|
CB RADEX ENTIR THRC LMBR CRV SAC SPI W/S
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
2900113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.81 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: First Health Workers Compensation |
$97.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$462.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: Zelis Auto |
$264.00
|
| Rate for Payer: Zelis Worker's Compensation |
$68.81
|
|
|
CB RADEX ENTIR THRC LMBR CRV SAC SPI W/S
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
2900115
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.81 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$287.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$396.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$287.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$228.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$561.00
|
| Rate for Payer: First Health Commercial |
$594.00
|
| Rate for Payer: First Health Workers Compensation |
$119.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$594.00
|
| Rate for Payer: GEHA Commercial |
$528.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$594.00
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$232.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$600.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$462.00
|
| Rate for Payer: One Health Plan PPO/POS |
$594.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$268.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$232.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$627.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$495.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$561.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$232.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$613.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$264.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$84.81
|
|
|
CB RADEX ENTIR THRC LMBR CRV SAC SPI W/S
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
2900114
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$72.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$52.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$182.40
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$73.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$85.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$73.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$193.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$73.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$37.18
|
|
|
CB RADEX ENTIR THRC LMBR CRV SAC SPI W/S
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
2900114
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$52.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$159.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Worker's Compensation |
$37.18
|
|
|
CB RADEX ESOPHAGUS
|
Facility
|
OP
|
$1,140.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
2900034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.86 |
| Max. Negotiated Rate |
$1,083.00 |
| 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 |
$684.00
|
| 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 |
$684.00
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cigna Commercial |
$969.00
|
| Rate for Payer: First Health Commercial |
$1,026.00
|
| Rate for Payer: First Health Workers Compensation |
$120.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,026.00
|
| Rate for Payer: GEHA Commercial |
$912.00
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,026.00
|
| 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 |
$1,037.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$798.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,026.00
|
| 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 |
$1,083.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$855.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$969.00
|
| 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 |
$1,060.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$456.00
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$84.86
|
|
|
CB RADEX ESOPHAGUS
|
Facility
|
IP
|
$1,140.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
2900034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.86 |
| Max. Negotiated Rate |
$1,083.00 |
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cigna Commercial |
$969.00
|
| Rate for Payer: First Health Commercial |
$1,026.00
|
| Rate for Payer: First Health Workers Compensation |
$120.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,026.00
|
| Rate for Payer: GEHA Commercial |
$798.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,026.00
|
| Rate for Payer: Multiplan All |
$1,037.40
|
| Rate for Payer: OMNI Networks Commercial |
$798.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,026.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,083.00
|
| Rate for Payer: Three Rivers Provider Network All |
$855.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,060.20
|
| Rate for Payer: Zelis Auto |
$456.00
|
| Rate for Payer: Zelis Worker's Compensation |
$84.86
|
|
|
CB RADEX HIP ARTHROGRAPHY RS&I LEFT
|
Facility
|
IP
|
$1,448.00
|
|
|
Service Code
|
CPT 73525
|
| Hospital Charge Code |
2900056
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.83 |
| Max. Negotiated Rate |
$1,375.60 |
| Rate for Payer: Cash Price |
$868.80
|
| Rate for Payer: Cash Price |
$868.80
|
| Rate for Payer: Cigna Commercial |
$1,230.80
|
| Rate for Payer: First Health Commercial |
$1,303.20
|
| Rate for Payer: First Health Workers Compensation |
$160.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,303.20
|
| Rate for Payer: GEHA Commercial |
$1,013.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,303.20
|
| Rate for Payer: Multiplan All |
$1,317.68
|
| Rate for Payer: OMNI Networks Commercial |
$1,013.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,303.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,375.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,086.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,346.64
|
| Rate for Payer: Zelis Auto |
$579.20
|
| Rate for Payer: Zelis Worker's Compensation |
$113.83
|
|
|
CB RADEX HIP ARTHROGRAPHY RS&I LEFT
|
Facility
|
OP
|
$1,448.00
|
|
|
Service Code
|
CPT 73525
|
| Hospital Charge Code |
2900056
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.83 |
| Max. Negotiated Rate |
$1,375.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$397.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$868.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$397.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$315.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$868.80
|
| Rate for Payer: Cash Price |
$868.80
|
| Rate for Payer: Cigna Commercial |
$1,230.80
|
| Rate for Payer: First Health Commercial |
$1,303.20
|
| Rate for Payer: First Health Workers Compensation |
$160.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,303.20
|
| Rate for Payer: GEHA Commercial |
$1,158.40
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,303.20
|
| 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 |
