|
US CHEST SOFT TISSUE
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
2407245
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$73.11 |
| Max. Negotiated Rate |
$786.60 |
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cigna Commercial |
$703.80
|
| Rate for Payer: First Health Commercial |
$745.20
|
| Rate for Payer: First Health Workers Compensation |
$103.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$745.20
|
| Rate for Payer: GEHA Commercial |
$579.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$745.20
|
| Rate for Payer: Multiplan All |
$753.48
|
| Rate for Payer: OMNI Networks Commercial |
$579.60
|
| Rate for Payer: One Health Plan PPO/POS |
$745.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$786.60
|
| Rate for Payer: Three Rivers Provider Network All |
$621.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$770.04
|
| Rate for Payer: Zelis Auto |
$331.20
|
| Rate for Payer: Zelis Worker's Compensation |
$73.11
|
|
|
US DOPP ECHO COLOR FLW
|
Facility
|
IP
|
$909.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
2666903
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$248.16 |
| Max. Negotiated Rate |
$863.55 |
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$772.65
|
| Rate for Payer: First Health Commercial |
$818.10
|
| Rate for Payer: First Health Workers Compensation |
$350.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$818.10
|
| Rate for Payer: GEHA Commercial |
$636.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$818.10
|
| Rate for Payer: Multiplan All |
$827.19
|
| Rate for Payer: OMNI Networks Commercial |
$636.30
|
| Rate for Payer: One Health Plan PPO/POS |
$818.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$863.55
|
| Rate for Payer: Three Rivers Provider Network All |
$681.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$845.37
|
| Rate for Payer: Zelis Auto |
$363.60
|
| Rate for Payer: Zelis Worker's Compensation |
$248.16
|
|
|
US DOPP ECHO COLOR FLW
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
2666903
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$227.25 |
| Max. Negotiated Rate |
$863.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$545.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$772.65
|
| Rate for Payer: First Health Commercial |
$818.10
|
| Rate for Payer: First Health Workers Compensation |
$350.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$818.10
|
| Rate for Payer: GEHA Commercial |
$727.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$818.10
|
| Rate for Payer: Humana ChoiceCare |
$236.34
|
| Rate for Payer: Multiplan All |
$827.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$545.40
|
| Rate for Payer: OMNI Networks Commercial |
$636.30
|
| Rate for Payer: One Health Plan PPO/POS |
$818.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$863.55
|
| Rate for Payer: Three Rivers Provider Network All |
$681.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$799.92
|
| Rate for Payer: United Healthcare Commercial |
$772.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$227.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$845.37
|
| Rate for Payer: Zelis Auto |
$363.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$454.50
|
| Rate for Payer: Zelis Worker's Compensation |
$248.16
|
|
|
US DOPPLER ECHO PULSED
|
Facility
|
OP
|
$1,101.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
2666902
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$275.25 |
| Max. Negotiated Rate |
$1,045.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$660.60
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna Commercial |
$935.85
|
| Rate for Payer: First Health Commercial |
$990.90
|
| Rate for Payer: First Health Workers Compensation |
$425.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$990.90
|
| Rate for Payer: GEHA Commercial |
$880.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$990.90
|
| Rate for Payer: Humana ChoiceCare |
$286.26
|
| Rate for Payer: Multiplan All |
$1,001.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$660.60
|
| Rate for Payer: OMNI Networks Commercial |
$770.70
|
| Rate for Payer: One Health Plan PPO/POS |
$990.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,045.95
|
| Rate for Payer: Three Rivers Provider Network All |
$825.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$968.88
|
| Rate for Payer: United Healthcare Commercial |
$935.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$275.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,023.93
|
| Rate for Payer: Zelis Auto |
$440.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$550.50
|
| Rate for Payer: Zelis Worker's Compensation |
$300.57
|
|
|
US DOPPLER ECHO PULSED
|
Facility
|
IP
|
$1,101.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
2666902
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$300.57 |
| Max. Negotiated Rate |
$1,045.95 |
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna Commercial |
$935.85
|
| Rate for Payer: First Health Commercial |
$990.90
|
| Rate for Payer: First Health Workers Compensation |
$425.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$990.90
|
| Rate for Payer: GEHA Commercial |
$770.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$990.90
|
| Rate for Payer: Multiplan All |
$1,001.91
|
| Rate for Payer: OMNI Networks Commercial |
$770.70
|
| Rate for Payer: One Health Plan PPO/POS |
$990.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,045.95
|
| Rate for Payer: Three Rivers Provider Network All |
$825.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,023.93
|
| Rate for Payer: Zelis Auto |
$440.40
|
| Rate for Payer: Zelis Worker's Compensation |
$300.57
|
|
|
US DUPLEX SCAN AORTA
|
Facility
|
OP
|
$1,437.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
2660000
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$184.27 |
| Max. Negotiated Rate |
$1,365.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$862.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$184.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$862.20
