|
BX SOFT TIS SHLDR SU
|
Facility
|
OP
|
$1,395.00
|
|
| Hospital Charge Code |
2410069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$348.75 |
| Max. Negotiated Rate |
$1,325.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$837.00
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$1,185.75
|
| Rate for Payer: First Health Commercial |
$1,255.50
|
| Rate for Payer: First Health Workers Compensation |
$538.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,255.50
|
| Rate for Payer: GEHA Commercial |
$1,116.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,255.50
|
| Rate for Payer: Humana ChoiceCare |
$362.70
|
| Rate for Payer: Multiplan All |
$1,269.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$837.00
|
| Rate for Payer: OMNI Networks Commercial |
$976.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,255.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,325.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,046.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,227.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$348.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,297.35
|
| Rate for Payer: Zelis Auto |
$558.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.50
|
| Rate for Payer: Zelis Worker's Compensation |
$380.83
|
|
|
BX THYROID PERC CORE
|
Facility
|
IP
|
$1,597.00
|
|
| Hospital Charge Code |
2407249
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$435.98 |
| Max. Negotiated Rate |
$1,517.15 |
| Rate for Payer: Cash Price |
$958.20
|
| Rate for Payer: Cigna Commercial |
$1,357.45
|
| Rate for Payer: First Health Commercial |
$1,437.30
|
| Rate for Payer: First Health Workers Compensation |
$616.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,437.30
|
| Rate for Payer: GEHA Commercial |
$1,117.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,437.30
|
| Rate for Payer: Multiplan All |
$1,453.27
|
| Rate for Payer: OMNI Networks Commercial |
$1,117.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,437.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,517.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,197.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,485.21
|
| Rate for Payer: Zelis Auto |
$638.80
|
| Rate for Payer: Zelis Worker's Compensation |
$435.98
|
|
|
BX THYROID PERC CORE
|
Facility
|
OP
|
$1,597.00
|
|
| Hospital Charge Code |
2407249
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$399.25 |
| Max. Negotiated Rate |
$1,517.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$958.20
|
| Rate for Payer: Cash Price |
$958.20
|
| Rate for Payer: Cigna Commercial |
$1,357.45
|
| Rate for Payer: First Health Commercial |
$1,437.30
|
| Rate for Payer: First Health Workers Compensation |
$616.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,437.30
|
| Rate for Payer: GEHA Commercial |
$1,277.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,437.30
|
| Rate for Payer: Humana ChoiceCare |
$415.22
|
| Rate for Payer: Multiplan All |
$1,453.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$958.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,117.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,437.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,517.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,197.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,405.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$399.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,485.21
|
| Rate for Payer: Zelis Auto |
$638.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$798.50
|
| Rate for Payer: Zelis Worker's Compensation |
$435.98
|
|
|
c1 esterase inhibitor REF004648
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
2299325
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: First Health Commercial |
$144.00
|
| Rate for Payer: First Health Workers Compensation |
$20.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.00
|
| Rate for Payer: GEHA Commercial |
$112.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.00
|
| Rate for Payer: Multiplan All |
$145.60
|
| Rate for Payer: OMNI Networks Commercial |
$112.00
|
| Rate for Payer: One Health Plan PPO/POS |
$144.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.00
|
| Rate for Payer: Three Rivers Provider Network All |
$120.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$148.80
|
| Rate for Payer: Zelis Auto |
$64.00
|
| Rate for Payer: Zelis Worker's Compensation |
$14.21
|
|
|
c1 esterase inhibitor REF004648
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
2299325
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$96.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: First Health Commercial |
$144.00
|
| Rate for Payer: First Health Workers Compensation |
$20.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.00
|
| Rate for Payer: GEHA Commercial |
$128.00
|
| Rate for Payer: GEHA Medicare |
$12.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.00
|
| Rate for Payer: Humana ChoiceCare |
$13.20
|
| Rate for Payer: Humana Medicare Advantage |
$12.00
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.00
|
| Rate for Payer: Multiplan All |
$145.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.40
|
| Rate for Payer: OMNI Networks Commercial |
$112.00
|
| Rate for Payer: One Health Plan PPO/POS |
$144.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.00
|
| Rate for Payer: Three Rivers Provider Network All |
$120.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.76
|
| Rate for Payer: United Healthcare Commercial |
$136.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$148.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.00
|
| Rate for Payer: Zelis Auto |
$64.00
|
| Rate for Payer: Zelis Medicare |
$10.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.40
|
| Rate for Payer: Zelis Worker's Compensation |
$14.21
|
|
|
C1 Inhibitor, Functional
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
2299326
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$20.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Worker's Compensation |
$14.21
|
|
|
C1 Inhibitor, Functional
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
2299326
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$20.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: GEHA Medicare |
$12.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Humana ChoiceCare |
$13.20
|
| Rate for Payer: Humana Medicare Advantage |
$12.00
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.00
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.40
