25
|
| Rate for Payer: First Health Commercial |
$436.50
|
| Rate for Payer: First Health Workers Compensation |
$187.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$436.50
|
| Rate for Payer: GEHA Commercial |
$388.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$436.50
|
| Rate for Payer: Humana ChoiceCare |
$126.10
|
| Rate for Payer: Multiplan All |
$441.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$291.00
|
| Rate for Payer: OMNI Networks Commercial |
$339.50
|
| Rate for Payer: One Health Plan PPO/POS |
$436.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$460.75
|
| Rate for Payer: Three Rivers Provider Network All |
$363.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$426.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$121.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$451.05
|
| Rate for Payer: Zelis Auto |
$194.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$242.50
|
| Rate for Payer: Zelis Worker's Compensation |
$132.41
|
|
|
RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INS
|
Facility
|
OP
|
$7,891.00
|
|
| Hospital Charge Code |
8136576
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,972.75 |
| Max. Negotiated Rate |
$7,496.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,734.60
|
| Rate for Payer: Cash Price |
$4,734.60
|
| Rate for Payer: Cigna Commercial |
$6,707.35
|
| Rate for Payer: First Health Commercial |
$7,101.90
|
| Rate for Payer: First Health Workers Compensation |
$3,046.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,101.90
|
| Rate for Payer: GEHA Commercial |
$6,312.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,101.90
|
| Rate for Payer: Humana ChoiceCare |
$2,051.66
|
| Rate for Payer: Multiplan All |
$7,180.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,734.60
|
| Rate for Payer: OMNI Networks Commercial |
$5,523.70
|
| Rate for Payer: One Health Plan PPO/POS |
$7,101.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,496.45
|
| Rate for Payer: Three Rivers Provider Network All |
$5,918.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,944.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,972.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,338.63
|
| Rate for Payer: Zelis Auto |
$3,156.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,945.50
|
| Rate for Payer: Zelis Worker's Compensation |
$2,154.24
|
|
|
RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INS
|
Facility
|
IP
|
$7,891.00
|
|
| Hospital Charge Code |
8136576
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,154.24 |
| Max. Negotiated Rate |
$7,496.45 |
| Rate for Payer: Cash Price |
$4,734.60
|
| Rate for Payer: Cigna Commercial |
$6,707.35
|
| Rate for Payer: First Health Commercial |
$7,101.90
|
| Rate for Payer: First Health Workers Compensation |
$3,046.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,101.90
|
| Rate for Payer: GEHA Commercial |
$5,523.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,101.90
|
| Rate for Payer: Multiplan All |
$7,180.81
|
| Rate for Payer: OMNI Networks Commercial |
$5,523.70
|
| Rate for Payer: One Health Plan PPO/POS |
$7,101.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,496.45
|
| Rate for Payer: Three Rivers Provider Network All |
$5,918.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,338.63
|
| Rate for Payer: Zelis Auto |
$3,156.40
|
| Rate for Payer: Zelis Worker's Compensation |
$2,154.24
|
|
|
RPR EPIGASTRIC HERN, BLOCKED
|
Facility
|
IP
|
$1,077.00
|
|
|
Service Code
|
CPT 49572
|
| Hospital Charge Code |
6149572
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$294.02 |
| Max. Negotiated Rate |
$1,023.15 |
| Rate for Payer: Cash Price |
$646.20
|
| Rate for Payer: Cigna Commercial |
$915.45
|
| Rate for Payer: First Health Commercial |
$969.30
|
| Rate for Payer: First Health Workers Compensation |
$415.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$969.30
|
| Rate for Payer: GEHA Commercial |
$753.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$969.30
|
| Rate for Payer: Multiplan All |
$980.07
|
| Rate for Payer: OMNI Networks Commercial |
$753.90
|
| Rate for Payer: One Health Plan PPO/POS |
$969.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,023.15
|
| Rate for Payer: Three Rivers Provider Network All |
$807.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,001.61
|
| Rate for Payer: Zelis Auto |
$430.80
|
| Rate for Payer: Zelis Worker's Compensation |
$294.02
|
|
|
RPR EPIGASTRIC HERN, BLOCKED
|
Facility
|
OP
|
$1,077.00
|
|
|
Service Code
|
CPT 49572
|
| Hospital Charge Code |
6149572
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$269.25 |
| Max. Negotiated Rate |
$1,023.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$646.20
|
| Rate for Payer: Cash Price |
$646.20
|
| Rate for Payer: Cigna Commercial |
$915.45
|
| Rate for Payer: First Health Commercial |
$969.30
|
| Rate for Payer: First Health Workers Compensation |
$415.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$969.30
|
| Rate for Payer: GEHA Commercial |
$861.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$969.30
|
| Rate for Payer: Humana ChoiceCare |
$280.02
|
| Rate for Payer: Multiplan All |
$980.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$646.20
|
| Rate for Payer: OMNI Networks Commercial |
$753.90
|
| Rate for Payer: One Health Plan PPO/POS |
$969.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,023.15
|
| Rate for Payer: Three Rivers Provider Network All |
$807.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$947.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$269.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,001.61
|
| Rate for Payer: Zelis Auto |
$430.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$538.50
|
| Rate for Payer: Zelis Worker's Compensation |
$294.02
|
|
|
RPR EPIGASTRIC HERN, REDUCE
|
Facility
|
IP
|
$866.00
|
