|
TRYPANOSOMA CRUZI AB TOTAL REF
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
2300029
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$19.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$84.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Worker's Compensation |
$13.75
|
|
|
TRYPANOSOMA CRUZI AB TOTAL REF
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
2200080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$22.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$22.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.39
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$19.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$96.00
|
| Rate for Payer: GEHA Medicare |
$12.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Humana ChoiceCare |
$13.63
|
| Rate for Payer: Humana Medicare Advantage |
$12.39
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.39
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.06
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.03
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.78
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.14
|
| Rate for Payer: United Healthcare Commercial |
$102.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.39
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Medicare |
$10.53
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.87
|
| Rate for Payer: Zelis Worker's Compensation |
$13.75
|
|
|
TRYPANOSOMA CRUZI AB TOTAL REF
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
2300029
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$22.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$22.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.39
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$19.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$96.00
|
| Rate for Payer: GEHA Medicare |
$12.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Humana ChoiceCare |
$13.63
|
| Rate for Payer: Humana Medicare Advantage |
$12.39
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.39
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.06
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.03
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.78
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.14
|
| Rate for Payer: United Healthcare Commercial |
$102.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.39
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Medicare |
$10.53
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.87
|
| Rate for Payer: Zelis Worker's Compensation |
$13.75
|
|
|
TRYPANOSOMA CRUZI AB TOTAL REF
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
2200080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$19.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$84.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Worker's Compensation |
$13.75
|
|
|
tryptase REF004280
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
22990870
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$20.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Worker's Compensation |
$14.31
|
|
|
tryptase REF004280
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
22990870
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$20.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: GEHA Medicare |
$17.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$19.00
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.27
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29.36
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$29.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34.54
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.92
|
| Rate for Payer: United Healthcare Commercial |
$211.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.27
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Medicare |
$14.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.72
|
| Rate for Payer: Zelis Worker's Compensation |
$14.31
|
|
|
TSH (Vitros)
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
2232254
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$199.50 |
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$178.50
|
| Rate for Payer: First Health Commercial |
$189.00
|
| Rate for Payer: First Health Workers Compensation |
$28.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$189.00
|
| Rate for Payer: GEHA Commercial |
$147.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$189.00
|
| Rate for Payer: Multiplan All |
$191.10
|
| Rate for Payer: OMNI Networks Commercial |
$147.00
|
| Rate for Payer: One Health Plan PPO/POS |
$189.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$199.50
|
| Rate for Payer: Three Rivers Provider Network All |
$157.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$195.30
|
| Rate for Payer: Zelis Auto |
$84.00
|
| Rate for Payer: Zelis Worker's Compensation |
$19.80
|
|
|
TSH (Vitros)
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
2232254
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$199.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.80
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$178.50
|
| Rate for Payer: First Health Commercial |
$189.00
|
| Rate for Payer: First Health Workers Compensation |
$28.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$189.00
|
| Rate for Payer: GEHA Commercial |
$168.00
|
| Rate for Payer: GEHA Medicare |
$16.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$189.00
|
| Rate for Payer: Humana ChoiceCare |
$18.48
|
| Rate for Payer: Humana Medicare Advantage |
$16.80
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.80
|
| Rate for Payer: Multiplan All |
$191.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.56
|
| Rate for Payer: OMNI Networks Commercial |
$147.00
|
| Rate for Payer: One Health Plan PPO/POS |
$189.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$199.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.60