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.00
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.76
|
| Rate for Payer: United Healthcare Commercial |
$142.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.00
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Medicare |
$10.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.40
|
| Rate for Payer: Zelis Worker's Compensation |
$14.21
|
|
|
c3 complement REF 006452
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
2286160
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: First Health Commercial |
$144.00
|
| Rate for Payer: First Health Workers Compensation |
$20.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.00
|
| Rate for Payer: GEHA Commercial |
$112.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.00
|
| Rate for Payer: Multiplan All |
$145.60
|
| Rate for Payer: OMNI Networks Commercial |
$112.00
|
| Rate for Payer: One Health Plan PPO/POS |
$144.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.00
|
| Rate for Payer: Three Rivers Provider Network All |
$120.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$148.80
|
| Rate for Payer: Zelis Auto |
$64.00
|
| Rate for Payer: Zelis Worker's Compensation |
$14.21
|
|
|
c3 complement REF 006452
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
2286160
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$96.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: First Health Commercial |
$144.00
|
| Rate for Payer: First Health Workers Compensation |
$20.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.00
|
| Rate for Payer: GEHA Commercial |
$128.00
|
| Rate for Payer: GEHA Medicare |
$12.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.00
|
| Rate for Payer: Humana ChoiceCare |
$13.20
|
| Rate for Payer: Humana Medicare Advantage |
$12.00
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.00
|
| Rate for Payer: Multiplan All |
$145.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.40
|
| Rate for Payer: OMNI Networks Commercial |
$112.00
|
| Rate for Payer: One Health Plan PPO/POS |
$144.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.00
|
| Rate for Payer: Three Rivers Provider Network All |
$120.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.76
|
| Rate for Payer: United Healthcare Commercial |
$136.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$148.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.00
|
| Rate for Payer: Zelis Auto |
$64.00
|
| Rate for Payer: Zelis Medicare |
$10.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.40
|
| Rate for Payer: Zelis Worker's Compensation |
$14.21
|
|
|
C3 INTELLIGNECE DOA
|
Facility
|
OP
|
$51.00
|
|
| Hospital Charge Code |
2202004
|
|
Hospital Revenue Code
|
111
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$43.35
|
| Rate for Payer: First Health Commercial |
$45.90
|
| Rate for Payer: First Health Workers Compensation |
$19.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.90
|
| Rate for Payer: GEHA Commercial |
$40.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.90
|
| Rate for Payer: Humana ChoiceCare |
$13.26
|
| Rate for Payer: Multiplan All |
$46.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.60
|
| Rate for Payer: OMNI Networks Commercial |
$35.70
|
| Rate for Payer: One Health Plan PPO/POS |
$45.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$48.45
|
| Rate for Payer: Three Rivers Provider Network All |
$38.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$44.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$47.43
|
| Rate for Payer: Zelis Auto |
$20.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$25.50
|
| Rate for Payer: Zelis Worker's Compensation |
$13.92
|
|
|
C3 INTELLIGNECE DOA
|
Facility
|
IP
|
$51.00
|
|
| Hospital Charge Code |
2202004
|
|
Hospital Revenue Code
|
111
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$43.35
|
| Rate for Payer: First Health Commercial |
$45.90
|
| Rate for Payer: First Health Workers Compensation |
$19.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.90
|
| Rate for Payer: GEHA Commercial |
$35.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.90
|
| Rate for Payer: Multiplan All |
$46.41
|
| Rate for Payer: OMNI Networks Commercial |
$35.70
|
| Rate for Payer: One Health Plan PPO/POS |
$45.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$48.45
|
| Rate for Payer: Three Rivers Provider Network All |
$38.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$47.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$360.00
|
| Rate for Payer: Zelis Auto |
$20.40
|
| Rate for Payer: Zelis Worker's Compensation |
$13.92
|
|
|
c4 complement REF 001834
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
2299179
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$96.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: First Health Commercial |
$144.00
|
| Rate for Payer: First Health Workers Compensation |
$20.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.00
|
| Rate for Payer: GEHA Commercial |
$128.00
|
| Rate for Payer: GEHA Medicare |
$12.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.00
|
| Rate for Payer: Humana ChoiceCare |
$13.20
|
| Rate for Payer: Humana Medicare Advantage |
$12.00
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.00
|
| Rate for Payer: Multiplan All |
$145.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.40
|
| Rate for Payer: OMNI Networks Commercial |
$112.00
|
| Rate for Payer: One Health Plan PPO/POS |
$144.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.00
|
| Rate for Payer: Three Rivers Provider Network All |
$120.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.76
|
| Rate for Payer: United Healthcare Commercial |
$136.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$148.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.00
|
| Rate for Payer: Zelis Auto |
$64.00
|
| Rate for Payer: Zelis Medicare |
$10.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.40
|
| Rate for Payer: Zelis Worker's Compensation |
$14.21
|
|
|
c4 complement REF 001834
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
2299179
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: First Health Commercial |
$144.00
|
| Rate for Payer: First Health Workers Compensation |
$20.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.00
|
| Rate for Payer: GEHA Commercial |
$112.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.00
|
| Rate for Payer: Multiplan All |
$145.60
|
| Rate for Payer: OMNI Networks Commercial |
