|
US EXTR NONVASC COMP
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
2600203
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.02 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: First Health Workers Compensation |
$141.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$726.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
| Rate for Payer: Zelis Worker's Compensation |
$100.02
|
|
|
US EXTR NONVASC COMP
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
2600203
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$986.10 |
| 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 |
$622.80
|
| 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 |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: First Health Workers Compensation |
$141.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$830.40
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| 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 |
$944.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| 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 |
$986.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$882.30
|
| 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 |
$965.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$415.20
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$100.02
|
|
|
US EXTR NONVASC COMP
|
Facility
|
OP
|
$1,374.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
8204013
|
|
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
|
|
|
US EXTR NONVASC COMP
|
Facility
|
IP
|
$1,374.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
8204013
|
|
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 LIMI
|
Facility
|
IP
|
$731.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
2600109
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$48.35 |
| Max. Negotiated Rate |
$694.45 |
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$621.35
|
| Rate for Payer: First Health Commercial |
$657.90
|
| Rate for Payer: First Health Workers Compensation |
$68.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$657.90
|
| Rate for Payer: GEHA Commercial |
$511.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$657.90
|
| Rate for Payer: Multiplan All |
$665.21
|
| Rate for Payer: OMNI Networks Commercial |
$511.70
|
| Rate for Payer: One Health Plan PPO/POS |
$657.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$694.45
|
| Rate for Payer: Three Rivers Provider Network All |
$548.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$679.83
|
| Rate for Payer: Zelis Auto |
$292.40
|
| Rate for Payer: Zelis Worker's Compensation |
$48.35
|
|
|
US EXTR NONVASC LIMI
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
2600109
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$48.35 |
| Max. Negotiated Rate |
$694.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$137.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$438.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$137.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$621.35
|
| Rate for Payer: First Health Commercial |
$657.90
|
| Rate for Payer: First Health Workers Compensation |
$68.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$657.90
|
| Rate for Payer: GEHA Commercial |
$584.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$657.90
|
| 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 |
$111.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$665.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$511.70
|
| Rate for Payer: One Health Plan PPO/POS |
$657.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$128.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$111.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$694.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$548.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$621.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$111.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$679.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$292.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$48.35
|
|
|
US EXTR NONVASC LIMITED
|
Facility
|
IP
|
$721.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
8800037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$48.35 |
| Max. Negotiated Rate |
$684.95 |
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cigna Commercial |
$612.85
|
| Rate for Payer: First Health Commercial |
$648.90
|
| Rate for Payer: First Health Workers Compensation |
$68.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$648.90
|
| Rate for Payer: GEHA Commercial |
$504.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$648.90
|
| Rate for Payer: Multiplan All |
$656.11
|
| Rate for Payer: OMNI Networks Commercial |
$504.70
|
| Rate for Payer: One Health Plan PPO/POS |
$648.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$684.95
|
| Rate for Payer: Three Rivers Provider Network All |
$540.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$670.53
|
| Rate for Payer: Zelis Auto |
$288.40
|
| Rate for Payer: Zelis Worker's Compensation |
$48.35
|
|
|
US EXTR NONVASC LIMITED
|
Facility
|
OP
|
$721.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
8800037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$48.35 |
| Max. Negotiated Rate |
$684.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$137.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$432.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$137.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cigna Commercial |
$612.85
|
| Rate for Payer: First Health Commercial |
$648.90
|
| Rate for Payer: First Health Workers Compensation |
$68.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$648.90
|
| Rate for Payer: GEHA Commercial |
$576.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$648.90
|
| 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 |
$111.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$656.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$504.70
|
| Rate for Payer: One Health Plan PPO/POS |
