|
CAST SUP LNG LEG SPLNT PED F
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT Q4044
|
| Hospital Charge Code |
21600132
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$21.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$15.29
|
|
|
CAST SUP SHT ARM SPLINT FBRG
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT Q4022
|
| Hospital Charge Code |
21600110
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$38.95 |
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$34.85
|
| Rate for Payer: First Health Commercial |
$36.90
|
| Rate for Payer: First Health Workers Compensation |
$15.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.90
|
| Rate for Payer: GEHA Commercial |
$28.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.90
|
| Rate for Payer: Multiplan All |
$37.31
|
| Rate for Payer: OMNI Networks Commercial |
$28.70
|
| Rate for Payer: One Health Plan PPO/POS |
$36.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.95
|
| Rate for Payer: Three Rivers Provider Network All |
$30.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$38.13
|
| Rate for Payer: Zelis Auto |
$16.40
|
| Rate for Payer: Zelis Worker's Compensation |
$11.19
|
|
|
CAST SUP SHT ARM SPLINT FBRG
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT Q4022
|
| Hospital Charge Code |
21600110
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$10.25 |
| Max. Negotiated Rate |
$38.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$34.85
|
| Rate for Payer: First Health Commercial |
$36.90
|
| Rate for Payer: First Health Workers Compensation |
$15.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$36.90
|
| Rate for Payer: GEHA Commercial |
$32.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$36.90
|
| Rate for Payer: Humana ChoiceCare |
$10.66
|
| Rate for Payer: Multiplan All |
$37.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.60
|
| Rate for Payer: OMNI Networks Commercial |
$28.70
|
| Rate for Payer: One Health Plan PPO/POS |
$36.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$38.95
|
| Rate for Payer: Three Rivers Provider Network All |
$30.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$36.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$10.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$38.13
|
| Rate for Payer: Zelis Auto |
$16.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.50
|
| Rate for Payer: Zelis Worker's Compensation |
$11.19
|
|
|
CAST SUP SHT ARM SPLNT PED F
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT Q4024
|
| Hospital Charge Code |
21600111
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$17.00
|
| Rate for Payer: First Health Commercial |
$18.00
|
| Rate for Payer: First Health Workers Compensation |
$7.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.00
|
| Rate for Payer: GEHA Commercial |
$16.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.00
|
| Rate for Payer: Humana ChoiceCare |
$5.20
|
| Rate for Payer: Multiplan All |
$18.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12.00
|
| Rate for Payer: OMNI Networks Commercial |
$14.00
|
| Rate for Payer: One Health Plan PPO/POS |
$18.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.00
|
| Rate for Payer: Three Rivers Provider Network All |
$15.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$18.60
|
| Rate for Payer: Zelis Auto |
$8.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.00
|
| Rate for Payer: Zelis Worker's Compensation |
$5.46
|
|
|
CAST SUP SHT ARM SPLNT PED F
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT Q4024
|
| Hospital Charge Code |
21600111
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$17.00
|
| Rate for Payer: First Health Commercial |
$18.00
|
| Rate for Payer: First Health Workers Compensation |
$7.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.00
|
| Rate for Payer: GEHA Commercial |
$14.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.00
|
| Rate for Payer: Multiplan All |
$18.20
|
| Rate for Payer: OMNI Networks Commercial |
$14.00
|
| Rate for Payer: One Health Plan PPO/POS |
$18.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.00
|
| Rate for Payer: Three Rivers Provider Network All |
$15.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$18.60
|
| Rate for Payer: Zelis Auto |
$8.00
|
| Rate for Payer: Zelis Worker's Compensation |
$5.46
|
|
|
CAST SUP SHT LEG SPLNT FBRGL
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT Q4046
|
| Hospital Charge Code |
21600149
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$57.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$36.60
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cigna Commercial |
$51.85
|
| Rate for Payer: First Health Commercial |
$54.90
|
| Rate for Payer: First Health Workers Compensation |
$23.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$54.90
|
| Rate for Payer: GEHA Commercial |
$48.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$54.90
|
| Rate for Payer: Humana ChoiceCare |
$15.86
|
| Rate for Payer: Multiplan All |
$55.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$36.60
|
| Rate for Payer: OMNI Networks Commercial |
$42.70
|
| Rate for Payer: One Health Plan PPO/POS |
$54.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$57.95
|
| Rate for Payer: Three Rivers Provider Network All |
$45.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$53.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$56.73
|
| Rate for Payer: Zelis Auto |
$24.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$30.50
|
| Rate for Payer: Zelis Worker's Compensation |
$16.65
|
|
|
CAST SUP SHT LEG SPLNT FBRGL
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT Q4046