$321.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$1,317.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,013.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,303.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$371.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$321.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,375.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$1,086.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$1,230.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$321.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,346.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$579.20
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$113.83
|
|
|
CB RADEX HIP ARTHROGRAPHY RS&I RIGHT
|
Facility
|
OP
|
$1,448.00
|
|
|
Service Code
|
CPT 73525
|
| Hospital Charge Code |
2900057
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.83 |
| Max. Negotiated Rate |
$1,375.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$397.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$868.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$397.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$315.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$868.80
|
| Rate for Payer: Cash Price |
$868.80
|
| Rate for Payer: Cigna Commercial |
$1,230.80
|
| Rate for Payer: First Health Commercial |
$1,303.20
|
| Rate for Payer: First Health Workers Compensation |
$160.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,303.20
|
| Rate for Payer: GEHA Commercial |
$1,158.40
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,303.20
|
| 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 |
$321.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$1,317.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,013.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,303.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$371.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$321.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,375.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$1,086.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$1,230.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$321.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,346.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$579.20
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$113.83
|
|
|
CB RADEX HIP ARTHROGRAPHY RS&I RIGHT
|
Facility
|
IP
|
$1,448.00
|
|
|
Service Code
|
CPT 73525
|
| Hospital Charge Code |
2900057
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.83 |
| Max. Negotiated Rate |
$1,375.60 |
| Rate for Payer: Cash Price |
$868.80
|
| Rate for Payer: Cash Price |
$868.80
|
| Rate for Payer: Cigna Commercial |
$1,230.80
|
| Rate for Payer: First Health Commercial |
$1,303.20
|
| Rate for Payer: First Health Workers Compensation |
$160.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,303.20
|
| Rate for Payer: GEHA Commercial |
$1,013.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,303.20
|
| Rate for Payer: Multiplan All |
$1,317.68
|
| Rate for Payer: OMNI Networks Commercial |
$1,013.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,303.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,375.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,086.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,346.64
|
| Rate for Payer: Zelis Auto |
$579.20
|
| Rate for Payer: Zelis Worker's Compensation |
$113.83
|
|
|
CB RADEX SHOULDER ARTHROGRAPHY RS&I LEFT
|
Facility
|
IP
|
$1,343.00
|
|
|
Service Code
|
CPT 73040
|
| Hospital Charge Code |
2900119
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.98 |
| Max. Negotiated Rate |
$1,275.85 |
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cigna Commercial |
$1,141.55
|
| Rate for Payer: First Health Commercial |
$1,208.70
|
| Rate for Payer: First Health Workers Compensation |
$158.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,208.70
|
| Rate for Payer: GEHA Commercial |
$940.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,208.70
|
| Rate for Payer: Multiplan All |
$1,222.13
|
| Rate for Payer: OMNI Networks Commercial |
$940.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,208.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,275.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,007.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,248.99
|
| Rate for Payer: Zelis Auto |
$537.20
|
| Rate for Payer: Zelis Worker's Compensation |
$111.98
|
|
|
CB RADEX SHOULDER ARTHROGRAPHY RS&I LEFT
|
Facility
|
OP
|
$1,343.00
|
|
|
Service Code
|
CPT 73040
|
| Hospital Charge Code |
2900119
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.98 |
| Max. Negotiated Rate |
$1,275.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$397.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$805.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$397.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$315.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cigna Commercial |
$1,141.55
|
| Rate for Payer: First Health Commercial |
$1,208.70
|
| Rate for Payer: First Health Workers Compensation |
$158.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,208.70
|
| Rate for Payer: GEHA Commercial |
$1,074.40
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,208.70
|
| 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 |
$321.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$1,222.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$940.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,208.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$371.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$321.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,275.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$1,007.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$1,141.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$321.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,248.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$537.20
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$111.98
|
|
|
CB RADEX SHOULDER ARTHROGRAPHY RS&I RIGH
|
Facility
|
OP
|
$1,343.00
|
|
|
Service Code
|
CPT 73040
|
| Hospital Charge Code |
2900120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.98 |
| Max. Negotiated Rate |
$1,275.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$397.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$805.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$397.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$315.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cigna Commercial |
$1,141.55
|
| Rate for Payer: First Health Commercial |
$1,208.70
|
| Rate for Payer: First Health Workers Compensation |
$158.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,208.70
|
| Rate for Payer: GEHA Commercial |
$1,074.40
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,208.70
|
| 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 |
