|
SYNCH AUDIO-VIDEO EST LOW 20
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 98005
|
| Hospital Charge Code |
198005
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$65.25 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$156.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$221.85
|
| Rate for Payer: First Health Commercial |
$234.90
|
| Rate for Payer: First Health Workers Compensation |
$100.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.90
|
| Rate for Payer: GEHA Commercial |
$208.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.90
|
| Rate for Payer: Humana ChoiceCare |
$67.86
|
| Rate for Payer: Multiplan All |
$237.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$156.60
|
| Rate for Payer: OMNI Networks Commercial |
$182.70
|
| Rate for Payer: One Health Plan PPO/POS |
$234.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$247.95
|
| Rate for Payer: Three Rivers Provider Network All |
$195.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$242.73
|
| Rate for Payer: Zelis Auto |
$104.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$130.50
|
| Rate for Payer: Zelis Worker's Compensation |
$71.25
|
|
|
SYNCH AUDIO-VIDEO EST MOD 30
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT 98006
|
| Hospital Charge Code |
198006
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$92.50 |
| Max. Negotiated Rate |
$351.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$314.50
|
| Rate for Payer: First Health Commercial |
$333.00
|
| Rate for Payer: First Health Workers Compensation |
$142.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.00
|
| Rate for Payer: GEHA Commercial |
$296.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.00
|
| Rate for Payer: Humana ChoiceCare |
$96.20
|
| Rate for Payer: Multiplan All |
$336.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$222.00
|
| Rate for Payer: OMNI Networks Commercial |
$259.00
|
| Rate for Payer: One Health Plan PPO/POS |
$333.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$351.50
|
| Rate for Payer: Three Rivers Provider Network All |
$277.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$325.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$92.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$344.10
|
| Rate for Payer: Zelis Auto |
$148.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$185.00
|
| Rate for Payer: Zelis Worker's Compensation |
$101.01
|
|
|
SYNCH AUDIO-VIDEO EST MOD 30
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 98006
|
| Hospital Charge Code |
198006
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$101.01 |
| Max. Negotiated Rate |
$351.50 |
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$314.50
|
| Rate for Payer: First Health Commercial |
$333.00
|
| Rate for Payer: First Health Workers Compensation |
$142.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.00
|
| Rate for Payer: GEHA Commercial |
$259.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.00
|
| Rate for Payer: Multiplan All |
$336.70
|
| Rate for Payer: OMNI Networks Commercial |
$259.00
|
| Rate for Payer: One Health Plan PPO/POS |
$333.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$351.50
|
| Rate for Payer: Three Rivers Provider Network All |
$277.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$344.10
|
| Rate for Payer: Zelis Auto |
$148.00
|
| Rate for Payer: Zelis Worker's Compensation |
$101.01
|
|
|
SYNCH AUDIO-VIDEO EST SF 10
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 98004
|
| Hospital Charge Code |
198004
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$40.75 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$130.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Humana ChoiceCare |
$42.38
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.80
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$143.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$40.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.50
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
SYNCH AUDIO-VIDEO EST SF 10
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 98004
|
| Hospital Charge Code |
198004
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$114.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
SYNCH AUDIO-VIDEO NEW HI 60
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 98003
|
| Hospital Charge Code |
198003
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$174.99 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$544.85
|
| Rate for Payer: First Health Commercial |
$576.90
|
| Rate for Payer: First Health Workers Compensation |
$247.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.90
|
| Rate for Payer: GEHA Commercial |
$448.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| Rate for Payer: Multiplan All |
$583.31
|
| Rate for Payer: OMNI Networks Commercial |
$448.70
|
| Rate for Payer: One Health Plan PPO/POS |
$576.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.95
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$596.13
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
SYNCH AUDIO-VIDEO NEW HI 60
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 98003
|
| Hospital Charge Code |
198003
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$160.25 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$384.60
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$544.85
|
| Rate for Payer: First Health Commercial |
$576.90
|
| Rate for Payer: First Health Workers Compensation |
$247.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.90
|
| Rate for Payer: GEHA Commercial |
$512.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| Rate for Payer: Humana ChoiceCare |
$166.66
|
| Rate for Payer: Multiplan All |
$583.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$384.60
|
| Rate for Payer: OMNI Networks Commercial |
$448.70
|
| Rate for Payer: One Health Plan PPO/POS |
$576.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.95
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$564.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$160.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$596.13
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$320.50
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
SYNCH AUDIO-VIDEO NEW LOW 30
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 98001
|
| Hospital Charge Code |
198001
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$309.70 |
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$277.10
|
| Rate for Payer: First Health Commercial |
