|
SMALL BOWEL ENDOSCOPY
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT 44380
|
| Hospital Charge Code |
6144380
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$52.96 |
| Max. Negotiated Rate |
$1,780.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$116.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$789.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$890.25
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$164.90
|
| Rate for Payer: First Health Commercial |
$174.60
|
| Rate for Payer: First Health Workers Compensation |
$74.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$174.60
|
| Rate for Payer: GEHA Commercial |
$155.20
|
| Rate for Payer: GEHA Medicare |
$890.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$174.60
|
| Rate for Payer: Humana ChoiceCare |
$979.27
|
| Rate for Payer: Humana Medicare Advantage |
$890.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,495.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$805.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$890.25
|
| Rate for Payer: Multiplan All |
$176.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,513.42
|
| Rate for Payer: OMNI Networks Commercial |
$135.80
|
| Rate for Payer: One Health Plan PPO/POS |
$174.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$929.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$805.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$890.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$184.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,780.50
|
| Rate for Payer: Three Rivers Provider Network All |
$145.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$872.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$805.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$890.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$180.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$890.25
|
| Rate for Payer: Zelis Auto |
$77.60
|
| Rate for Payer: Zelis Medicare |
$756.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,068.30
|
| Rate for Payer: Zelis Worker's Compensation |
$52.96
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 44360
|
| Hospital Charge Code |
6144360
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$128.31 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$282.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$789.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$399.50
|
| Rate for Payer: First Health Commercial |
$423.00
|
| Rate for Payer: First Health Workers Compensation |
$181.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$423.00
|
| Rate for Payer: GEHA Commercial |
$376.00
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$423.00
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$805.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$427.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$329.00
|
| Rate for Payer: One Health Plan PPO/POS |
$423.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$929.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$805.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$446.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$352.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$805.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$437.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$188.00
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$128.31
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 44360
|
| Hospital Charge Code |
6144360
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$128.31 |
| Max. Negotiated Rate |
$446.50 |
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$399.50
|
| Rate for Payer: First Health Commercial |
$423.00
|
| Rate for Payer: First Health Workers Compensation |
$181.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$423.00
|
| Rate for Payer: GEHA Commercial |
$329.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$423.00
|
| Rate for Payer: Multiplan All |
$427.70
|
| Rate for Payer: OMNI Networks Commercial |
$329.00
|
| Rate for Payer: One Health Plan PPO/POS |
$423.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$446.50
|
| Rate for Payer: Three Rivers Provider Network All |
$352.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$437.10
|
| Rate for Payer: Zelis Auto |
$188.00
|
| Rate for Payer: Zelis Worker's Compensation |
$128.31
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
CPT 44373
|
| Hospital Charge Code |
6144373
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$142.51 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cigna Commercial |
$443.70
|
| Rate for Payer: First Health Commercial |
$469.80
|
| Rate for Payer: First Health Workers Compensation |
$201.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$469.80
|
| Rate for Payer: GEHA Commercial |
$365.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$469.80
|
| Rate for Payer: Multiplan All |
$475.02
|
| Rate for Payer: OMNI Networks Commercial |
$365.40
|
| Rate for Payer: One Health Plan PPO/POS |
$469.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$495.90
|
| Rate for Payer: Three Rivers Provider Network All |
$391.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$485.46
|
| Rate for Payer: Zelis Auto |
$208.80
|
| Rate for Payer: Zelis Worker's Compensation |