|
| Rate for Payer: Cash Price |
$862.20
|
| Rate for Payer: Cigna Commercial |
$1,221.45
|
| Rate for Payer: First Health Commercial |
$1,293.30
|
| Rate for Payer: First Health Workers Compensation |
$554.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,293.30
|
| Rate for Payer: GEHA Commercial |
$1,149.60
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,293.30
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$188.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$1,307.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,005.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,293.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$217.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$188.02
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,365.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$1,077.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$1,221.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$188.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,336.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$574.80
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$392.30
|
|
|
US DUPLEX SCAN AORTA
|
Facility
|
IP
|
$1,437.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
2660000
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$392.30 |
| Max. Negotiated Rate |
$1,365.15 |
| Rate for Payer: Cash Price |
$862.20
|
| Rate for Payer: Cigna Commercial |
$1,221.45
|
| Rate for Payer: First Health Commercial |
$1,293.30
|
| Rate for Payer: First Health Workers Compensation |
$554.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,293.30
|
| Rate for Payer: GEHA Commercial |
$1,005.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,293.30
|
| Rate for Payer: Multiplan All |
$1,307.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,005.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,293.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,365.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,077.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,336.41
|
| Rate for Payer: Zelis Auto |
$574.80
|
| Rate for Payer: Zelis Worker's Compensation |
$392.30
|
|
|
US DUPLX LO EXT ART FU
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
2666901
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$339.07 |
| Max. Negotiated Rate |
$1,179.90 |
| Rate for Payer: Cash Price |
$745.20
|
| Rate for Payer: Cigna Commercial |
$1,055.70
|
| Rate for Payer: First Health Commercial |
$1,117.80
|
| Rate for Payer: First Health Workers Compensation |
$479.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,117.80
|
| Rate for Payer: GEHA Commercial |
$869.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,117.80
|
| Rate for Payer: Multiplan All |
$1,130.22
|
| Rate for Payer: OMNI Networks Commercial |
$869.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,117.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,179.90
|
| Rate for Payer: Three Rivers Provider Network All |
$931.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,155.06
|
| Rate for Payer: Zelis Auto |
$496.80
|
| Rate for Payer: Zelis Worker's Compensation |
$339.07
|
|
|
US DUPLX LO EXT ART FU
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
2666901
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,179.90 |
| 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 |
$745.20
|
| 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 |
$745.20
|
| Rate for Payer: Cash Price |
$745.20
|
| Rate for Payer: Cigna Commercial |
$1,055.70
|
| Rate for Payer: First Health Commercial |
$1,117.80
|
| Rate for Payer: First Health Workers Compensation |
$479.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,117.80
|
| Rate for Payer: GEHA Commercial |
$993.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,117.80
|
| 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 |
$117.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$1,130.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$869.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,117.80
|
| 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 |
$1,179.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$931.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$1,055.70
|
| 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 |
$1,155.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$496.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$339.07
|
|
|
US DUPLX UNI EXT FU/LIM
|
Facility
|
OP
|
$1,366.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
2666900
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,297.70 |
| 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 |
$819.60
|
| 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 |
$819.60
|
| Rate for Payer: Cash Price |
$819.60
|
| Rate for Payer: Cigna Commercial |
$1,161.10
|
| Rate for Payer: First Health Commercial |
$1,229.40
|
| Rate for Payer: First Health Workers Compensation |
$527.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,229.40
|
| Rate for Payer: GEHA Commercial |
$1,092.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,229.40
|
| 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 |
$1,243.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$956.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,229.40
|
| 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 |
$1,297.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$1,024.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$1,161.10
|
| 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 |
$1,270.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$546.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$372.92
|
|
|
US DUPLX UNI EXT FU/LIM
|
Facility
|
IP
|
$1,366.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
2666900
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$372.92 |
| Max. Negotiated Rate |
$1,297.70 |
| Rate for Payer: Cash Price |
$819.60
|
| Rate for Payer: Cigna Commercial |
$1,161.10
|
| Rate for Payer: First Health Commercial |
$1,229.40
|
| Rate for Payer: First Health Workers Compensation |
