|
TYMPANOPLASTY W/O MASTOIDECT W/O OSS REC
|
Facility
|
OP
|
$2,679.00
|
|
|
Service Code
|
CPT 69631
|
| Hospital Charge Code |
20300086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$731.37 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,607.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,607.40
|
| Rate for Payer: Cash Price |
$1,607.40
|
| Rate for Payer: Cigna Commercial |
$2,277.15
|
| Rate for Payer: First Health Commercial |
$2,411.10
|
| Rate for Payer: First Health Workers Compensation |
$1,034.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,411.10
|
| Rate for Payer: GEHA Commercial |
$2,143.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,411.10
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$2,437.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,875.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,411.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,545.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$2,009.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,491.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$1,071.60
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$731.37
|
|
|
TYMPANOPLASTY W/O MASTOIDECT W/O OSS REC
|
Facility
|
IP
|
$2,679.00
|
|
|
Service Code
|
CPT 69631
|
| Hospital Charge Code |
20300086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$731.37 |
| Max. Negotiated Rate |
$2,545.05 |
| Rate for Payer: Cash Price |
$1,607.40
|
| Rate for Payer: Cigna Commercial |
$2,277.15
|
| Rate for Payer: First Health Commercial |
$2,411.10
|
| Rate for Payer: First Health Workers Compensation |
$1,034.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,411.10
|
| Rate for Payer: GEHA Commercial |
$1,875.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,411.10
|
| Rate for Payer: Multiplan All |
$2,437.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,875.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,411.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,545.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,009.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,491.47
|
| Rate for Payer: Zelis Auto |
$1,071.60
|
| Rate for Payer: Zelis Worker's Compensation |
$731.37
|
|
|
TYMPANOPLASTY W/O MASTOIDECT W/O OSS REC
|
Facility
|
IP
|
$2,679.00
|
|
|
Service Code
|
CPT 69631
|
| Hospital Charge Code |
6169631
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$731.37 |
| Max. Negotiated Rate |
$2,545.05 |
| Rate for Payer: Cash Price |
$1,607.40
|
| Rate for Payer: Cigna Commercial |
$2,277.15
|
| Rate for Payer: First Health Commercial |
$2,411.10
|
| Rate for Payer: First Health Workers Compensation |
$1,034.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,411.10
|
| Rate for Payer: GEHA Commercial |
$1,875.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,411.10
|
| Rate for Payer: Multiplan All |
$2,437.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,875.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,411.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,545.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,009.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,491.47
|
| Rate for Payer: Zelis Auto |
$1,071.60
|
| Rate for Payer: Zelis Worker's Compensation |
$731.37
|
|
|
TYMPANOPLASTY W/O MASTOIDECT W/O OSS REC
|
Facility
|
OP
|
$2,679.00
|
|
|
Service Code
|
CPT 69631
|
| Hospital Charge Code |
6169631
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$731.37 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,607.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,607.40
|
| Rate for Payer: Cash Price |
$1,607.40
|
| Rate for Payer: Cigna Commercial |
$2,277.15
|
| Rate for Payer: First Health Commercial |
$2,411.10
|
| Rate for Payer: First Health Workers Compensation |
$1,034.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,411.10
|
| Rate for Payer: GEHA Commercial |
$2,143.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,411.10
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$2,437.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,875.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,411.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,545.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$2,009.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,491.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$1,071.60
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$731.37
|
|
|
TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
6169433
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$109.47 |
| Max. Negotiated Rate |
$967.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$240.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$483.55
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cigna Commercial |
$340.85
|
| Rate for Payer: First Health Commercial |
$360.90
|
| Rate for Payer: First Health Workers Compensation |
$154.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.90
|
| Rate for Payer: GEHA Commercial |
$320.80
|
| Rate for Payer: GEHA Medicare |
$483.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.90
|
| Rate for Payer: Humana ChoiceCare |
$531.90
|
| Rate for Payer: Humana Medicare Advantage |
$483.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$812.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$483.55
|
| Rate for Payer: Multiplan All |
$364.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$822.03
|
| Rate for Payer: OMNI Networks Commercial |
$280.70
|
| Rate for Payer: One Health Plan PPO/POS |
$360.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$483.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$967.10
|
| Rate for Payer: Three Rivers Provider Network All |
$300.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$473.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$483.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$483.55
|
| Rate for Payer: Zelis Auto |