$142.51
|
|
|
SMALL BOWEL ENDOSCOPY/BIOPSY
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
CPT 44361
|
| Hospital Charge Code |
6144361
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$141.69 |
| Max. Negotiated Rate |
$493.05 |
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cigna Commercial |
$441.15
|
| Rate for Payer: First Health Commercial |
$467.10
|
| Rate for Payer: First Health Workers Compensation |
$200.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$467.10
|
| Rate for Payer: GEHA Commercial |
$363.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$467.10
|
| Rate for Payer: Multiplan All |
$472.29
|
| Rate for Payer: OMNI Networks Commercial |
$363.30
|
| Rate for Payer: One Health Plan PPO/POS |
$467.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$493.05
|
| Rate for Payer: Three Rivers Provider Network All |
$389.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$482.67
|
| Rate for Payer: Zelis Auto |
$207.60
|
| Rate for Payer: Zelis Worker's Compensation |
$141.69
|
|
|
SMALL BOWEL ENDOSCOPY/BIOPSY
|
Facility
|
IP
|
$806.00
|
|
|
Service Code
|
CPT 44377
|
| Hospital Charge Code |
6144377
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$220.04 |
| Max. Negotiated Rate |
$765.70 |
| Rate for Payer: Cash Price |
$483.60
|
| Rate for Payer: Cigna Commercial |
$685.10
|
| Rate for Payer: First Health Commercial |
$725.40
|
| Rate for Payer: First Health Workers Compensation |
$311.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$725.40
|
| Rate for Payer: GEHA Commercial |
$564.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$725.40
|
| Rate for Payer: Multiplan All |
$733.46
|
| Rate for Payer: OMNI Networks Commercial |
$564.20
|
| Rate for Payer: One Health Plan PPO/POS |
$725.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$765.70
|
| Rate for Payer: Three Rivers Provider Network All |
$604.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$749.58
|
| Rate for Payer: Zelis Auto |
$322.40
|
| Rate for Payer: Zelis Worker's Compensation |
$220.04
|
|
|
SMALL BOWEL ENDOSCOPY/BIOPSY
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
CPT 44361
|
| Hospital Charge Code |
6144361
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$141.69 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$311.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$789.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cigna Commercial |
$441.15
|
| Rate for Payer: First Health Commercial |
$467.10
|
| Rate for Payer: First Health Workers Compensation |
$200.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$467.10
|
| Rate for Payer: GEHA Commercial |
$415.20
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$467.10
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$805.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$472.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$363.30
|
| Rate for Payer: One Health Plan PPO/POS |
$467.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$929.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$805.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$493.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$389.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$805.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$482.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$207.60
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$141.69
|
|
|
SMALL BOWEL ENDOSCOPY/BIOPSY
|
Facility
|
OP
|
$806.00
|
|
|
Service Code
|
CPT 44377
|
| Hospital Charge Code |
6144377
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$220.04 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$483.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$995.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$789.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$483.60
|
| Rate for Payer: Cash Price |
$483.60
|
| Rate for Payer: Cigna Commercial |
$685.10
|
| Rate for Payer: First Health Commercial |
$725.40
|
| Rate for Payer: First Health Workers Compensation |
$311.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$725.40
|
| Rate for Payer: GEHA Commercial |
$644.80
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$725.40
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$805.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$733.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$564.20
|
| Rate for Payer: One Health Plan PPO/POS |
$725.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$929.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$805.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$765.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$604.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$805.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$749.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$322.40
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$220.04
|
|
|
SMALL BOWEL ENDOSCOPY/STENT
|
Facility
|
IP
|
$719.00
|
|
|
Service Code
|
CPT 44370
|
| Hospital Charge Code |
6144370
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$196.29 |
| Max. Negotiated Rate |
$683.05 |
| Rate for Payer: Cash Price |
$431.40
|
| Rate for Payer: Cigna Commercial |
$611.15
|
| Rate for Payer: First Health Commercial |
$647.10
|
| Rate for Payer: First Health Workers Compensation |
