|
US THORACENTESIS (NON-RAD)
|
Facility
|
OP
|
$1,320.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2600123
|
|
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 THORACENTESIS (RADIOLOGIST)
|
Facility
|
IP
|
$2,756.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
7732555
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$752.39 |
| Max. Negotiated Rate |
$2,618.20 |
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cigna Commercial |
$2,342.60
|
| Rate for Payer: First Health Commercial |
$2,480.40
|
| Rate for Payer: First Health Workers Compensation |
$1,064.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,480.40
|
| Rate for Payer: GEHA Commercial |
$1,929.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,480.40
|
| Rate for Payer: Multiplan All |
$2,507.96
|
| Rate for Payer: OMNI Networks Commercial |
$1,929.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,480.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,618.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,067.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,563.08
|
| Rate for Payer: Zelis Auto |
$1,102.40
|
| Rate for Payer: Zelis Worker's Compensation |
$752.39
|
|
|
US THORACENTESIS (RADIOLOGIST)
|
Facility
|
OP
|
$2,756.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
7732555
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$463.20 |
| Max. Negotiated Rate |
$2,618.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$584.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,653.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$584.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$463.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$587.06
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cigna Commercial |
$2,342.60
|
| Rate for Payer: First Health Commercial |
$2,480.40
|
| Rate for Payer: First Health Workers Compensation |
$755.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,480.40
|
| Rate for Payer: GEHA Commercial |
$2,204.80
|
| Rate for Payer: GEHA Medicare |
$587.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,480.40
|
| Rate for Payer: Humana ChoiceCare |
$645.77
|
| Rate for Payer: Humana Medicare Advantage |
$587.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$986.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$472.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$587.06
|
| Rate for Payer: Multiplan All |
$2,507.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$998.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,929.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,480.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$545.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$472.63
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$587.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,618.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,174.12
|
| Rate for Payer: Three Rivers Provider Network All |
$2,067.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$575.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$472.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$587.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,563.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$587.06
|
| Rate for Payer: Zelis Auto |
$1,102.40
|
| Rate for Payer: Zelis Medicare |
$499.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$704.47
|
| Rate for Payer: Zelis Worker's Compensation |
$534.22
|
|
|
US THYROID
|
Facility
|
OP
|
$1,148.50
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
2600124
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,091.08 |
| 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 |
$689.10
|
| 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 |
$689.10
|
| Rate for Payer: Cash Price |
$689.10
|
| Rate for Payer: Cigna Commercial |
$976.23
|
| Rate for Payer: First Health Commercial |
$1,033.65
|
| Rate for Payer: First Health Workers Compensation |
$138.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,033.65
|
| Rate for Payer: GEHA Commercial |
$918.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,033.65
|
| 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 |
$1,045.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$803.95
|
| Rate for Payer: One Health Plan PPO/POS |
$1,033.65
|
| 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 |
$1,091.08
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$861.38
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$976.23
|
| 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 |
$1,068.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$459.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$98.06
|
|
|
US THYROID
|
Facility
|
IP
|
$1,148.50
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
2600124
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.06 |
| Max. Negotiated Rate |
$1,091.08 |
| Rate for Payer: Cash Price |
$689.10
|
| Rate for Payer: Cash Price |
$689.10
|
| Rate for Payer: Cigna Commercial |
$976.23
|
| Rate for Payer: First Health Commercial |
$1,033.65
|
| Rate for Payer: First Health Workers Compensation |
$138.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,033.65
|
| Rate for Payer: GEHA Commercial |
$803.95
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,033.65
|
| Rate for Payer: Multiplan All |
$1,045.13
|
| Rate for Payer: OMNI Networks Commercial |
$803.95
|
| Rate for Payer: One Health Plan PPO/POS |
$1,033.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,091.08
|
| Rate for Payer: Three Rivers Provider Network All |
$861.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,068.11
|
| Rate for Payer: Zelis Auto |
$459.40
|
| Rate for Payer: Zelis Worker's Compensation |
$98.06
|
|
|
US TRANSVAGINAL
|
Facility
|
OP
|
$1,072.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
2600126
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,018.40 |
| 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 |