$648.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$128.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$111.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$684.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$540.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$612.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$111.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$670.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$288.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$48.35
|
|
|
US EXTR NONVASC LIMITED
|
Facility
|
OP
|
$721.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
8204014
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$48.35 |
| Max. Negotiated Rate |
$684.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$137.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$432.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$137.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cigna Commercial |
$612.85
|
| Rate for Payer: First Health Commercial |
$648.90
|
| Rate for Payer: First Health Workers Compensation |
$68.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$648.90
|
| Rate for Payer: GEHA Commercial |
$576.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$648.90
|
| 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 |
$111.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$656.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$504.70
|
| Rate for Payer: One Health Plan PPO/POS |
$648.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$128.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$111.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$684.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$540.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$612.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$111.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$670.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$288.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$48.35
|
|
|
US EXTR NONVASC LIMITED
|
Facility
|
IP
|
$721.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
8204014
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$48.35 |
| Max. Negotiated Rate |
$684.95 |
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cigna Commercial |
$612.85
|
| Rate for Payer: First Health Commercial |
$648.90
|
| Rate for Payer: First Health Workers Compensation |
$68.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$648.90
|
| Rate for Payer: GEHA Commercial |
$504.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$648.90
|
| Rate for Payer: Multiplan All |
$656.11
|
| Rate for Payer: OMNI Networks Commercial |
$504.70
|
| Rate for Payer: One Health Plan PPO/POS |
$648.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$684.95
|
| Rate for Payer: Three Rivers Provider Network All |
$540.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$670.53
|
| Rate for Payer: Zelis Auto |
$288.40
|
| Rate for Payer: Zelis Worker's Compensation |
$48.35
|
|
|
US FETAL BIOP PRO
|
Facility
|
IP
|
$1,236.00
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
2666893
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$102.58 |
| Max. Negotiated Rate |
$1,174.20 |
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cigna Commercial |
$1,050.60
|
| Rate for Payer: First Health Commercial |
$1,112.40
|
| Rate for Payer: First Health Workers Compensation |
$145.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,112.40
|
| Rate for Payer: GEHA Commercial |
$865.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,112.40
|
| Rate for Payer: Multiplan All |
$1,124.76
|
| Rate for Payer: OMNI Networks Commercial |
$865.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,112.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,174.20
|
| Rate for Payer: Three Rivers Provider Network All |
$927.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,149.48
|
| Rate for Payer: Zelis Auto |
$494.40
|
| Rate for Payer: Zelis Worker's Compensation |
$102.58
|
|
|
US FETAL BIOP PRO
|
Facility
|
OP
|
$1,236.00
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
2666893
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,174.20 |
| 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 |
$741.60
|
| 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 |
$741.60
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cigna Commercial |
$1,050.60
|
| Rate for Payer: First Health Commercial |
$1,112.40
|
| Rate for Payer: First Health Workers Compensation |
$145.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,112.40
|
| Rate for Payer: GEHA Commercial |
$988.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,112.40
|
| 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 |
$1,124.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$865.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,112.40
|
| 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 |
$1,174.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$927.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$1,050.60
|
| 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 |
$1,149.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$494.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$102.58
|
|
|
US GUIDANCE NEEDLE PLACEMENT IMG S&I
|
Facility
|
IP
|
$1,320.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2600112
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$1,254.00 |
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna Commercial |
$1,122.00
|
| Rate for Payer: First Health Commercial |
$1,188.00
|
| Rate for Payer: First Health Workers Compensation |
$117.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,188.00
|
| Rate for Payer: GEHA Commercial |
$924.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,188.00
|
| Rate for Payer: Multiplan All |
$1,201.20
|
| Rate for Payer: OMNI Networks Commercial |
$924.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,188.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,254.00