|
| Hospital Charge Code |
21600149
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$57.95 |
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cigna Commercial |
$51.85
|
| Rate for Payer: First Health Commercial |
$54.90
|
| Rate for Payer: First Health Workers Compensation |
$23.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$54.90
|
| Rate for Payer: GEHA Commercial |
$42.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$54.90
|
| Rate for Payer: Multiplan All |
$55.51
|
| Rate for Payer: OMNI Networks Commercial |
$42.70
|
| Rate for Payer: One Health Plan PPO/POS |
$54.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$57.95
|
| Rate for Payer: Three Rivers Provider Network All |
$45.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$56.73
|
| Rate for Payer: Zelis Auto |
$24.40
|
| Rate for Payer: Zelis Worker's Compensation |
$16.65
|
|
|
CAST SUP SHT LEG SPLNT PED F
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT Q4048
|
| Hospital Charge Code |
21600130
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: First Health Workers Compensation |
$11.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$21.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.19
|
|
|
CAST SUP SHT LEG SPLNT PED F
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT Q4048
|
| Hospital Charge Code |
21600130
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: First Health Workers Compensation |
$11.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$24.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Humana ChoiceCare |
$7.80
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.00
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$26.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.19
|
|
|
CAST SUP SHT LEG SPLNT PLSTR
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT Q4045
|
| Hospital Charge Code |
21600129
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: First Health Workers Compensation |
$11.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$21.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.19
|
|
|
CAST SUP SHT LEG SPLNT PLSTR
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT Q4045
|
| Hospital Charge Code |
21600129
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: First Health Workers Compensation |
$11.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$24.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Humana ChoiceCare |
$7.80
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.00
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$26.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.19
|
|
|
catecholamines plasma REF084152
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
2200311
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.46 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$45.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$45.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$36.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$25.25
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$45.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: GEHA Medicare |
$25.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$27.77
|
| Rate for Payer: Humana Medicare Advantage |
$25.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$42.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$36.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$25.25
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$42.92
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$42.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$36.74
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$25.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$50.50
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$24.75
|
| Rate for Payer: United Healthcare Commercial |
$211.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$36.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$25.25
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Medicare |
$21.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$30.30
|
| Rate for Payer: Zelis Worker's Compensation |
$32.16
|
|
|
catecholamines plasma REF084152
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
2200311
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: First Health Workers Compensation |
$45.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Worker's Compensation |
$32.16
|
|
|
catecolamines frac 24hr urine REF004176
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
22990759
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.46 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$45.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$45.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$36.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$25.25
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$284.75
|
| Rate for Payer: First Health Commercial |
$301.50
|
| Rate for Payer: First Health Workers Compensation |
$45.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$301.50
|
| Rate for Payer: GEHA Commercial |
$268.00
|
| Rate for Payer: GEHA Medicare |
$25.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$301.50
|
| Rate for Payer: Humana ChoiceCare |
$27.77
|
| Rate for Payer: Humana Medicare Advantage |
$25.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$42.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$36.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$25.25
|
| Rate for Payer: Multiplan All |
$304.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$42.92
|
| Rate for Payer: OMNI Networks Commercial |
$234.50
|
