|
US OB <14 WEEKS ADD FETUS
|
Facility
|
OP
|
$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: 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 |
$315.60
|
| 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: 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 |
$420.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$473.40
|
| Rate for Payer: Humana ChoiceCare |
$136.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$75.74
|
| Rate for Payer: Multiplan All |
$478.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$315.60
|
| Rate for Payer: OMNI Networks Commercial |
$368.20
|
| Rate for Payer: One Health Plan PPO/POS |
$473.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$87.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$75.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$499.70
|
| Rate for Payer: Three Rivers Provider Network All |
$394.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$462.88
|
| Rate for Payer: United Healthcare Commercial |
$447.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$75.74
|
| Rate for Payer: United Payors & United Providers UP&UP |
$489.18
|
| Rate for Payer: Zelis Auto |
$210.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$263.00
|
| Rate for Payer: Zelis Worker's Compensation |
$55.84
|
|
|
US OB >14 WEEKS ADD FETUS
|
Facility
|
IP
|
$1,123.00
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
2600128
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$99.31 |
| Max. Negotiated Rate |
$1,066.85 |
| Rate for Payer: Cash Price |
$673.80
|
| Rate for Payer: Cash Price |
$673.80
|
| Rate for Payer: Cigna Commercial |
$954.55
|
| Rate for Payer: First Health Commercial |
$1,010.70
|
| Rate for Payer: First Health Workers Compensation |
$140.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,010.70
|
| Rate for Payer: GEHA Commercial |
$786.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,010.70
|
| Rate for Payer: Multiplan All |
$1,021.93
|
| Rate for Payer: OMNI Networks Commercial |
$786.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,010.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,066.85
|
| Rate for Payer: Three Rivers Provider Network All |
$842.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,044.39
|
| Rate for Payer: Zelis Auto |
$449.20
|
| Rate for Payer: Zelis Worker's Compensation |
$99.31
|
|
|
US OB >14 WEEKS ADD FETUS
|
Facility
|
OP
|
$1,123.00
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
2600128
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$99.31 |
| Max. Negotiated Rate |
$1,066.85 |
| 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 |
$673.80
|
| 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: Cash Price |
$673.80
|
| Rate for Payer: Cash Price |
$673.80
|
| Rate for Payer: Cigna Commercial |
$954.55
|
| Rate for Payer: First Health Commercial |
$1,010.70
|
| Rate for Payer: First Health Workers Compensation |
$140.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,010.70
|
| Rate for Payer: GEHA Commercial |
$898.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,010.70
|
| Rate for Payer: Humana ChoiceCare |
$291.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$117.96
|
| Rate for Payer: Multiplan All |
$1,021.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$673.80
|
| Rate for Payer: OMNI Networks Commercial |
$786.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,010.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$136.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$117.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,066.85
|
| Rate for Payer: Three Rivers Provider Network All |
$842.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$988.24
|
| Rate for Payer: United Healthcare Commercial |
$954.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,044.39
|
| Rate for Payer: Zelis Auto |
$449.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$561.50
|
| Rate for Payer: Zelis Worker's Compensation |
$99.31
|
|
|
US OB>14WK SGL 1ST G
|
Facility
|
OP
|
$1,224.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
2600117
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,162.80 |
| 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 |
$734.40
|
| 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 |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cigna Commercial |
$1,040.40
|
| Rate for Payer: First Health Commercial |
$1,101.60
|
| Rate for Payer: First Health Workers Compensation |
$166.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,101.60
|
| Rate for Payer: GEHA Commercial |
$979.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,101.60
|
| 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 |
$1,113.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$856.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,101.60
|
| 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 |
$1,162.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$918.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$1,040.40
|
| 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 |
$1,138.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$489.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$117.98
|
|
|
US OB>14WK SGL 1ST G
|
Facility
|
IP
|
$1,224.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
2600117
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$117.98 |
| Max. Negotiated Rate |
$1,162.80 |
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cigna Commercial |
$1,040.40
|
| Rate for Payer: First Health Commercial |
$1,101.60
|
| Rate for Payer: First Health Workers Compensation |