$293.40
|
| Rate for Payer: First Health Workers Compensation |
$125.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$293.40
|
| Rate for Payer: GEHA Commercial |
$228.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$293.40
|
| Rate for Payer: Multiplan All |
$296.66
|
| Rate for Payer: OMNI Networks Commercial |
$228.20
|
| Rate for Payer: One Health Plan PPO/POS |
$293.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$309.70
|
| Rate for Payer: Three Rivers Provider Network All |
$244.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$303.18
|
| Rate for Payer: Zelis Auto |
$130.40
|
| Rate for Payer: Zelis Worker's Compensation |
$89.00
|
|
|
SYNCH AUDIO-VIDEO NEW LOW 30
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 98001
|
| Hospital Charge Code |
198001
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$81.50 |
| Max. Negotiated Rate |
$309.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$195.60
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$277.10
|
| Rate for Payer: First Health Commercial |
$293.40
|
| Rate for Payer: First Health Workers Compensation |
$125.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$293.40
|
| Rate for Payer: GEHA Commercial |
$260.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$293.40
|
| Rate for Payer: Humana ChoiceCare |
$84.76
|
| Rate for Payer: Multiplan All |
$296.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$195.60
|
| Rate for Payer: OMNI Networks Commercial |
$228.20
|
| Rate for Payer: One Health Plan PPO/POS |
$293.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$309.70
|
| Rate for Payer: Three Rivers Provider Network All |
$244.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$286.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$81.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$303.18
|
| Rate for Payer: Zelis Auto |
$130.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$163.00
|
| Rate for Payer: Zelis Worker's Compensation |
$89.00
|
|
|
SYNCH AUDIO-VIDEO NEW MOD 45
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
CPT 98002
|
| Hospital Charge Code |
198002
|
|
Hospital Revenue Code
|
780
|
| 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
|
|
|
SYNCH AUDIO-VIDEO NEW MOD 45
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
CPT 98002
|
| Hospital Charge Code |
198002
|
|
Hospital Revenue Code
|
780
|
| 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
|
|
|
SYNCH AUDIO-VIDEO NEW SF 15
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 98000
|
| Hospital Charge Code |
198000
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$57.06 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: First Health Workers Compensation |
$80.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$188.10
|
| Rate for Payer: GEHA Commercial |
$146.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$188.10
|
| Rate for Payer: Multiplan All |
$190.19
|
| Rate for Payer: OMNI Networks Commercial |
$146.30
|
| Rate for Payer: One Health Plan PPO/POS |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$198.55
|
| Rate for Payer: Three Rivers Provider Network All |
$156.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$194.37
|
| Rate for Payer: Zelis Auto |
$83.60
|
| Rate for Payer: Zelis Worker's Compensation |
$57.06
|
|
|
SYNCH AUDIO-VIDEO NEW SF 15
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT 98000
|
| Hospital Charge Code |
198000
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$52.25 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: First Health Workers Compensation |
$80.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$188.10
|
| Rate for Payer: GEHA Commercial |
$167.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$188.10
|
| Rate for Payer: Humana ChoiceCare |
$54.34
|
| Rate for Payer: Multiplan All |
$190.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$125.40
|
| Rate for Payer: OMNI Networks Commercial |
$146.30
|
| Rate for Payer: One Health Plan PPO/POS |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$198.55
|
| Rate for Payer: Three Rivers Provider Network All |
$156.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$183.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$52.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$194.37
|
| Rate for Payer: Zelis Auto |
$83.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$104.50
|
| Rate for Payer: Zelis Worker's Compensation |
$57.06
|
|
|
SYNOVECTOMY, TENDON SHEATH, FOOT; FLEXOR
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 28086
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,749.66 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,208.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,749.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,785.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,061.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,785.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,785.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$2,803.61
|
|
|
SYNOVIAL FLUID CRYSTAL ID AGH
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
2200340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$13.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$79.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$13.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$10.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7.33
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$112.20
|
| Rate for Payer: First Health Commercial |
$118.80
|
| Rate for Payer: First Health Workers Compensation |
$28.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$118.80
|
| Rate for Payer: GEHA Commercial |
$105.60
|
| Rate for Payer: GEHA Medicare |
$7.33
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$118.80
|
| Rate for Payer: Humana ChoiceCare |
$8.06
|
| Rate for Payer: Humana Medicare Advantage |
$7.33
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$12.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$10.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7.33
|
| Rate for Payer: Multiplan All |
$120.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12.46
|
| Rate for Payer: OMNI Networks Commercial |
$92.40
|
| Rate for Payer: One Health Plan PPO/POS |
$118.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$12.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$10.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$125.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$14.66
|
| Rate for Payer: Three Rivers Provider Network All |