| Rate for Payer: One Health Plan PPO/POS |
$301.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$42.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$36.74
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$25.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$318.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$50.50
|
| Rate for Payer: Three Rivers Provider Network All |
$251.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$24.75
|
| Rate for Payer: United Healthcare Commercial |
$284.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$36.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$311.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$25.25
|
| Rate for Payer: Zelis Auto |
$134.00
|
| Rate for Payer: Zelis Medicare |
$21.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$30.30
|
| Rate for Payer: Zelis Worker's Compensation |
$32.16
|
|
|
catecolamines frac 24hr urine REF004176
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
22990759
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$284.75
|
| Rate for Payer: First Health Commercial |
$301.50
|
| Rate for Payer: First Health Workers Compensation |
$45.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$301.50
|
| Rate for Payer: GEHA Commercial |
$234.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$301.50
|
| Rate for Payer: Multiplan All |
$304.85
|
| Rate for Payer: OMNI Networks Commercial |
$234.50
|
| Rate for Payer: One Health Plan PPO/POS |
$301.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$318.25
|
| Rate for Payer: Three Rivers Provider Network All |
$251.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$311.55
|
| Rate for Payer: Zelis Auto |
$134.00
|
| Rate for Payer: Zelis Worker's Compensation |
$32.16
|
|
|
cat hair/dander IgE REF602454
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299149
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
cat hair/dander IgE REF602454
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299149
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
CATHETER BALLOON EXPRESS RFA BARRX
|
Facility
|
OP
|
$8,282.00
|
|
|
Service Code
|
CPT C1733
|
| Hospital Charge Code |
7006546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,070.50 |
| Max. Negotiated Rate |
$7,867.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,969.20
|
| Rate for Payer: Cash Price |
$4,969.20
|
| Rate for Payer: Cash Price |
$4,969.20
|
| Rate for Payer: Cigna Commercial |
$7,039.70
|
| Rate for Payer: First Health Commercial |
$7,453.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,453.80
|
| Rate for Payer: GEHA Commercial |
$6,625.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,453.80
|
| Rate for Payer: Humana ChoiceCare |
$2,153.32
|
| Rate for Payer: Multiplan All |
$7,536.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,969.20
|
| Rate for Payer: OMNI Networks Commercial |
$5,797.40
|
| Rate for Payer: One Health Plan PPO/POS |
$7,453.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,867.90
|
| Rate for Payer: Three Rivers Provider Network All |
$6,211.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7,288.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,070.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,702.26
|
| Rate for Payer: Zelis Auto |
$3,312.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,141.00
|
|
|
CATHETER BALLOON EXPRESS RFA BARRX
|
Facility
|
IP
|
$8,282.00
|
|
|
Service Code
|
CPT C1733
|
| Hospital Charge Code |
7006546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,312.80 |
| Max. Negotiated Rate |
$7,867.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,625.60
|
| Rate for Payer: Cash Price |
$4,969.20
|
| Rate for Payer: Cash Price |
$4,969.20
|
| Rate for Payer: Cigna Commercial |
$7,039.70
|
| Rate for Payer: First Health Commercial |
$7,453.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7,453.80
|
| Rate for Payer: GEHA Commercial |
$5,797.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7,453.80
|
| Rate for Payer: Multiplan All |
$7,536.62
|
| Rate for Payer: OMNI Networks Commercial |
$5,797.40
|
| Rate for Payer: One Health Plan PPO/POS |
$7,453.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,867.90
|
| Rate for Payer: Three Rivers Provider Network All |
$6,211.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,702.26
|
| Rate for Payer: Zelis Auto |
$3,312.80
|
|
|
CATHETER BARRX 360RFA 22MM
|
Facility
|
OP
|
$6,181.00
|
|
|
Service Code
|
CPT C1733
|
| Hospital Charge Code |
7006562
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.25 |
| Max. Negotiated Rate |
$5,871.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,708.60
|
| Rate for Payer: Cash Price |
$3,708.60
|
| Rate for Payer: Cash Price |
$3,708.60
|
| Rate for Payer: Cigna Commercial |
$5,253.85
|
| Rate for Payer: First Health Commercial |
$5,562.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,562.90
|
| Rate for Payer: GEHA Commercial |
$4,944.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,562.90
|
| Rate for Payer: Humana ChoiceCare |
$1,607.06
|
| Rate for Payer: Multiplan All |
$5,624.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,708.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,326.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,562.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,871.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,635.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,439.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,545.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,748.33
|
| Rate for Payer: Zelis Auto |
$2,472.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,090.50
