|
URINE PROTEIN RANDOM
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
2204180
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$7.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$86.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Worker's Compensation |
$5.09
|
|
|
URINE PROTEIN RANDOM (Vitros)
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
2232243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$74.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3.67
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$7.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$99.20
|
| Rate for Payer: GEHA Medicare |
$3.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Humana ChoiceCare |
$4.04
|
| Rate for Payer: Humana Medicare Advantage |
$3.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3.67
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.24
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7.34
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.60
|
| Rate for Payer: United Healthcare Commercial |
$105.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3.67
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Medicare |
$3.12
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.40
|
| Rate for Payer: Zelis Worker's Compensation |
$5.09
|
|
|
URINE PROTEIN RANDOM (Vitros)
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
2232243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$7.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$86.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Worker's Compensation |
$5.09
|
|
|
URINE SHUNT TO INTESTINE
|
Facility
|
OP
|
$2,528.00
|
|
|
Service Code
|
CPT 50815
|
| Hospital Charge Code |
6150815
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$632.00 |
| Max. Negotiated Rate |
$2,401.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,516.80
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cigna Commercial |
$2,148.80
|
| Rate for Payer: First Health Commercial |
$2,275.20
|
| Rate for Payer: First Health Workers Compensation |
$976.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,275.20
|
| Rate for Payer: GEHA Commercial |
$2,022.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,275.20
|
| Rate for Payer: Humana ChoiceCare |
$657.28
|
| Rate for Payer: Multiplan All |
$2,300.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,516.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,769.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,275.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,401.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,896.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,224.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$632.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,351.04
|
| Rate for Payer: Zelis Auto |
$1,011.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,264.00
|
| Rate for Payer: Zelis Worker's Compensation |
$690.14
|
|
|
URINE SHUNT TO INTESTINE
|
Facility
|
IP
|
$2,528.00
|
|
|
Service Code
|
CPT 50815
|
| Hospital Charge Code |
6150815
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$690.14 |
| Max. Negotiated Rate |
$2,401.60 |
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cigna Commercial |
$2,148.80
|
| Rate for Payer: First Health Commercial |
$2,275.20
|
| Rate for Payer: First Health Workers Compensation |
$976.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,275.20
|
| Rate for Payer: GEHA Commercial |
$1,769.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,275.20
|
| Rate for Payer: Multiplan All |
$2,300.48
|
| Rate for Payer: OMNI Networks Commercial |
$1,769.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,275.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,401.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,896.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,351.04
|
| Rate for Payer: Zelis Auto |
$1,011.20
|
| Rate for Payer: Zelis Worker's Compensation |
$690.14
|
|
|
urine sodium 24 hour REF003178
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
2200682
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$73.95
|
| Rate for Payer: First Health Commercial |
$78.30
|
| Rate for Payer: First Health Workers Compensation |
$8.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$78.30
|
| Rate for Payer: GEHA Commercial |
$60.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$78.30
|
| Rate for Payer: Multiplan All |
$79.17
|
| Rate for Payer: OMNI Networks Commercial |
$60.90
|
| Rate for Payer: One Health Plan PPO/POS |
$78.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$82.65
|
| Rate for Payer: Three Rivers Provider Network All |
$65.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$80.91
|
| Rate for Payer: Zelis Auto |
$34.80
|
| Rate for Payer: Zelis Worker's Compensation |
$6.12
|
|
|
urine sodium 24 hour REF003178
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
2200682
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.06
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$73.95
|
| Rate for Payer: First Health Commercial |
$78.30
|
| Rate for Payer: First Health Workers Compensation |
$8.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$78.30
|
| Rate for Payer: GEHA Commercial |
$69.60
|
| Rate for Payer: GEHA Medicare |
$5.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$78.30
|
| Rate for Payer: Humana ChoiceCare |
$5.57
|
| Rate for Payer: Humana Medicare Advantage |
$5.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.06
|
| Rate for Payer: Multiplan All |
$79.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.60
|
| Rate for Payer: OMNI Networks Commercial |
$60.90
|
| Rate for Payer: One Health Plan PPO/POS |
$78.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.36
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$82.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.12
|
| Rate for Payer: Three Rivers Provider Network All |
$65.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.96
|
| Rate for Payer: United Healthcare Commercial |
$73.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$80.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.06
|
| Rate for Payer: Zelis Auto |
$34.80
|
| Rate for Payer: Zelis Medicare |
$4.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.07
|
| Rate for Payer: Zelis Worker's Compensation |
$6.12
|
|
|
urine sodium REF013326
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
2200681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$73.95
|
| Rate for Payer: First Health Commercial |
$78.30
|
| Rate for Payer: First Health Workers Compensation |
$8.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$78.30
|
| Rate for Payer: GEHA Commercial |
