|
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
|
|
|
CB US EXTR NONVASC COMP
|
Facility
|
IP
|
$1,038.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
2100048
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.02 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: First Health Workers Compensation |
$141.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$726.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: Zelis Auto |
$415.20
|
| Rate for Payer: Zelis Worker's Compensation |
$100.02
|
|
|
CB US EXTR NONVASC COMP
|
Facility
|
OP
|
$1,038.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
2100048
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$986.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$141.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$622.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$141.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$111.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$882.30
|
| Rate for Payer: First Health Commercial |
$934.20
|
| Rate for Payer: First Health Workers Compensation |
$141.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$934.20
|
| Rate for Payer: GEHA Commercial |
$830.40
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$934.20
|
| 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 |
$114.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$944.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$726.60
|
| Rate for Payer: One Health Plan PPO/POS |
$934.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$131.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$114.25
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$986.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$778.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$882.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$114.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$965.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$415.20
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$100.02
|
|
|
CB US EXTR NONVASC LIMI
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
2176882
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$48.35 |
| Max. Negotiated Rate |
$694.45 |
| 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 |
$438.60
|
| 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 |
$438.60
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$621.35
|
| Rate for Payer: First Health Commercial |
$657.90
|
| Rate for Payer: First Health Workers Compensation |
$68.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$657.90
|
| Rate for Payer: GEHA Commercial |
$584.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$657.90
|
| 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 |
$665.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$511.70
|
| Rate for Payer: One Health Plan PPO/POS |
$657.90
|
| 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 |
$694.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$548.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$621.35
|
| 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 |
$679.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$292.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$48.35
|
|
|
CB US EXTR NONVASC LIMI
|
Facility
|
IP
|
$731.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
2176882
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$48.35 |
| Max. Negotiated Rate |
$694.45 |
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$621.35
|
| Rate for Payer: First Health Commercial |
$657.90
|
| Rate for Payer: First Health Workers Compensation |
$68.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$657.90
|
| Rate for Payer: GEHA Commercial |
$511.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$657.90
|
| Rate for Payer: Multiplan All |
$665.21
|
| Rate for Payer: OMNI Networks Commercial |
$511.70
|
| Rate for Payer: One Health Plan PPO/POS |
$657.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$694.45
|
| Rate for Payer: Three Rivers Provider Network All |
$548.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$679.83
|
| Rate for Payer: Zelis Auto |
$292.40
|
| Rate for Payer: Zelis Worker's Compensation |
$48.35
|
|
|
CB US FETAL BIOP PRO
|
Facility
|
IP
|
$1,236.00
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
2100040
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$102.58 |
| Max. Negotiated Rate |
$1,174.20 |
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cigna Commercial |
$1,050.60
|
| Rate for Payer: First Health Commercial |
$1,112.40
|
| Rate for Payer: First Health Workers Compensation |
$145.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,112.40
|
| Rate for Payer: GEHA Commercial |
$865.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,112.40
|
| Rate for Payer: Multiplan All |
$1,124.76
|
| Rate for Payer: OMNI Networks Commercial |
$865.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,112.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,174.20
|
| Rate for Payer: Three Rivers Provider Network All |
$927.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,149.48
|
| Rate for Payer: Zelis Auto |
$494.40
|
| Rate for Payer: Zelis Worker's Compensation |
$102.58
|
|
|
CB US FETAL BIOP PRO
|
Facility
|
OP
|
$1,236.00
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
2100040
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,174.20 |
| 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 |
$741.60
|
| 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 |
$741.60
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cigna Commercial |
$1,050.60
|
| Rate for Payer: First Health Commercial |
$1,112.40
|
| Rate for Payer: First Health Workers Compensation |
$145.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,112.40
|
| Rate for Payer: GEHA Commercial |
$988.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,112.40
|
| 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 |
$117.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$1,124.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$865.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,112.40
|
| 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 |
$1,174.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$927.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$1,050.60
|
| 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 |
$1,149.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$494.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$102.58
|
|
|
CB US INFANT HIPS
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
2176885
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$121.18 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$425.00
|
| Rate for Payer: First Health Commercial |
$450.00
|
| Rate for Payer: First Health Workers Compensation |
$171.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$450.00
|
| Rate for Payer: GEHA Commercial |
$350.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$450.00
|
| Rate for Payer: Multiplan All |
$455.00
|
| Rate for Payer: OMNI Networks Commercial |
$350.00
|
| Rate for Payer: One Health Plan PPO/POS |
$450.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$475.00
|
| Rate for Payer: Three Rivers Provider Network All |
$375.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$465.00
|
| Rate for Payer: Zelis Auto |
$200.00
|
| Rate for Payer: Zelis Worker's Compensation |
$121.18
|
|
|
CB US INFANT HIPS
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
2176885
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$71.07 |
| Max. Negotiated Rate |
$475.00 |
| 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 |
$300.00
|
| 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 |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$425.00
|
| Rate for Payer: First Health Commercial |
$450.00
|
| Rate for Payer: First Health Workers Compensation |
$171.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$450.00