$277.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$647.10
|
| Rate for Payer: GEHA Commercial |
$503.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$647.10
|
| Rate for Payer: Multiplan All |
$654.29
|
| Rate for Payer: OMNI Networks Commercial |
$503.30
|
| Rate for Payer: One Health Plan PPO/POS |
$647.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$683.05
|
| Rate for Payer: Three Rivers Provider Network All |
$539.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$668.67
|
| Rate for Payer: Zelis Auto |
$287.60
|
| Rate for Payer: Zelis Worker's Compensation |
$196.29
|
|
|
SMALL BOWEL ENDOSCOPY/STENT
|
Facility
|
OP
|
$719.00
|
|
|
Service Code
|
CPT 44370
|
| Hospital Charge Code |
6144370
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$196.29 |
| Max. Negotiated Rate |
$11,304.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,678.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$431.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,678.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,121.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,652.43
|
| Rate for Payer: Cash Price |
$431.40
|
| Rate for Payer: Cash Price |
$431.40
|
| Rate for Payer: Cigna Commercial |
$611.15
|
| Rate for Payer: First Health Commercial |
$647.10
|
| Rate for Payer: First Health Workers Compensation |
$277.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$647.10
|
| Rate for Payer: GEHA Commercial |
$575.20
|
| Rate for Payer: GEHA Medicare |
$5,652.43
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$647.10
|
| Rate for Payer: Humana ChoiceCare |
$6,217.67
|
| Rate for Payer: Humana Medicare Advantage |
$5,652.43
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,496.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,165.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,652.43
|
| Rate for Payer: Multiplan All |
$654.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,609.13
|
| Rate for Payer: OMNI Networks Commercial |
$503.30
|
| Rate for Payer: One Health Plan PPO/POS |
$647.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,499.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,165.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,652.43
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$683.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,304.86
|
| Rate for Payer: Three Rivers Provider Network All |
$539.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,539.38
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,165.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,652.43
|
| Rate for Payer: United Payors & United Providers UP&UP |
$668.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,652.43
|
| Rate for Payer: Zelis Auto |
$287.60
|
| Rate for Payer: Zelis Medicare |
$4,804.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,782.92
|
| Rate for Payer: Zelis Worker's Compensation |
$196.29
|
|
|
SMART TOE 19P
|
Facility
|
OP
|
$3,337.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006451
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$834.30 |
| Max. Negotiated Rate |
$3,170.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,002.32
|
| Rate for Payer: Cash Price |
$2,002.32
|
| Rate for Payer: Cash Price |
$2,002.32
|
| Rate for Payer: Cigna Commercial |
$2,836.62
|
| Rate for Payer: First Health Commercial |
$3,003.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,003.48
|
| Rate for Payer: GEHA Commercial |
$2,669.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,003.48
|
| Rate for Payer: Humana ChoiceCare |
$867.67
|
| Rate for Payer: Multiplan All |
$3,036.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,002.32
|
| Rate for Payer: OMNI Networks Commercial |
$2,336.04
|
| Rate for Payer: One Health Plan PPO/POS |
$3,003.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,170.34
|
| Rate for Payer: Three Rivers Provider Network All |
$2,502.90
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,936.74
|
| Rate for Payer: United Healthcare Managed Medicaid |
$834.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,103.60
|
| Rate for Payer: Zelis Auto |
$1,334.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,668.60
|
|
|
SMART TOE 19P
|
Facility
|
IP
|
$3,337.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006451
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,334.88 |
| Max. Negotiated Rate |
$3,170.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,669.76
|
| Rate for Payer: Cash Price |
$2,002.32
|
| Rate for Payer: Cash Price |
$2,002.32
|
| Rate for Payer: Cigna Commercial |
$2,836.62
|
| Rate for Payer: First Health Commercial |
$3,003.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,003.48
|
| Rate for Payer: GEHA Commercial |
$2,336.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,003.48
|
| Rate for Payer: Multiplan All |
$3,036.85
|
| Rate for Payer: OMNI Networks Commercial |
$2,336.04
|
| Rate for Payer: One Health Plan PPO/POS |
$3,003.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,170.34
|
| Rate for Payer: Three Rivers Provider Network All |
$2,502.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,103.60
|
| Rate for Payer: Zelis Auto |
$1,334.88
|
|
|
SMART TOE 20P
|
Facility
|
OP
|
$3,337.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$834.30 |