|
| Rate for Payer: Three Rivers Provider Network All |
$157.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.46
|
| Rate for Payer: United Healthcare Commercial |
$178.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.80
|
| Rate for Payer: United Payors & United Providers UP&UP |
$195.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.80
|
| Rate for Payer: Zelis Auto |
$84.00
|
| Rate for Payer: Zelis Medicare |
$14.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.16
|
| Rate for Payer: Zelis Worker's Compensation |
$19.80
|
|
|
TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARA
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
CPT 95921
|
| Hospital Charge Code |
21995921
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$95.84 |
| Max. Negotiated Rate |
$444.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$120.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$280.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$120.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$95.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$148.57
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cigna Commercial |
$397.80
|
| Rate for Payer: First Health Commercial |
$421.20
|
| Rate for Payer: First Health Workers Compensation |
$180.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$421.20
|
| Rate for Payer: GEHA Commercial |
$374.40
|
| Rate for Payer: GEHA Medicare |
$148.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$421.20
|
| Rate for Payer: Humana ChoiceCare |
$163.43
|
| Rate for Payer: Humana Medicare Advantage |
$148.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$249.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$97.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$148.57
|
| Rate for Payer: Multiplan All |
$425.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.57
|
| Rate for Payer: OMNI Networks Commercial |
$327.60
|
| Rate for Payer: One Health Plan PPO/POS |
$421.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$112.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$97.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$148.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$444.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$297.14
|
| Rate for Payer: Three Rivers Provider Network All |
$351.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$435.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$148.57
|
| Rate for Payer: Zelis Auto |
$187.20
|
| Rate for Payer: Zelis Medicare |
$126.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.28
|
| Rate for Payer: Zelis Worker's Compensation |
$127.76
|
|
|
TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARA
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
CPT 95921
|
| Hospital Charge Code |
21995921
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$127.76 |
| Max. Negotiated Rate |
$444.60 |
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cigna Commercial |
$397.80
|
| Rate for Payer: First Health Commercial |
$421.20
|
| Rate for Payer: First Health Workers Compensation |
$180.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$421.20
|
| Rate for Payer: GEHA Commercial |
$327.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$421.20
|
| Rate for Payer: Multiplan All |
$425.88
|
| Rate for Payer: OMNI Networks Commercial |
$327.60
|
| Rate for Payer: One Health Plan PPO/POS |
$421.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$444.60
|
| Rate for Payer: Three Rivers Provider Network All |
$351.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$435.24
|
| Rate for Payer: Zelis Auto |
$187.20
|
| Rate for Payer: Zelis Worker's Compensation |
$127.76
|
|
|
TTE W OR W/O CONTR, CONT ECG
|
Facility
|
IP
|
$3,421.00
|
|
|
Service Code
|
CPT C8930
|
| Hospital Charge Code |
2600130
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$933.93 |
| Max. Negotiated Rate |
$3,249.95 |
| Rate for Payer: Cash Price |
$2,052.60
|
| Rate for Payer: Cigna Commercial |
$2,907.85
|
| Rate for Payer: First Health Commercial |
$3,078.90
|
| Rate for Payer: First Health Workers Compensation |
$1,320.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,078.90
|
| Rate for Payer: GEHA Commercial |
$2,394.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,078.90
|
| Rate for Payer: Multiplan All |
$3,113.11
|
| Rate for Payer: OMNI Networks Commercial |
$2,394.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,078.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,249.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,565.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,181.53
|
| Rate for Payer: Zelis Auto |
$1,368.40
|
| Rate for Payer: Zelis Worker's Compensation |
$933.93
|
|
|
TTE W OR W/O CONTR, CONT ECG
|
Facility
|
OP
|
$3,421.00
|
|
|
Service Code
|
CPT C8930
|
| Hospital Charge Code |
2600130
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$637.66 |
| Max. Negotiated Rate |
$3,249.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$976.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,052.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$976.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$773.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$750.19
|
| Rate for Payer: Cash Price |
$2,052.60
|
| Rate for Payer: Cash Price |
$2,052.60
|
| Rate for Payer: Cigna Commercial |
$2,907.85
|
| Rate for Payer: First Health Commercial |
$3,078.90
|
| Rate for Payer: First Health Workers Compensation |
$1,320.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,078.90
|
| Rate for Payer: GEHA Commercial |
$2,736.80
|
| Rate for Payer: GEHA Medicare |
$750.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,078.90
|
| Rate for Payer: Humana ChoiceCare |
$825.21
|
| Rate for Payer: Humana Medicare Advantage |
$750.19