$160.40
|
| Rate for Payer: Zelis Medicare |
$411.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$580.26
|
| Rate for Payer: Zelis Worker's Compensation |
$109.47
|
|
|
TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA
|
Facility
|
IP
|
$595.00
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
20300085
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$162.44 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$505.75
|
| Rate for Payer: First Health Commercial |
$535.50
|
| Rate for Payer: First Health Workers Compensation |
$229.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$535.50
|
| Rate for Payer: GEHA Commercial |
$416.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$535.50
|
| Rate for Payer: Multiplan All |
$541.45
|
| Rate for Payer: OMNI Networks Commercial |
$416.50
|
| Rate for Payer: One Health Plan PPO/POS |
$535.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$565.25
|
| Rate for Payer: Three Rivers Provider Network All |
$446.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$553.35
|
| Rate for Payer: Zelis Auto |
$238.00
|
| Rate for Payer: Zelis Worker's Compensation |
$162.44
|
|
|
TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
20300085
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$162.44 |
| Max. Negotiated Rate |
$967.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$483.55
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$505.75
|
| Rate for Payer: First Health Commercial |
$535.50
|
| Rate for Payer: First Health Workers Compensation |
$229.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$535.50
|
| Rate for Payer: GEHA Commercial |
$476.00
|
| Rate for Payer: GEHA Medicare |
$483.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$535.50
|
| Rate for Payer: Humana ChoiceCare |
$531.90
|
| Rate for Payer: Humana Medicare Advantage |
$483.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$812.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$483.55
|
| Rate for Payer: Multiplan All |
$541.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$822.03
|
| Rate for Payer: OMNI Networks Commercial |
$416.50
|
| Rate for Payer: One Health Plan PPO/POS |
$535.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$483.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$565.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$967.10
|
| Rate for Payer: Three Rivers Provider Network All |
$446.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$473.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$483.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$553.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$483.55
|
| Rate for Payer: Zelis Auto |
$238.00
|
| Rate for Payer: Zelis Medicare |
$411.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$580.26
|
| Rate for Payer: Zelis Worker's Compensation |
$162.44
|
|
|
TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
8369433
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$162.44 |
| Max. Negotiated Rate |
$967.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$483.55
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$505.75
|
| Rate for Payer: First Health Commercial |
$535.50
|
| Rate for Payer: First Health Workers Compensation |
$229.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$535.50
|
| Rate for Payer: GEHA Commercial |
$476.00
|
| Rate for Payer: GEHA Medicare |
$483.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$535.50
|
| Rate for Payer: Humana ChoiceCare |
$531.90
|
| Rate for Payer: Humana Medicare Advantage |
$483.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$812.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$483.55
|
| Rate for Payer: Multiplan All |
$541.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$822.03
|
| Rate for Payer: OMNI Networks Commercial |
$416.50
|
| Rate for Payer: One Health Plan PPO/POS |
$535.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$483.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$565.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$967.10
|
| Rate for Payer: Three Rivers Provider Network All |
$446.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$473.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$483.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$553.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$483.55
|
| Rate for Payer: Zelis Auto |
$238.00
|
| Rate for Payer: Zelis Medicare |
$411.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$580.26
|
| Rate for Payer: Zelis Worker's Compensation |
$162.44
|
|
|
TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
6169433
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$109.47 |
| Max. Negotiated Rate |
$380.95 |
| Rate for Payer: Cash Price |
$240.60
|
| Rate for Payer: Cigna Commercial |
$340.85
|
| Rate for Payer: First Health Commercial |
$360.90
|
| Rate for Payer: First Health Workers Compensation |
$154.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.90
|
| Rate for Payer: GEHA Commercial |
$280.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.90
|
| Rate for Payer: Multiplan All |
$364.91
|
| Rate for Payer: OMNI Networks Commercial |
$280.70
|
| Rate for Payer: One Health Plan PPO/POS |
$360.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.95
|
| Rate for Payer: Three Rivers Provider Network All |
$300.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.93
|
| Rate for Payer: Zelis Auto |
$160.40
|
| Rate for Payer: Zelis Worker's Compensation |
$109.47
|
|
|
TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA
|
Facility
|
IP
|
$595.00
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
8369433
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$162.44 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$505.75
|
| Rate for Payer: First Health Commercial |
$535.50
|
| Rate for Payer: First Health Workers Compensation |
