|
CAUTERY CERVIX CRYOCAUTERY INITIAL/REPEA
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
6157511
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$108.93 |
| Max. Negotiated Rate |
$379.05 |
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cigna Commercial |
$339.15
|
| Rate for Payer: First Health Commercial |
$359.10
|
| Rate for Payer: First Health Workers Compensation |
$154.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$359.10
|
| Rate for Payer: GEHA Commercial |
$279.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$359.10
|
| Rate for Payer: Multiplan All |
$363.09
|
| Rate for Payer: OMNI Networks Commercial |
$279.30
|
| Rate for Payer: One Health Plan PPO/POS |
$359.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$379.05
|
| Rate for Payer: Three Rivers Provider Network All |
$299.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$371.07
|
| Rate for Payer: Zelis Auto |
$159.60
|
| Rate for Payer: Zelis Worker's Compensation |
$108.93
|
|
|
CB CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRA
|
Facility
|
IP
|
$953.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
2900019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.76 |
| Max. Negotiated Rate |
$905.35 |
| Rate for Payer: Cash Price |
$571.80
|
| Rate for Payer: Cash Price |
$571.80
|
| Rate for Payer: Cigna Commercial |
$810.05
|
| Rate for Payer: First Health Commercial |
$857.70
|
| Rate for Payer: First Health Workers Compensation |
$61.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$857.70
|
| Rate for Payer: GEHA Commercial |
$667.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$857.70
|
| Rate for Payer: Multiplan All |
$867.23
|
| Rate for Payer: OMNI Networks Commercial |
$667.10
|
| Rate for Payer: One Health Plan PPO/POS |
$857.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$905.35
|
| Rate for Payer: Three Rivers Provider Network All |
$714.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$886.29
|
| Rate for Payer: Zelis Auto |
$381.20
|
| Rate for Payer: Zelis Worker's Compensation |
$43.76
|
|
|
CB CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRA
|
Facility
|
OP
|
$953.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
2900019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.76 |
| Max. Negotiated Rate |
$905.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$571.80
|
| Rate for Payer: Cash Price |
$571.80
|
| Rate for Payer: Cash Price |
$571.80
|
| Rate for Payer: Cigna Commercial |
$810.05
|
| Rate for Payer: First Health Commercial |
$857.70
|
| Rate for Payer: First Health Workers Compensation |
$61.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$857.70
|
| Rate for Payer: GEHA Commercial |
$762.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$857.70
|
| Rate for Payer: Humana ChoiceCare |
$247.78
|
| Rate for Payer: Multiplan All |
$867.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$571.80
|
| Rate for Payer: OMNI Networks Commercial |
$667.10
|
| Rate for Payer: One Health Plan PPO/POS |
$857.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$905.35
|
| Rate for Payer: Three Rivers Provider Network All |
$714.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$838.64
|
| Rate for Payer: United Healthcare Commercial |
$810.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$238.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$886.29
|
| Rate for Payer: Zelis Auto |
$381.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$476.50
|
| Rate for Payer: Zelis Worker's Compensation |
$43.76
|
|
|
CB CHOLECYSTOGRAPHY ORAL CONTRST
|
Facility
|
IP
|
$853.00
|
|
|
Service Code
|
CPT 74290
|
| Hospital Charge Code |
2900020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.42 |
| Max. Negotiated Rate |
$810.35 |
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cigna Commercial |
$725.05
|
| Rate for Payer: First Health Commercial |
$767.70
|
| Rate for Payer: First Health Workers Compensation |
$105.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$767.70
|
| Rate for Payer: GEHA Commercial |
$597.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$767.70
|
| Rate for Payer: Multiplan All |
$776.23
|
| Rate for Payer: OMNI Networks Commercial |
$597.10
|
| Rate for Payer: One Health Plan PPO/POS |
$767.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$810.35
|
| Rate for Payer: Three Rivers Provider Network All |
$639.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$793.29
|
| Rate for Payer: Zelis Auto |
$341.20
|
| Rate for Payer: Zelis Worker's Compensation |
$74.42
|
|
|
CB CHOLECYSTOGRAPHY ORAL CONTRST
|
Facility
|
OP
|
$853.00
|
|
|
Service Code
|
CPT 74290
|
| Hospital Charge Code |
2900020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.42 |
| Max. Negotiated Rate |
$810.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$131.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$511.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$131.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$104.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$169.04
|
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cash Price |
$511.80
|
| Rate for Payer: Cigna Commercial |
$725.05
|
| Rate for Payer: First Health Commercial |
$767.70
|
| Rate for Payer: First Health Workers Compensation |
$105.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$767.70
|
| Rate for Payer: GEHA Commercial |
$682.40
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$767.70
|
| Rate for Payer: Humana ChoiceCare |
$185.94
|
| Rate for Payer: Humana Medicare Advantage |
$169.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$283.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$106.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$776.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$597.10
|
| Rate for Payer: One Health Plan PPO/POS |
$767.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$122.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$106.13
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$169.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$810.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$639.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$725.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$106.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$793.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$341.20
