|
CB US SACRAL DIMPLE (INFANT)
|
Facility
|
IP
|
$424.68
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
2176800
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$128.41 |
| Max. Negotiated Rate |
$403.45 |
| Rate for Payer: Cash Price |
$254.81
|
| Rate for Payer: Cash Price |
$254.81
|
| Rate for Payer: Cigna Commercial |
$360.98
|
| Rate for Payer: First Health Commercial |
$382.21
|
| Rate for Payer: First Health Workers Compensation |
$181.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$382.21
|
| Rate for Payer: GEHA Commercial |
$297.28
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$382.21
|
| Rate for Payer: Multiplan All |
$386.46
|
| Rate for Payer: OMNI Networks Commercial |
$297.28
|
| Rate for Payer: One Health Plan PPO/POS |
$382.21
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$403.45
|
| Rate for Payer: Three Rivers Provider Network All |
$318.51
|
| Rate for Payer: United Payors & United Providers UP&UP |
$394.95
|
| Rate for Payer: Zelis Auto |
$169.87
|
| Rate for Payer: Zelis Worker's Compensation |
$128.41
|
|
|
CB US SACRAL DIMPLE (INFANT)
|
Facility
|
OP
|
$424.68
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
2176800
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$87.58 |
| Max. Negotiated Rate |
$403.45 |
| 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 |
$254.81
|
| 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 |
$103.04
|
| Rate for Payer: Cash Price |
$254.81
|
| Rate for Payer: Cash Price |
$254.81
|
| Rate for Payer: Cigna Commercial |
$360.98
|
| Rate for Payer: First Health Commercial |
$382.21
|
| Rate for Payer: First Health Workers Compensation |
$181.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$382.21
|
| Rate for Payer: GEHA Commercial |
$339.74
|
| Rate for Payer: GEHA Medicare |
$103.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$382.21
|
| Rate for Payer: Humana ChoiceCare |
$113.34
|
| Rate for Payer: Humana Medicare Advantage |
$103.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$173.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$111.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$103.04
|
| Rate for Payer: Multiplan All |
$386.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.17
|
| Rate for Payer: OMNI Networks Commercial |
$297.28
|
| Rate for Payer: One Health Plan PPO/POS |
$382.21
|
| 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 |
$103.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$403.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$206.08
|
| Rate for Payer: Three Rivers Provider Network All |
$318.51
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.98
|
| Rate for Payer: United Healthcare Commercial |
$360.98
|
| Rate for Payer: United Healthcare Managed Medicaid |
$111.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$394.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$103.04
|
| Rate for Payer: Zelis Auto |
$169.87
|
| Rate for Payer: Zelis Medicare |
$87.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$123.65
|
| Rate for Payer: Zelis Worker's Compensation |
$128.41
|
|
|
CB US SCROTUM/TESTICULA
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
2100058
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$88.31 |
| Max. Negotiated Rate |
$1,137.15 |
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$1,017.45
|
| Rate for Payer: First Health Commercial |
$1,077.30
|
| Rate for Payer: First Health Workers Compensation |
$124.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,077.30
|
| Rate for Payer: GEHA Commercial |
$837.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,077.30
|
| Rate for Payer: Multiplan All |
$1,089.27
|
| Rate for Payer: OMNI Networks Commercial |
$837.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,077.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,137.15
|
| Rate for Payer: Three Rivers Provider Network All |
$897.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,113.21
|
| Rate for Payer: Zelis Auto |
$478.80
|
| Rate for Payer: Zelis Worker's Compensation |
$88.31
|
|
|
CB US SCROTUM/TESTICULA
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
2100058
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$87.58 |
| Max. Negotiated Rate |
$1,137.15 |
| 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 |
$718.20
|
| 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 |
$103.04
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$1,017.45
|
| Rate for Payer: First Health Commercial |
$1,077.30
|
| Rate for Payer: First Health Workers Compensation |
$124.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,077.30
|
| Rate for Payer: GEHA Commercial |
$957.60
|
| Rate for Payer: GEHA Medicare |
$103.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,077.30
|
| Rate for Payer: Humana ChoiceCare |
$113.34
|
| Rate for Payer: Humana Medicare Advantage |
$103.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$173.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$117.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$103.04
|
| Rate for Payer: Multiplan All |
$1,089.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.17
|
| Rate for Payer: OMNI Networks Commercial |
$837.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,077.30