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,260.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$789.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$750.19
|
| Rate for Payer: Multiplan All |
$3,113.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,275.32
|
| Rate for Payer: OMNI Networks Commercial |
$2,394.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,078.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$911.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$789.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$750.19
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,249.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,500.38
|
| Rate for Payer: Three Rivers Provider Network All |
$2,565.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$735.19
|
| Rate for Payer: United Healthcare Commercial |
$2,907.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$789.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$750.19
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,181.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$750.19
|
| Rate for Payer: Zelis Auto |
$1,368.40
|
| Rate for Payer: Zelis Medicare |
$637.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$900.23
|
| Rate for Payer: Zelis Worker's Compensation |
$933.93
|
|
|
TTE W OR WO FOL WCON,DOPPLER
|
Facility
|
OP
|
$3,445.00
|
|
|
Service Code
|
CPT C8929
|
| Hospital Charge Code |
2600129
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$637.66 |
| Max. Negotiated Rate |
$3,272.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$976.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,067.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$976.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$773.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$750.19
|
| Rate for Payer: Cash Price |
$2,067.00
|
| Rate for Payer: Cash Price |
$2,067.00
|
| Rate for Payer: Cigna Commercial |
$2,928.25
|
| Rate for Payer: First Health Commercial |
$3,100.50
|
| Rate for Payer: First Health Workers Compensation |
$1,330.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,100.50
|
| Rate for Payer: GEHA Commercial |
$2,756.00
|
| Rate for Payer: GEHA Medicare |
$750.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,100.50
|
| Rate for Payer: Humana ChoiceCare |
$825.21
|
| Rate for Payer: Humana Medicare Advantage |
$750.19
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,260.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$789.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$750.19
|
| Rate for Payer: Multiplan All |
$3,134.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,275.32
|
| Rate for Payer: OMNI Networks Commercial |
$2,411.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,100.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$911.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$789.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$750.19
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,272.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,500.38
|
| Rate for Payer: Three Rivers Provider Network All |
$2,583.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$735.19
|
| Rate for Payer: United Healthcare Commercial |
$2,928.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$789.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$750.19
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,203.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$750.19
|
| Rate for Payer: Zelis Auto |
$1,378.00
|
| Rate for Payer: Zelis Medicare |
$637.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$900.23
|
| Rate for Payer: Zelis Worker's Compensation |
$940.49
|
|
|
TTE W OR WO FOL WCON,DOPPLER
|
Facility
|
IP
|
$3,445.00
|
|
|
Service Code
|
CPT C8929
|
| Hospital Charge Code |
2600129
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$940.49 |
| Max. Negotiated Rate |
$3,272.75 |
| Rate for Payer: Cash Price |
$2,067.00
|
| Rate for Payer: Cigna Commercial |
$2,928.25
|
| Rate for Payer: First Health Commercial |
$3,100.50
|
| Rate for Payer: First Health Workers Compensation |
$1,330.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,100.50
|
| Rate for Payer: GEHA Commercial |
$2,411.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,100.50
|
| Rate for Payer: Multiplan All |
$3,134.95
|
| Rate for Payer: OMNI Networks Commercial |
$2,411.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,100.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,272.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,583.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,203.85
|
| Rate for Payer: Zelis Auto |
$1,378.00
|
| Rate for Payer: Zelis Worker's Compensation |
$940.49
|
|
|
TUBE ENDOTRACH 5.5MM CUFFED
|
Facility
|
IP
|
$42.00
|
|
| Hospital Charge Code |
90020255
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$39.90 |
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$35.70
|
| Rate for Payer: First Health Commercial |
$37.80
|
| Rate for Payer: First Health Workers Compensation |
$16.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$37.80
|
| Rate for Payer: GEHA Commercial |
$29.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$37.80
|
| Rate for Payer: Multiplan All |
$38.22
|
| Rate for Payer: OMNI Networks Commercial |
$29.40
|
| Rate for Payer: One Health Plan PPO/POS |
$37.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$39.90
|
| Rate for Payer: Three Rivers Provider Network All |
$31.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$39.06
|
| Rate for Payer: Zelis Auto |
$16.80
|
| Rate for Payer: Zelis Worker's Compensation |
$11.47
|
|
|
TUBE ENDOTRACH 5.5MM CUFFED
|
Facility
|
OP
|
$42.00
|
|
| Hospital Charge Code |
90020255
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$39.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$35.70
|
| Rate for Payer: First Health Commercial |
$37.80
|
| Rate for Payer: First Health Workers Compensation |