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$74.42
|
|
|
CB CYSTOGRAPHY MINIMUM 3 VIEWS RS&I
|
Facility
|
OP
|
$1,059.00
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
2900027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.96 |
| Max. Negotiated Rate |
$1,006.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$257.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$635.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$257.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$203.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cigna Commercial |
$900.15
|
| Rate for Payer: First Health Commercial |
$953.10
|
| Rate for Payer: First Health Workers Compensation |
$65.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$953.10
|
| Rate for Payer: GEHA Commercial |
$847.20
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$953.10
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$963.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$741.30
|
| Rate for Payer: One Health Plan PPO/POS |
$953.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$240.27
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,006.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$794.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$900.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$984.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$423.60
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$45.96
|
|
|
CB CYSTOGRAPHY MINIMUM 3 VIEWS RS&I
|
Facility
|
IP
|
$1,059.00
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
2900027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.96 |
| Max. Negotiated Rate |
$1,006.05 |
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cigna Commercial |
$900.15
|
| Rate for Payer: First Health Commercial |
$953.10
|
| Rate for Payer: First Health Workers Compensation |
$65.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$953.10
|
| Rate for Payer: GEHA Commercial |
$741.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$953.10
|
| Rate for Payer: Multiplan All |
$963.69
|
| Rate for Payer: OMNI Networks Commercial |
$741.30
|
| Rate for Payer: One Health Plan PPO/POS |
$953.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,006.05
|
| Rate for Payer: Three Rivers Provider Network All |
$794.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$984.87
|
| Rate for Payer: Zelis Auto |
$423.60
|
| Rate for Payer: Zelis Worker's Compensation |
$45.96
|
|
|
CB ECHO TRANSTHORC R-T 2D W/WO LIMITED
|
Facility
|
OP
|
$1,289.50
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
2193308
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$1,225.03 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$396.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$773.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$396.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$314.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$773.70
|
| Rate for Payer: Cash Price |
$773.70
|
| Rate for Payer: Cigna Commercial |
$1,096.08
|
| Rate for Payer: First Health Commercial |
$1,160.55
|
| Rate for Payer: First Health Workers Compensation |
$497.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,160.55
|
| Rate for Payer: GEHA Commercial |
$1,031.60
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,160.55
|
| 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 |
$320.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$1,173.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$902.65
|
| Rate for Payer: One Health Plan PPO/POS |
$1,160.55
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$370.15
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$320.57
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,225.03
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$967.12
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$1,096.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$320.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,199.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$515.80
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$352.03
|
|
|
CB ECHO TRANSTHORC R-T 2D W/WO LIMITED
|
Facility
|
IP
|
$1,289.50
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
2193308
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$352.03 |
| Max. Negotiated Rate |
$1,225.03 |
| Rate for Payer: Cash Price |
$773.70
|
| Rate for Payer: Cigna Commercial |
$1,096.08
|
| Rate for Payer: First Health Commercial |
$1,160.55
|
| Rate for Payer: First Health Workers Compensation |
$497.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,160.55
|
| Rate for Payer: GEHA Commercial |
$902.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,160.55
|
| Rate for Payer: Multiplan All |
$1,173.44
|
| Rate for Payer: OMNI Networks Commercial |
$902.65
|
| Rate for Payer: One Health Plan PPO/POS |
$1,160.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,225.03
|
| Rate for Payer: Three Rivers Provider Network All |
$967.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,199.23
|
| Rate for Payer: Zelis Auto |
$515.80
|
| Rate for Payer: Zelis Worker's Compensation |
$352.03
|
|
|
CBFP RAPID STREP AGH
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 87430
|
| Hospital Charge Code |
21600805
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.29 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$45.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.81
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: First Health Workers Compensation |
$20.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$68.40
|
| Rate for Payer: GEHA Commercial |
$60.80
|
| Rate for Payer: GEHA Medicare |
$16.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$68.40
|
| Rate for Payer: Humana ChoiceCare |
$18.49
|
| Rate for Payer: Humana Medicare Advantage |
$16.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.81
|
| Rate for Payer: Multiplan All |
$69.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.58
|
| Rate for Payer: OMNI Networks Commercial |
$53.20
|
| Rate for Payer: One Health Plan PPO/POS |
$68.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$72.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.62
|
| Rate for Payer: Three Rivers Provider Network All |
$57.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.47
|
| Rate for Payer: United Healthcare Commercial |