|
| 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 |
$103.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,137.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$206.08
|
| Rate for Payer: Three Rivers Provider Network All |
$897.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.98
|
| Rate for Payer: United Healthcare Commercial |
$1,017.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,113.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$103.04
|
| Rate for Payer: Zelis Auto |
$478.80
|
| Rate for Payer: Zelis Medicare |
$87.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$123.65
|
| Rate for Payer: Zelis Worker's Compensation |
$88.31
|
|
|
CB US SFT TISS/HEAD/NECK/THYROID
|
Facility
|
OP
|
$1,148.50
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
2100074
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$87.58 |
| Max. Negotiated Rate |
$1,091.08 |
| 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 |
$689.10
|
| 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 |
$103.04
|
| Rate for Payer: Cash Price |
$689.10
|
| Rate for Payer: Cash Price |
$689.10
|
| Rate for Payer: Cigna Commercial |
$976.23
|
| Rate for Payer: First Health Commercial |
$1,033.65
|
| Rate for Payer: First Health Workers Compensation |
$138.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,033.65
|
| Rate for Payer: GEHA Commercial |
$918.80
|
| Rate for Payer: GEHA Medicare |
$103.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,033.65
|
| Rate for Payer: Humana ChoiceCare |
$113.34
|
| Rate for Payer: Humana Medicare Advantage |
$103.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$173.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$117.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$103.04
|
| Rate for Payer: Multiplan All |
$1,045.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.17
|
| Rate for Payer: OMNI Networks Commercial |
$803.95
|
| Rate for Payer: One Health Plan PPO/POS |
$1,033.65
|
| 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 |
$103.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,091.08
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$206.08
|
| Rate for Payer: Three Rivers Provider Network All |
$861.38
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.98
|
| Rate for Payer: United Healthcare Commercial |
$976.23
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,068.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$103.04
|
| Rate for Payer: Zelis Auto |
$459.40
|
| Rate for Payer: Zelis Medicare |
$87.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$123.65
|
| Rate for Payer: Zelis Worker's Compensation |
$98.06
|
|
|
CB US SFT TISS/HEAD/NECK/THYROID
|
Facility
|
IP
|
$1,148.50
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
2100074
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.06 |
| Max. Negotiated Rate |
$1,091.08 |
| Rate for Payer: Cash Price |
$689.10
|
| Rate for Payer: Cash Price |
$689.10
|
| Rate for Payer: Cigna Commercial |
$976.23
|
| Rate for Payer: First Health Commercial |
$1,033.65
|
| Rate for Payer: First Health Workers Compensation |
$138.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,033.65
|
| Rate for Payer: GEHA Commercial |
$803.95
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,033.65
|
| Rate for Payer: Multiplan All |
$1,045.13
|
| Rate for Payer: OMNI Networks Commercial |
$803.95
|
| Rate for Payer: One Health Plan PPO/POS |
$1,033.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,091.08
|
| Rate for Payer: Three Rivers Provider Network All |
$861.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,068.11
|
| Rate for Payer: Zelis Auto |
$459.40
|
| Rate for Payer: Zelis Worker's Compensation |
$98.06
|
|
|
CB US TRANSVAGINAL
|
Facility
|
IP
|
$1,072.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
2100078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$104.38 |
| Max. Negotiated Rate |
$1,018.40 |
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cigna Commercial |
$911.20
|
| Rate for Payer: First Health Commercial |
$964.80
|
| Rate for Payer: First Health Workers Compensation |
$147.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$964.80
|
| Rate for Payer: GEHA Commercial |
$750.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$964.80
|
| Rate for Payer: Multiplan All |
$975.52
|
| Rate for Payer: OMNI Networks Commercial |
$750.40
|
| Rate for Payer: One Health Plan PPO/POS |
$964.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,018.40
|
| Rate for Payer: Three Rivers Provider Network All |
$804.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$996.96
|
| Rate for Payer: Zelis Auto |
$428.80
|
| Rate for Payer: Zelis Worker's Compensation |
$104.38
|
|
|
CB US TRANSVAGINAL
|
Facility
|
OP
|
$1,072.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
2100078
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$87.58 |
| Max. Negotiated Rate |
$1,018.40 |
| 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 |
$643.20
|
| 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 |
$103.04
|
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cash Price |
$643.20
|
| Rate for Payer: Cigna Commercial |
$911.20
|
| Rate for Payer: First Health Commercial |
