|
CB US ART DOPP BIL LE
|
Facility
|
IP
|
$1,848.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
2193925
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$504.50 |
| Max. Negotiated Rate |
$1,755.60 |
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Cigna Commercial |
$1,570.80
|
| Rate for Payer: First Health Commercial |
$1,663.20
|
| Rate for Payer: First Health Workers Compensation |
$713.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,663.20
|
| Rate for Payer: GEHA Commercial |
$1,293.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,663.20
|
| Rate for Payer: Multiplan All |
$1,681.68
|
| Rate for Payer: OMNI Networks Commercial |
$1,293.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,663.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,755.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,386.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,718.64
|
| Rate for Payer: Zelis Auto |
$739.20
|
| Rate for Payer: Zelis Worker's Compensation |
$504.50
|
|
|
CB US ART DOPP BIL LE
|
Facility
|
OP
|
$1,848.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
2193925
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$184.27 |
| Max. Negotiated Rate |
$1,755.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,108.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$184.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Cigna Commercial |
$1,570.80
|
| Rate for Payer: First Health Commercial |
$1,663.20
|
| Rate for Payer: First Health Workers Compensation |
$713.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,663.20
|
| Rate for Payer: GEHA Commercial |
$1,478.40
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,663.20
|
| 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 |
$188.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$1,681.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,293.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,663.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$217.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$188.02
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,755.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$1,386.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$1,570.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$188.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,718.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$739.20
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$504.50
|
|
|
CB US ART DOPP BIL UE
|
Facility
|
IP
|
$1,778.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
2100079
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$485.39 |
| Max. Negotiated Rate |
$1,689.10 |
| Rate for Payer: Cash Price |
$1,066.80
|
| Rate for Payer: Cigna Commercial |
$1,511.30
|
| Rate for Payer: First Health Commercial |
$1,600.20
|
| Rate for Payer: First Health Workers Compensation |
$686.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,600.20
|
| Rate for Payer: GEHA Commercial |
$1,244.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,600.20
|
| Rate for Payer: Multiplan All |
$1,617.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,244.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,600.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,689.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,333.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,653.54
|
| Rate for Payer: Zelis Auto |
$711.20
|
| Rate for Payer: Zelis Worker's Compensation |
$485.39
|
|
|
CB US ART DOPP BIL UE
|
Facility
|
OP
|
$1,848.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
2100072
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$184.27 |
| Max. Negotiated Rate |
$1,755.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,108.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$184.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Cigna Commercial |
$1,570.80
|
| Rate for Payer: First Health Commercial |
$1,663.20
|
| Rate for Payer: First Health Workers Compensation |
$713.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,663.20
|
| Rate for Payer: GEHA Commercial |
$1,478.40
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,663.20
|
| 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 |
$188.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$1,681.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,293.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,663.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$217.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$188.02
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,755.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$1,386.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$1,570.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$188.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,718.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$739.20
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$504.50
|
|
|
CB US ART DOPP BIL UE
|
Facility
|
OP
|
$1,778.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
2100079
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$184.27 |
| Max. Negotiated Rate |
$1,689.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,066.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$184.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$1,066.80
|
| Rate for Payer: Cash Price |
$1,066.80
|
| Rate for Payer: Cigna Commercial |
$1,511.30
|
| Rate for Payer: First Health Commercial |
$1,600.20
|
| Rate for Payer: First Health Workers Compensation |
$686.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,600.20
|
| Rate for Payer: GEHA Commercial |
$1,422.40
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,600.20
|
| 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 |
$188.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$1,617.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,244.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,600.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$217.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$188.02
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,689.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$1,333.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$1,511.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$188.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,653.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$711.20