$321.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$1,222.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$940.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,208.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$371.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$321.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,275.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$1,007.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$1,141.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$321.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,248.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$537.20
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$111.98
|
|
|
CB RADEX SHOULDER ARTHROGRAPHY RS&I RIGH
|
Facility
|
IP
|
$1,343.00
|
|
|
Service Code
|
CPT 73040
|
| Hospital Charge Code |
2900120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.98 |
| Max. Negotiated Rate |
$1,275.85 |
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cash Price |
$805.80
|
| Rate for Payer: Cigna Commercial |
$1,141.55
|
| Rate for Payer: First Health Commercial |
$1,208.70
|
| Rate for Payer: First Health Workers Compensation |
$158.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,208.70
|
| Rate for Payer: GEHA Commercial |
$940.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,208.70
|
| Rate for Payer: Multiplan All |
$1,222.13
|
| Rate for Payer: OMNI Networks Commercial |
$940.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,208.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,275.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,007.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,248.99
|
| Rate for Payer: Zelis Auto |
$537.20
|
| Rate for Payer: Zelis Worker's Compensation |
$111.98
|
|
|
CB RADEX SINUSES PARANASAL <3 VIEWS
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
2900124
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$335.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$211.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cigna Commercial |
$300.05
|
| Rate for Payer: First Health Commercial |
$317.70
|
| Rate for Payer: First Health Workers Compensation |
$38.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$317.70
|
| Rate for Payer: GEHA Commercial |
$282.40
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$317.70
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$321.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$247.10
|
| Rate for Payer: One Health Plan PPO/POS |
$317.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$335.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$264.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$300.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$328.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$141.20
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$27.42
|
|
|
CB RADEX SINUSES PARANASAL <3 VIEWS
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
2900124
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$335.35 |
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cigna Commercial |
$300.05
|
| Rate for Payer: First Health Commercial |
$317.70
|
| Rate for Payer: First Health Workers Compensation |
$38.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$317.70
|
| Rate for Payer: GEHA Commercial |
$247.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$317.70
|
| Rate for Payer: Multiplan All |
$321.23
|
| Rate for Payer: OMNI Networks Commercial |
$247.10
|
| Rate for Payer: One Health Plan PPO/POS |
$317.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$335.35
|
| Rate for Payer: Three Rivers Provider Network All |
$264.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$328.29
|
| Rate for Payer: Zelis Auto |
$141.20
|
| Rate for Payer: Zelis Worker's Compensation |
$27.42
|
|
|
CB RADEX SMALL INTESTINE W/MULTIPLE SERI
|
Facility
|
IP
|
$1,014.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
2900127
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.71 |
| Max. Negotiated Rate |
$963.30 |
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna Commercial |
$861.90
|
| Rate for Payer: First Health Commercial |
$912.60
|
| Rate for Payer: First Health Workers Compensation |
$149.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$912.60
|
| Rate for Payer: GEHA Commercial |
$709.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$912.60
|
| Rate for Payer: Multiplan All |
$922.74
|
| Rate for Payer: OMNI Networks Commercial |
$709.80
|
| Rate for Payer: One Health Plan PPO/POS |
$912.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$963.30
|
| Rate for Payer: Three Rivers Provider Network All |
$760.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$943.02
|
| Rate for Payer: Zelis Auto |
$405.60
|
| Rate for Payer: Zelis Worker's Compensation |
$105.71
|
|
|
CB RADEX SMALL INTESTINE W/MULTIPLE SERI
|
Facility
|
OP
|
$1,014.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
2900127
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$963.30 |
| 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 |
$608.40
|
| 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 |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna Commercial |
$861.90
|
| Rate for Payer: First Health Commercial |
$912.60
|
| Rate for Payer: First Health Workers Compensation |
$149.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$912.60
|
| Rate for Payer: GEHA Commercial |
$811.20
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$912.60
|
| 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 |
$922.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$709.80
|
| Rate for Payer: One Health Plan PPO/POS |
$912.60
|
| 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 |
$963.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$760.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$861.90
|
| 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 |
$943.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$405.60
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$105.71
|
|
|
CB RADEX UPPER GI W/WO GLUCAGON/DELAY IM
|
Facility
|
IP
|
$1,037.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
2900138
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.90 |
| Max. Negotiated Rate |
$985.15 |
| Rate for Payer: Cash Price |
$622.20
|
| Rate for Payer: Cash Price |
$622.20
|
| Rate for Payer: Cigna Commercial |
$881.45
|
| Rate for Payer: First Health Commercial |
$933.30
|
| Rate for Payer: First Health Workers Compensation |
$170.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$933.30
|
| Rate for Payer: GEHA Commercial |
$725.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$933.30
|
| Rate for Payer: Multiplan All |
$943.67
|
| Rate for Payer: OMNI Networks Commercial |
$725.90
|
| Rate for Payer: One Health Plan PPO/POS |
$933.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$985.15
|
| Rate for Payer: Three Rivers Provider Network All |
$777.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$964.41
|
| Rate for Payer: Zelis Auto |
$414.80
|
| Rate for Payer: Zelis Worker's Compensation |
$120.90
|
|
|
CB RADEX UPPER GI W/WO GLUCAGON/DELAY IM
|
Facility
|
OP
|
$1,037.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
2900138
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$985.15 |
| 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 |
$622.20
|
| 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 |
