|
Carbamide Peroxide 6.5% Earwax Removal
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
NDC 78112073623
|
| Hospital Charge Code |
3301827
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$45.05
|
| Rate for Payer: First Health Commercial |
$47.70
|
| Rate for Payer: First Health Workers Compensation |
$20.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$47.70
|
| Rate for Payer: GEHA Commercial |
$42.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$47.70
|
| Rate for Payer: Humana ChoiceCare |
$13.78
|
| Rate for Payer: Multiplan All |
$48.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.80
|
| Rate for Payer: OMNI Networks Commercial |
$37.10
|
| Rate for Payer: One Health Plan PPO/POS |
$47.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$50.35
|
| Rate for Payer: Three Rivers Provider Network All |
$39.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$46.64
|
| Rate for Payer: United Healthcare Commercial |
$45.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$49.29
|
| Rate for Payer: Zelis Auto |
$21.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$26.50
|
| Rate for Payer: Zelis Worker's Compensation |
$14.47
|
|
|
CARBIDOPA & LEVODOPA 10-100MG TAB
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
NDC 62756051788
|
| Hospital Charge Code |
3300147
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$8.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Humana ChoiceCare |
$2.60
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.00
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
|
|
CARBIDOPA & LEVODOPA 10-100MG TAB
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
NDC 62756051788
|
| Hospital Charge Code |
3300147
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$7.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
|
|
CARBIDOPA & LEVODOPA 25-100MG TAB
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
NDC 68084009301
|
| Hospital Charge Code |
3300148
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$9.35
|
| Rate for Payer: First Health Commercial |
$9.90
|
| Rate for Payer: First Health Workers Compensation |
$4.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.90
|
| Rate for Payer: GEHA Commercial |
$8.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.90
|
| Rate for Payer: Humana ChoiceCare |
$2.86
|
| Rate for Payer: Multiplan All |
$10.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.60
|
| Rate for Payer: OMNI Networks Commercial |
$7.70
|
| Rate for Payer: One Health Plan PPO/POS |
$9.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10.45
|
| Rate for Payer: Three Rivers Provider Network All |
$8.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10.23
|
| Rate for Payer: Zelis Auto |
$4.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.50
|
| Rate for Payer: Zelis Worker's Compensation |
$3.00
|
|
|
CARBIDOPA & LEVODOPA 25-100MG TAB
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
NDC 68084009301
|
| Hospital Charge Code |
3300148
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$9.35
|
| Rate for Payer: First Health Commercial |
$9.90
|
| Rate for Payer: First Health Workers Compensation |
$4.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.90
|
| Rate for Payer: GEHA Commercial |
$7.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.90
|
| Rate for Payer: Multiplan All |
$10.01
|
| Rate for Payer: OMNI Networks Commercial |
$7.70
|
| Rate for Payer: One Health Plan PPO/POS |
$9.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10.45
|
| Rate for Payer: Three Rivers Provider Network All |
$8.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10.23
|
| Rate for Payer: Zelis Auto |
$4.40
|
| Rate for Payer: Zelis Worker's Compensation |
$3.00
|
|
|
CARBIDOPA & LEVODOPA 25-250MG TAB
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 62756051988
|
| Hospital Charge Code |
3300149
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$10.80
|
| Rate for Payer: First Health Workers Compensation |
$4.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10.80
|
| Rate for Payer: GEHA Commercial |
$9.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10.80
|
| Rate for Payer: Humana ChoiceCare |
$3.12
|
| Rate for Payer: Multiplan All |
$10.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.20
|
| Rate for Payer: OMNI Networks Commercial |
$8.40
|
| Rate for Payer: One Health Plan PPO/POS |
$10.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11.40
|
| Rate for Payer: Three Rivers Provider Network All |
$9.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11.16
|
| Rate for Payer: Zelis Auto |
$4.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3.28
|
|
|
CARBIDOPA & LEVODOPA 25-250MG TAB
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 62756051988
|
| Hospital Charge Code |
3300149
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$10.20
|
| Rate for Payer: First Health Commercial |
$10.80
|
| Rate for Payer: First Health Workers Compensation |
$4.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10.80
|
| Rate for Payer: GEHA Commercial |
$8.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10.80
|
| Rate for Payer: Multiplan All |
$10.92
|
| Rate for Payer: OMNI Networks Commercial |
$8.40
|
| Rate for Payer: One Health Plan PPO/POS |
$10.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$11.40
|
| Rate for Payer: Three Rivers Provider Network All |
$9.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$11.16
|
| Rate for Payer: Zelis Auto |
$4.80
|
| Rate for Payer: Zelis Worker's Compensation |
$3.28
|
|
|
carbohydrate deficient transfe REF123211
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
2200586
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.35 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$32.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$174.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$32.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.06
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$246.50
|
| Rate for Payer: First Health Commercial |
$261.00
|
| Rate for Payer: First Health Workers Compensation |
$23.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$261.00
|
| Rate for Payer: GEHA Commercial |
$232.00
|
| Rate for Payer: GEHA Medicare |
$18.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$261.00
|
| Rate for Payer: Humana ChoiceCare |
$19.87
|
| Rate for Payer: Humana Medicare Advantage |
$18.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.06
|
| Rate for Payer: Multiplan All |
$263.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.70
|
| Rate for Payer: OMNI Networks Commercial |
$203.00
|
| Rate for Payer: One Health Plan PPO/POS |
$261.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$275.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$36.12