$643.20
|
| 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 |
$643.20
|
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cigna Commercial |
$911.20
|
| Rate for Payer: First Health Commercial |
$964.80
|
| Rate for Payer: First Health Workers Compensation |
$147.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$964.80
|
| Rate for Payer: GEHA Commercial |
$857.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$964.80
|
| 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 |
$975.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$750.40
|
| Rate for Payer: One Health Plan PPO/POS |
$964.80
|
| 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 |
$1,018.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$804.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$911.20
|
| 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 |
$996.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$428.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$104.38
|
|
|
US TRANSVAGINAL
|
Facility
|
IP
|
$1,072.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
2600126
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$104.38 |
| Max. Negotiated Rate |
$1,018.40 |
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cigna Commercial |
$911.20
|
| Rate for Payer: First Health Commercial |
$964.80
|
| Rate for Payer: First Health Workers Compensation |
$147.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$964.80
|
| Rate for Payer: GEHA Commercial |
$750.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$964.80
|
| Rate for Payer: Multiplan All |
$975.52
|
| Rate for Payer: OMNI Networks Commercial |
$750.40
|
| Rate for Payer: One Health Plan PPO/POS |
$964.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,018.40
|
| Rate for Payer: Three Rivers Provider Network All |
$804.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$996.96
|
| Rate for Payer: Zelis Auto |
$428.80
|
| Rate for Payer: Zelis Worker's Compensation |
$104.38
|
|
|
US VASC ACCESS SITS VSL PATENCY NDL ENTR
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
6131631
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$85.00
|
| Rate for Payer: First Health Commercial |
$90.00
|
| Rate for Payer: First Health Workers Compensation |
$47.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$90.00
|
| Rate for Payer: GEHA Commercial |
$80.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$90.00
|
| Rate for Payer: Humana ChoiceCare |
$26.00
|
| Rate for Payer: Multiplan All |
$91.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$60.00
|
| Rate for Payer: OMNI Networks Commercial |
$70.00
|
| Rate for Payer: One Health Plan PPO/POS |
$90.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$95.00
|
| Rate for Payer: Three Rivers Provider Network All |
$75.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$88.00
|
| Rate for Payer: United Healthcare Commercial |
$85.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$93.00
|
| Rate for Payer: Zelis Auto |
$40.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$50.00
|
| Rate for Payer: Zelis Worker's Compensation |
$33.35
|
|
|
US VASC ACCESS SITS VSL PATENCY NDL ENTR
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
6131631
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.35 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$85.00
|
| Rate for Payer: First Health Commercial |
$90.00
|
| Rate for Payer: First Health Workers Compensation |
$47.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$90.00
|
| Rate for Payer: GEHA Commercial |
$70.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$90.00
|
| Rate for Payer: Multiplan All |
$91.00
|
| Rate for Payer: OMNI Networks Commercial |
$70.00
|
| Rate for Payer: One Health Plan PPO/POS |
$90.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$95.00
|
| Rate for Payer: Three Rivers Provider Network All |
$75.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$93.00
|
| Rate for Payer: Zelis Auto |
$40.00
|
| Rate for Payer: Zelis Worker's Compensation |
$33.35
|
|
|
US VASC ACCESS SITS VSL PATENCY NDL ENTR
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
376937
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.35 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna Commercial |
$680.00
|
| Rate for Payer: First Health Commercial |
$720.00
|
| Rate for Payer: First Health Workers Compensation |
$47.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$720.00
|
| Rate for Payer: GEHA Commercial |
$560.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$720.00
|
| Rate for Payer: Multiplan All |
$728.00
|
| Rate for Payer: OMNI Networks Commercial |
$560.00
|
| Rate for Payer: One Health Plan PPO/POS |
$720.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$760.00
|
| Rate for Payer: Three Rivers Provider Network All |
$600.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$744.00
|
| Rate for Payer: Zelis Auto |
$320.00
|
| Rate for Payer: Zelis Worker's Compensation |
$33.35
|
|
|
US VASC ACCESS SITS VSL PATENCY NDL ENTR
|
Facility
|
OP
|
$800.00
|
|
| Hospital Charge Code |
8176937
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.00 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$480.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna Commercial |
$680.00
|
| Rate for Payer: First Health Commercial |
$720.00
|
| Rate for Payer: First Health Workers Compensation |
$308.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$720.00
|
| Rate for Payer: GEHA Commercial |
$640.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$720.00
|
| Rate for Payer: Humana ChoiceCare |
$208.00
|
| Rate for Payer: Multiplan All |
$728.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$480.00
|
| Rate for Payer: OMNI Networks Commercial |
$560.00
|
| Rate for Payer: One Health Plan PPO/POS |
$720.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$760.00
|
| Rate for Payer: Three Rivers Provider Network All |