$60.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$78.30
|
| Rate for Payer: Multiplan All |
$79.17
|
| Rate for Payer: OMNI Networks Commercial |
$60.90
|
| Rate for Payer: One Health Plan PPO/POS |
$78.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$82.65
|
| Rate for Payer: Three Rivers Provider Network All |
$65.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$80.91
|
| Rate for Payer: Zelis Auto |
$34.80
|
| Rate for Payer: Zelis Worker's Compensation |
$6.12
|
|
|
urine sodium REF013326
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
2200681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.06
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$73.95
|
| Rate for Payer: First Health Commercial |
$78.30
|
| Rate for Payer: First Health Workers Compensation |
$8.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$78.30
|
| Rate for Payer: GEHA Commercial |
$69.60
|
| Rate for Payer: GEHA Medicare |
$5.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$78.30
|
| Rate for Payer: Humana ChoiceCare |
$5.57
|
| Rate for Payer: Humana Medicare Advantage |
$5.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.06
|
| Rate for Payer: Multiplan All |
$79.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.60
|
| Rate for Payer: OMNI Networks Commercial |
$60.90
|
| Rate for Payer: One Health Plan PPO/POS |
$78.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.36
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$82.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.12
|
| Rate for Payer: Three Rivers Provider Network All |
$65.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.96
|
| Rate for Payer: United Healthcare Commercial |
$73.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$80.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.06
|
| Rate for Payer: Zelis Auto |
$34.80
|
| Rate for Payer: Zelis Medicare |
$4.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.07
|
| Rate for Payer: Zelis Worker's Compensation |
$6.12
|
|
|
URNALYSIS/VOLUME MEA
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
2201006
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3.64
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$14.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$4.00
|
| Rate for Payer: GEHA Medicare |
$3.64
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Humana ChoiceCare |
$4.00
|
| Rate for Payer: Humana Medicare Advantage |
$3.64
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3.64
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.19
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3.64
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7.28
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.57
|
| Rate for Payer: United Healthcare Commercial |
$4.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.64
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3.64
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Medicare |
$3.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.37
|
| Rate for Payer: Zelis Worker's Compensation |
$9.93
|
|
|
URNALYSIS/VOLUME MEA
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
2201006
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$14.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$3.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$9.93
|
|
|
US ABD AORTA
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
2652101
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$169.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$421.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$169.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$133.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cigna Commercial |
$596.70
|
| Rate for Payer: First Health Commercial |
$631.80
|
| Rate for Payer: First Health Workers Compensation |
$134.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$631.80
|
| Rate for Payer: GEHA Commercial |
$561.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$631.80
|
| 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 |
$136.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$638.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$491.40
|
| Rate for Payer: One Health Plan PPO/POS |
$631.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$157.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$136.64
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$666.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$526.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$596.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$136.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$652.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$280.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$94.77
|
|
|
US ABD AORTA
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
2652101
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$94.77 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cigna Commercial |
$596.70
|
| Rate for Payer: First Health Commercial |
$631.80
|
| Rate for Payer: First Health Workers Compensation |
$134.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$631.80
|
| Rate for Payer: GEHA Commercial |
$491.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$631.80
|
| Rate for Payer: Multiplan All |
$638.82
|
| Rate for Payer: OMNI Networks Commercial |
$491.40
|
| Rate for Payer: One Health Plan PPO/POS |
$631.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$666.90
|
| Rate for Payer: Three Rivers Provider Network All |
$526.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$652.86
|
| Rate for Payer: Zelis Auto |
$280.80
|
| Rate for Payer: Zelis Worker's Compensation |
$94.77
|
|
|
US ABDOMEN LIMITED
|
Facility
|
IP
|
$1,013.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
2600103
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$73.82 |
| Max. Negotiated Rate |
$962.35 |
| Rate for Payer: Cash Price |
$607.80
|
| Rate for Payer: Cash Price |
$607.80
|
| Rate for Payer: Cigna Commercial |
$861.05
|
| Rate for Payer: First Health Commercial |
$911.70
|
| Rate for Payer: First Health Workers Compensation |
$104.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$911.70
|
| Rate for Payer: GEHA Commercial |
$709.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$911.70
|
| Rate for Payer: Multiplan All |
$921.83
|
| Rate for Payer: OMNI Networks Commercial |
$709.10
|
| Rate for Payer: One Health Plan PPO/POS |
$911.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$962.35
|
| Rate for Payer: Three Rivers Provider Network All |
$759.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$942.09
|
| Rate for Payer: Zelis Auto |
$405.20
|
| Rate for Payer: Zelis Worker's Compensation |
$73.82
|
|
|
US ABDOMEN LIMITED
|
Facility
|