$166.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,101.60
|
| Rate for Payer: GEHA Commercial |
$856.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,101.60
|
| Rate for Payer: Multiplan All |
$1,113.84
|
| Rate for Payer: OMNI Networks Commercial |
$856.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,101.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,162.80
|
| Rate for Payer: Three Rivers Provider Network All |
$918.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,138.32
|
| Rate for Payer: Zelis Auto |
$489.60
|
| Rate for Payer: Zelis Worker's Compensation |
$117.98
|
|
|
US OB<14WKS SGL 1GES
|
Facility
|
OP
|
$1,088.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
2666890
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,033.60 |
| 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 |
$652.80
|
| 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 |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cigna Commercial |
$924.80
|
| Rate for Payer: First Health Commercial |
$979.20
|
| Rate for Payer: First Health Workers Compensation |
$144.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$979.20
|
| Rate for Payer: GEHA Commercial |
$870.40
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$979.20
|
| 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 |
$117.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$990.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$761.60
|
| Rate for Payer: One Health Plan PPO/POS |
$979.20
|
| 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 |
$1,033.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$816.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$924.80
|
| 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 |
$1,011.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$435.20
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$102.30
|
|
|
US OB<14WKS SGL 1GES
|
Facility
|
IP
|
$1,088.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
2666890
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$102.30 |
| Max. Negotiated Rate |
$1,033.60 |
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cigna Commercial |
$924.80
|
| Rate for Payer: First Health Commercial |
$979.20
|
| Rate for Payer: First Health Workers Compensation |
$144.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$979.20
|
| Rate for Payer: GEHA Commercial |
$761.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$979.20
|
| Rate for Payer: Multiplan All |
$990.08
|
| Rate for Payer: OMNI Networks Commercial |
$761.60
|
| Rate for Payer: One Health Plan PPO/POS |
$979.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,033.60
|
| Rate for Payer: Three Rivers Provider Network All |
$816.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,011.84
|
| Rate for Payer: Zelis Auto |
$435.20
|
| Rate for Payer: Zelis Worker's Compensation |
$102.30
|
|
|
US OB PEL/PREG COMP
|
Facility
|
OP
|
$812.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
2600115
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$70.81 |
| Max. Negotiated Rate |
$771.40 |
| 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 |
$487.20
|
| 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 |
$487.20
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cigna Commercial |
$690.20
|
| Rate for Payer: First Health Commercial |
$730.80
|
| Rate for Payer: First Health Workers Compensation |
$100.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$730.80
|
| Rate for Payer: GEHA Commercial |
$649.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$730.80
|
| 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 |
$75.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$738.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$568.40
|
| Rate for Payer: One Health Plan PPO/POS |
$730.80
|
| 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 |
$771.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$609.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$690.20
|
| 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 |
$755.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$324.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$70.81
|
|
|
US OB PEL/PREG COMP
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
2600115
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$70.81 |
| Max. Negotiated Rate |
$771.40 |
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cigna Commercial |
$690.20
|
| Rate for Payer: First Health Commercial |
$730.80
|
| Rate for Payer: First Health Workers Compensation |
$100.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$730.80
|
| Rate for Payer: GEHA Commercial |
$568.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$730.80
|
| Rate for Payer: Multiplan All |
$738.92
|
| Rate for Payer: OMNI Networks Commercial |
$568.40
|
| Rate for Payer: One Health Plan PPO/POS |
$730.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$771.40
|
| Rate for Payer: Three Rivers Provider Network All |
$609.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$755.16
|
| Rate for Payer: Zelis Auto |
$324.80
|
| Rate for Payer: Zelis Worker's Compensation |
$70.81
|
|
|
US PARACENTESIS
|
Facility
|
OP
|
$1,756.00
|
|
| Hospital Charge Code |
2407210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$439.00 |
| Max. Negotiated Rate |
$1,668.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,053.60
|
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Cigna Commercial |
$1,492.60
|
| Rate for Payer: First Health Commercial |
$1,580.40
|