$229.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$535.50
|
| Rate for Payer: GEHA Commercial |
$416.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$535.50
|
| Rate for Payer: Multiplan All |
$541.45
|
| Rate for Payer: OMNI Networks Commercial |
$416.50
|
| Rate for Payer: One Health Plan PPO/POS |
$535.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$565.25
|
| Rate for Payer: Three Rivers Provider Network All |
$446.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$553.35
|
| Rate for Payer: Zelis Auto |
$238.00
|
| Rate for Payer: Zelis Worker's Compensation |
$162.44
|
|
|
TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
7969433
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$162.44 |
| Max. Negotiated Rate |
$967.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$483.55
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$505.75
|
| Rate for Payer: First Health Commercial |
$535.50
|
| Rate for Payer: First Health Workers Compensation |
$229.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$535.50
|
| Rate for Payer: GEHA Commercial |
$476.00
|
| Rate for Payer: GEHA Medicare |
$483.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$535.50
|
| Rate for Payer: Humana ChoiceCare |
$531.90
|
| Rate for Payer: Humana Medicare Advantage |
$483.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$812.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$483.55
|
| Rate for Payer: Multiplan All |
$541.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$822.03
|
| Rate for Payer: OMNI Networks Commercial |
$416.50
|
| Rate for Payer: One Health Plan PPO/POS |
$535.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$483.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$565.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$967.10
|
| Rate for Payer: Three Rivers Provider Network All |
$446.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$473.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$483.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$553.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$483.55
|
| Rate for Payer: Zelis Auto |
$238.00
|
| Rate for Payer: Zelis Medicare |
$411.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$580.26
|
| Rate for Payer: Zelis Worker's Compensation |
$162.44
|
|
|
TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA
|
Facility
|
IP
|
$595.00
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
7969433
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$162.44 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$505.75
|
| Rate for Payer: First Health Commercial |
$535.50
|
| Rate for Payer: First Health Workers Compensation |
$229.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$535.50
|
| Rate for Payer: GEHA Commercial |
$416.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$535.50
|
| Rate for Payer: Multiplan All |
$541.45
|
| Rate for Payer: OMNI Networks Commercial |
$416.50
|
| Rate for Payer: One Health Plan PPO/POS |
$535.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$565.25
|
| Rate for Payer: Three Rivers Provider Network All |
$446.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$553.35
|
| Rate for Payer: Zelis Auto |
$238.00
|
| Rate for Payer: Zelis Worker's Compensation |
$162.44
|
|
|
u 1 snrnp antibodies REF816839
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2299533
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$130.90
|
| Rate for Payer: First Health Commercial |
$138.60
|
| Rate for Payer: First Health Workers Compensation |
$20.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$138.60
|
| Rate for Payer: GEHA Commercial |
$107.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$138.60
|
| Rate for Payer: Multiplan All |
$140.14
|
| Rate for Payer: OMNI Networks Commercial |
$107.80
|
| Rate for Payer: One Health Plan PPO/POS |
$138.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$146.30
|
| Rate for Payer: Three Rivers Provider Network All |
$115.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$143.22
|
| Rate for Payer: Zelis Auto |
$61.60
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
u 1 snrnp antibodies REF816839
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2299533
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$92.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$130.90
|
| Rate for Payer: First Health Commercial |
$138.60
|
| Rate for Payer: First Health Workers Compensation |
$20.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$138.60
|
| Rate for Payer: GEHA Commercial |
$123.20
|
| Rate for Payer: GEHA Medicare |
$11.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$138.60
|
| Rate for Payer: Humana ChoiceCare |
$12.68
|
| Rate for Payer: Humana Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$19.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.53
|
| Rate for Payer: Multiplan All |
$140.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.60
|
| Rate for Payer: OMNI Networks Commercial |
$107.80
|
| Rate for Payer: One Health Plan PPO/POS |
$138.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$146.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.06
|
| Rate for Payer: Three Rivers Provider Network All |
$115.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.30
|
| Rate for Payer: United Healthcare Commercial |
$130.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$143.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.53
|
| Rate for Payer: Zelis Auto |
$61.60
|
| Rate for Payer: Zelis Medicare |
$9.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.84
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
UA COMPLETE
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
2201000
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$38.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3.17
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$54.40
|
| Rate for Payer: First Health Commercial |