$600.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$704.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$200.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$744.00
|
| Rate for Payer: Zelis Auto |
$320.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$400.00
|
| Rate for Payer: Zelis Worker's Compensation |
$218.40
|
|
|
US VASC ACCESS SITS VSL PATENCY NDL ENTR
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
1000058
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.35 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna Commercial |
$680.00
|
| Rate for Payer: First Health Commercial |
$720.00
|
| Rate for Payer: First Health Workers Compensation |
$47.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$720.00
|
| Rate for Payer: GEHA Commercial |
$560.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$720.00
|
| Rate for Payer: Multiplan All |
$728.00
|
| Rate for Payer: OMNI Networks Commercial |
$560.00
|
| Rate for Payer: One Health Plan PPO/POS |
$720.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$760.00
|
| Rate for Payer: Three Rivers Provider Network All |
$600.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$744.00
|
| Rate for Payer: Zelis Auto |
$320.00
|
| Rate for Payer: Zelis Worker's Compensation |
$33.35
|
|
|
US VASC ACCESS SITS VSL PATENCY NDL ENTR
|
Facility
|
IP
|
$800.00
|
|
| Hospital Charge Code |
8176937
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna Commercial |
$680.00
|
| Rate for Payer: First Health Commercial |
$720.00
|
| Rate for Payer: First Health Workers Compensation |
$308.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$720.00
|
| Rate for Payer: GEHA Commercial |
$560.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$720.00
|
| Rate for Payer: Multiplan All |
$728.00
|
| Rate for Payer: OMNI Networks Commercial |
$560.00
|
| Rate for Payer: One Health Plan PPO/POS |
$720.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$760.00
|
| Rate for Payer: Three Rivers Provider Network All |
$600.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$744.00
|
| Rate for Payer: Zelis Auto |
$320.00
|
| Rate for Payer: Zelis Worker's Compensation |
$218.40
|
|
|
US VASCULAR STUDY
|
Facility
|
IP
|
$1,845.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
2676819
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$503.69 |
| Max. Negotiated Rate |
$1,752.75 |
| Rate for Payer: Cash Price |
$1,107.00
|
| Rate for Payer: Cigna Commercial |
$1,568.25
|
| Rate for Payer: First Health Commercial |
$1,660.50
|
| Rate for Payer: First Health Workers Compensation |
$712.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,660.50
|
| Rate for Payer: GEHA Commercial |
$1,291.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,660.50
|
| Rate for Payer: Multiplan All |
$1,678.95
|
| Rate for Payer: OMNI Networks Commercial |
$1,291.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,660.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,752.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,383.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,715.85
|
| Rate for Payer: Zelis Auto |
$738.00
|
| Rate for Payer: Zelis Worker's Compensation |
$503.69
|
|
|
US VASCULAR STUDY
|
Facility
|
OP
|
$1,845.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
2676819
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$184.27 |
| Max. Negotiated Rate |
$1,752.75 |
| 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 |
$1,107.00
|
| 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 |
$1,107.00
|
| Rate for Payer: Cash Price |
$1,107.00
|
| Rate for Payer: Cigna Commercial |
$1,568.25
|
| Rate for Payer: First Health Commercial |
$1,660.50
|
| Rate for Payer: First Health Workers Compensation |
$712.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,660.50
|
| Rate for Payer: GEHA Commercial |
$1,476.00
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,660.50
|
| 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 |
$1,678.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,291.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,660.50
|
| 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 |
$1,752.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$1,383.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$1,568.25
|
| 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 |
$1,715.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$738.00
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$503.69
|
|
|
US VEN DOPP BILAT
|
Facility
|
OP
|
$2,059.70
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
2600205
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$184.27 |
| Max. Negotiated Rate |
$1,956.71 |
| 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 |
$1,235.82
|
| 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 |
$1,235.82
|
| Rate for Payer: Cash Price |
$1,235.82
|
| Rate for Payer: Cigna Commercial |
$1,750.74
|
| Rate for Payer: First Health Commercial |
$1,853.73
|
| Rate for Payer: First Health Workers Compensation |
$795.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,853.73
|
| Rate for Payer: GEHA Commercial |
$1,647.76
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,853.73
|
| 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 |
$1,874.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,441.79
|
| Rate for Payer: One Health Plan PPO/POS |
$1,853.73
|
| 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 |
$1,956.71
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$1,544.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$1,750.74
|
| 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 |
$1,915.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$823.88
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$562.30
|
|
|
US VEN DOPP BILAT
|
Facility
|
IP
|
$2,059.70
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
2600205
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$562.30 |
| Max. Negotiated Rate |