|
|
|
CATHETER BARRX 360RFA 22MM
|
Facility
|
IP
|
$6,181.00
|
|
|
Service Code
|
CPT C1733
|
| Hospital Charge Code |
7006562
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,472.40 |
| Max. Negotiated Rate |
$5,871.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,944.80
|
| Rate for Payer: Cash Price |
$3,708.60
|
| Rate for Payer: Cash Price |
$3,708.60
|
| Rate for Payer: Cigna Commercial |
$5,253.85
|
| Rate for Payer: First Health Commercial |
$5,562.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,562.90
|
| Rate for Payer: GEHA Commercial |
$4,326.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,562.90
|
| Rate for Payer: Multiplan All |
$5,624.71
|
| Rate for Payer: OMNI Networks Commercial |
$4,326.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,562.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,871.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,635.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,748.33
|
| Rate for Payer: Zelis Auto |
$2,472.40
|
|
|
CATHETER BARRX 360RFA 28MM
|
Facility
|
IP
|
$6,181.00
|
|
|
Service Code
|
CPT C1733
|
| Hospital Charge Code |
7006563
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,472.40 |
| Max. Negotiated Rate |
$5,871.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,944.80
|
| Rate for Payer: Cash Price |
$3,708.60
|
| Rate for Payer: Cash Price |
$3,708.60
|
| Rate for Payer: Cigna Commercial |
$5,253.85
|
| Rate for Payer: First Health Commercial |
$5,562.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,562.90
|
| Rate for Payer: GEHA Commercial |
$4,326.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,562.90
|
| Rate for Payer: Multiplan All |
$5,624.71
|
| Rate for Payer: OMNI Networks Commercial |
$4,326.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,562.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,871.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,635.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,748.33
|
| Rate for Payer: Zelis Auto |
$2,472.40
|
|
|
CATHETER BARRX 360RFA 28MM
|
Facility
|
OP
|
$6,181.00
|
|
|
Service Code
|
CPT C1733
|
| Hospital Charge Code |
7006563
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.25 |
| Max. Negotiated Rate |
$5,871.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,708.60
|
| Rate for Payer: Cash Price |
$3,708.60
|
| Rate for Payer: Cash Price |
$3,708.60
|
| Rate for Payer: Cigna Commercial |
$5,253.85
|
| Rate for Payer: First Health Commercial |
$5,562.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,562.90
|
| Rate for Payer: GEHA Commercial |
$4,944.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,562.90
|
| Rate for Payer: Humana ChoiceCare |
$1,607.06
|
| Rate for Payer: Multiplan All |
$5,624.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,708.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,326.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,562.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,871.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,635.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,439.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,545.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,748.33
|
| Rate for Payer: Zelis Auto |
$2,472.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,090.50
|
|
|
CATHETER BARRX 360RFA 31MM
|
Facility
|
IP
|
$6,181.00
|
|
|
Service Code
|
CPT C1733
|
| Hospital Charge Code |
7006564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,472.40 |
| Max. Negotiated Rate |
$5,871.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,944.80
|
| Rate for Payer: Cash Price |
$3,708.60
|
| Rate for Payer: Cash Price |
$3,708.60
|
| Rate for Payer: Cigna Commercial |
$5,253.85
|
| Rate for Payer: First Health Commercial |
$5,562.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,562.90
|
| Rate for Payer: GEHA Commercial |
$4,326.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,562.90
|
| Rate for Payer: Multiplan All |
$5,624.71
|
| Rate for Payer: OMNI Networks Commercial |
$4,326.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,562.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,871.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,635.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,748.33
|
| Rate for Payer: Zelis Auto |
$2,472.40
|
|
|
CATHETER BARRX 360RFA 31MM
|
Facility
|
OP
|
$6,181.00
|
|
|
Service Code
|
CPT C1733
|
| Hospital Charge Code |
7006564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.25 |
| Max. Negotiated Rate |
$5,871.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,708.60
|
| Rate for Payer: Cash Price |
$3,708.60
|
| Rate for Payer: Cash Price |
$3,708.60
|
| Rate for Payer: Cigna Commercial |
$5,253.85
|
| Rate for Payer: First Health Commercial |
$5,562.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,562.90
|
| Rate for Payer: GEHA Commercial |
$4,944.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,562.90
|
| Rate for Payer: Humana ChoiceCare |
$1,607.06
|
| Rate for Payer: Multiplan All |
$5,624.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,708.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,326.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,562.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,871.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,635.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,439.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,545.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,748.33
|
| Rate for Payer: Zelis Auto |
$2,472.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,090.50
|
|