| Rate for Payer: First Health Workers Compensation |
$677.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,580.40
|
| Rate for Payer: GEHA Commercial |
$1,404.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,580.40
|
| Rate for Payer: Humana ChoiceCare |
$456.56
|
| Rate for Payer: Multiplan All |
$1,597.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,053.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,229.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,580.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,668.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,317.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,545.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$439.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,633.08
|
| Rate for Payer: Zelis Auto |
$702.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$878.00
|
| Rate for Payer: Zelis Worker's Compensation |
$479.39
|
|
|
US PARACENTESIS
|
Facility
|
IP
|
$1,756.00
|
|
| Hospital Charge Code |
2407210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$479.39 |
| Max. Negotiated Rate |
$1,668.20 |
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Cigna Commercial |
$1,492.60
|
| Rate for Payer: First Health Commercial |
$1,580.40
|
| Rate for Payer: First Health Workers Compensation |
$677.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,580.40
|
| Rate for Payer: GEHA Commercial |
$1,229.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,580.40
|
| Rate for Payer: Multiplan All |
$1,597.96
|
| Rate for Payer: OMNI Networks Commercial |
$1,229.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,580.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,668.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,317.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,633.08
|
| Rate for Payer: Zelis Auto |
$702.40
|
| Rate for Payer: Zelis Worker's Compensation |
$479.39
|
|
|
US PARACENTESIS (NON-RAD)
|
Facility
|
OP
|
$1,320.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2600247
|
|
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 PARACENTESIS (NON-RAD)
|
Facility
|
IP
|
$1,320.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2600247
|
|
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 PARACENTESIS (RADIOLOGIST)
|
Facility
|
IP
|
$2,752.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
7749083
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$751.30 |
| Max. Negotiated Rate |
$2,614.40 |
| Rate for Payer: Cash Price |
$1,651.20
|
| Rate for Payer: Cigna Commercial |
$2,339.20
|
| Rate for Payer: First Health Commercial |
$2,476.80
|
| Rate for Payer: First Health Workers Compensation |
$1,062.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,476.80
|
| Rate for Payer: GEHA Commercial |
$1,926.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,476.80
|
| Rate for Payer: Multiplan All |
$2,504.32
|
| Rate for Payer: OMNI Networks Commercial |
$1,926.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,476.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,614.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,064.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,559.36
|
| Rate for Payer: Zelis Auto |
$1,100.80
|
| Rate for Payer: Zelis Worker's Compensation |
$751.30
|
|
|
US PARACENTESIS (RADIOLOGIST)
|
Facility
|
OP
|
$2,752.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
7749083
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$440.79 |
| Max. Negotiated Rate |
$2,614.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$556.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,651.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$556.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$440.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$890.25
|
| Rate for Payer: Cash Price |
$1,651.20
|
| Rate for Payer: Cash Price |
$1,651.20
|
| Rate for Payer: Cigna Commercial |
$2,339.20
|
| Rate for Payer: First Health Commercial |
$2,476.80
|
| Rate for Payer: First Health Workers Compensation |
$1,145.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,476.80
|
| Rate for Payer: GEHA Commercial |
$2,201.60
|
| Rate for Payer: GEHA Medicare |
$890.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,476.80
|
| Rate for Payer: Humana ChoiceCare |
$979.27
|
| Rate for Payer: Humana Medicare Advantage |
$890.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,495.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$449.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$890.25
|
| Rate for Payer: Multiplan All |
$2,504.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,513.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,926.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,476.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$519.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$449.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$890.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,614.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,780.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,064.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$872.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$449.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$890.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,559.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$890.25
|
| Rate for Payer: Zelis Auto |
$1,100.80
|
| Rate for Payer: Zelis Medicare |
$756.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,068.30
|
| Rate for Payer: Zelis Worker's Compensation |
$810.13
|
|
|