OP
|
$1,013.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
2600103
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$73.82 |
| Max. Negotiated Rate |
$962.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$607.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$115.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$607.80
|
| Rate for Payer: Cash Price |
$607.80
|
| Rate for Payer: Cigna Commercial |
$861.05
|
| Rate for Payer: First Health Commercial |
$911.70
|
| Rate for Payer: First Health Workers Compensation |
$104.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$911.70
|
| Rate for Payer: GEHA Commercial |
$810.40
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$911.70
|
| 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 |
$117.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$921.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$709.10
|
| Rate for Payer: One Health Plan PPO/POS |
$911.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$136.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$117.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$962.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$759.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$861.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$942.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$405.20
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$73.82
|
|
|
US ABDOMINAL REAL TIME W/IMAGE DOCUMENTA
|
Facility
|
OP
|
$1,402.00
|
|
| Hospital Charge Code |
8176700
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$350.50 |
| Max. Negotiated Rate |
$1,331.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$1,191.70
|
| Rate for Payer: First Health Commercial |
$1,261.80
|
| Rate for Payer: First Health Workers Compensation |
$541.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,261.80
|
| Rate for Payer: GEHA Commercial |
$1,121.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,261.80
|
| Rate for Payer: Humana ChoiceCare |
$364.52
|
| Rate for Payer: Multiplan All |
$1,275.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$841.20
|
| Rate for Payer: OMNI Networks Commercial |
$981.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,261.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,331.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,051.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,233.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$350.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,303.86
|
| Rate for Payer: Zelis Auto |
$560.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$701.00
|
| Rate for Payer: Zelis Worker's Compensation |
$382.75
|
|
|
US ABDOMINAL REAL TIME W/IMAGE DOCUMENTA
|
Facility
|
IP
|
$1,402.00
|
|
| Hospital Charge Code |
8176700
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$382.75 |
| Max. Negotiated Rate |
$1,331.90 |
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$1,191.70
|
| Rate for Payer: First Health Commercial |
$1,261.80
|
| Rate for Payer: First Health Workers Compensation |
$541.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,261.80
|
| Rate for Payer: GEHA Commercial |
$981.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,261.80
|
| Rate for Payer: Multiplan All |
$1,275.82
|
| Rate for Payer: OMNI Networks Commercial |
$981.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,261.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,331.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,051.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,303.86
|
| Rate for Payer: Zelis Auto |
$560.80
|
| Rate for Payer: Zelis Worker's Compensation |
$382.75
|
|
|
US ABDOMINAL REAL TIME W/IMAGE LIMITED
|
Facility
|
IP
|
$894.00
|
|
| Hospital Charge Code |
8176705
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$244.06 |
| Max. Negotiated Rate |
$849.30 |
| Rate for Payer: Cash Price |
$536.40
|
| Rate for Payer: Cigna Commercial |
$759.90
|
| Rate for Payer: First Health Commercial |
$804.60
|
| Rate for Payer: First Health Workers Compensation |
$345.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$804.60
|
| Rate for Payer: GEHA Commercial |
$625.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$804.60
|
| Rate for Payer: Multiplan All |
$813.54
|
| Rate for Payer: OMNI Networks Commercial |
$625.80
|
| Rate for Payer: One Health Plan PPO/POS |
$804.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$849.30
|
| Rate for Payer: Three Rivers Provider Network All |
$670.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$831.42
|
| Rate for Payer: Zelis Auto |
$357.60
|
| Rate for Payer: Zelis Worker's Compensation |
$244.06
|
|
|
US ABDOMINAL REAL TIME W/IMAGE LIMITED
|
Facility
|
OP
|
$894.00
|
|
| Hospital Charge Code |
8176705
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$223.50 |
| Max. Negotiated Rate |
$849.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$536.40
|
| Rate for Payer: Cash Price |
$536.40
|
| Rate for Payer: Cigna Commercial |
$759.90
|
| Rate for Payer: First Health Commercial |
$804.60
|
| Rate for Payer: First Health Workers Compensation |
$345.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$804.60
|
| Rate for Payer: GEHA Commercial |
$715.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$804.60
|
| Rate for Payer: Humana ChoiceCare |
$232.44
|
| Rate for Payer: Multiplan All |
$813.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$536.40
|
| Rate for Payer: OMNI Networks Commercial |
$625.80
|
| Rate for Payer: One Health Plan PPO/POS |
$804.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$849.30
|
| Rate for Payer: Three Rivers Provider Network All |
$670.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$786.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$223.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$831.42
|
| Rate for Payer: Zelis Auto |
$357.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$447.00
|
| Rate for Payer: Zelis Worker's Compensation |
$244.06
|
|
|
US ABD/RUQ/GB
|
Facility
|
OP
|
$1,238.30
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
2600104
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.14 |
| Max. Negotiated Rate |
$1,176.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$742.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$115.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$742.98
|
| Rate for Payer: Cash Price |
$742.98
|
| Rate for Payer: Cigna Commercial |
$1,052.56
|
| Rate for Payer: First Health Commercial |
$1,114.47
|
| Rate for Payer: First Health Workers Compensation |
$114.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,114.47
|
| Rate for Payer: GEHA Commercial |
$990.64
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,114.47
|