$57.60
|
| Rate for Payer: First Health Workers Compensation |
$6.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$57.60
|
| Rate for Payer: GEHA Commercial |
$51.20
|
| Rate for Payer: GEHA Medicare |
$3.17
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$57.60
|
| Rate for Payer: Humana ChoiceCare |
$3.49
|
| Rate for Payer: Humana Medicare Advantage |
$3.17
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3.17
|
| Rate for Payer: Multiplan All |
$58.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5.39
|
| Rate for Payer: OMNI Networks Commercial |
$44.80
|
| Rate for Payer: One Health Plan PPO/POS |
$57.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4.61
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3.17
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$60.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6.34
|
| Rate for Payer: Three Rivers Provider Network All |
$48.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.11
|
| Rate for Payer: United Healthcare Commercial |
$54.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.17
|
| Rate for Payer: United Payors & United Providers UP&UP |
$59.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3.17
|
| Rate for Payer: Zelis Auto |
$25.60
|
| Rate for Payer: Zelis Medicare |
$2.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3.80
|
| Rate for Payer: Zelis Worker's Compensation |
$4.42
|
|
|
UA COMPLETE
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
2201000
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$54.40
|
| Rate for Payer: First Health Commercial |
$57.60
|
| Rate for Payer: First Health Workers Compensation |
$6.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$57.60
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$57.60
|
| Rate for Payer: Multiplan All |
$58.24
|
| Rate for Payer: OMNI Networks Commercial |
$44.80
|
| Rate for Payer: One Health Plan PPO/POS |
$57.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$60.80
|
| Rate for Payer: Three Rivers Provider Network All |
$48.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$59.52
|
| Rate for Payer: Zelis Auto |
$25.60
|
| Rate for Payer: Zelis Worker's Compensation |
$4.42
|
|
|
UA MICROSCOPIC ONLY
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 81015
|
| Hospital Charge Code |
2299890
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$19.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3.05
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$27.20
|
| Rate for Payer: First Health Commercial |
$28.80
|
| Rate for Payer: First Health Workers Compensation |
$5.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$28.80
|
| Rate for Payer: GEHA Commercial |
$25.60
|
| Rate for Payer: GEHA Medicare |
$3.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$28.80
|
| Rate for Payer: Humana ChoiceCare |
$3.35
|
| Rate for Payer: Humana Medicare Advantage |
$3.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3.05
|
| Rate for Payer: Multiplan All |
$29.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5.18
|
| Rate for Payer: OMNI Networks Commercial |
$22.40
|
| Rate for Payer: One Health Plan PPO/POS |
$28.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$30.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6.10
|
| Rate for Payer: Three Rivers Provider Network All |
$24.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.99
|
| Rate for Payer: United Healthcare Commercial |
$27.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$29.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3.05
|
| Rate for Payer: Zelis Auto |
$12.80
|
| Rate for Payer: Zelis Medicare |
$2.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3.66
|
| Rate for Payer: Zelis Worker's Compensation |
$3.54
|
|
|
UA MICROSCOPIC ONLY
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 81015
|
| Hospital Charge Code |
2299890
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$27.20
|
| Rate for Payer: First Health Commercial |
$28.80
|
| Rate for Payer: First Health Workers Compensation |
$5.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$28.80
|
| Rate for Payer: GEHA Commercial |
$22.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$28.80
|
| Rate for Payer: Multiplan All |
$29.12
|
| Rate for Payer: OMNI Networks Commercial |
$22.40
|
| Rate for Payer: One Health Plan PPO/POS |
$28.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$30.40
|
| Rate for Payer: Three Rivers Provider Network All |
$24.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$29.76
|
| Rate for Payer: Zelis Auto |
$12.80
|
| Rate for Payer: Zelis Worker's Compensation |
$3.54
|
|
|
UA PH AGH
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
2201001
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$38.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2.25
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$54.40
|
| Rate for Payer: First Health Commercial |
$57.60
|
| Rate for Payer: First Health Workers Compensation |
$3.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$57.60
|
| Rate for Payer: GEHA Commercial |
$51.20
|
| Rate for Payer: GEHA Medicare |
$2.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$57.60
|
| Rate for Payer: Humana ChoiceCare |
$2.48
|
| Rate for Payer: Humana Medicare Advantage |
$2.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2.25
|
| Rate for Payer: Multiplan All |
$58.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3.83
|
| Rate for Payer: OMNI Networks Commercial |
$44.80
|
| Rate for Payer: One Health Plan PPO/POS |
$57.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$60.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$4.50
|
| Rate for Payer: Three Rivers Provider Network All |
$48.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.21
|
| Rate for Payer: United Healthcare Commercial |
$54.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$59.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2.25
