|
CB RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&
|
Facility
|
IP
|
$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: 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 |
$851.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,095.30
|
| Rate for Payer: Multiplan All |
$1,107.47
|
| Rate for Payer: OMNI Networks Commercial |
$851.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,095.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,156.15
|
| Rate for Payer: Three Rivers Provider Network All |
$912.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,131.81
|
| Rate for Payer: Zelis Auto |
$486.80
|
| Rate for Payer: Zelis Worker's Compensation |
$124.14
|
|
|
CB RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&
|
Facility
|
OP
|
$1,217.00
|
|
|
Service Code
|
CPT 73580
|
| Hospital Charge Code |
2900076
|
|
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
|
|
|
CB RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&
|
Facility
|
IP
|
$1,217.00
|
|
|
Service Code
|
CPT 73580
|
| Hospital Charge Code |
2900076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.14 |
| Max. Negotiated Rate |
$1,156.15 |
| 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 |
$851.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,095.30
|
| Rate for Payer: Multiplan All |
$1,107.47
|
| Rate for Payer: OMNI Networks Commercial |
$851.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,095.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,156.15
|
| Rate for Payer: Three Rivers Provider Network All |
$912.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,131.81
|
| Rate for Payer: Zelis Auto |
$486.80
|
| Rate for Payer: Zelis Worker's Compensation |
$124.14
|
|
|
CB SWALLOWING FUNCJ W/CINERADIOGRAPY/VID
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
2900090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$841.70 |
| 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 |
$531.60
|
| 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 |
$531.60
|
| Rate for Payer: Cash Price |
$531.60
|
| Rate for Payer: Cigna Commercial |
$753.10
|
| Rate for Payer: First Health Commercial |
$797.40
|
| Rate for Payer: First Health Workers Compensation |
$158.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$797.40
|
| Rate for Payer: GEHA Commercial |
$708.80
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$797.40
|
| 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 |
$806.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$620.20
|
| Rate for Payer: One Health Plan PPO/POS |
$797.40
|
| 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 |
$841.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$664.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$753.10
|
| 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 |
$823.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$354.40
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$112.12
|
|
|
CB SWALLOWING FUNCJ W/CINERADIOGRAPY/VID
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
2900029
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.12 |
| Max. Negotiated Rate |
$841.70 |
| Rate for Payer: Cash Price |
$531.60
|
| Rate for Payer: Cash Price |
$531.60
|
| Rate for Payer: Cigna Commercial |
$753.10
|
| Rate for Payer: First Health Commercial |
$797.40
|
| Rate for Payer: First Health Workers Compensation |
$158.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$797.40
|
| Rate for Payer: GEHA Commercial |
$620.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$797.40
|
| Rate for Payer: Multiplan All |
$806.26
|
| Rate for Payer: OMNI Networks Commercial |
$620.20
|
| Rate for Payer: One Health Plan PPO/POS |
$797.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$841.70
|
| Rate for Payer: Three Rivers Provider Network All |
$664.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$823.98
|
| Rate for Payer: Zelis Auto |
$354.40
|
| Rate for Payer: Zelis Worker's Compensation |
$112.12
|
|
|
CB SWALLOWING FUNCJ W/CINERADIOGRAPY/VID
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
2900029
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$841.70 |
| 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 |
$531.60
|
| 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 |
$531.60
|
| Rate for Payer: Cash Price |
$531.60
|
| Rate for Payer: Cigna Commercial |
$753.10
|
| Rate for Payer: First Health Commercial |
$797.40
|
| Rate for Payer: First Health Workers Compensation |
$158.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$797.40
|
| Rate for Payer: GEHA Commercial |
$708.80
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$797.40
|
| 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 |
$806.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$620.20
|
| Rate for Payer: One Health Plan PPO/POS |
$797.40
|
| 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 |
$841.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$664.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$753.10
|
| 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 |
$823.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$354.40
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$112.12
|
|
|
CB SWALLOWING FUNCJ W/CINERADIOGRAPY/VID
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
2900090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.12 |
| Max. Negotiated Rate |
$841.70 |
| Rate for Payer: Cash Price |
$531.60
|
| Rate for Payer: Cash Price |
$531.60
|
| Rate for Payer: Cigna Commercial |
$753.10
|
| Rate for Payer: First Health Commercial |
$797.40
|
| Rate for Payer: First Health Workers Compensation |
$158.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$797.40
|
| Rate for Payer: GEHA Commercial |