|
| Rate for Payer: Three Rivers Provider Network All |
$217.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.70
|
| Rate for Payer: United Healthcare Commercial |
$246.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$269.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.06
|
| Rate for Payer: Zelis Auto |
$116.00
|
| Rate for Payer: Zelis Medicare |
$15.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.67
|
| Rate for Payer: Zelis Worker's Compensation |
$16.91
|
|
|
carbohydrate deficient transfe REF123211
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
2200586
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$246.50
|
| Rate for Payer: First Health Commercial |
$261.00
|
| Rate for Payer: First Health Workers Compensation |
$23.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$261.00
|
| Rate for Payer: GEHA Commercial |
$203.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$261.00
|
| Rate for Payer: Multiplan All |
$263.90
|
| Rate for Payer: OMNI Networks Commercial |
$203.00
|
| Rate for Payer: One Health Plan PPO/POS |
$261.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$275.50
|
| Rate for Payer: Three Rivers Provider Network All |
$217.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$269.70
|
| Rate for Payer: Zelis Auto |
$116.00
|
| Rate for Payer: Zelis Worker's Compensation |
$16.91
|
|
|
carbon monoxide REF007187
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
2200461
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.73 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$23.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$117.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Worker's Compensation |
$16.73
|
|
|
carbon monoxide REF007187
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
2200461
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.47 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$22.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$22.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.32
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$23.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: GEHA Medicare |
$12.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Humana ChoiceCare |
$13.55
|
| Rate for Payer: Humana Medicare Advantage |
$12.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.32
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.94
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.69
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.64
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.07
|
| Rate for Payer: United Healthcare Commercial |
$142.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.32
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Medicare |
$10.47
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.78
|
| Rate for Payer: Zelis Worker's Compensation |
$16.73
|
|
|
CARBOXYHEMOGLOBIN ARTERIAL RESP
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
4210016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.73 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cigna Commercial |
$149.60
|
| Rate for Payer: First Health Commercial |
$158.40
|
| Rate for Payer: First Health Workers Compensation |
$23.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$158.40
|
| Rate for Payer: GEHA Commercial |
$123.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$158.40
|
| Rate for Payer: Multiplan All |
$160.16
|
| Rate for Payer: OMNI Networks Commercial |
$123.20
|
| Rate for Payer: One Health Plan PPO/POS |
$158.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$167.20
|
| Rate for Payer: Three Rivers Provider Network All |
$132.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$163.68
|
| Rate for Payer: Zelis Auto |
$70.40
|
| Rate for Payer: Zelis Worker's Compensation |
$16.73
|
|
|
CARBOXYHEMOGLOBIN ARTERIAL RESP
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
4210016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.47 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$22.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$105.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$22.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.32
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cigna Commercial |
$149.60
|
| Rate for Payer: First Health Commercial |
$158.40
|
| Rate for Payer: First Health Workers Compensation |
$23.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$158.40
|
| Rate for Payer: GEHA Commercial |
$140.80
|
| Rate for Payer: GEHA Medicare |
$12.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$158.40
|
| Rate for Payer: Humana ChoiceCare |
$13.55
|
| Rate for Payer: Humana Medicare Advantage |
$12.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.32
|
| Rate for Payer: Multiplan All |
$160.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.94
|
| Rate for Payer: OMNI Networks Commercial |
$123.20
|
| Rate for Payer: One Health Plan PPO/POS |
$158.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.69
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$167.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.64
|
| Rate for Payer: Three Rivers Provider Network All |
$132.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.07
|
| Rate for Payer: United Healthcare Commercial |
$149.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$163.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.32
|
| Rate for Payer: Zelis Auto |
$70.40
|
| Rate for Payer: Zelis Medicare |
$10.47
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.78
|
| Rate for Payer: Zelis Worker's Compensation |
$16.73
|
|
|
CARDIAC ARREST PROC
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
4000013
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$196.66 |
| Max. Negotiated Rate |
$1,662.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$248.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$248.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$196.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,487.50
|
| Rate for Payer: First Health Commercial |
$1,575.00
|
| Rate for Payer: First Health Workers Compensation |
$675.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,575.00
|
| Rate for Payer: GEHA Commercial |
$1,400.00
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,575.00
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$200.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$1,592.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,225.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,575.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$231.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$200.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,662.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Commercial |