$16.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$37.80
|
| Rate for Payer: GEHA Commercial |
$33.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$37.80
|
| Rate for Payer: Humana ChoiceCare |
$10.92
|
| Rate for Payer: Multiplan All |
$38.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.20
|
| Rate for Payer: OMNI Networks Commercial |
$29.40
|
| Rate for Payer: One Health Plan PPO/POS |
$37.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$39.90
|
| Rate for Payer: Three Rivers Provider Network All |
$31.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$36.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$10.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$39.06
|
| Rate for Payer: Zelis Auto |
$16.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.00
|
| Rate for Payer: Zelis Worker's Compensation |
$11.47
|
|
|
TUBE FEEDING 14FR 4.0
|
Facility
|
OP
|
$884.00
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
7006643
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$241.33 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$530.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$700.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cigna Commercial |
$751.40
|
| Rate for Payer: First Health Commercial |
$795.60
|
| Rate for Payer: First Health Workers Compensation |
$341.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$795.60
|
| Rate for Payer: GEHA Commercial |
$707.20
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$795.60
|
| 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 |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$804.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$618.80
|
| Rate for Payer: One Health Plan PPO/POS |
$795.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$825.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$714.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$839.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$663.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$822.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$353.60
|
| 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 |
$241.33
|
|
|
TUBE FEEDING 14FR 4.0
|
Facility
|
IP
|
$884.00
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
7006643
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$241.33 |
| Max. Negotiated Rate |
$839.80 |
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cigna Commercial |
$751.40
|
| Rate for Payer: First Health Commercial |
$795.60
|
| Rate for Payer: First Health Workers Compensation |
$341.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$795.60
|
| Rate for Payer: GEHA Commercial |
$618.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$795.60
|
| Rate for Payer: Multiplan All |
$804.44
|
| Rate for Payer: OMNI Networks Commercial |
$618.80
|
| Rate for Payer: One Health Plan PPO/POS |
$795.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$839.80
|
| Rate for Payer: Three Rivers Provider Network All |
$663.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$822.12
|
| Rate for Payer: Zelis Auto |
$353.60
|
| Rate for Payer: Zelis Worker's Compensation |
$241.33
|
|
|
TUBE FEEDING 16FR 4.5 MIC-KEY
|
Facility
|
IP
|
$808.00
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
90008245
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$220.58 |
| Max. Negotiated Rate |
$767.60 |
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cigna Commercial |
$686.80
|
| Rate for Payer: First Health Commercial |
$727.20
|
| Rate for Payer: First Health Workers Compensation |
$311.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$727.20
|
| Rate for Payer: GEHA Commercial |
$565.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$727.20
|
| Rate for Payer: Multiplan All |
$735.28
|
| Rate for Payer: OMNI Networks Commercial |
$565.60
|
| Rate for Payer: One Health Plan PPO/POS |
$727.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$767.60
|
| Rate for Payer: Three Rivers Provider Network All |
$606.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$751.44
|
| Rate for Payer: Zelis Auto |
$323.20
|
| Rate for Payer: Zelis Worker's Compensation |
$220.58
|
|
|
TUBE FEEDING 16FR 4.5 MIC-KEY
|
Facility
|
OP
|
$808.00
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
90008245
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$220.58 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$484.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$700.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cigna Commercial |
$686.80
|
| Rate for Payer: First Health Commercial |
$727.20
|
| Rate for Payer: First Health Workers Compensation |
$311.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$727.20
|
| Rate for Payer: GEHA Commercial |
$646.40
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$727.20
|
| 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 |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$735.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$565.60
|
| Rate for Payer: One Health Plan PPO/POS |
$727.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$825.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$714.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$767.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$606.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$751.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$323.20
|
| 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 |
$220.58
|
|
|
TUBE FEEDING 16FR 4.5 MIC-KEY0120-16-4.5
|
Facility
|
IP
|
$808.00
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
7006644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$220.58 |
| Max. Negotiated Rate |
$767.60 |
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cigna Commercial |
$686.80
|
| Rate for Payer: First Health Commercial |
$727.20
|
| Rate for Payer: First Health Workers Compensation |