$99.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.18
|
| Rate for Payer: United Healthcare Commercial |
$112.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$10.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.33
|
| Rate for Payer: United Payors & United Providers UP&UP |
$122.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7.33
|
| Rate for Payer: Zelis Auto |
$52.80
|
| Rate for Payer: Zelis Medicare |
$6.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.80
|
| Rate for Payer: Zelis Worker's Compensation |
$19.82
|
|
|
SYNOVIAL FLUID CRYSTAL ID AGH
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
2200340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.82 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$112.20
|
| Rate for Payer: First Health Commercial |
$118.80
|
| Rate for Payer: First Health Workers Compensation |
$28.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$118.80
|
| Rate for Payer: GEHA Commercial |
$92.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$118.80
|
| Rate for Payer: Multiplan All |
$120.12
|
| Rate for Payer: OMNI Networks Commercial |
$92.40
|
| Rate for Payer: One Health Plan PPO/POS |
$118.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$125.40
|
| Rate for Payer: Three Rivers Provider Network All |
$99.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$122.76
|
| Rate for Payer: Zelis Auto |
$52.80
|
| Rate for Payer: Zelis Worker's Compensation |
$19.82
|
|
|
SYNVISC
|
Facility
|
OP
|
$2,472.00
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
3300432
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$2,348.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$18.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,483.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$18.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$15.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7.95
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cigna Commercial |
$2,101.20
|
| Rate for Payer: First Health Commercial |
$2,224.80
|
| Rate for Payer: First Health Workers Compensation |
$954.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,224.80
|
| Rate for Payer: GEHA Commercial |
$8.74
|
| Rate for Payer: GEHA Medicare |
$7.95
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,224.80
|
| Rate for Payer: Humana ChoiceCare |
$8.74
|
| Rate for Payer: Humana Medicare Advantage |
$7.95
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$15.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7.95
|
| Rate for Payer: Multiplan All |
$2,249.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.52
|
| Rate for Payer: OMNI Networks Commercial |
$1,730.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,224.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$17.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$15.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7.95
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,348.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$15.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,854.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.95
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,298.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7.95
|
| Rate for Payer: Zelis Auto |
$988.80
|
| Rate for Payer: Zelis Medicare |
$6.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.54
|
| Rate for Payer: Zelis Worker's Compensation |
$674.86
|
|
|
SYNVISC
|
Facility
|
IP
|
$2,472.00
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
3300432
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$674.86 |
| Max. Negotiated Rate |
$2,348.40 |
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cigna Commercial |
$2,101.20
|
| Rate for Payer: First Health Commercial |
$2,224.80
|
| Rate for Payer: First Health Workers Compensation |
$954.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,224.80
|
| Rate for Payer: GEHA Commercial |
$1,730.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,224.80
|
| Rate for Payer: Multiplan All |
$2,249.52
|
| Rate for Payer: OMNI Networks Commercial |
$1,730.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,224.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,348.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,854.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,298.96
|
| Rate for Payer: Zelis Auto |
$988.80
|
| Rate for Payer: Zelis Worker's Compensation |
$674.86
|
|
|
SYNVISC ONE
|
Facility
|
IP
|
$2,472.00
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
3300433
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$674.86 |
| Max. Negotiated Rate |
$2,348.40 |
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cigna Commercial |
$2,101.20
|
| Rate for Payer: First Health Commercial |
$2,224.80
|
| Rate for Payer: First Health Workers Compensation |
$954.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,224.80
|
| Rate for Payer: GEHA Commercial |
$1,730.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,224.80
|
| Rate for Payer: Multiplan All |
$2,249.52
|
| Rate for Payer: OMNI Networks Commercial |
$1,730.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,224.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,348.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,854.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,298.96
|
| Rate for Payer: Zelis Auto |
$988.80
|
| Rate for Payer: Zelis Worker's Compensation |
$674.86
|
|
|
SYNVISC ONE
|
Facility
|
OP
|
$2,472.00
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
3300433
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$2,348.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$18.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,483.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$18.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$15.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7.95
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cigna Commercial |
$2,101.20
|
| Rate for Payer: First Health Commercial |
$2,224.80
|
| Rate for Payer: First Health Workers Compensation |
$954.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,224.80
|
| Rate for Payer: GEHA Commercial |
$8.74
|
| Rate for Payer: GEHA Medicare |
$7.95
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,224.80
|
| Rate for Payer: Humana ChoiceCare |
$8.74
|
| Rate for Payer: Humana Medicare Advantage |
$7.95
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$15.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7.95
|