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$485.39
|
|
|
CB US ART DOPP BIL UE
|
Facility
|
IP
|
$1,848.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
2100072
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$504.50 |
| Max. Negotiated Rate |
$1,755.60 |
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Cigna Commercial |
$1,570.80
|
| Rate for Payer: First Health Commercial |
$1,663.20
|
| Rate for Payer: First Health Workers Compensation |
$713.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,663.20
|
| Rate for Payer: GEHA Commercial |
$1,293.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,663.20
|
| Rate for Payer: Multiplan All |
$1,681.68
|
| Rate for Payer: OMNI Networks Commercial |
$1,293.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,663.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,755.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,386.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,718.64
|
| Rate for Payer: Zelis Auto |
$739.20
|
| Rate for Payer: Zelis Worker's Compensation |
$504.50
|
|
|
CB US ART DOPP UNI LE
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
2100045
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$339.07 |
| Max. Negotiated Rate |
$1,179.90 |
| Rate for Payer: Cash Price |
$745.20
|
| Rate for Payer: Cigna Commercial |
$1,055.70
|
| Rate for Payer: First Health Commercial |
$1,117.80
|
| Rate for Payer: First Health Workers Compensation |
$479.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,117.80
|
| Rate for Payer: GEHA Commercial |
$869.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,117.80
|
| Rate for Payer: Multiplan All |
$1,130.22
|
| Rate for Payer: OMNI Networks Commercial |
$869.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,117.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,179.90
|
| Rate for Payer: Three Rivers Provider Network All |
$931.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,155.06
|
| Rate for Payer: Zelis Auto |
$496.80
|
| Rate for Payer: Zelis Worker's Compensation |
$339.07
|
|
|
CB US ART DOPP UNI LE
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
2100045
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,179.90 |
| 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 |
$745.20
|
| 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 |
$745.20
|
| Rate for Payer: Cash Price |
$745.20
|
| Rate for Payer: Cigna Commercial |
$1,055.70
|
| Rate for Payer: First Health Commercial |
$1,117.80
|
| Rate for Payer: First Health Workers Compensation |
$479.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,117.80
|
| Rate for Payer: GEHA Commercial |
$993.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,117.80
|
| 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 |
$1,130.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$869.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,117.80
|
| 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 |
$1,179.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$931.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$1,055.70
|
| 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 |
$1,155.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$496.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$339.07
|
|
|
CB US ART DOPP UNI UE
|
Facility
|
IP
|
$1,160.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
2100080
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$316.68 |
| Max. Negotiated Rate |
$1,102.00 |
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$986.00
|
| Rate for Payer: First Health Commercial |
$1,044.00
|
| Rate for Payer: First Health Workers Compensation |
$447.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.00
|
| Rate for Payer: GEHA Commercial |
$812.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.00
|
| Rate for Payer: Multiplan All |
$1,055.60
|
| Rate for Payer: OMNI Networks Commercial |
$812.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,102.00
|
| Rate for Payer: Three Rivers Provider Network All |
$870.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,078.80
|
| Rate for Payer: Zelis Auto |
$464.00
|
| Rate for Payer: Zelis Worker's Compensation |
$316.68
|
|
|
CB US ART DOPP UNI UE
|
Facility
|
OP
|
$1,160.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
2100080
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,102.00 |
| 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 |
$696.00
|
| 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 |
$696.00
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$986.00
|
| Rate for Payer: First Health Commercial |
$1,044.00
|
| Rate for Payer: First Health Workers Compensation |
$447.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.00
|
| Rate for Payer: GEHA Commercial |
$928.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.00
|
| 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 |
$117.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$1,055.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$812.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.00
|
| 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 |
$1,102.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$870.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$986.00
|
| 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 |
$1,078.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$464.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$316.68
|
|
|
CB US BREAST
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT 76641
|
| Hospital Charge Code |
2100070
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$118.74 |
| Max. Negotiated Rate |
$865.45 |
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cigna Commercial |
$774.35
|
| Rate for Payer: First Health Commercial |
$819.90
|
| Rate for Payer: First Health Workers Compensation |
$167.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$819.90
|
| Rate for Payer: GEHA Commercial |
$637.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$819.90
|
| Rate for Payer: Multiplan All |
$829.01
|
| Rate for Payer: OMNI Networks Commercial |
$637.70
|
| Rate for Payer: One Health Plan PPO/POS |
$819.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$865.45