|
| Rate for Payer: GEHA Commercial |
$400.00
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$450.00
|
| 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 |
$455.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$350.00
|
| Rate for Payer: One Health Plan PPO/POS |
$450.00
|
| 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 |
$475.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$375.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$425.00
|
| 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 |
$465.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$200.00
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$121.18
|
|
|
CB US OB>14WK SGL 1ST G
|
Facility
|
IP
|
$1,224.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
2100051
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$117.98 |
| Max. Negotiated Rate |
$1,162.80 |
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cigna Commercial |
$1,040.40
|
| Rate for Payer: First Health Commercial |
$1,101.60
|
| Rate for Payer: First Health Workers Compensation |
$166.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,101.60
|
| Rate for Payer: GEHA Commercial |
$856.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,101.60
|
| Rate for Payer: Multiplan All |
$1,113.84
|
| Rate for Payer: OMNI Networks Commercial |
$856.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,101.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,162.80
|
| Rate for Payer: Three Rivers Provider Network All |
$918.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,138.32
|
| Rate for Payer: Zelis Auto |
$489.60
|
| Rate for Payer: Zelis Worker's Compensation |
$117.98
|
|
|
CB US OB>14WK SGL 1ST G
|
Facility
|
OP
|
$1,224.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
2100051
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,162.80 |
| 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 |
$734.40
|
| 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 |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cigna Commercial |
$1,040.40
|
| Rate for Payer: First Health Commercial |
$1,101.60
|
| Rate for Payer: First Health Workers Compensation |
$166.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,101.60
|
| Rate for Payer: GEHA Commercial |
$979.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,101.60
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$117.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$1,113.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$856.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,101.60
|
| 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 |
$1,162.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$918.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$1,040.40
|
| 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 |
$1,138.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$489.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$117.98
|
|
|
CB US OB<14WKS SGL 1GES
|
Facility
|
IP
|
$1,088.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
2100052
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$102.30 |
| Max. Negotiated Rate |
$1,033.60 |
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cigna Commercial |
$924.80
|
| Rate for Payer: First Health Commercial |
$979.20
|
| Rate for Payer: First Health Workers Compensation |
$144.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$979.20
|
| Rate for Payer: GEHA Commercial |
$761.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$979.20
|
| Rate for Payer: Multiplan All |
$990.08
|
| Rate for Payer: OMNI Networks Commercial |
$761.60
|
| Rate for Payer: One Health Plan PPO/POS |
$979.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,033.60
|
| Rate for Payer: Three Rivers Provider Network All |
$816.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,011.84
|
| Rate for Payer: Zelis Auto |
$435.20
|
| Rate for Payer: Zelis Worker's Compensation |
$102.30
|
|
|
CB US OB<14WKS SGL 1GES
|
Facility
|
OP
|
$1,088.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
2100052
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,033.60 |
| 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 |
$652.80
|
| 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 |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cigna Commercial |
$924.80
|
| Rate for Payer: First Health Commercial |
$979.20
|
| Rate for Payer: First Health Workers Compensation |
$144.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$979.20
|
| Rate for Payer: GEHA Commercial |
$870.40
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$979.20
|
| 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 |
$117.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$990.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$761.60
|
| Rate for Payer: One Health Plan PPO/POS |
$979.20
|
| 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 |
$1,033.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$816.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$924.80
|
| 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 |
$1,011.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$435.20
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$102.30
|
|
|
CB US OB FOLLOW-UP PER FETUS
|
Facility
|
IP
|
$719.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
2100062
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$96.19 |
| 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 |
$136.05
|
| 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 |
$96.19
|
|
|
CB US OB FOLLOW-UP PER FETUS
|
Facility
|
OP
|
$719.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
2100062
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| 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 |
$100.97
|
| 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 |
$136.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$647.10
|
| Rate for Payer: GEHA Commercial |
$575.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$647.10
|
| 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 |
$654.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| 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 |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$683.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$539.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$611.15
|
| 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 |
$668.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$287.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$96.19
|
|
|
CB US PELVIC COMP
|
Facility
|
OP
|
$1,292.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
2100075
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,227.40 |
| 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 |
$775.20
|
| 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 |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna Commercial |
$1,098.20
|
| Rate for Payer: First Health Commercial |
$1,162.80
|
| Rate for Payer: First Health Workers Compensation |
$131.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,162.80
|
| Rate for Payer: GEHA Commercial |
$1,033.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,162.80
|
| 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 |
$1,175.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$904.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,162.80
|
| 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 |
$1,227.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$969.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$1,098.20
|
| 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 |
$1,201.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$516.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$93.16
|
|
|
CB US PELVIC COMP
|
Facility
|
IP
|
$1,292.00
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
2100075
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$93.16 |