|
| Rate for Payer: Three Rivers Provider Network All |
$990.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,227.60
|
| Rate for Payer: Zelis Auto |
$528.00
|
| Rate for Payer: Zelis Worker's Compensation |
$83.26
|
|
|
US GUIDANCE NEEDLE PLACEMENT IMG S&I
|
Facility
|
OP
|
$1,320.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2600112
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$1,254.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna Commercial |
$1,122.00
|
| Rate for Payer: First Health Commercial |
$1,188.00
|
| Rate for Payer: First Health Workers Compensation |
$117.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,188.00
|
| Rate for Payer: GEHA Commercial |
$1,056.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,188.00
|
| Rate for Payer: Humana ChoiceCare |
$343.20
|
| Rate for Payer: Multiplan All |
$1,201.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$792.00
|
| Rate for Payer: OMNI Networks Commercial |
$924.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,188.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,254.00
|
| Rate for Payer: Three Rivers Provider Network All |
$990.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,161.60
|
| Rate for Payer: United Healthcare Commercial |
$1,122.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$330.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,227.60
|
| Rate for Payer: Zelis Auto |
$528.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$660.00
|
| Rate for Payer: Zelis Worker's Compensation |
$83.26
|
|
|
US GUIDANCE VASC ACC
|
Facility
|
IP
|
$896.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
2666894
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.35 |
| Max. Negotiated Rate |
$851.20 |
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$761.60
|
| Rate for Payer: First Health Commercial |
$806.40
|
| Rate for Payer: First Health Workers Compensation |
$47.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$806.40
|
| Rate for Payer: GEHA Commercial |
$627.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$806.40
|
| Rate for Payer: Multiplan All |
$815.36
|
| Rate for Payer: OMNI Networks Commercial |
$627.20
|
| Rate for Payer: One Health Plan PPO/POS |
$806.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$851.20
|
| Rate for Payer: Three Rivers Provider Network All |
$672.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$833.28
|
| Rate for Payer: Zelis Auto |
$358.40
|
| Rate for Payer: Zelis Worker's Compensation |
$33.35
|
|
|
US GUIDANCE VASC ACC
|
Facility
|
OP
|
$896.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
2666894
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.35 |
| Max. Negotiated Rate |
$851.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$537.60
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$761.60
|
| Rate for Payer: First Health Commercial |
$806.40
|
| Rate for Payer: First Health Workers Compensation |
$47.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$806.40
|
| Rate for Payer: GEHA Commercial |
$716.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$806.40
|
| Rate for Payer: Humana ChoiceCare |
$232.96
|
| Rate for Payer: Multiplan All |
$815.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$537.60
|
| Rate for Payer: OMNI Networks Commercial |
$627.20
|
| Rate for Payer: One Health Plan PPO/POS |
$806.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$851.20
|
| Rate for Payer: Three Rivers Provider Network All |
$672.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$788.48
|
| Rate for Payer: United Healthcare Commercial |
$761.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$224.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$833.28
|
| Rate for Payer: Zelis Auto |
$358.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$448.00
|
| Rate for Payer: Zelis Worker's Compensation |
$33.35
|
|
|
US GUIDE NEEDLE PLAC
|
Facility
|
OP
|
$1,320.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2600245
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$1,254.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna Commercial |
$1,122.00
|
| Rate for Payer: First Health Commercial |
$1,188.00
|
| Rate for Payer: First Health Workers Compensation |
$117.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,188.00
|
| Rate for Payer: GEHA Commercial |
$1,056.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,188.00
|
| Rate for Payer: Humana ChoiceCare |
$343.20
|
| Rate for Payer: Multiplan All |
$1,201.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$792.00
|
| Rate for Payer: OMNI Networks Commercial |
$924.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,188.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,254.00
|
| Rate for Payer: Three Rivers Provider Network All |
$990.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,161.60
|
| Rate for Payer: United Healthcare Commercial |
$1,122.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$330.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,227.60
|
| Rate for Payer: Zelis Auto |
$528.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$660.00
|
| Rate for Payer: Zelis Worker's Compensation |
$83.26
|
|
|
US GUIDE NEEDLE PLAC
|
Facility
|
IP
|
$1,320.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2600245
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$1,254.00 |
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna Commercial |
$1,122.00
|
| Rate for Payer: First Health Commercial |
$1,188.00
|
| Rate for Payer: First Health Workers Compensation |
$117.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,188.00
|
| Rate for Payer: GEHA Commercial |
$924.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,188.00
|
| Rate for Payer: Multiplan All |
$1,201.20
|
| Rate for Payer: OMNI Networks Commercial |
$924.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,188.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,254.00
|
| Rate for Payer: Three Rivers Provider Network All |