$1,487.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$200.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,627.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$700.00
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$477.75
|
|
|
CARDIAC ARREST PROC
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
4000013
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$477.75 |
| Max. Negotiated Rate |
$1,662.50 |
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,487.50
|
| Rate for Payer: First Health Commercial |
$1,575.00
|
| Rate for Payer: First Health Workers Compensation |
$675.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,575.00
|
| Rate for Payer: GEHA Commercial |
$1,225.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,575.00
|
| Rate for Payer: Multiplan All |
$1,592.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,225.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,575.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,662.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,312.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,627.50
|
| Rate for Payer: Zelis Auto |
$700.00
|
| Rate for Payer: Zelis Worker's Compensation |
$477.75
|
|
|
CARDIAC STRESS TEST
|
Facility
|
OP
|
$2,118.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
4000020
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$251.34 |
| Max. Negotiated Rate |
$2,012.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$356.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,270.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$356.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$282.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cigna Commercial |
$1,800.30
|
| Rate for Payer: First Health Commercial |
$1,906.20
|
| Rate for Payer: First Health Workers Compensation |
$817.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,906.20
|
| Rate for Payer: GEHA Commercial |
$1,694.40
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,906.20
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$288.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$1,927.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,482.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,906.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$333.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$288.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,012.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$1,588.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Commercial |
$1,800.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$288.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,969.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$847.20
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$578.21
|
|
|
CARDIAC STRESS TEST
|
Facility
|
IP
|
$2,118.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
4000020
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$578.21 |
| Max. Negotiated Rate |
$2,012.10 |
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cigna Commercial |
$1,800.30
|
| Rate for Payer: First Health Commercial |
$1,906.20
|
| Rate for Payer: First Health Workers Compensation |
$817.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,906.20
|
| Rate for Payer: GEHA Commercial |
$1,482.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,906.20
|
| Rate for Payer: Multiplan All |
$1,927.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,482.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,906.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,012.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,588.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,969.74
|
| Rate for Payer: Zelis Auto |
$847.20
|
| Rate for Payer: Zelis Worker's Compensation |
$578.21
|
|
|
CARDIOPULMONARY RESUSCITATION
|
Facility
|
IP
|
$1,540.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
10092950
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.42 |
| Max. Negotiated Rate |
$1,463.00 |
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cigna Commercial |
$1,309.00
|
| Rate for Payer: First Health Commercial |
$1,386.00
|
| Rate for Payer: First Health Workers Compensation |
$594.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,386.00
|
| Rate for Payer: GEHA Commercial |
$1,078.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,386.00
|
| Rate for Payer: Multiplan All |
$1,401.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,078.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,386.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,463.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,155.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,432.20
|
| Rate for Payer: Zelis Auto |
$616.00
|
| Rate for Payer: Zelis Worker's Compensation |
$420.42
|
|
|
CARDIOPULMONARY RESUSCITATION
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
6192950
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$477.75 |
| Max. Negotiated Rate |
$1,662.50 |
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,487.50
|
| Rate for Payer: First Health Commercial |
$1,575.00
|
| Rate for Payer: First Health Workers Compensation |
$675.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,575.00
|
| Rate for Payer: GEHA Commercial |
$1,225.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,575.00
|
| Rate for Payer: Multiplan All |
$1,592.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,225.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,575.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,662.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,312.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,627.50
|
| Rate for Payer: Zelis Auto |
$700.00
|
| Rate for Payer: Zelis Worker's Compensation |
$477.75
|
|
|
CARDIOPULMONARY RESUSCITATION
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
6192950
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$196.66 |
| Max. Negotiated Rate |
$1,662.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$248.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$248.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$196.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,487.50
|
| Rate for Payer: First Health Commercial |
$1,575.00
|
| Rate for Payer: First Health Workers Compensation |
$675.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,575.00
|
| Rate for Payer: GEHA Commercial |
$1,400.00
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,575.00
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$200.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$1,592.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,225.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,575.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$231.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$200.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,662.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$200.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,627.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$700.00