$527.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,229.40
|
| Rate for Payer: GEHA Commercial |
$956.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,229.40
|
| Rate for Payer: Multiplan All |
$1,243.06
|
| Rate for Payer: OMNI Networks Commercial |
$956.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,229.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,297.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,024.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,270.38
|
| Rate for Payer: Zelis Auto |
$546.40
|
| Rate for Payer: Zelis Worker's Compensation |
$372.92
|
|
|
US DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/
|
Facility
|
IP
|
$1,266.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
2676820
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$345.62 |
| Max. Negotiated Rate |
$1,202.70 |
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cigna Commercial |
$1,076.10
|
| Rate for Payer: First Health Commercial |
$1,139.40
|
| Rate for Payer: First Health Workers Compensation |
$488.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,139.40
|
| Rate for Payer: GEHA Commercial |
$886.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,139.40
|
| Rate for Payer: Multiplan All |
$1,152.06
|
| Rate for Payer: OMNI Networks Commercial |
$886.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,139.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,202.70
|
| Rate for Payer: Three Rivers Provider Network All |
$949.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,177.38
|
| Rate for Payer: Zelis Auto |
$506.40
|
| Rate for Payer: Zelis Worker's Compensation |
$345.62
|
|
|
US DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/
|
Facility
|
OP
|
$1,266.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
2676820
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,202.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$759.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$184.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cigna Commercial |
$1,076.10
|
| Rate for Payer: First Health Commercial |
$1,139.40
|
| Rate for Payer: First Health Workers Compensation |
$488.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,139.40
|
| Rate for Payer: GEHA Commercial |
$1,012.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,139.40
|
| 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 |
$188.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$1,152.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$886.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,139.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$217.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$188.02
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,202.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$949.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$1,076.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$188.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,177.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$506.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$345.62
|
|
|
US ECHO 2-D/M W DOP &CF
|
Facility
|
IP
|
$3,402.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
2600250
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$928.75 |
| Max. Negotiated Rate |
$3,231.90 |
| Rate for Payer: Cash Price |
$2,041.20
|
| Rate for Payer: Cigna Commercial |
$2,891.70
|
| Rate for Payer: First Health Commercial |
$3,061.80
|
| Rate for Payer: First Health Workers Compensation |
$1,313.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,061.80
|
| Rate for Payer: GEHA Commercial |
$2,381.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,061.80
|
| Rate for Payer: Multiplan All |
$3,095.82
|
| Rate for Payer: OMNI Networks Commercial |
$2,381.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,061.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,231.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,551.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,163.86
|
| Rate for Payer: Zelis Auto |
$1,360.80
|
| Rate for Payer: Zelis Worker's Compensation |
$928.75
|
|
|
US ECHO 2-D/M W DOP &CF
|
Facility
|
OP
|
$3,402.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
2600250
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$442.54 |
| Max. Negotiated Rate |
$3,231.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$676.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,041.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$676.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$535.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$520.63
|
| Rate for Payer: Cash Price |
$2,041.20
|
| Rate for Payer: Cash Price |
$2,041.20
|
| Rate for Payer: Cigna Commercial |
$2,891.70
|
| Rate for Payer: First Health Commercial |
$3,061.80
|
| Rate for Payer: First Health Workers Compensation |
$1,313.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,061.80
|
| Rate for Payer: GEHA Commercial |
$2,721.60
|
| Rate for Payer: GEHA Medicare |
$520.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,061.80
|
| Rate for Payer: Humana ChoiceCare |
$572.69
|
| Rate for Payer: Humana Medicare Advantage |
$520.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$874.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$546.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$520.63
|
| Rate for Payer: Multiplan All |
$3,095.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$885.07
|
| Rate for Payer: OMNI Networks Commercial |
$2,381.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,061.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$631.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$546.80
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$520.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,231.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,041.26
|
| Rate for Payer: Three Rivers Provider Network All |
$2,551.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$510.22
|
| Rate for Payer: United Healthcare Commercial |