$620.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$797.40
|
| Rate for Payer: Multiplan All |
$806.26
|
| Rate for Payer: OMNI Networks Commercial |
$620.20
|
| Rate for Payer: One Health Plan PPO/POS |
$797.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$841.70
|
| Rate for Payer: Three Rivers Provider Network All |
$664.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$823.98
|
| Rate for Payer: Zelis Auto |
$354.40
|
| Rate for Payer: Zelis Worker's Compensation |
$112.12
|
|
|
CB URETHROCYSTOGRAPHY VOIDING RS&I
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
CPT 74455
|
| Hospital Charge Code |
2900142
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$463.60 |
| 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 |
$292.80
|
| 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 |
$229.52
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cigna Commercial |
$414.80
|
| Rate for Payer: First Health Commercial |
$439.20
|
| Rate for Payer: First Health Workers Compensation |
$126.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$439.20
|
| Rate for Payer: GEHA Commercial |
$390.40
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$439.20
|
| 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 |
$208.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$444.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$341.60
|
| Rate for Payer: One Health Plan PPO/POS |
$439.20
|
| 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 |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$463.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$366.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$414.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$453.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$195.20
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$89.43
|
|
|
CB URETHROCYSTOGRAPHY VOIDING RS&I
|
Facility
|
IP
|
$488.00
|
|
|
Service Code
|
CPT 74455
|
| Hospital Charge Code |
2900142
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$463.60 |
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cigna Commercial |
$414.80
|
| Rate for Payer: First Health Commercial |
$439.20
|
| Rate for Payer: First Health Workers Compensation |
$126.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$439.20
|
| Rate for Payer: GEHA Commercial |
$341.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$439.20
|
| Rate for Payer: Multiplan All |
$444.08
|
| Rate for Payer: OMNI Networks Commercial |
$341.60
|
| Rate for Payer: One Health Plan PPO/POS |
$439.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$463.60
|
| Rate for Payer: Three Rivers Provider Network All |
$366.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$453.84
|
| Rate for Payer: Zelis Auto |
$195.20
|
| Rate for Payer: Zelis Worker's Compensation |
$89.43
|
|
|
CB UROGRAPHY ANTEGRADE RS&I
|
Facility
|
OP
|
$1,187.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
2900097
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$116.99 |
| Max. Negotiated Rate |
$1,127.65 |
| 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 |
$712.20
|
| 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 |
$712.20
|
| Rate for Payer: Cash Price |
$712.20
|
| Rate for Payer: Cigna Commercial |
$1,008.95
|
| Rate for Payer: First Health Commercial |
$1,068.30
|
| Rate for Payer: First Health Workers Compensation |
$165.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,068.30
|
| Rate for Payer: GEHA Commercial |
$949.60
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,068.30
|
| 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 |
$208.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$1,080.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$830.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,068.30
|
| 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 |
$1,127.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$890.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$1,008.95
|
| 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 |
$1,103.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$474.80
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$116.99
|
|
|
CB UROGRAPHY ANTEGRADE RS&I
|
Facility
|
IP
|
$1,187.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
2900097
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$116.99 |
| Max. Negotiated Rate |
$1,127.65 |
| Rate for Payer: Cash Price |
$712.20
|
| Rate for Payer: Cash Price |
$712.20
|
| Rate for Payer: Cigna Commercial |
$1,008.95
|
| Rate for Payer: First Health Commercial |
$1,068.30
|
| Rate for Payer: First Health Workers Compensation |
$165.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,068.30
|
| Rate for Payer: GEHA Commercial |
$830.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,068.30
|
| Rate for Payer: Multiplan All |
$1,080.17
|
| Rate for Payer: OMNI Networks Commercial |
$830.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,068.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,127.65
|
| Rate for Payer: Three Rivers Provider Network All |
$890.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,103.91
|
| Rate for Payer: Zelis Auto |
$474.80
|
| Rate for Payer: Zelis Worker's Compensation |
$116.99
|
|
|
CB UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY
|
Facility
|
IP
|
$1,101.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
2900070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$115.93 |
| Max. Negotiated Rate |
$1,045.95 |
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna Commercial |
$935.85
|
| Rate for Payer: First Health Commercial |
$990.90
|
| Rate for Payer: First Health Workers Compensation |
$163.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$990.90
|
| Rate for Payer: GEHA Commercial |