| Max. Negotiated Rate |
$3,170.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,002.32
|
| Rate for Payer: Cash Price |
$2,002.32
|
| Rate for Payer: Cash Price |
$2,002.32
|
| Rate for Payer: Cigna Commercial |
$2,836.62
|
| Rate for Payer: First Health Commercial |
$3,003.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,003.48
|
| Rate for Payer: GEHA Commercial |
$2,669.76
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,003.48
|
| Rate for Payer: Humana ChoiceCare |
$867.67
|
| Rate for Payer: Multiplan All |
$3,036.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,002.32
|
| Rate for Payer: OMNI Networks Commercial |
$2,336.04
|
| Rate for Payer: One Health Plan PPO/POS |
$3,003.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,170.34
|
| Rate for Payer: Three Rivers Provider Network All |
$2,502.90
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,936.74
|
| Rate for Payer: United Healthcare Managed Medicaid |
$834.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,103.60
|
| Rate for Payer: Zelis Auto |
$1,334.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,668.60
|
|
|
SMART TOE 20P
|
Facility
|
IP
|
$3,337.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,334.88 |
| Max. Negotiated Rate |
$3,170.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,669.76
|
| Rate for Payer: Cash Price |
$2,002.32
|
| Rate for Payer: Cash Price |
$2,002.32
|
| Rate for Payer: Cigna Commercial |
$2,836.62
|
| Rate for Payer: First Health Commercial |
$3,003.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,003.48
|
| Rate for Payer: GEHA Commercial |
$2,336.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,003.48
|
| Rate for Payer: Multiplan All |
$3,036.85
|
| Rate for Payer: OMNI Networks Commercial |
$2,336.04
|
| Rate for Payer: One Health Plan PPO/POS |
$3,003.48
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,170.34
|
| Rate for Payer: Three Rivers Provider Network All |
$2,502.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,103.60
|
| Rate for Payer: Zelis Auto |
$1,334.88
|
|
|
SMOKING&TOB CNSL; INTENSV > 10 MINS
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
7299407
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$31.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$51.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$31.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$28.29
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$73.10
|
| Rate for Payer: First Health Commercial |
$77.40
|
| Rate for Payer: First Health Workers Compensation |
$33.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$77.40
|
| Rate for Payer: GEHA Commercial |
$68.80
|
| Rate for Payer: GEHA Medicare |
$28.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$77.40
|
| Rate for Payer: Humana ChoiceCare |
$31.12
|
| Rate for Payer: Humana Medicare Advantage |
$28.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$47.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$28.29
|
| Rate for Payer: Multiplan All |
$78.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.09
|
| Rate for Payer: OMNI Networks Commercial |
$60.20
|
| Rate for Payer: One Health Plan PPO/POS |
$77.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$29.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$28.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$81.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$56.58
|
| Rate for Payer: Three Rivers Provider Network All |
$64.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$79.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$28.29
|
| Rate for Payer: Zelis Auto |
$34.40
|
| Rate for Payer: Zelis Medicare |
$24.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.95
|
| Rate for Payer: Zelis Worker's Compensation |
$23.48
|
|
|
SMOKING&TOB CNSL; INTENSV > 10 MINS
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
8500376
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$73.10
|
| Rate for Payer: First Health Commercial |
$77.40
|
| Rate for Payer: First Health Workers Compensation |
$33.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$77.40
|
| Rate for Payer: GEHA Commercial |
$60.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$77.40
|
| Rate for Payer: Multiplan All |
$78.26
|
| Rate for Payer: OMNI Networks Commercial |
$60.20
|
| Rate for Payer: One Health Plan PPO/POS |
$77.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$81.70
|
| Rate for Payer: Three Rivers Provider Network All |
$64.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$79.98
|
| Rate for Payer: Zelis Auto |
$34.40
|
| Rate for Payer: Zelis Worker's Compensation |
$23.48
|
|
|
SMOKING&TOB CNSL; INTENSV > 10 MINS
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
7299407
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$73.10
|
| Rate for Payer: First Health Commercial |
$77.40
|
| Rate for Payer: First Health Workers Compensation |
$33.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$77.40
|
| Rate for Payer: GEHA Commercial |
$60.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$77.40
|
| Rate for Payer: Multiplan All |
$78.26
|
| Rate for Payer: OMNI Networks Commercial |
$60.20
|
| Rate for Payer: One Health Plan PPO/POS |
$77.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$81.70