| 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 |
$117.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$1,126.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$866.81
|
| Rate for Payer: One Health Plan PPO/POS |
$1,114.47
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$136.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$117.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,176.38
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$928.73
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$1,052.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,151.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$495.32
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$81.14
|
|
|
US ABD/RUQ/GB
|
Facility
|
IP
|
$1,238.30
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
2600104
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.14 |
| Max. Negotiated Rate |
$1,176.38 |
| Rate for Payer: Cash Price |
$742.98
|
| Rate for Payer: Cash Price |
$742.98
|
| Rate for Payer: Cigna Commercial |
$1,052.56
|
| Rate for Payer: First Health Commercial |
$1,114.47
|
| Rate for Payer: First Health Workers Compensation |
$114.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,114.47
|
| Rate for Payer: GEHA Commercial |
$866.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,114.47
|
| Rate for Payer: Multiplan All |
$1,126.85
|
| Rate for Payer: OMNI Networks Commercial |
$866.81
|
| Rate for Payer: One Health Plan PPO/POS |
$1,114.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,176.38
|
| Rate for Payer: Three Rivers Provider Network All |
$928.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,151.62
|
| Rate for Payer: Zelis Auto |
$495.32
|
| Rate for Payer: Zelis Worker's Compensation |
$81.14
|
|
|
US ABD SOFT TISSUE
|
Facility
|
IP
|
$1,553.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
2600202
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$105.15 |
| Max. Negotiated Rate |
$1,475.35 |
| Rate for Payer: Cash Price |
$931.80
|
| Rate for Payer: Cash Price |
$931.80
|
| Rate for Payer: Cigna Commercial |
$1,320.05
|
| Rate for Payer: First Health Commercial |
$1,397.70
|
| Rate for Payer: First Health Workers Compensation |
$148.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,397.70
|
| Rate for Payer: GEHA Commercial |
$1,087.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,397.70
|
| Rate for Payer: Multiplan All |
$1,413.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,087.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,397.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,475.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,164.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,444.29
|
| Rate for Payer: Zelis Auto |
$621.20
|
| Rate for Payer: Zelis Worker's Compensation |
$105.15
|
|
|
US ABD SOFT TISSUE
|
Facility
|
OP
|
$1,553.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
2600202
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,475.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$931.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$115.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$931.80
|
| Rate for Payer: Cash Price |
$931.80
|
| Rate for Payer: Cigna Commercial |
$1,320.05
|
| Rate for Payer: First Health Commercial |
$1,397.70
|
| Rate for Payer: First Health Workers Compensation |
$148.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,397.70
|
| Rate for Payer: GEHA Commercial |
$1,242.40
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,397.70
|
| 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 |
$117.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$1,413.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$1,087.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,397.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$136.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$117.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,475.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$1,164.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$1,320.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,444.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$621.20
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$105.15
|
|
|
US ABD SURVEY COMP
|
Facility
|
IP
|
$1,553.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
2600105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$105.15 |
| Max. Negotiated Rate |
$1,475.35 |
| Rate for Payer: Cash Price |
$931.80
|
| Rate for Payer: Cash Price |
$931.80
|
| Rate for Payer: Cigna Commercial |
$1,320.05
|
| Rate for Payer: First Health Commercial |
$1,397.70
|
| Rate for Payer: First Health Workers Compensation |
$148.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,397.70
|
| Rate for Payer: GEHA Commercial |
$1,087.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,397.70
|
| Rate for Payer: Multiplan All |
$1,413.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,087.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,397.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,475.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,164.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,444.29
|
| Rate for Payer: Zelis Auto |
$621.20
|
| Rate for Payer: Zelis Worker's Compensation |
$105.15
|
|
|
US ABD SURVEY COMP
|
Facility
|
OP
|
$1,553.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
2600105
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,475.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$931.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$115.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$931.80
|
| Rate for Payer: Cash Price |
$931.80
|
| Rate for Payer: Cigna Commercial |
$1,320.05
|
| Rate for Payer: First Health Commercial |
$1,397.70
|
| Rate for Payer: First Health Workers Compensation |
$148.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,397.70
|
| Rate for Payer: GEHA Commercial |
$1,242.40
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,397.70
|
| 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 |
$117.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$1,413.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$1,087.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,397.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$136.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$117.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,475.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$1,164.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$1,320.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,444.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$621.20
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$105.15
|
|