$770.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$990.90
|
| Rate for Payer: Multiplan All |
$1,001.91
|
| Rate for Payer: OMNI Networks Commercial |
$770.70
|
| Rate for Payer: One Health Plan PPO/POS |
$990.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,045.95
|
| Rate for Payer: Three Rivers Provider Network All |
$825.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,023.93
|
| Rate for Payer: Zelis Auto |
$440.40
|
| Rate for Payer: Zelis Worker's Compensation |
$115.93
|
|
|
CB UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY
|
Facility
|
OP
|
$1,101.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
2900070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$115.93 |
| Max. Negotiated Rate |
$1,045.95 |
| 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 |
$660.60
|
| 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 |
$169.04
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna Commercial |
$935.85
|
| Rate for Payer: First Health Commercial |
$990.90
|
| Rate for Payer: First Health Workers Compensation |
$163.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$990.90
|
| Rate for Payer: GEHA Commercial |
$880.80
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$990.90
|
| 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 |
$208.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$1,001.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$770.70
|
| Rate for Payer: One Health Plan PPO/POS |
$990.90
|
| 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 |
$169.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,045.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$825.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$935.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,023.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$440.40
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$115.93
|
|
|
CB US <14 WEEKS ADD FETUS
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
2100050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.84 |
| Max. Negotiated Rate |
$499.70 |
| Rate for Payer: Cash Price |
$315.60
|
| Rate for Payer: Cash Price |
$315.60
|
| Rate for Payer: Cigna Commercial |
$447.10
|
| Rate for Payer: First Health Commercial |
$473.40
|
| Rate for Payer: First Health Workers Compensation |
$78.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$473.40
|
| Rate for Payer: GEHA Commercial |
$368.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$473.40
|
| Rate for Payer: Multiplan All |
$478.66
|
| Rate for Payer: OMNI Networks Commercial |
$368.20
|
| Rate for Payer: One Health Plan PPO/POS |
$473.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$499.70
|
| Rate for Payer: Three Rivers Provider Network All |
$394.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$489.18
|
| Rate for Payer: Zelis Auto |
$210.40
|
| Rate for Payer: Zelis Worker's Compensation |
$55.84
|
|
|
CB US <14 WEEKS ADD FETUS
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
2100050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.84 |
| Max. Negotiated Rate |
$499.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$93.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$315.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$93.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$74.23
|
| Rate for Payer: Cash Price |
$315.60
|
| Rate for Payer: Cash Price |
$315.60
|
| Rate for Payer: Cigna Commercial |
$447.10
|
| Rate for Payer: First Health Commercial |
$473.40
|
| Rate for Payer: First Health Workers Compensation |
$78.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$473.40
|
| Rate for Payer: GEHA Commercial |
$420.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$473.40
|
| Rate for Payer: Humana ChoiceCare |
$136.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$75.74
|
| Rate for Payer: Multiplan All |
$478.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$315.60
|
| Rate for Payer: OMNI Networks Commercial |
$368.20
|
| Rate for Payer: One Health Plan PPO/POS |
$473.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$87.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$75.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$499.70
|
| Rate for Payer: Three Rivers Provider Network All |
$394.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$462.88
|
| Rate for Payer: United Healthcare Commercial |
$447.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$75.74
|
| Rate for Payer: United Payors & United Providers UP&UP |
$489.18
|
| Rate for Payer: Zelis Auto |
$210.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$263.00
|
| Rate for Payer: Zelis Worker's Compensation |
$55.84
|
|
|
CB US ABD AORTA
|
Facility
|
OP
|
$725.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
2176706
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$688.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$169.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$435.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$169.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$133.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$616.25
|
| Rate for Payer: First Health Commercial |
$652.50
|
| Rate for Payer: First Health Workers Compensation |
$134.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$652.50
|
| Rate for Payer: GEHA Commercial |
$580.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$652.50
|
| 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 |
$136.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$659.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$507.50
|
| Rate for Payer: One Health Plan PPO/POS |
$652.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$157.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$136.64