|
| Rate for Payer: Three Rivers Provider Network All |
$683.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$847.23
|
| Rate for Payer: Zelis Auto |
$364.40
|
| Rate for Payer: Zelis Worker's Compensation |
$118.74
|
|
|
CB US BREAST
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT 76641
|
| Hospital Charge Code |
2100070
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$865.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$137.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$546.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$137.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cigna Commercial |
$774.35
|
| Rate for Payer: First Health Commercial |
$819.90
|
| Rate for Payer: First Health Workers Compensation |
$167.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$819.90
|
| Rate for Payer: GEHA Commercial |
$728.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$819.90
|
| 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 |
$111.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$829.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$637.70
|
| Rate for Payer: One Health Plan PPO/POS |
$819.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$128.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$111.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$865.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$683.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$774.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$111.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$847.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$364.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$118.74
|
|
|
CB US BREAST LIMITED
|
Facility
|
OP
|
$719.00
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
2600102
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$71.07 |
| Max. Negotiated Rate |
$683.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$137.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$431.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$137.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$431.40
|
| Rate for Payer: Cash Price |
$431.40
|
| Rate for Payer: Cigna Commercial |
$611.15
|
| Rate for Payer: First Health Commercial |
$647.10
|
| Rate for Payer: First Health Workers Compensation |
$138.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$647.10
|
| Rate for Payer: GEHA Commercial |
$575.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$647.10
|
| 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 |
$111.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$654.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$503.30
|
| Rate for Payer: One Health Plan PPO/POS |
$647.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$128.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$111.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$683.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$539.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$611.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$111.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$668.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$287.60
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$97.65
|
|
|
CB US BREAST LIMITED
|
Facility
|
IP
|
$719.00
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
2600102
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$97.65 |
| Max. Negotiated Rate |
$683.05 |
| Rate for Payer: Cash Price |
$431.40
|
| Rate for Payer: Cash Price |
$431.40
|
| Rate for Payer: Cigna Commercial |
$611.15
|
| Rate for Payer: First Health Commercial |
$647.10
|
| Rate for Payer: First Health Workers Compensation |
$138.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$647.10
|
| Rate for Payer: GEHA Commercial |
$503.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$647.10
|
| Rate for Payer: Multiplan All |
$654.29
|
| Rate for Payer: OMNI Networks Commercial |
$503.30
|
| Rate for Payer: One Health Plan PPO/POS |
$647.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$683.05
|
| Rate for Payer: Three Rivers Provider Network All |
$539.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$668.67
|
| Rate for Payer: Zelis Auto |
$287.60
|
| Rate for Payer: Zelis Worker's Compensation |
$97.65
|
|
|
CB US BREAST UNI REAL TIME W/IMAGE LIMIT
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
2100061
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$97.65 |
| Max. Negotiated Rate |
$651.70 |
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cigna Commercial |
$583.10
|
| Rate for Payer: First Health Commercial |
$617.40
|
| Rate for Payer: First Health Workers Compensation |
$138.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$617.40
|
| Rate for Payer: GEHA Commercial |
$480.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$617.40
|
| Rate for Payer: Multiplan All |
$624.26
|
| Rate for Payer: OMNI Networks Commercial |
$480.20
|
| Rate for Payer: One Health Plan PPO/POS |
$617.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$651.70
|
| Rate for Payer: Three Rivers Provider Network All |
$514.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.98
|
| Rate for Payer: Zelis Auto |
$274.40
|
| Rate for Payer: Zelis Worker's Compensation |
$97.65
|
|
|
CB US BREAST UNI REAL TIME W/IMAGE LIMIT
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
2100061
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$71.07 |
| Max. Negotiated Rate |
$651.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$137.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$411.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$137.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cigna Commercial |
$583.10
|
| Rate for Payer: First Health Commercial |
$617.40
|
| Rate for Payer: First Health Workers Compensation |
$138.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$617.40
|
| Rate for Payer: GEHA Commercial |
$548.80
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$617.40
|
| 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 |
$111.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$624.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$480.20
|
| Rate for Payer: One Health Plan PPO/POS |