US PELVIC COMP
|
Facility
|
IP
|
$1,292.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
2600116
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$93.16 |
| Max. Negotiated Rate |
$1,227.40 |
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna Commercial |
$1,098.20
|
| Rate for Payer: First Health Commercial |
$1,162.80
|
| Rate for Payer: First Health Workers Compensation |
$131.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,162.80
|
| Rate for Payer: GEHA Commercial |
$904.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,162.80
|
| Rate for Payer: Multiplan All |
$1,175.72
|
| Rate for Payer: OMNI Networks Commercial |
$904.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,162.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,227.40
|
| Rate for Payer: Three Rivers Provider Network All |
$969.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,201.56
|
| Rate for Payer: Zelis Auto |
$516.80
|
| Rate for Payer: Zelis Worker's Compensation |
$93.16
|
|
|
US PELVIC COMP
|
Facility
|
OP
|
$1,292.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
2600116
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,227.40 |
| 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 |
$775.20
|
| 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 |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna Commercial |
$1,098.20
|
| Rate for Payer: First Health Commercial |
$1,162.80
|
| Rate for Payer: First Health Workers Compensation |
$131.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,162.80
|
| Rate for Payer: GEHA Commercial |
$1,033.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,162.80
|
| 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 |
$1,175.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$904.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,162.80
|
| 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 |
$1,227.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$969.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$1,098.20
|
| 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 |
$1,201.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$516.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$93.16
|
|
|
US PELVIS LIMITED
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
2600118
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$755.25 |
| Rate for Payer: Cash Price |
$477.00
|
| Rate for Payer: Cash Price |
$477.00
|
| Rate for Payer: Cigna Commercial |
$675.75
|
| Rate for Payer: First Health Commercial |
$715.50
|
| Rate for Payer: First Health Workers Compensation |
$94.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$715.50
|
| Rate for Payer: GEHA Commercial |
$556.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$715.50
|
| Rate for Payer: Multiplan All |
$723.45
|
| Rate for Payer: OMNI Networks Commercial |
$556.50
|
| Rate for Payer: One Health Plan PPO/POS |
$715.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$755.25
|
| Rate for Payer: Three Rivers Provider Network All |
$596.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$739.35
|
| Rate for Payer: Zelis Auto |
$318.00
|
| Rate for Payer: Zelis Worker's Compensation |
$66.60
|
|
|
US PELVIS LIMITED
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
2600118
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$755.25 |
| 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 |
$477.00
|
| 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 |
$477.00
|
| Rate for Payer: Cash Price |
$477.00
|
| Rate for Payer: Cigna Commercial |
$675.75
|
| Rate for Payer: First Health Commercial |
$715.50
|
| Rate for Payer: First Health Workers Compensation |
$94.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$715.50
|
| Rate for Payer: GEHA Commercial |
$636.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$715.50
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$75.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$723.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$556.50
|
| Rate for Payer: One Health Plan PPO/POS |
$715.50
|
| 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 |
$755.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$596.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$675.75
|
| 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 |
$739.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$318.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$66.60
|
|
|
US PREG FETAL POSIT
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
2600249
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$70.81 |
| Max. Negotiated Rate |
$771.40 |
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cigna Commercial |
$690.20
|
| Rate for Payer: First Health Commercial |
$730.80
|
| Rate for Payer: First Health Workers Compensation |
$100.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$730.80
|
| Rate for Payer: GEHA Commercial |
$568.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$730.80
|
| Rate for Payer: Multiplan All |
$738.92
|
| Rate for Payer: OMNI Networks Commercial |
$568.40
|
| Rate for Payer: One Health Plan PPO/POS |
$730.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$771.40
|
| Rate for Payer: Three Rivers Provider Network All |
$609.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$755.16
|
| Rate for Payer: Zelis Auto |
$324.80
|
| Rate for Payer: Zelis Worker's Compensation |
$70.81
|
|
|
US PREG FETAL POSIT
|
Facility
|
OP
|
$812.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
2600249
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$70.81 |