$112.00
|
| Rate for Payer: One Health Plan PPO/POS |
$144.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.00
|
| Rate for Payer: Three Rivers Provider Network All |
$120.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$148.80
|
| Rate for Payer: Zelis Auto |
$64.00
|
| Rate for Payer: Zelis Worker's Compensation |
$14.21
|
|
|
ca 125 REF002303
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
2236229
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: First Health Workers Compensation |
$38.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$124.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
| Rate for Payer: Zelis Worker's Compensation |
$27.46
|
|
|
ca 125 REF002303
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
2236229
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.69 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$37.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$106.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$37.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$29.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: First Health Workers Compensation |
$38.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$142.40
|
| Rate for Payer: GEHA Medicare |
$20.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Humana ChoiceCare |
$22.89
|
| Rate for Payer: Humana Medicare Advantage |
$20.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$34.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20.81
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.38
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$34.96
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$30.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$41.62
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$20.39
|
| Rate for Payer: United Healthcare Commercial |
$151.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$20.81
|
| Rate for Payer: Zelis Auto |
$71.20
|
| Rate for Payer: Zelis Medicare |
$17.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24.97
|
| Rate for Payer: Zelis Worker's Compensation |
$27.46
|
|
|
ca 15-3 REF143404
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
2299210
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$189.05 |
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$169.15
|
| Rate for Payer: First Health Commercial |
$179.10
|
| Rate for Payer: First Health Workers Compensation |
$38.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$179.10
|
| Rate for Payer: GEHA Commercial |
$139.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$179.10
|
| Rate for Payer: Multiplan All |
$181.09
|
| Rate for Payer: OMNI Networks Commercial |
$139.30
|
| Rate for Payer: One Health Plan PPO/POS |
$179.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$189.05
|
| Rate for Payer: Three Rivers Provider Network All |
$149.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$185.07
|
| Rate for Payer: Zelis Auto |
$79.60
|
| Rate for Payer: Zelis Worker's Compensation |
$27.46
|
|
|
ca 15-3 REF143404
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
2299210
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.69 |
| Max. Negotiated Rate |
$189.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$37.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$119.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$37.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$29.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$169.15
|
| Rate for Payer: First Health Commercial |
$179.10
|
| Rate for Payer: First Health Workers Compensation |
$38.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$179.10
|
| Rate for Payer: GEHA Commercial |
$159.20
|
| Rate for Payer: GEHA Medicare |
$20.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$179.10
|
| Rate for Payer: Humana ChoiceCare |
$22.89
|
| Rate for Payer: Humana Medicare Advantage |
$20.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$34.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20.81
|
| Rate for Payer: Multiplan All |
$181.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.38
|
| Rate for Payer: OMNI Networks Commercial |
$139.30
|
| Rate for Payer: One Health Plan PPO/POS |
$179.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$34.96
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$30.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$189.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$41.62
|
| Rate for Payer: Three Rivers Provider Network All |
$149.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$20.39
|
| Rate for Payer: United Healthcare Commercial |
$169.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$185.07
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$20.81
|
| Rate for Payer: Zelis Auto |
$79.60
|
| Rate for Payer: Zelis Medicare |
$17.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24.97
|
| Rate for Payer: Zelis Worker's Compensation |
$27.46
|
|
|
CA 19-9
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
2234900
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$38.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Worker's Compensation |
$27.46
|
|
|
CA 19-9
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
2234900
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.69 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$37.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$37.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$29.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$38.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$153.60
|
| Rate for Payer: GEHA Medicare |
$20.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Humana ChoiceCare |
$22.89
|
| Rate for Payer: Humana Medicare Advantage |
$20.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$34.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20.81
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.38
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$34.96
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$30.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$41.62
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$20.39
|
| Rate for Payer: United Healthcare Commercial |
$163.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$20.81
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Medicare |
$17.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24.97
|
| Rate for Payer: Zelis Worker's Compensation |
$27.46
|
|
|
ca 19-9 REF002261
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