| Max. Negotiated Rate |
$1,227.40 |
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna Commercial |
$1,098.20
|
| Rate for Payer: First Health Commercial |
$1,162.80
|
| Rate for Payer: First Health Workers Compensation |
$131.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,162.80
|
| Rate for Payer: GEHA Commercial |
$904.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,162.80
|
| Rate for Payer: Multiplan All |
$1,175.72
|
| Rate for Payer: OMNI Networks Commercial |
$904.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,162.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,227.40
|
| Rate for Payer: Three Rivers Provider Network All |
$969.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,201.56
|
| Rate for Payer: Zelis Auto |
$516.80
|
| Rate for Payer: Zelis Worker's Compensation |
$93.16
|
|
|
CB US PELVIS LIMITED
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
2100041
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$755.25 |
| 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 |
$477.00
|
| 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 |
$477.00
|
| Rate for Payer: Cash Price |
$477.00
|
| Rate for Payer: Cigna Commercial |
$675.75
|
| Rate for Payer: First Health Commercial |
$715.50
|
| Rate for Payer: First Health Workers Compensation |
$94.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$715.50
|
| Rate for Payer: GEHA Commercial |
$636.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$715.50
|
| 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 |
$75.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$723.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$556.50
|
| Rate for Payer: One Health Plan PPO/POS |
$715.50
|
| 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 |
$755.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$596.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$675.75
|
| 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 |
$739.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$318.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$66.60
|
|
|
CB US PELVIS LIMITED
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
2100041
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$755.25 |
| Rate for Payer: Cash Price |
$477.00
|
| Rate for Payer: Cash Price |
$477.00
|
| Rate for Payer: Cigna Commercial |
$675.75
|
| Rate for Payer: First Health Commercial |
$715.50
|
| Rate for Payer: First Health Workers Compensation |
$94.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$715.50
|
| Rate for Payer: GEHA Commercial |
$556.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$715.50
|
| Rate for Payer: Multiplan All |
$723.45
|
| Rate for Payer: OMNI Networks Commercial |
$556.50
|
| Rate for Payer: One Health Plan PPO/POS |
$715.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$755.25
|
| Rate for Payer: Three Rivers Provider Network All |
$596.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$739.35
|
| Rate for Payer: Zelis Auto |
$318.00
|
| Rate for Payer: Zelis Worker's Compensation |
$66.60
|
|
|
CB US PROSTATE TRANSRECTAL
|
Facility
|
OP
|
$1,004.00
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
2176872
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$953.80 |
| 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 |
$602.40
|
| 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 |
$602.40
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cigna Commercial |
$853.40
|
| Rate for Payer: First Health Commercial |
$903.60
|
| Rate for Payer: First Health Workers Compensation |
$241.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$903.60
|
| Rate for Payer: GEHA Commercial |
$803.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$903.60
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$117.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$913.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$702.80
|
| Rate for Payer: One Health Plan PPO/POS |
$903.60
|
| 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 |
$953.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$753.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$853.40
|
| 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 |
$933.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$401.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$170.55
|
|
|
CB US PROSTATE TRANSRECTAL
|
Facility
|
IP
|
$1,004.00
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
2176872
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$170.55 |
| Max. Negotiated Rate |
$953.80 |
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cigna Commercial |
$853.40
|
| Rate for Payer: First Health Commercial |
$903.60
|
| Rate for Payer: First Health Workers Compensation |
$241.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$903.60
|
| Rate for Payer: GEHA Commercial |
$702.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$903.60
|
| Rate for Payer: Multiplan All |
$913.64
|
| Rate for Payer: OMNI Networks Commercial |
$702.80
|
| Rate for Payer: One Health Plan PPO/POS |
$903.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$953.80
|
| Rate for Payer: Three Rivers Provider Network All |
$753.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$933.72
|
| Rate for Payer: Zelis Auto |
$401.60
|
| Rate for Payer: Zelis Worker's Compensation |
$170.55
|
|
|
CB US RENAL
|
Facility
|
OP
|
$1,013.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
2176775
|
|
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 RENAL
|
Facility
|
IP
|
$1,013.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
2176775
|
|
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 RETROPERITONEAL
|
Facility
|
IP
|
$1,258.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
2100076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$99.23 |
| Max. Negotiated Rate |
$1,195.10 |
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cigna Commercial |
$1,069.30
|
| Rate for Payer: First Health Commercial |
$1,132.20
|
| Rate for Payer: First Health Workers Compensation |
$140.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,132.20
|
| Rate for Payer: GEHA Commercial |
$880.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,132.20
|
| Rate for Payer: Multiplan All |
$1,144.78
|
| Rate for Payer: OMNI Networks Commercial |
$880.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,132.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,195.10
|
| Rate for Payer: Three Rivers Provider Network All |
$943.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,169.94
|
| Rate for Payer: Zelis Auto |
$503.20
|
| Rate for Payer: Zelis Worker's Compensation |
$99.23
|
|
|
CB US RETROPERITONEAL
|
Facility
|
OP
|
$1,258.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
2100076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,195.10 |
| 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 |
$754.80
|
| 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 |
$754.80
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cigna Commercial |
$1,069.30
|
| Rate for Payer: First Health Commercial |
$1,132.20
|
| Rate for Payer: First Health Workers Compensation |
$140.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,132.20
|
| Rate for Payer: GEHA Commercial |
$1,006.40
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,132.20
|
| 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 |
$117.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$1,144.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$880.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,132.20
|
| 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 |
$1,195.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$943.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$1,069.30
|
| 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 |
$1,169.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$503.20
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$99.23
|
|