$64.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$70.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.81
|
| Rate for Payer: Zelis Auto |
$30.40
|
| Rate for Payer: Zelis Medicare |
$14.29
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.17
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
|
CBFP RAPID STREP AGH
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 87430
|
| Hospital Charge Code |
21600805
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: First Health Workers Compensation |
$20.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$68.40
|
| Rate for Payer: GEHA Commercial |
$53.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$68.40
|
| Rate for Payer: Multiplan All |
$69.16
|
| Rate for Payer: OMNI Networks Commercial |
$53.20
|
| Rate for Payer: One Health Plan PPO/POS |
$68.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$72.20
|
| Rate for Payer: Three Rivers Provider Network All |
$57.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$70.68
|
| Rate for Payer: Zelis Auto |
$30.40
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
|
CBFP URINE PREGNANCY TEST
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
21600810
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.61
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$9.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$101.60
|
| Rate for Payer: GEHA Medicare |
$8.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Humana ChoiceCare |
$9.47
|
| Rate for Payer: Humana Medicare Advantage |
$8.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.61
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.64
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.22
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.44
|
| Rate for Payer: United Healthcare Commercial |
$107.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.61
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Medicare |
$7.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.33
|
| Rate for Payer: Zelis Worker's Compensation |
$6.79
|
|
|
CBFP URINE PREGNANCY TEST
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
21600810
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$9.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$88.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Worker's Compensation |
$6.79
|
|
|
CB GASTRIC EMPTYNG IMAG STD W/SM BWL TRA
|
Facility
|
IP
|
$1,320.00
|
|
|
Service Code
|
CPT 78265
|
| Hospital Charge Code |
2900051
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$355.44 |
| Max. Negotiated Rate |
$1,254.00 |
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna Commercial |
$1,122.00
|
| Rate for Payer: First Health Commercial |
$1,188.00
|
| Rate for Payer: First Health Workers Compensation |
$502.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,188.00
|
| Rate for Payer: GEHA Commercial |
$924.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,188.00
|
| Rate for Payer: Multiplan All |
$1,201.20
|
| Rate for Payer: OMNI Networks Commercial |
$924.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,188.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,254.00
|
| Rate for Payer: Three Rivers Provider Network All |
$990.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,227.60
|
| Rate for Payer: Zelis Auto |
$528.00
|
| Rate for Payer: Zelis Worker's Compensation |
$355.44
|
|
|
CB GASTRIC EMPTYNG IMAG STD W/SM BWL TRA
|
Facility
|
OP
|
$1,320.00
|
|
|
Service Code
|
CPT 78265
|
| Hospital Charge Code |
2900051
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$324.32 |
| Max. Negotiated Rate |
$1,254.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$498.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$792.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$498.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$395.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$381.55
|
| 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 |
$502.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,188.00
|
| Rate for Payer: GEHA Commercial |
$1,056.00
|
| Rate for Payer: GEHA Medicare |
$381.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,188.00
|
| Rate for Payer: Humana ChoiceCare |
$419.70
|
| Rate for Payer: Humana Medicare Advantage |
$381.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$641.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$403.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$381.55
|
| Rate for Payer: Multiplan All |
$1,201.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$648.63
|
| Rate for Payer: OMNI Networks Commercial |
$924.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,188.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$465.71
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$403.34
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$381.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,254.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$763.10
|
| Rate for Payer: Three Rivers Provider Network All |
$990.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$373.92
|
| Rate for Payer: United Healthcare Commercial |
$1,122.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$403.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,227.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$381.55
|
| Rate for Payer: Zelis Auto |
$528.00
|
| Rate for Payer: Zelis Medicare |
$324.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$457.86
|
| Rate for Payer: Zelis Worker's Compensation |
$355.44
|
|
|
CB GSTRC EMPTNG IMAG STD W/SM BWL COL TR
|
Facility
|
OP
|
$1,726.00
|
|
|
Service Code
|
CPT 78266
|
| Hospital Charge Code |
2900050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$423.16 |
| Max. Negotiated Rate |
$1,639.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$662.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,035.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$662.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$524.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$511.11
|
| Rate for Payer: Cash Price |
$1,035.60
|
| Rate for Payer: Cash Price |
$1,035.60
|
| Rate for Payer: Cigna Commercial |
$1,467.10
|
| Rate for Payer: First Health Commercial |
$1,553.40
|
| Rate for Payer: First Health Workers Compensation |
$598.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,553.40
|