|
| Rate for Payer: Three Rivers Provider Network All |
$64.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$79.98
|
| Rate for Payer: Zelis Auto |
$34.40
|
| Rate for Payer: Zelis Worker's Compensation |
$23.48
|
|
|
SMOKING&TOB CNSL; INTENSV > 10 MINS
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
8500376
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$31.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$51.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$31.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$28.29
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$73.10
|
| Rate for Payer: First Health Commercial |
$77.40
|
| Rate for Payer: First Health Workers Compensation |
$33.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$77.40
|
| Rate for Payer: GEHA Commercial |
$68.80
|
| Rate for Payer: GEHA Medicare |
$28.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$77.40
|
| Rate for Payer: Humana ChoiceCare |
$31.12
|
| Rate for Payer: Humana Medicare Advantage |
$28.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$47.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$28.29
|
| Rate for Payer: Multiplan All |
$78.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.09
|
| Rate for Payer: OMNI Networks Commercial |
$60.20
|
| Rate for Payer: One Health Plan PPO/POS |
$77.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$29.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$28.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$81.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$56.58
|
| Rate for Payer: Three Rivers Provider Network All |
$64.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$79.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$28.29
|
| Rate for Payer: Zelis Auto |
$34.40
|
| Rate for Payer: Zelis Medicare |
$24.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.95
|
| Rate for Payer: Zelis Worker's Compensation |
$23.48
|
|
|
SMOKING&TOB CNSL; INTRMED 3-10 MINS
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
8500375
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$39.10
|
| Rate for Payer: First Health Commercial |
$41.40
|
| Rate for Payer: First Health Workers Compensation |
$17.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$41.40
|
| Rate for Payer: GEHA Commercial |
$32.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$41.40
|
| Rate for Payer: Multiplan All |
$41.86
|
| Rate for Payer: OMNI Networks Commercial |
$32.20
|
| Rate for Payer: One Health Plan PPO/POS |
$41.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$43.70
|
| Rate for Payer: Three Rivers Provider Network All |
$34.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$42.78
|
| Rate for Payer: Zelis Auto |
$18.40
|
| Rate for Payer: Zelis Worker's Compensation |
$12.56
|
|
|
SMOKING&TOB CNSL; INTRMED 3-10 MINS
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
8500375
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$56.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$31.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$27.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$31.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$28.29
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$39.10
|
| Rate for Payer: First Health Commercial |
$41.40
|
| Rate for Payer: First Health Workers Compensation |
$17.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$41.40
|
| Rate for Payer: GEHA Commercial |
$36.80
|
| Rate for Payer: GEHA Medicare |
$28.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$41.40
|
| Rate for Payer: Humana ChoiceCare |
$31.12
|
| Rate for Payer: Humana Medicare Advantage |
$28.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$47.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$28.29
|
| Rate for Payer: Multiplan All |
$41.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.09
|
| Rate for Payer: OMNI Networks Commercial |
$32.20
|
| Rate for Payer: One Health Plan PPO/POS |
$41.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$29.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$28.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$43.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$56.58
|
| Rate for Payer: Three Rivers Provider Network All |
$34.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$42.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$28.29
|
| Rate for Payer: Zelis Auto |
$18.40
|
| Rate for Payer: Zelis Medicare |
$24.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.95
|
| Rate for Payer: Zelis Worker's Compensation |
$12.56
|
|
|
SMOKING&TOB CNSL; INTRMED 3-10 MINS
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
7299406
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$39.10
|
| Rate for Payer: First Health Commercial |
$41.40
|
| Rate for Payer: First Health Workers Compensation |
$17.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$41.40
|
| Rate for Payer: GEHA Commercial |
$32.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$41.40
|
| Rate for Payer: Multiplan All |
$41.86
|
| Rate for Payer: OMNI Networks Commercial |
$32.20
|
| Rate for Payer: One Health Plan PPO/POS |
$41.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$43.70
|
| Rate for Payer: Three Rivers Provider Network All |