$311.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$727.20
|
| Rate for Payer: GEHA Commercial |
$565.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$727.20
|
| Rate for Payer: Multiplan All |
$735.28
|
| Rate for Payer: OMNI Networks Commercial |
$565.60
|
| Rate for Payer: One Health Plan PPO/POS |
$727.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$767.60
|
| Rate for Payer: Three Rivers Provider Network All |
$606.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$751.44
|
| Rate for Payer: Zelis Auto |
$323.20
|
| Rate for Payer: Zelis Worker's Compensation |
$220.58
|
|
|
TUBE FEEDING 16FR 4.5 MIC-KEY0120-16-4.5
|
Facility
|
OP
|
$808.00
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
7006644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$220.58 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$484.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$700.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cigna Commercial |
$686.80
|
| Rate for Payer: First Health Commercial |
$727.20
|
| Rate for Payer: First Health Workers Compensation |
$311.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$727.20
|
| Rate for Payer: GEHA Commercial |
$646.40
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$727.20
|
| 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 |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$735.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$565.60
|
| Rate for Payer: One Health Plan PPO/POS |
$727.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$825.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$714.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$767.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$606.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$751.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$323.20
|
| 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 |
$220.58
|
|
|
TUBE MIC FEEDING 24F
|
Facility
|
OP
|
$248.00
|
|
| Hospital Charge Code |
90009942
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$235.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cigna Commercial |
$210.80
|
| Rate for Payer: First Health Commercial |
$223.20
|
| Rate for Payer: First Health Workers Compensation |
$95.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$223.20
|
| Rate for Payer: GEHA Commercial |
$198.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$223.20
|
| Rate for Payer: Humana ChoiceCare |
$64.48
|
| Rate for Payer: Multiplan All |
$225.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$148.80
|
| Rate for Payer: OMNI Networks Commercial |
$173.60
|
| Rate for Payer: One Health Plan PPO/POS |
$223.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$235.60
|
| Rate for Payer: Three Rivers Provider Network All |
$186.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$218.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$62.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$230.64
|
| Rate for Payer: Zelis Auto |
$99.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$124.00
|
| Rate for Payer: Zelis Worker's Compensation |
$67.70
|
|
|
TUBE MIC FEEDING 24F
|
Facility
|
IP
|
$248.00
|
|
| Hospital Charge Code |
90009942
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$67.70 |
| Max. Negotiated Rate |
$235.60 |
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cigna Commercial |
$210.80
|
| Rate for Payer: First Health Commercial |
$223.20
|
| Rate for Payer: First Health Workers Compensation |
$95.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$223.20
|
| Rate for Payer: GEHA Commercial |
$173.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$223.20
|
| Rate for Payer: Multiplan All |
$225.68
|
| Rate for Payer: OMNI Networks Commercial |
$173.60
|
| Rate for Payer: One Health Plan PPO/POS |
$223.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$235.60
|
| Rate for Payer: Three Rivers Provider Network All |
$186.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$230.64
|
| Rate for Payer: Zelis Auto |
$99.20
|
| Rate for Payer: Zelis Worker's Compensation |
$67.70
|
|
|
TUBERCULIN PPD INJ 5 UNIT/0.1ML
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
3300930
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$16.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$16.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$23.25
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$42.50
|
| Rate for Payer: First Health Commercial |
$45.00
|
| Rate for Payer: First Health Workers Compensation |
$11.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.00
|
| Rate for Payer: GEHA Commercial |
$40.00
|
| Rate for Payer: GEHA Medicare |
$23.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.00
|
| Rate for Payer: Humana ChoiceCare |
$25.57
|
| Rate for Payer: Humana Medicare Advantage |
$23.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$39.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$23.25
|
| Rate for Payer: Multiplan All |
$45.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.52
|
| Rate for Payer: OMNI Networks Commercial |
$35.00
|
| Rate for Payer: One Health Plan PPO/POS |
$45.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$15.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$23.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$47.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$46.50
|
| Rate for Payer: Three Rivers Provider Network All |
$37.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$22.79
|
| Rate for Payer: United Healthcare Commercial |
$42.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$46.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$23.25
|
| Rate for Payer: Zelis Auto |
$20.00
|
| Rate for Payer: Zelis Medicare |
$19.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$27.90
|
| Rate for Payer: Zelis Worker's Compensation |
$8.39
|
|