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$688.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$543.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$616.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$136.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$674.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$290.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$94.77
|
|
|
CB US ABD AORTA
|
Facility
|
IP
|
$725.00
|
|
|
Service Code
|
CPT 76706
|
| Hospital Charge Code |
2176706
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$94.77 |
| Max. Negotiated Rate |
$688.75 |
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$616.25
|
| Rate for Payer: First Health Commercial |
$652.50
|
| Rate for Payer: First Health Workers Compensation |
$134.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$652.50
|
| Rate for Payer: GEHA Commercial |
$507.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$652.50
|
| Rate for Payer: Multiplan All |
$659.75
|
| Rate for Payer: OMNI Networks Commercial |
$507.50
|
| Rate for Payer: One Health Plan PPO/POS |
$652.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$688.75
|
| Rate for Payer: Three Rivers Provider Network All |
$543.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$674.25
|
| Rate for Payer: Zelis Auto |
$290.00
|
| Rate for Payer: Zelis Worker's Compensation |
$94.77
|
|
|
CB US ABD LIMITED
|
Facility
|
OP
|
$1,013.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
2100077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$73.82 |
| Max. Negotiated Rate |
$962.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$607.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$115.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$607.80
|
| Rate for Payer: Cash Price |
$607.80
|
| Rate for Payer: Cigna Commercial |
$861.05
|
| Rate for Payer: First Health Commercial |
$911.70
|
| Rate for Payer: First Health Workers Compensation |
$104.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$911.70
|
| Rate for Payer: GEHA Commercial |
$810.40
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$911.70
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$117.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$921.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$709.10
|
| Rate for Payer: One Health Plan PPO/POS |
$911.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$136.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$117.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$962.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$759.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$861.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$942.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$405.20
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$73.82
|
|
|
CB US ABD LIMITED
|
Facility
|
IP
|
$1,013.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
2100077
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$73.82 |
| Max. Negotiated Rate |
$962.35 |
| Rate for Payer: Cash Price |
$607.80
|
| Rate for Payer: Cash Price |
$607.80
|
| Rate for Payer: Cigna Commercial |
$861.05
|
| Rate for Payer: First Health Commercial |
$911.70
|
| Rate for Payer: First Health Workers Compensation |
$104.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$911.70
|
| Rate for Payer: GEHA Commercial |
$709.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$911.70
|
| Rate for Payer: Multiplan All |
$921.83
|
| Rate for Payer: OMNI Networks Commercial |
$709.10
|
| Rate for Payer: One Health Plan PPO/POS |
$911.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$962.35
|
| Rate for Payer: Three Rivers Provider Network All |
$759.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$942.09
|
| Rate for Payer: Zelis Auto |
$405.20
|
| Rate for Payer: Zelis Worker's Compensation |
$73.82
|
|
|
CB US ABD/RUQ/GB
|
Facility
|
IP
|
$1,238.30
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
2100068
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.14 |
| Max. Negotiated Rate |
$1,176.38 |
| Rate for Payer: Cash Price |
$742.98
|
| Rate for Payer: Cash Price |
$742.98
|
| Rate for Payer: Cigna Commercial |
$1,052.56
|
| Rate for Payer: First Health Commercial |
$1,114.47
|
| Rate for Payer: First Health Workers Compensation |
$114.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,114.47
|
| Rate for Payer: GEHA Commercial |
$866.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,114.47
|
| Rate for Payer: Multiplan All |
$1,126.85
|
| Rate for Payer: OMNI Networks Commercial |
$866.81
|
| Rate for Payer: One Health Plan PPO/POS |
$1,114.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,176.38
|
| Rate for Payer: Three Rivers Provider Network All |
$928.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,151.62
|
| Rate for Payer: Zelis Auto |
$495.32
|
| Rate for Payer: Zelis Worker's Compensation |
$81.14
|
|
|
CB US ABD/RUQ/GB
|
Facility
|
OP
|
$1,238.30
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
2100068
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.14 |
| Max. Negotiated Rate |
$1,176.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$742.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$115.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$742.98
|
| Rate for Payer: Cash Price |
$742.98
|
| Rate for Payer: Cigna Commercial |
$1,052.56
|
| Rate for Payer: First Health Commercial |
$1,114.47
|
| Rate for Payer: First Health Workers Compensation |
$114.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,114.47
|
| Rate for Payer: GEHA Commercial |
$990.64
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,114.47