$622.20
|
| Rate for Payer: Cash Price |
$622.20
|
| Rate for Payer: Cigna Commercial |
$881.45
|
| Rate for Payer: First Health Commercial |
$933.30
|
| Rate for Payer: First Health Workers Compensation |
$170.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$933.30
|
| Rate for Payer: GEHA Commercial |
$829.60
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$933.30
|
| 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 |
$943.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$725.90
|
| Rate for Payer: One Health Plan PPO/POS |
$933.30
|
| 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 |
$985.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$777.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$881.45
|
| 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 |
$964.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$414.80
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$120.90
|
|
|
CB RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT
|
Facility
|
OP
|
$2,596.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
2900028
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$144.01 |
| Max. Negotiated Rate |
$2,466.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,557.60
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Cigna Commercial |
$2,206.60
|
| Rate for Payer: First Health Commercial |
$2,336.40
|
| Rate for Payer: First Health Workers Compensation |
$203.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,336.40
|
| Rate for Payer: GEHA Commercial |
$2,076.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,336.40
|
| Rate for Payer: Humana ChoiceCare |
$674.96
|
| Rate for Payer: Multiplan All |
$2,362.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,557.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,817.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,336.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,466.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,947.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,284.48
|
| Rate for Payer: United Healthcare Commercial |
$2,206.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$649.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,414.28
|
| Rate for Payer: Zelis Auto |
$1,038.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,298.00
|
| Rate for Payer: Zelis Worker's Compensation |
$144.01
|
|
|
CB RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT
|
Facility
|
IP
|
$2,596.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
2900028
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$144.01 |
| Max. Negotiated Rate |
$2,466.20 |
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Cigna Commercial |
$2,206.60
|
| Rate for Payer: First Health Commercial |
$2,336.40
|
| Rate for Payer: First Health Workers Compensation |
$203.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,336.40
|
| Rate for Payer: GEHA Commercial |
$1,817.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,336.40
|
| Rate for Payer: Multiplan All |
$2,362.36
|
| Rate for Payer: OMNI Networks Commercial |
$1,817.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,336.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,466.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,947.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,414.28
|
| Rate for Payer: Zelis Auto |
$1,038.40
|
| Rate for Payer: Zelis Worker's Compensation |
$144.01
|
|
|
CB RADIOLOGIC EXAM EYE DETECT FOREIGN BO
|
Facility
|
IP
|
$395.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
2900035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$375.25 |
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$335.75
|
| Rate for Payer: First Health Commercial |
$355.50
|
| Rate for Payer: First Health Workers Compensation |
$39.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$355.50
|
| Rate for Payer: GEHA Commercial |
$276.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$355.50
|
| Rate for Payer: Multiplan All |
$359.45
|
| Rate for Payer: OMNI Networks Commercial |
$276.50
|
| Rate for Payer: One Health Plan PPO/POS |
$355.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$375.25
|
| Rate for Payer: Three Rivers Provider Network All |
$296.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$367.35
|
| Rate for Payer: Zelis Auto |
$158.00
|
| Rate for Payer: Zelis Worker's Compensation |
$27.71
|
|
|
CB RADIOLOGIC EXAM EYE DETECT FOREIGN BO
|
Facility
|
OP
|
$395.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
2900035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$375.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$237.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$335.75
|
| Rate for Payer: First Health Commercial |
$355.50
|
| Rate for Payer: First Health Workers Compensation |
$39.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$355.50
|
| Rate for Payer: GEHA Commercial |
$316.00
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$355.50
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$359.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$276.50
|
| Rate for Payer: One Health Plan PPO/POS |
$355.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$375.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$296.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$335.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$367.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$158.00
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$27.71
|
|
|
CB RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&
|
Facility
|
OP
|
$1,217.00
|
|
|
Service Code
|
CPT 73580
|
| Hospital Charge Code |
2900077
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.14 |
| Max. Negotiated Rate |
$1,156.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$397.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$730.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$397.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$315.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$730.20
|
| Rate for Payer: Cash Price |
$730.20
|
| Rate for Payer: Cigna Commercial |
$1,034.45
|
| Rate for Payer: First Health Commercial |
$1,095.30
|
| Rate for Payer: First Health Workers Compensation |
$175.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,095.30
|
| Rate for Payer: GEHA Commercial |
$973.60
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,095.30
|
| 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 |
$321.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$1,107.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$851.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,095.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$371.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$321.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,156.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$912.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$1,034.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$321.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,131.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$486.80
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$124.14
|
|