$990.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,227.60
|
| Rate for Payer: Zelis Auto |
$528.00
|
| Rate for Payer: Zelis Worker's Compensation |
$83.26
|
|
|
US INFANT HIPS
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
2476885
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$71.07 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$137.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$137.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$425.00
|
| Rate for Payer: First Health Commercial |
$450.00
|
| Rate for Payer: First Health Workers Compensation |
$171.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$450.00
|
| Rate for Payer: GEHA Commercial |
$400.00
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$450.00
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$111.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$455.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$350.00
|
| Rate for Payer: One Health Plan PPO/POS |
$450.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$128.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$111.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$475.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$375.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$425.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$111.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$465.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$200.00
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$121.18
|
|
|
US INFANT HIPS
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
2476885
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$121.18 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$425.00
|
| Rate for Payer: First Health Commercial |
$450.00
|
| Rate for Payer: First Health Workers Compensation |
$171.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$450.00
|
| Rate for Payer: GEHA Commercial |
$350.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$450.00
|
| Rate for Payer: Multiplan All |
$455.00
|
| Rate for Payer: OMNI Networks Commercial |
$350.00
|
| Rate for Payer: One Health Plan PPO/POS |
$450.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$475.00
|
| Rate for Payer: Three Rivers Provider Network All |
$375.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$465.00
|
| Rate for Payer: Zelis Auto |
$200.00
|
| Rate for Payer: Zelis Worker's Compensation |
$121.18
|
|
|
US (KIDNEY) EXAM ABDO BACK WALL CO
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
8900019
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,073.50 |
| 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 |
$678.00
|
| 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 |
$678.00
|
| Rate for Payer: Cash Price |
$678.00
|
| Rate for Payer: Cigna Commercial |
$960.50
|
| Rate for Payer: First Health Commercial |
$1,017.00
|
| Rate for Payer: First Health Workers Compensation |
$140.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,017.00
|
| Rate for Payer: GEHA Commercial |
$904.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,017.00
|
| 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 |
$1,028.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$791.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,017.00
|
| 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 |
$1,073.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$847.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$960.50
|
| 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 |
$1,050.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$452.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$99.23
|
|
|
US (KIDNEY) EXAM ABDO BACK WALL CO
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
8900019
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$99.23 |
| Max. Negotiated Rate |
$1,073.50 |
| Rate for Payer: Cash Price |
$678.00
|
| Rate for Payer: Cash Price |
$678.00
|
| Rate for Payer: Cigna Commercial |
$960.50
|
| Rate for Payer: First Health Commercial |
$1,017.00
|
| Rate for Payer: First Health Workers Compensation |
$140.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,017.00
|
| Rate for Payer: GEHA Commercial |
$791.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,017.00
|
| Rate for Payer: Multiplan All |
$1,028.30
|
| Rate for Payer: OMNI Networks Commercial |
$791.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,017.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,073.50
|
| Rate for Payer: Three Rivers Provider Network All |
$847.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,050.90
|
| Rate for Payer: Zelis Auto |
$452.00
|
| Rate for Payer: Zelis Worker's Compensation |
$99.23
|
|
|
US LIVER
|
Facility
|
IP
|
$1,238.30
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
2600114
|
|
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 LIVER
|
Facility
|
OP
|
$1,238.30
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
2600114
|
|
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 OB <14 WEEKS ADD FETUS
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
2666892
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.84 |
| Max. Negotiated Rate |
$499.70 |
| Rate for Payer: Cash Price |
$315.60
|
| Rate for Payer: Cash Price |
$315.60
|
| Rate for Payer: Cigna Commercial |
$447.10
|
| Rate for Payer: First Health Commercial |
$473.40
|
| Rate for Payer: First Health Workers Compensation |
$78.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$473.40
|
| Rate for Payer: GEHA Commercial |
$368.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$473.40
|
| Rate for Payer: Multiplan All |
$478.66
|
| Rate for Payer: OMNI Networks Commercial |
$368.20
|
| Rate for Payer: One Health Plan PPO/POS |
$473.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$499.70
|
| Rate for Payer: Three Rivers Provider Network All |
$394.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$489.18
|
| Rate for Payer: Zelis Auto |
$210.40
|
| Rate for Payer: Zelis Worker's Compensation |
$55.84
|
|