$34.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$42.78
|
| Rate for Payer: Zelis Auto |
$18.40
|
| Rate for Payer: Zelis Worker's Compensation |
$12.56
|
|
|
SMOKING&TOB CNSL; INTRMED 3-10 MINS
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
7299406
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$56.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$31.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$27.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$31.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$28.29
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$39.10
|
| Rate for Payer: First Health Commercial |
$41.40
|
| Rate for Payer: First Health Workers Compensation |
$17.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$41.40
|
| Rate for Payer: GEHA Commercial |
$36.80
|
| Rate for Payer: GEHA Medicare |
$28.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$41.40
|
| Rate for Payer: Humana ChoiceCare |
$31.12
|
| Rate for Payer: Humana Medicare Advantage |
$28.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$47.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$28.29
|
| Rate for Payer: Multiplan All |
$41.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.09
|
| Rate for Payer: OMNI Networks Commercial |
$32.20
|
| Rate for Payer: One Health Plan PPO/POS |
$41.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$29.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$28.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$43.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$56.58
|
| Rate for Payer: Three Rivers Provider Network All |
$34.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$42.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$28.29
|
| Rate for Payer: Zelis Auto |
$18.40
|
| Rate for Payer: Zelis Medicare |
$24.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.95
|
| Rate for Payer: Zelis Worker's Compensation |
$12.56
|
|
|
SMPL REPAIR S/N/A/G/T 2.6-7.5CM
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
6112002
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$49.69 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$109.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$154.70
|
| Rate for Payer: First Health Commercial |
$163.80
|
| Rate for Payer: First Health Workers Compensation |
$70.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$163.80
|
| Rate for Payer: GEHA Commercial |
$145.60
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$163.80
|
| 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 |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$165.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$127.40
|
| Rate for Payer: One Health Plan PPO/POS |
$163.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$172.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$136.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$169.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$72.80
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.69
|
|
|
SMPL REPAIR S/N/A/G/T 2.6-7.5CM
|
Facility
|
OP
|
$318.03
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
8512002
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$86.82 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$190.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$190.82
|
| Rate for Payer: Cash Price |
$190.82
|
| Rate for Payer: Cigna Commercial |
$270.33
|
| Rate for Payer: First Health Commercial |
$286.23
|
| Rate for Payer: First Health Workers Compensation |
$122.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$286.23
|
| Rate for Payer: GEHA Commercial |
$254.42
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$286.23
|
| 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 |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$289.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$222.62
|
| Rate for Payer: One Health Plan PPO/POS |
$286.23
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$302.13
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$238.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$295.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$127.21
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$86.82
|
|
|
SMPL REPAIR S/N/A/G/T 2.6-7.5CM
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
21600103
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$49.69 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$109.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$154.70
|
| Rate for Payer: First Health Commercial |
$163.80
|
| Rate for Payer: First Health Workers Compensation |
$70.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$163.80
|
| Rate for Payer: GEHA Commercial |
$145.60
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$163.80
|
| 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 |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$165.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$127.40
|
| Rate for Payer: One Health Plan PPO/POS |
$163.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$172.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$136.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$169.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$72.80
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.69
|
|