| Max. Negotiated Rate |
$771.40 |
| 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 |
$487.20
|
| 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 |
$487.20
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cigna Commercial |
$690.20
|
| Rate for Payer: First Health Commercial |
$730.80
|
| Rate for Payer: First Health Workers Compensation |
$100.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$730.80
|
| Rate for Payer: GEHA Commercial |
$649.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$730.80
|
| 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 |
$75.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$738.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$568.40
|
| Rate for Payer: One Health Plan PPO/POS |
$730.80
|
| 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 |
$771.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$609.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$690.20
|
| 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 |
$755.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$324.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$70.81
|
|
|
US PREG UTERUS REAL TIME W/IMAGE DCMTN T
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
2676817
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$74.23 |
| Max. Negotiated Rate |
$902.50 |
| 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 |
$570.00
|
| 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 |
$570.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cigna Commercial |
$807.50
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: First Health Workers Compensation |
$114.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$855.00
|
| Rate for Payer: GEHA Commercial |
$760.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$855.00
|
| 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 |
$75.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$864.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$665.00
|
| Rate for Payer: One Health Plan PPO/POS |
$855.00
|
| 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 |
$902.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$712.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$807.50
|
| 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 |
$883.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$380.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$80.85
|
|
|
US PREG UTERUS REAL TIME W/IMAGE DCMTN T
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
2676817
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$80.85 |
| Max. Negotiated Rate |
$902.50 |
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cigna Commercial |
$807.50
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: First Health Workers Compensation |
$114.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$855.00
|
| Rate for Payer: GEHA Commercial |
$665.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$855.00
|
| Rate for Payer: Multiplan All |
$864.50
|
| Rate for Payer: OMNI Networks Commercial |
$665.00
|
| Rate for Payer: One Health Plan PPO/POS |
$855.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$902.50
|
| Rate for Payer: Three Rivers Provider Network All |
$712.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$883.50
|
| Rate for Payer: Zelis Auto |
$380.00
|
| Rate for Payer: Zelis Worker's Compensation |
$80.85
|
|
|
US PROSTATE
|
Facility
|
IP
|
$1,004.00
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
2600119
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$170.55 |
| Max. Negotiated Rate |
$953.80 |
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cigna Commercial |
$853.40
|
| Rate for Payer: First Health Commercial |
$903.60
|
| Rate for Payer: First Health Workers Compensation |
$241.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$903.60
|
| Rate for Payer: GEHA Commercial |
$702.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$903.60
|
| Rate for Payer: Multiplan All |
$913.64
|
| Rate for Payer: OMNI Networks Commercial |
$702.80
|
| Rate for Payer: One Health Plan PPO/POS |
$903.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$953.80
|
| Rate for Payer: Three Rivers Provider Network All |
$753.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$933.72
|
| Rate for Payer: Zelis Auto |
$401.60
|
| Rate for Payer: Zelis Worker's Compensation |
$170.55
|
|
|
US PROSTATE
|
Facility
|
OP
|
$1,004.00
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
2600119
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$953.80 |
| 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 |
$602.40
|
| 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 |
$602.40
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cigna Commercial |
$853.40
|
| Rate for Payer: First Health Commercial |
$903.60
|
| Rate for Payer: First Health Workers Compensation |
$241.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$903.60
|
| Rate for Payer: GEHA Commercial |
$803.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$903.60
|
| 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 |
$913.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$702.80
|
| Rate for Payer: One Health Plan PPO/POS |
$903.60
|
| 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 |
$953.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$753.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$853.40
|
| 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 |
$933.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$401.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$170.55
|
|