2299084
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.69 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$37.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$37.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$29.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$38.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$153.60
|
| Rate for Payer: GEHA Medicare |
$20.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Humana ChoiceCare |
$22.89
|
| Rate for Payer: Humana Medicare Advantage |
$20.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$34.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20.81
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.38
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$34.96
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$30.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$41.62
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$20.39
|
| Rate for Payer: United Healthcare Commercial |
$163.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$20.81
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Medicare |
$17.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24.97
|
| Rate for Payer: Zelis Worker's Compensation |
$27.46
|
|
|
ca 19-9 REF002261
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
2299084
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$38.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Worker's Compensation |
$27.46
|
|
|
ca 27.29 REF140293
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
2234998
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.69 |
| Max. Negotiated Rate |
$189.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$37.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$119.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$37.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$29.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$169.15
|
| Rate for Payer: First Health Commercial |
$179.10
|
| Rate for Payer: First Health Workers Compensation |
$38.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$179.10
|
| Rate for Payer: GEHA Commercial |
$159.20
|
| Rate for Payer: GEHA Medicare |
$20.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$179.10
|
| Rate for Payer: Humana ChoiceCare |
$22.89
|
| Rate for Payer: Humana Medicare Advantage |
$20.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$34.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20.81
|
| Rate for Payer: Multiplan All |
$181.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.38
|
| Rate for Payer: OMNI Networks Commercial |
$139.30
|
| Rate for Payer: One Health Plan PPO/POS |
$179.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$34.96
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$30.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$189.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$41.62
|
| Rate for Payer: Three Rivers Provider Network All |
$149.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$20.39
|
| Rate for Payer: United Healthcare Commercial |
$169.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$185.07
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$20.81
|
| Rate for Payer: Zelis Auto |
$79.60
|
| Rate for Payer: Zelis Medicare |
$17.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24.97
|
| Rate for Payer: Zelis Worker's Compensation |
$27.46
|
|
|
ca 27.29 REF140293
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
2234998
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$189.05 |
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$169.15
|
| Rate for Payer: First Health Commercial |
$179.10
|
| Rate for Payer: First Health Workers Compensation |
$38.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$179.10
|
| Rate for Payer: GEHA Commercial |
$139.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$179.10
|
| Rate for Payer: Multiplan All |
$181.09
|
| Rate for Payer: OMNI Networks Commercial |
$139.30
|
| Rate for Payer: One Health Plan PPO/POS |
$179.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$189.05
|
| Rate for Payer: Three Rivers Provider Network All |
$149.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$185.07
|
| Rate for Payer: Zelis Auto |
$79.60
|
| Rate for Payer: Zelis Worker's Compensation |
$27.46
|
|
|
CAGE ECLIPSE SCREW M 35MM
|
Facility
|
IP
|
$14,025.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,610.00 |
| Max. Negotiated Rate |
$13,323.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$11,220.00
|
| Rate for Payer: Cash Price |
$8,415.00
|
| Rate for Payer: Cash Price |
$8,415.00
|
| Rate for Payer: Cigna Commercial |
$11,921.25
|
| Rate for Payer: First Health Commercial |
$12,622.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12,622.50
|
| Rate for Payer: GEHA Commercial |
$9,817.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12,622.50
|
| Rate for Payer: Multiplan All |
$12,762.75
|
| Rate for Payer: OMNI Networks Commercial |
$9,817.50
|
| Rate for Payer: One Health Plan PPO/POS |
$12,622.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13,323.75
|
| Rate for Payer: Three Rivers Provider Network All |
$10,518.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,043.25
|
| Rate for Payer: Zelis Auto |
$5,610.00
|
|
|
CAGE ECLIPSE SCREW M 35MM
|
Facility
|
OP
|
$14,025.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,506.25 |
| Max. Negotiated Rate |
$13,323.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,415.00
|
| Rate for Payer: Cash Price |
$8,415.00
|
| Rate for Payer: Cash Price |
$8,415.00
|
| Rate for Payer: Cigna Commercial |
$11,921.25
|
| Rate for Payer: First Health Commercial |
$12,622.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$12,622.50
|
| Rate for Payer: GEHA Commercial |
$11,220.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$12,622.50
|
| Rate for Payer: Humana ChoiceCare |
$3,646.50
|
| Rate for Payer: Multiplan All |
$12,762.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,415.00
|
| Rate for Payer: OMNI Networks Commercial |
$9,817.50
|
| Rate for Payer: One Health Plan PPO/POS |
$12,622.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$13,323.75
|
| Rate for Payer: Three Rivers Provider Network All |
$10,518.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12,342.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,506.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,043.25
|
| Rate for Payer: Zelis Auto |
$5,610.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,012.50
|
|