$617.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$128.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$111.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$651.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$514.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$583.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$111.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$637.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$274.40
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$97.65
|
|
|
CB US CAROTID DOP BILAT
|
Facility
|
OP
|
$1,891.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
2100069
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$184.27 |
| Max. Negotiated Rate |
$1,796.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,134.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$184.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$1,134.60
|
| Rate for Payer: Cash Price |
$1,134.60
|
| Rate for Payer: Cigna Commercial |
$1,607.35
|
| Rate for Payer: First Health Commercial |
$1,701.90
|
| Rate for Payer: First Health Workers Compensation |
$730.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,701.90
|
| Rate for Payer: GEHA Commercial |
$1,512.80
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,701.90
|
| 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 |
$188.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$1,720.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$1,323.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,701.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$217.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$188.02
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,796.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$1,418.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$1,607.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$188.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,758.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$756.40
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$516.24
|
|
|
CB US CAROTID DOP BILAT
|
Facility
|
IP
|
$1,891.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
2100069
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$516.24 |
| Max. Negotiated Rate |
$1,796.45 |
| Rate for Payer: Cash Price |
$1,134.60
|
| Rate for Payer: Cigna Commercial |
$1,607.35
|
| Rate for Payer: First Health Commercial |
$1,701.90
|
| Rate for Payer: First Health Workers Compensation |
$730.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,701.90
|
| Rate for Payer: GEHA Commercial |
$1,323.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,701.90
|
| Rate for Payer: Multiplan All |
$1,720.81
|
| Rate for Payer: OMNI Networks Commercial |
$1,323.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,701.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,796.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,418.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,758.63
|
| Rate for Payer: Zelis Auto |
$756.40
|
| Rate for Payer: Zelis Worker's Compensation |
$516.24
|
|
|
CB US CHEST SOFT TISSUE
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
2100055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$73.11 |
| Max. Negotiated Rate |
$786.60 |
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cigna Commercial |
$703.80
|
| Rate for Payer: First Health Commercial |
$745.20
|
| Rate for Payer: First Health Workers Compensation |
$103.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$745.20
|
| Rate for Payer: GEHA Commercial |
$579.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$745.20
|
| Rate for Payer: Multiplan All |
$753.48
|
| Rate for Payer: OMNI Networks Commercial |
$579.60
|
| Rate for Payer: One Health Plan PPO/POS |
$745.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$786.60
|
| Rate for Payer: Three Rivers Provider Network All |
$621.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$770.04
|
| Rate for Payer: Zelis Auto |
$331.20
|
| Rate for Payer: Zelis Worker's Compensation |
$73.11
|
|
|
CB US CHEST SOFT TISSUE
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
2100055
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$73.11 |
| Max. Negotiated Rate |
$786.60 |
| 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 |
$496.80
|
| 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: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cigna Commercial |
$703.80
|
| Rate for Payer: First Health Commercial |
$745.20
|
| Rate for Payer: First Health Workers Compensation |
$103.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$745.20
|
| Rate for Payer: GEHA Commercial |
$662.40
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$745.20
|
| 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 |
$75.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$753.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$579.60
|
| Rate for Payer: One Health Plan PPO/POS |
$745.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$87.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$75.74
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$786.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$621.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$703.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$75.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$770.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$331.20
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$73.11
|
|
|
CB US DUPLX LO EXT ART FU LE
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
2193926
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,179.90 |
| 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 |
$745.20
|
| 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 |
$745.20
|
| Rate for Payer: Cash Price |
$745.20
|
| Rate for Payer: Cigna Commercial |
$1,055.70
|
| Rate for Payer: First Health Commercial |
$1,117.80
|
| Rate for Payer: First Health Workers Compensation |
$479.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,117.80
|
| Rate for Payer: GEHA Commercial |
$993.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,117.80
|
| 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 |
$1,130.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$869.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,117.80
|
| 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 |