|
| Rate for Payer: Zelis Auto |
$25.60
|
| Rate for Payer: Zelis Medicare |
$1.91
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.70
|
| Rate for Payer: Zelis Worker's Compensation |
$2.68
|
|
|
UA PH AGH
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
2201001
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$54.40
|
| Rate for Payer: First Health Commercial |
$57.60
|
| Rate for Payer: First Health Workers Compensation |
$3.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$57.60
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$57.60
|
| Rate for Payer: Multiplan All |
$58.24
|
| Rate for Payer: OMNI Networks Commercial |
$44.80
|
| Rate for Payer: One Health Plan PPO/POS |
$57.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$60.80
|
| Rate for Payer: Three Rivers Provider Network All |
$48.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$59.52
|
| Rate for Payer: Zelis Auto |
$25.60
|
| Rate for Payer: Zelis Worker's Compensation |
$2.68
|
|
|
UC BONE SURVEY LMTD METS
|
Facility
|
IP
|
$959.00
|
|
|
Service Code
|
CPT 77074
|
| Hospital Charge Code |
21600373
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$911.05 |
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cigna Commercial |
$815.15
|
| Rate for Payer: First Health Commercial |
$863.10
|
| Rate for Payer: First Health Workers Compensation |
$78.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$863.10
|
| Rate for Payer: GEHA Commercial |
$671.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$863.10
|
| Rate for Payer: Multiplan All |
$872.69
|
| Rate for Payer: OMNI Networks Commercial |
$671.30
|
| Rate for Payer: One Health Plan PPO/POS |
$863.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$911.05
|
| Rate for Payer: Three Rivers Provider Network All |
$719.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$891.87
|
| Rate for Payer: Zelis Auto |
$383.60
|
| Rate for Payer: Zelis Worker's Compensation |
$55.60
|
|
|
UC BONE SURVEY LMTD METS
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
CPT 77074
|
| Hospital Charge Code |
21600373
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$911.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$575.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cigna Commercial |
$815.15
|
| Rate for Payer: First Health Commercial |
$863.10
|
| Rate for Payer: First Health Workers Compensation |
$78.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$863.10
|
| Rate for Payer: GEHA Commercial |
$767.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$863.10
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$872.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$671.30
|
| Rate for Payer: One Health Plan PPO/POS |
$863.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$911.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$719.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$815.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$891.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$383.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$55.60
|
|
|
UC RADEX SPINE THORACIC 3 VIEWS
|
Facility
|
IP
|
$595.00
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
21600456
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$505.75
|
| Rate for Payer: First Health Commercial |
$535.50
|
| Rate for Payer: First Health Workers Compensation |
$47.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$535.50
|
| Rate for Payer: GEHA Commercial |
$416.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$535.50
|
| Rate for Payer: Multiplan All |
$541.45
|
| Rate for Payer: OMNI Networks Commercial |
$416.50
|
| Rate for Payer: One Health Plan PPO/POS |
$535.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$565.25
|
| Rate for Payer: Three Rivers Provider Network All |
$446.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$553.35
|
| Rate for Payer: Zelis Auto |
$238.00
|
| Rate for Payer: Zelis Worker's Compensation |
$33.36
|
|
|
UC RADEX SPINE THORACIC 3 VIEWS
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
21600456
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$505.75
|
| Rate for Payer: First Health Commercial |
$535.50
|
| Rate for Payer: First Health Workers Compensation |
$47.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$535.50
|
| Rate for Payer: GEHA Commercial |
$476.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$535.50
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$541.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$416.50
|
| Rate for Payer: One Health Plan PPO/POS |
$535.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$565.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$446.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$505.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$553.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$238.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$33.36
|
|
|
UC XR ABD 1V
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
21600362
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.31 |
| Max. Negotiated Rate |
$457.90 |
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$409.70
|
| Rate for Payer: First Health Commercial |
$433.80
|
| Rate for Payer: First Health Workers Compensation |
$37.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$433.80
|
| Rate for Payer: GEHA Commercial |
$337.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$433.80
|
| Rate for Payer: Multiplan All |
$438.62
|
| Rate for Payer: OMNI Networks Commercial |
$337.40
|
| Rate for Payer: One Health Plan PPO/POS |
$433.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$457.90
|
| Rate for Payer: Three Rivers Provider Network All |
$361.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$448.26
|
| Rate for Payer: Zelis Auto |
$192.80
|
| Rate for Payer: Zelis Worker's Compensation |
$26.31
|
|