$1,956.71 |
| Rate for Payer: Cash Price |
$1,235.82
|
| Rate for Payer: Cigna Commercial |
$1,750.74
|
| Rate for Payer: First Health Commercial |
$1,853.73
|
| Rate for Payer: First Health Workers Compensation |
$795.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,853.73
|
| Rate for Payer: GEHA Commercial |
$1,441.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,853.73
|
| Rate for Payer: Multiplan All |
$1,874.33
|
| Rate for Payer: OMNI Networks Commercial |
$1,441.79
|
| Rate for Payer: One Health Plan PPO/POS |
$1,853.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,956.71
|
| Rate for Payer: Three Rivers Provider Network All |
$1,544.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,915.52
|
| Rate for Payer: Zelis Auto |
$823.88
|
| Rate for Payer: Zelis Worker's Compensation |
$562.30
|
|
|
US VEN DOPP LE
|
Facility
|
IP
|
$1,366.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
2600242
|
|
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 VEN DOPP LE
|
Facility
|
OP
|
$1,366.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
2600242
|
|
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 VEN DOPP UE
|
Facility
|
IP
|
$1,366.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
2600241
|
|
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 VEN DOPP UE
|
Facility
|
OP
|
$1,366.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
2600241
|
|
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 VENOUS INSUFFICIENCY BILAT
|
Facility
|
OP
|
$2,082.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
2493970
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$184.27 |
| Max. Negotiated Rate |
$1,977.90 |
| 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 |
$1,249.20
|
| 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 |
$1,249.20
|
| Rate for Payer: Cash Price |
$1,249.20
|
| Rate for Payer: Cigna Commercial |
$1,769.70
|
| Rate for Payer: First Health Commercial |
$1,873.80
|
| Rate for Payer: First Health Workers Compensation |
$803.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,873.80
|
| Rate for Payer: GEHA Commercial |
$1,665.60
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,873.80
|
| 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 |
$1,894.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,457.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,873.80
|
| 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 |
$1,977.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$1,561.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$1,769.70
|
| 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 |
$1,936.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$832.80
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$568.39
|
|
|
US VENOUS INSUFFICIENCY BILAT
|
Facility
|
IP
|
$2,082.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
2493970
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$568.39 |
| Max. Negotiated Rate |
$1,977.90 |
| Rate for Payer: Cash Price |
$1,249.20
|
| Rate for Payer: Cigna Commercial |
$1,769.70
|
| Rate for Payer: First Health Commercial |
$1,873.80
|
| Rate for Payer: First Health Workers Compensation |
$803.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,873.80
|
| Rate for Payer: GEHA Commercial |
$1,457.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,873.80
|
| Rate for Payer: Multiplan All |
$1,894.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,457.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,873.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,977.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,561.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,936.26
|
| Rate for Payer: Zelis Auto |
$832.80
|
| Rate for Payer: Zelis Worker's Compensation |
$568.39
|
|
|
VAG DELIVERY ONLY
|
Facility
|
IP
|
$5,591.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
8150104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,526.34 |
| Max. Negotiated Rate |
$5,311.45 |
| Rate for Payer: Cash Price |
$3,354.60
|
| Rate for Payer: Cigna Commercial |
$4,752.35
|
| Rate for Payer: First Health Commercial |
$5,031.90
|
| Rate for Payer: First Health Workers Compensation |
$2,158.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,031.90
|
| Rate for Payer: GEHA Commercial |
$3,913.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,031.90
|
| Rate for Payer: Multiplan All |
$5,087.81
|
| Rate for Payer: OMNI Networks Commercial |
$3,913.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,031.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,311.45
|
| Rate for Payer: Three Rivers Provider Network All |
$4,193.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,199.63
|
| Rate for Payer: Zelis Auto |
$2,236.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,526.34
|
|
|
VAG DELIVERY ONLY
|
Facility
|
OP
|
$5,591.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
8150104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,526.34 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,354.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$3,354.60
|
| Rate for Payer: Cash Price |
$3,354.60
|
| Rate for Payer: Cigna Commercial |
$4,752.35
|
| Rate for Payer: First Health Commercial |
$5,031.90
|
| Rate for Payer: First Health Workers Compensation |
$2,158.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,031.90
|
| Rate for Payer: GEHA Commercial |
$4,472.80
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,031.90
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$5,087.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$3,913.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,031.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,311.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$4,193.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,199.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$2,236.40
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$1,526.34
|
|