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$477.75
|
|
|
CARDIOPULMONARY RESUSCITATION
|
Facility
|
IP
|
$1,274.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
6100005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$347.80 |
| Max. Negotiated Rate |
$1,210.30 |
| Rate for Payer: Cash Price |
$764.40
|
| Rate for Payer: Cigna Commercial |
$1,082.90
|
| Rate for Payer: First Health Commercial |
$1,146.60
|
| Rate for Payer: First Health Workers Compensation |
$491.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,146.60
|
| Rate for Payer: GEHA Commercial |
$891.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,146.60
|
| Rate for Payer: Multiplan All |
$1,159.34
|
| Rate for Payer: OMNI Networks Commercial |
$891.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,146.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,210.30
|
| Rate for Payer: Three Rivers Provider Network All |
$955.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,184.82
|
| Rate for Payer: Zelis Auto |
$509.60
|
| Rate for Payer: Zelis Worker's Compensation |
$347.80
|
|
|
CARDIOPULMONARY RESUSCITATION
|
Facility
|
OP
|
$1,274.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
6100005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$196.66 |
| Max. Negotiated Rate |
$1,210.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$248.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$764.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$248.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$196.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$764.40
|
| Rate for Payer: Cash Price |
$764.40
|
| Rate for Payer: Cigna Commercial |
$1,082.90
|
| Rate for Payer: First Health Commercial |
$1,146.60
|
| Rate for Payer: First Health Workers Compensation |
$380.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,146.60
|
| Rate for Payer: GEHA Commercial |
$1,019.20
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,146.60
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$200.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$1,159.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$891.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,146.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$231.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$200.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,210.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$955.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$200.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,184.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$509.60
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$269.08
|
|
|
CARDIOPULMONARY RESUSSITATION PROFEE
|
Facility
|
IP
|
$1,274.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
8150111
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$347.80 |
| Max. Negotiated Rate |
$1,210.30 |
| Rate for Payer: Cash Price |
$764.40
|
| Rate for Payer: Cigna Commercial |
$1,082.90
|
| Rate for Payer: First Health Commercial |
$1,146.60
|
| Rate for Payer: First Health Workers Compensation |
$491.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,146.60
|
| Rate for Payer: GEHA Commercial |
$891.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,146.60
|
| Rate for Payer: Multiplan All |
$1,159.34
|
| Rate for Payer: OMNI Networks Commercial |
$891.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,146.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,210.30
|
| Rate for Payer: Three Rivers Provider Network All |
$955.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,184.82
|
| Rate for Payer: Zelis Auto |
$509.60
|
| Rate for Payer: Zelis Worker's Compensation |
$347.80
|
|
|
CARDIOPULMONARY RESUSSITATION PROFEE
|
Facility
|
OP
|
$1,274.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
8150111
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$196.66 |
| Max. Negotiated Rate |
$1,210.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$248.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$764.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$248.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$196.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$764.40
|
| Rate for Payer: Cash Price |
$764.40
|
| Rate for Payer: Cigna Commercial |
$1,082.90
|
| Rate for Payer: First Health Commercial |
$1,146.60
|
| Rate for Payer: First Health Workers Compensation |
$491.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,146.60
|
| Rate for Payer: GEHA Commercial |
$1,019.20
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,146.60
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$200.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$1,159.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$891.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,146.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$231.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$200.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,210.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$955.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$200.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,184.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$509.60
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$347.80
|
|
|
CARDIO STRESS TEST (GLOBA
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 93018
|
| Hospital Charge Code |
9100010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$39.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$35.70
|
| Rate for Payer: First Health Commercial |
$37.80
|
| Rate for Payer: First Health Workers Compensation |
$16.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$37.80
|
| Rate for Payer: GEHA Commercial |
$33.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$37.80
|
| Rate for Payer: Humana ChoiceCare |
$10.92
|
| Rate for Payer: Multiplan All |
$38.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.20
|
| Rate for Payer: OMNI Networks Commercial |
$29.40
|
| Rate for Payer: One Health Plan PPO/POS |
$37.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$39.90
|
| Rate for Payer: Three Rivers Provider Network All |
$31.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$36.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$10.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$39.06
|
| Rate for Payer: Zelis Auto |
$16.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.00
|
| Rate for Payer: Zelis Worker's Compensation |
$11.47
|
|