| Rate for Payer: GEHA Commercial |
$1,380.80
|
| Rate for Payer: GEHA Medicare |
$511.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,553.40
|
| Rate for Payer: Humana ChoiceCare |
$562.22
|
| Rate for Payer: Humana Medicare Advantage |
$511.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$858.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$535.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$511.11
|
| Rate for Payer: Multiplan All |
$1,570.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$868.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,208.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,553.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$617.90
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$535.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$511.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,639.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,022.22
|
| Rate for Payer: Three Rivers Provider Network All |
$1,294.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$500.89
|
| Rate for Payer: United Healthcare Commercial |
$1,467.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$535.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$511.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,605.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$511.11
|
| Rate for Payer: Zelis Auto |
$690.40
|
| Rate for Payer: Zelis Medicare |
$434.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$613.33
|
| Rate for Payer: Zelis Worker's Compensation |
$423.16
|
|
|
CB GSTRC EMPTNG IMAG STD W/SM BWL COL TR
|
Facility
|
IP
|
$1,726.00
|
|
|
Service Code
|
CPT 78266
|
| Hospital Charge Code |
2900050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$423.16 |
| Max. Negotiated Rate |
$1,639.70 |
| Rate for Payer: Cash Price |
$1,035.60
|
| Rate for Payer: Cash Price |
$1,035.60
|
| Rate for Payer: Cigna Commercial |
$1,467.10
|
| Rate for Payer: First Health Commercial |
$1,553.40
|
| Rate for Payer: First Health Workers Compensation |
$598.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,553.40
|
| Rate for Payer: GEHA Commercial |
$1,208.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,553.40
|
| Rate for Payer: Multiplan All |
$1,570.66
|
| Rate for Payer: OMNI Networks Commercial |
$1,208.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,553.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,639.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,294.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,605.18
|
| Rate for Payer: Zelis Auto |
$690.40
|
| Rate for Payer: Zelis Worker's Compensation |
$423.16
|
|
|
CB HYSTEROSALPINGOGRAPHY RS&I
|
Facility
|
IP
|
$889.00
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
2900069
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.66 |
| Max. Negotiated Rate |
$844.55 |
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cigna Commercial |
$755.65
|
| Rate for Payer: First Health Commercial |
$800.10
|
| Rate for Payer: First Health Workers Compensation |
$116.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$800.10
|
| Rate for Payer: GEHA Commercial |
$622.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$800.10
|
| Rate for Payer: Multiplan All |
$808.99
|
| Rate for Payer: OMNI Networks Commercial |
$622.30
|
| Rate for Payer: One Health Plan PPO/POS |
$800.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$844.55
|
| Rate for Payer: Three Rivers Provider Network All |
$666.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$826.77
|
| Rate for Payer: Zelis Auto |
$355.60
|
| Rate for Payer: Zelis Worker's Compensation |
$82.66
|
|
|
CB HYSTEROSALPINGOGRAPHY RS&I
|
Facility
|
OP
|
$889.00
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
2900069
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.66 |
| Max. Negotiated Rate |
$844.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$315.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$533.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$315.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$249.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cigna Commercial |
$755.65
|
| Rate for Payer: First Health Commercial |
$800.10
|
| Rate for Payer: First Health Workers Compensation |
$116.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$800.10
|
| Rate for Payer: GEHA Commercial |
$711.20
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$800.10
|
| 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 |
$254.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$808.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$622.30
|
| Rate for Payer: One Health Plan PPO/POS |
$800.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$294.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$254.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$844.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$666.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$755.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$254.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$826.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$355.60
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$82.66
|
|
|
CB JOINT SURVEY SINGLE VIEW 2 OR MORE JO
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 77077
|
| Hospital Charge Code |
2900071
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.87 |
| Max. Negotiated Rate |
$355.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$224.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$317.90
|
| Rate for Payer: First Health Commercial |
$336.60
|
| Rate for Payer: First Health Workers Compensation |
$56.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$336.60
|
| Rate for Payer: GEHA Commercial |
$299.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$336.60
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$340.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$261.80
|
| Rate for Payer: One Health Plan PPO/POS |
$336.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$355.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$280.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$317.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$347.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$149.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$39.87
|
|
|
CB JOINT SURVEY SINGLE VIEW 2 OR MORE JO