|
|
Service Code
|
CPT 49570
|
| Hospital Charge Code |
6149570
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$236.42 |
| Max. Negotiated Rate |
$822.70 |
| Rate for Payer: Cash Price |
$519.60
|
| Rate for Payer: Cigna Commercial |
$736.10
|
| Rate for Payer: First Health Commercial |
$779.40
|
| Rate for Payer: First Health Workers Compensation |
$334.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$779.40
|
| Rate for Payer: GEHA Commercial |
$606.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$779.40
|
| Rate for Payer: Multiplan All |
$788.06
|
| Rate for Payer: OMNI Networks Commercial |
$606.20
|
| Rate for Payer: One Health Plan PPO/POS |
$779.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$822.70
|
| Rate for Payer: Three Rivers Provider Network All |
$649.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$805.38
|
| Rate for Payer: Zelis Auto |
$346.40
|
| Rate for Payer: Zelis Worker's Compensation |
$236.42
|
|
|
RPR EPIGASTRIC HERN, REDUCE
|
Facility
|
OP
|
$866.00
|
|
|
Service Code
|
CPT 49570
|
| Hospital Charge Code |
6149570
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$216.50 |
| Max. Negotiated Rate |
$822.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$519.60
|
| Rate for Payer: Cash Price |
$519.60
|
| Rate for Payer: Cigna Commercial |
$736.10
|
| Rate for Payer: First Health Commercial |
$779.40
|
| Rate for Payer: First Health Workers Compensation |
$334.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$779.40
|
| Rate for Payer: GEHA Commercial |
$692.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$779.40
|
| Rate for Payer: Humana ChoiceCare |
$225.16
|
| Rate for Payer: Multiplan All |
$788.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$519.60
|
| Rate for Payer: OMNI Networks Commercial |
$606.20
|
| Rate for Payer: One Health Plan PPO/POS |
$779.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$822.70
|
| Rate for Payer: Three Rivers Provider Network All |
$649.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$762.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$216.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$805.38
|
| Rate for Payer: Zelis Auto |
$346.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$433.00
|
| Rate for Payer: Zelis Worker's Compensation |
$236.42
|
|
|
RPR FE/E/EN/L/M 20.1-30.0 CM
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
CPT 12017
|
| Hospital Charge Code |
6112017
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$132.13 |
| Max. Negotiated Rate |
$459.80 |
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cigna Commercial |
$411.40
|
| Rate for Payer: First Health Commercial |
$435.60
|
| Rate for Payer: First Health Workers Compensation |
$186.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$435.60
|
| Rate for Payer: GEHA Commercial |
$338.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$435.60
|
| Rate for Payer: Multiplan All |
$440.44
|
| Rate for Payer: OMNI Networks Commercial |
$338.80
|
| Rate for Payer: One Health Plan PPO/POS |
$435.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$459.80
|
| Rate for Payer: Three Rivers Provider Network All |
$363.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$450.12
|
| Rate for Payer: Zelis Auto |
$193.60
|
| Rate for Payer: Zelis Worker's Compensation |
$132.13
|
|
|
RPR FE/E/EN/L/M 20.1-30.0 CM
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
CPT 12017
|
| Hospital Charge Code |
6112017
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$108.47 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$290.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cigna Commercial |
$411.40
|
| Rate for Payer: First Health Commercial |
$435.60
|
| Rate for Payer: First Health Workers Compensation |
$186.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$435.60
|
| Rate for Payer: GEHA Commercial |
$387.20
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$435.60
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$110.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$440.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$338.80
|
| Rate for Payer: One Health Plan PPO/POS |
$435.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$127.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$110.68
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$459.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$363.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$450.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$193.60
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$132.13
|
|
|
RPR F/E/E/N/L/M >30.0 CM
|
Facility
|
OP
|
$548.00
|
|
|
Service Code
|
CPT 12018
|
| Hospital Charge Code |
6112018
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$108.47 |
| Max. Negotiated Rate |
$520.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$328.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cigna Commercial |
$465.80
|
| Rate for Payer: First Health Commercial |
$493.20
|
| Rate for Payer: First Health Workers Compensation |
$211.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$493.20
|
| Rate for Payer: GEHA Commercial |
$438.40
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$493.20
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$110.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$498.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$383.60
|
| Rate for Payer: One Health Plan PPO/POS |
$493.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$127.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$110.68
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$520.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$411.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$509.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$219.20
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$149.60
|
|