$1,179.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$931.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$1,055.70
|
| 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 |
$1,155.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$496.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$339.07
|
|
|
CB US DUPLX LO EXT ART FU LE
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
2193926
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$339.07 |
| Max. Negotiated Rate |
$1,179.90 |
| Rate for Payer: Cash Price |
$745.20
|
| Rate for Payer: Cigna Commercial |
$1,055.70
|
| Rate for Payer: First Health Commercial |
$1,117.80
|
| Rate for Payer: First Health Workers Compensation |
$479.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,117.80
|
| Rate for Payer: GEHA Commercial |
$869.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,117.80
|
| Rate for Payer: Multiplan All |
$1,130.22
|
| Rate for Payer: OMNI Networks Commercial |
$869.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,117.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,179.90
|
| Rate for Payer: Three Rivers Provider Network All |
$931.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,155.06
|
| Rate for Payer: Zelis Auto |
$496.80
|
| Rate for Payer: Zelis Worker's Compensation |
$339.07
|
|
|
CB US DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/
|
Facility
|
IP
|
$1,266.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
2100029
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$345.62 |
| Max. Negotiated Rate |
$1,202.70 |
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cigna Commercial |
$1,076.10
|
| Rate for Payer: First Health Commercial |
$1,139.40
|
| Rate for Payer: First Health Workers Compensation |
$488.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,139.40
|
| Rate for Payer: GEHA Commercial |
$886.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,139.40
|
| Rate for Payer: Multiplan All |
$1,152.06
|
| Rate for Payer: OMNI Networks Commercial |
$886.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,139.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,202.70
|
| Rate for Payer: Three Rivers Provider Network All |
$949.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,177.38
|
| Rate for Payer: Zelis Auto |
$506.40
|
| Rate for Payer: Zelis Worker's Compensation |
$345.62
|
|
|
CB US DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/
|
Facility
|
OP
|
$1,266.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
2100029
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,202.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$759.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$232.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$184.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cash Price |
$759.60
|
| Rate for Payer: Cigna Commercial |
$1,076.10
|
| Rate for Payer: First Health Commercial |
$1,139.40
|
| Rate for Payer: First Health Workers Compensation |
$488.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,139.40
|
| Rate for Payer: GEHA Commercial |
$1,012.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,139.40
|
| 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 |
$188.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$1,152.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$886.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,139.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$217.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$188.02
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,202.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$949.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$1,076.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$188.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,177.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$506.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$345.62
|
|
|
CB US ECHO 2-D/M W DOP &CF
|
Facility
|
OP
|
$3,402.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
2100071
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$442.54 |
| Max. Negotiated Rate |
$3,231.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$676.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,041.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$676.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$535.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$520.63
|
| Rate for Payer: Cash Price |
$2,041.20
|
| Rate for Payer: Cash Price |
$2,041.20
|
| Rate for Payer: Cigna Commercial |
$2,891.70
|
| Rate for Payer: First Health Commercial |
$3,061.80
|
| Rate for Payer: First Health Workers Compensation |
$1,313.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,061.80
|
| Rate for Payer: GEHA Commercial |
$2,721.60
|
| Rate for Payer: GEHA Medicare |
$520.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,061.80
|
| Rate for Payer: Humana ChoiceCare |
$572.69
|
| Rate for Payer: Humana Medicare Advantage |
$520.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$874.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$546.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$520.63
|
| Rate for Payer: Multiplan All |
$3,095.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$885.07
|
| Rate for Payer: OMNI Networks Commercial |
$2,381.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,061.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$631.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$546.80
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$520.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,231.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,041.26
|
| Rate for Payer: Three Rivers Provider Network All |
$2,551.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$510.22
|
| Rate for Payer: United Healthcare Commercial |
$2,891.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$546.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$520.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,163.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$520.63
|
| Rate for Payer: Zelis Auto |
$1,360.80
|
| Rate for Payer: Zelis Medicare |
$442.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$624.76
|
| Rate for Payer: Zelis Worker's Compensation |
$928.75
|
|