$2,891.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$546.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$520.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,163.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$520.63
|
| Rate for Payer: Zelis Auto |
$1,360.80
|
| Rate for Payer: Zelis Medicare |
$442.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$624.76
|
| Rate for Payer: Zelis Worker's Compensation |
$928.75
|
|
|
US ECHO CONTRAST
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 93352
|
| Hospital Charge Code |
2693352
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$82.45
|
| Rate for Payer: First Health Commercial |
$87.30
|
| Rate for Payer: First Health Workers Compensation |
$37.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$87.30
|
| Rate for Payer: GEHA Commercial |
$77.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$87.30
|
| Rate for Payer: Humana ChoiceCare |
$25.22
|
| Rate for Payer: Multiplan All |
$88.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$58.20
|
| Rate for Payer: OMNI Networks Commercial |
$67.90
|
| Rate for Payer: One Health Plan PPO/POS |
$87.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$92.15
|
| Rate for Payer: Three Rivers Provider Network All |
$72.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$85.36
|
| Rate for Payer: United Healthcare Commercial |
$82.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$90.21
|
| Rate for Payer: Zelis Auto |
$38.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$48.50
|
| Rate for Payer: Zelis Worker's Compensation |
$26.48
|
|
|
US ECHO CONTRAST
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 93352
|
| Hospital Charge Code |
2693352
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$26.48 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$82.45
|
| Rate for Payer: First Health Commercial |
$87.30
|
| Rate for Payer: First Health Workers Compensation |
$37.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$87.30
|
| Rate for Payer: GEHA Commercial |
$67.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$87.30
|
| Rate for Payer: Multiplan All |
$88.27
|
| Rate for Payer: OMNI Networks Commercial |
$67.90
|
| Rate for Payer: One Health Plan PPO/POS |
$87.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$92.15
|
| Rate for Payer: Three Rivers Provider Network All |
$72.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$90.21
|
| Rate for Payer: Zelis Auto |
$38.80
|
| Rate for Payer: Zelis Worker's Compensation |
$26.48
|
|
|
US EXAM ECHOGRAP TRANS R PROS STUDY
|
Facility
|
IP
|
$492.00
|
|
|
Service Code
|
CPT 76873
|
| Hospital Charge Code |
8976873
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$148.59 |
| Max. Negotiated Rate |
$467.40 |
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cigna Commercial |
$418.20
|
| Rate for Payer: First Health Commercial |
$442.80
|
| Rate for Payer: First Health Workers Compensation |
$210.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$442.80
|
| Rate for Payer: GEHA Commercial |
$344.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$442.80
|
| Rate for Payer: Multiplan All |
$447.72
|
| Rate for Payer: OMNI Networks Commercial |
$344.40
|
| Rate for Payer: One Health Plan PPO/POS |
$442.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$467.40
|
| Rate for Payer: Three Rivers Provider Network All |
$369.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$457.56
|
| Rate for Payer: Zelis Auto |
$196.80
|
| Rate for Payer: Zelis Worker's Compensation |
$148.59
|
|
|
US EXAM ECHOGRAP TRANS R PROS STUDY
|
Facility
|
OP
|
$492.00
|
|
|
Service Code
|
CPT 76873
|
| Hospital Charge Code |
8976873
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$467.40 |
| 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 |
$295.20
|
| 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 |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cigna Commercial |
$418.20
|
| Rate for Payer: First Health Commercial |
$442.80
|
| Rate for Payer: First Health Workers Compensation |
$210.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$442.80
|
| Rate for Payer: GEHA Commercial |
$393.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$442.80
|
| 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 |
$117.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$447.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$344.40
|
| Rate for Payer: One Health Plan PPO/POS |
$442.80
|
| 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 |
$467.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$369.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$418.20
|
| 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 |
$457.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$196.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$148.59
|
|
|
US EXAM PELVIC LIMITED
|
Facility
|
OP
|
$841.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
8900021
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$798.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$93.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$504.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$93.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$74.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$504.60
|
| Rate for Payer: Cash Price |
$504.60
|
| Rate for Payer: Cigna Commercial |
$714.85
|
| Rate for Payer: First Health Commercial |
$756.90
|
| Rate for Payer: First Health Workers Compensation |
$94.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$756.90
|
| Rate for Payer: GEHA Commercial |
$672.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$756.90
|
| 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 |
$75.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$765.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$588.70
|
| Rate for Payer: One Health Plan PPO/POS |
$756.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$87.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$75.74