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$117.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$1,126.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$866.81
|
| Rate for Payer: One Health Plan PPO/POS |
$1,114.47
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$136.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$117.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,176.38
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$928.73
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$1,052.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,151.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$495.32
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$81.14
|
|
|
CB US ABD SURVEY COMP
|
Facility
|
OP
|
$1,553.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
2100037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,475.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$931.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$115.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$931.80
|
| Rate for Payer: Cash Price |
$931.80
|
| Rate for Payer: Cigna Commercial |
$1,320.05
|
| Rate for Payer: First Health Commercial |
$1,397.70
|
| Rate for Payer: First Health Workers Compensation |
$148.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,397.70
|
| Rate for Payer: GEHA Commercial |
$1,242.40
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,397.70
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$117.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$1,413.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$1,087.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,397.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$136.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$117.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,475.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$1,164.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$1,320.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,444.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$621.20
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$105.15
|
|
|
CB US ABD SURVEY COMP
|
Facility
|
IP
|
$1,553.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
2100037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$105.15 |
| Max. Negotiated Rate |
$1,475.35 |
| Rate for Payer: Cash Price |
$931.80
|
| Rate for Payer: Cash Price |
$931.80
|
| Rate for Payer: Cigna Commercial |
$1,320.05
|
| Rate for Payer: First Health Commercial |
$1,397.70
|
| Rate for Payer: First Health Workers Compensation |
$148.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,397.70
|
| Rate for Payer: GEHA Commercial |
$1,087.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,397.70
|
| Rate for Payer: Multiplan All |
$1,413.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,087.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,397.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,475.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,164.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,444.29
|
| Rate for Payer: Zelis Auto |
$621.20
|
| Rate for Payer: Zelis Worker's Compensation |
$105.15
|
|
|
CB US ANKLE BRACHIAL
|
Facility
|
OP
|
$833.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
2193922
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$78.88 |
| Max. Negotiated Rate |
$791.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$99.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$499.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$99.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$78.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$499.80
|
| Rate for Payer: Cash Price |
$499.80
|
| Rate for Payer: Cigna Commercial |
$708.05
|
| Rate for Payer: First Health Commercial |
$749.70
|
| Rate for Payer: First Health Workers Compensation |
$321.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$749.70
|
| Rate for Payer: GEHA Commercial |
$666.40
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$749.70
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$80.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$758.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$583.10
|
| Rate for Payer: One Health Plan PPO/POS |
$749.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$92.93
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$80.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$791.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$624.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Commercial |
$708.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$80.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$774.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$333.20
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$227.41
|
|
|
CB US ANKLE BRACHIAL
|
Facility
|
IP
|
$833.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
2193922
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$227.41 |
| Max. Negotiated Rate |
$791.35 |
| Rate for Payer: Cash Price |
$499.80
|
| Rate for Payer: Cigna Commercial |
$708.05
|
| Rate for Payer: First Health Commercial |
$749.70
|
| Rate for Payer: First Health Workers Compensation |
$321.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$749.70
|
| Rate for Payer: GEHA Commercial |
$583.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$749.70
|
| Rate for Payer: Multiplan All |
$758.03
|
| Rate for Payer: OMNI Networks Commercial |
$583.10
|
| Rate for Payer: One Health Plan PPO/POS |
$749.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$791.35
|
| Rate for Payer: Three Rivers Provider Network All |
$624.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$774.69
|
| Rate for Payer: Zelis Auto |
$333.20
|
| Rate for Payer: Zelis Worker's Compensation |
$227.41
|
|