| Rate for Payer: Multiplan All |
$2,249.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.52
|
| Rate for Payer: OMNI Networks Commercial |
$1,730.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,224.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$17.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$15.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7.95
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,348.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$15.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,854.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.95
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,298.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7.95
|
| Rate for Payer: Zelis Auto |
$988.80
|
| Rate for Payer: Zelis Medicare |
$6.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.54
|
| Rate for Payer: Zelis Worker's Compensation |
$674.86
|
|
|
SYSTANE OPTHALMIC
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 00065043133
|
| Hospital Charge Code |
3300731
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna Commercial |
$5.95
|
| Rate for Payer: First Health Commercial |
$6.30
|
| Rate for Payer: First Health Workers Compensation |
$2.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6.30
|
| Rate for Payer: GEHA Commercial |
$4.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6.30
|
| Rate for Payer: Multiplan All |
$6.37
|
| Rate for Payer: OMNI Networks Commercial |
$4.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6.65
|
| Rate for Payer: Three Rivers Provider Network All |
$5.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6.51
|
| Rate for Payer: Zelis Auto |
$2.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1.91
|
|
|
SYSTANE OPTHALMIC
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
NDC 00065043133
|
| Hospital Charge Code |
3300731
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4.20
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna Commercial |
$5.95
|
| Rate for Payer: First Health Commercial |
$6.30
|
| Rate for Payer: First Health Workers Compensation |
$2.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6.30
|
| Rate for Payer: GEHA Commercial |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6.30
|
| Rate for Payer: Humana ChoiceCare |
$1.82
|
| Rate for Payer: Multiplan All |
$6.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.20
|
| Rate for Payer: OMNI Networks Commercial |
$4.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6.65
|
| Rate for Payer: Three Rivers Provider Network All |
$5.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6.51
|
| Rate for Payer: Zelis Auto |
$2.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1.91
|
|
|
SYSTEM IMPLANT BIOCOMPOSITE MPFL
|
Facility
|
IP
|
$7,232.00
|
|
| Hospital Charge Code |
90061280
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,892.80 |
| Max. Negotiated Rate |
$6,870.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,785.60
|
| Rate for Payer: Cash Price |
$4,339.20
|
| Rate for Payer: Cash Price |
$4,339.20
|
| Rate for Payer: Cigna Commercial |
$6,147.20
|
| Rate for Payer: First Health Commercial |
$6,508.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,508.80
|
| Rate for Payer: GEHA Commercial |
$5,062.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,508.80
|
| Rate for Payer: Multiplan All |
$6,581.12
|
| Rate for Payer: OMNI Networks Commercial |
$5,062.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,508.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,870.40
|
| Rate for Payer: Three Rivers Provider Network All |
$5,424.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,725.76
|
| Rate for Payer: Zelis Auto |
$2,892.80
|
|
|
SYSTEM IMPLANT BIOCOMPOSITE MPFL
|
Facility
|
OP
|
$7,232.00
|
|
| Hospital Charge Code |
90061280
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,808.00 |
| Max. Negotiated Rate |
$6,870.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,339.20
|
| Rate for Payer: Cash Price |
$4,339.20
|
| Rate for Payer: Cash Price |
$4,339.20
|
| Rate for Payer: Cigna Commercial |
$6,147.20
|
| Rate for Payer: First Health Commercial |
$6,508.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,508.80
|
| Rate for Payer: GEHA Commercial |
$5,785.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,508.80
|
| Rate for Payer: Humana ChoiceCare |
$1,880.32
|
| Rate for Payer: Multiplan All |
$6,581.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,339.20
|
| Rate for Payer: OMNI Networks Commercial |
$5,062.40
|
| Rate for Payer: One Health Plan PPO/POS |
$6,508.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,870.40
|
| Rate for Payer: Three Rivers Provider Network All |
$5,424.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,364.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,808.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,725.76
|
| Rate for Payer: Zelis Auto |
$2,892.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,616.00
|
|
|
t3 free dialysis lc/ms-ms REF503600
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
2200654
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$237.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.94
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$212.50
|
| Rate for Payer: First Health Commercial |
$225.00
|
| Rate for Payer: First Health Workers Compensation |
$31.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$225.00
|
| Rate for Payer: GEHA Commercial |
$200.00
|
| Rate for Payer: GEHA Medicare |
$16.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$225.00
|
| Rate for Payer: Humana ChoiceCare |
$18.63
|
| Rate for Payer: Humana Medicare Advantage |
$16.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.94
|
| Rate for Payer: Multiplan All |
$227.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.80
|
| Rate for Payer: OMNI Networks Commercial |
$175.00
|
| Rate for Payer: One Health Plan PPO/POS |
$225.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$237.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.88
|
| Rate for Payer: Three Rivers Provider Network All |
$187.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.60
|
| Rate for Payer: United Healthcare Commercial |
$212.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$232.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.94
|
| Rate for Payer: Zelis Auto |
$100.00
|
| Rate for Payer: Zelis Medicare |
$14.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.33
|
| Rate for Payer: Zelis Worker's Compensation |
$22.03
|
|