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$798.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$630.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$714.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$75.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$782.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$336.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$66.60
|
|
|
US EXAM PELVIC LIMITED
|
Facility
|
IP
|
$841.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
8900021
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$798.95 |
| Rate for Payer: Cash Price |
$504.60
|
| Rate for Payer: Cash Price |
$504.60
|
| Rate for Payer: Cigna Commercial |
$714.85
|
| Rate for Payer: First Health Commercial |
$756.90
|
| Rate for Payer: First Health Workers Compensation |
$94.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$756.90
|
| Rate for Payer: GEHA Commercial |
$588.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$756.90
|
| Rate for Payer: Multiplan All |
$765.31
|
| Rate for Payer: OMNI Networks Commercial |
$588.70
|
| Rate for Payer: One Health Plan PPO/POS |
$756.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$798.95
|
| Rate for Payer: Three Rivers Provider Network All |
$630.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$782.13
|
| Rate for Payer: Zelis Auto |
$336.40
|
| Rate for Payer: Zelis Worker's Compensation |
$66.60
|
|
|
US EXAM SCROTUM
|
Facility
|
OP
|
$1,054.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
8900022
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,001.30 |
| 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 |
$632.40
|
| 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 |
$632.40
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cigna Commercial |
$895.90
|
| Rate for Payer: First Health Commercial |
$948.60
|
| Rate for Payer: First Health Workers Compensation |
$124.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$948.60
|
| Rate for Payer: GEHA Commercial |
$843.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$948.60
|
| 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 |
$959.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$737.80
|
| Rate for Payer: One Health Plan PPO/POS |
$948.60
|
| 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 |
$1,001.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$790.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$895.90
|
| 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 |
$980.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$421.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$88.31
|
|
|
US EXAM SCROTUM
|
Facility
|
IP
|
$1,054.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
8900022
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$88.31 |
| Max. Negotiated Rate |
$1,001.30 |
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cigna Commercial |
$895.90
|
| Rate for Payer: First Health Commercial |
$948.60
|
| Rate for Payer: First Health Workers Compensation |
$124.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$948.60
|
| Rate for Payer: GEHA Commercial |
$737.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$948.60
|
| Rate for Payer: Multiplan All |
$959.14
|
| Rate for Payer: OMNI Networks Commercial |
$737.80
|
| Rate for Payer: One Health Plan PPO/POS |
$948.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,001.30
|
| Rate for Payer: Three Rivers Provider Network All |
$790.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$980.22
|
| Rate for Payer: Zelis Auto |
$421.60
|
| Rate for Payer: Zelis Worker's Compensation |
$88.31
|
|
|
US EXTR NONVASC COMP
|
Facility
|
IP
|
$1,374.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
8800036
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.02 |
| Max. Negotiated Rate |
$1,305.30 |
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cigna Commercial |
$1,167.90
|
| Rate for Payer: First Health Commercial |
$1,236.60
|
| Rate for Payer: First Health Workers Compensation |
$141.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,236.60
|
| Rate for Payer: GEHA Commercial |
$961.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,236.60
|
| Rate for Payer: Multiplan All |
$1,250.34
|
| Rate for Payer: OMNI Networks Commercial |
$961.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,236.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,305.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,030.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,277.82
|
| Rate for Payer: Zelis Auto |
$549.60
|
| Rate for Payer: Zelis Worker's Compensation |
$100.02
|
|
|
US EXTR NONVASC COMP
|
Facility
|
OP
|
$1,374.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
8800036
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,305.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$141.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$824.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$141.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$111.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cigna Commercial |
$1,167.90
|
| Rate for Payer: First Health Commercial |
$1,236.60
|
| Rate for Payer: First Health Workers Compensation |
$141.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,236.60
|
| Rate for Payer: GEHA Commercial |
$1,099.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,236.60
|
| 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 |
$114.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$1,250.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$961.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,236.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$131.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$114.25
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,305.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$1,030.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$1,167.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$114.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,277.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$549.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$100.02
|
|