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 77077
|
| Hospital Charge Code |
2900071
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.87 |
| Max. Negotiated Rate |
$355.30 |
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$317.90
|
| Rate for Payer: First Health Commercial |
$336.60
|
| Rate for Payer: First Health Workers Compensation |
$56.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$336.60
|
| Rate for Payer: GEHA Commercial |
$261.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$336.60
|
| Rate for Payer: Multiplan All |
$340.34
|
| Rate for Payer: OMNI Networks Commercial |
$261.80
|
| Rate for Payer: One Health Plan PPO/POS |
$336.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$355.30
|
| Rate for Payer: Three Rivers Provider Network All |
$280.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$347.82
|
| Rate for Payer: Zelis Auto |
$149.60
|
| Rate for Payer: Zelis Worker's Compensation |
$39.87
|
|
|
CB MOTION FLUOR EVAL SWLNG FUNCJ C/V REC
|
Facility
|
OP
|
$1,176.00
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
2900129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.53 |
| Max. Negotiated Rate |
$1,117.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$128.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$705.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$128.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$101.53
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cigna Commercial |
$999.60
|
| Rate for Payer: First Health Commercial |
$1,058.40
|
| Rate for Payer: First Health Workers Compensation |
$454.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,058.40
|
| Rate for Payer: GEHA Commercial |
$940.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,058.40
|
| Rate for Payer: Humana ChoiceCare |
$305.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$103.60
|
| Rate for Payer: Multiplan All |
$1,070.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$705.60
|
| Rate for Payer: OMNI Networks Commercial |
$823.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,058.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$119.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$103.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,117.20
|
| Rate for Payer: Three Rivers Provider Network All |
$882.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,034.88
|
| Rate for Payer: United Healthcare Commercial |
$999.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$103.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,093.68
|
| Rate for Payer: Zelis Auto |
$470.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$588.00
|
| Rate for Payer: Zelis Worker's Compensation |
$321.05
|
|
|
CB MOTION FLUOR EVAL SWLNG FUNCJ C/V REC
|
Facility
|
IP
|
$1,176.00
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
2900129
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$321.05 |
| Max. Negotiated Rate |
$1,117.20 |
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cigna Commercial |
$999.60
|
| Rate for Payer: First Health Commercial |
$1,058.40
|
| Rate for Payer: First Health Workers Compensation |
$454.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,058.40
|
| Rate for Payer: GEHA Commercial |
$823.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,058.40
|
| Rate for Payer: Multiplan All |
$1,070.16
|
| Rate for Payer: OMNI Networks Commercial |
$823.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,058.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,117.20
|
| Rate for Payer: Three Rivers Provider Network All |
$882.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,093.68
|
| Rate for Payer: Zelis Auto |
$470.40
|
| Rate for Payer: Zelis Worker's Compensation |
$321.05
|
|
|
CB MRA HEAD W/CON
|
Facility
|
IP
|
$4,178.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
2100081
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$449.73 |
| Max. Negotiated Rate |
$3,969.10 |
| Rate for Payer: Cash Price |
$2,506.80
|
| Rate for Payer: Cash Price |
$2,506.80
|
| Rate for Payer: Cigna Commercial |
$3,551.30
|
| Rate for Payer: First Health Commercial |
$3,760.20
|
| Rate for Payer: First Health Workers Compensation |
$636.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,760.20
|
| Rate for Payer: GEHA Commercial |
$2,924.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,760.20
|
| Rate for Payer: Multiplan All |
$3,801.98
|
| Rate for Payer: OMNI Networks Commercial |
$2,924.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,760.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,969.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,133.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,885.54
|
| Rate for Payer: Zelis Auto |
$1,671.20
|
| Rate for Payer: Zelis Worker's Compensation |
$449.73
|
|
|
CB MRA HEAD W/CON
|
Facility
|
OP
|
$4,178.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
2100081
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$3,969.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,506.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$635.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$503.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$2,506.80
|
| Rate for Payer: Cash Price |
$2,506.80
|
| Rate for Payer: Cigna Commercial |
$3,551.30
|
| Rate for Payer: First Health Commercial |
$3,760.20
|
| Rate for Payer: First Health Workers Compensation |
$636.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,760.20
|
| Rate for Payer: GEHA Commercial |
$3,342.40
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,760.20
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$514.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$3,801.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$2,924.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,760.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$593.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$514.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,969.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$3,133.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$3,551.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$514.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,885.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$1,671.20
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$449.73
|
|