$964.80
|
| Rate for Payer: First Health Workers Compensation |
$147.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$964.80
|
| Rate for Payer: GEHA Commercial |
$857.60
|
| Rate for Payer: GEHA Medicare |
$103.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$964.80
|
| Rate for Payer: Humana ChoiceCare |
$113.34
|
| Rate for Payer: Humana Medicare Advantage |
$103.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$173.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$117.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$103.04
|
| Rate for Payer: Multiplan All |
$975.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.17
|
| Rate for Payer: OMNI Networks Commercial |
$750.40
|
| Rate for Payer: One Health Plan PPO/POS |
$964.80
|
| 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 |
$103.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,018.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$206.08
|
| Rate for Payer: Three Rivers Provider Network All |
$804.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.98
|
| Rate for Payer: United Healthcare Commercial |
$911.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$996.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$103.04
|
| Rate for Payer: Zelis Auto |
$428.80
|
| Rate for Payer: Zelis Medicare |
$87.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$123.65
|
| Rate for Payer: Zelis Worker's Compensation |
$104.38
|
|
|
CB US TRANSVAGINAL US OBSTETRIC
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
2100053
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$74.23 |
| Max. Negotiated Rate |
$902.50 |
| 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 |
$570.00
|
| 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 |
$103.04
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cigna Commercial |
$807.50
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: First Health Workers Compensation |
$114.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$855.00
|
| Rate for Payer: GEHA Commercial |
$760.00
|
| Rate for Payer: GEHA Medicare |
$103.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$855.00
|
| Rate for Payer: Humana ChoiceCare |
$113.34
|
| Rate for Payer: Humana Medicare Advantage |
$103.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$173.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$75.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$103.04
|
| Rate for Payer: Multiplan All |
$864.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.17
|
| Rate for Payer: OMNI Networks Commercial |
$665.00
|
| Rate for Payer: One Health Plan PPO/POS |
$855.00
|
| 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 |
$103.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$902.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$206.08
|
| Rate for Payer: Three Rivers Provider Network All |
$712.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.98
|
| Rate for Payer: United Healthcare Commercial |
$807.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$75.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$883.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$103.04
|
| Rate for Payer: Zelis Auto |
$380.00
|
| Rate for Payer: Zelis Medicare |
$87.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$123.65
|
| Rate for Payer: Zelis Worker's Compensation |
$80.85
|
|
|
CB US TRANSVAGINAL US OBSTETRIC
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
2100053
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$80.85 |
| Max. Negotiated Rate |
$902.50 |
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cigna Commercial |
$807.50
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: First Health Workers Compensation |
$114.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$855.00
|
| Rate for Payer: GEHA Commercial |
$665.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$855.00
|
| Rate for Payer: Multiplan All |
$864.50
|
| Rate for Payer: OMNI Networks Commercial |
$665.00
|
| Rate for Payer: One Health Plan PPO/POS |
$855.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$902.50
|
| Rate for Payer: Three Rivers Provider Network All |
$712.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$883.50
|
| Rate for Payer: Zelis Auto |
$380.00
|
| Rate for Payer: Zelis Worker's Compensation |
$80.85
|
|
|
CB US UPR/LXTR ART STDY 3+ LVLS
|
Facility
|
OP
|
$1,265.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
2100003
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$128.76 |
| Max. Negotiated Rate |
$1,201.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$162.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$759.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$162.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$128.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$151.61
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$1,075.25
|
| Rate for Payer: First Health Commercial |
$1,138.50
|
| Rate for Payer: First Health Workers Compensation |
$488.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,138.50
|
| Rate for Payer: GEHA Commercial |
$1,012.00
|
| Rate for Payer: GEHA Medicare |
$151.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,138.50
|
| Rate for Payer: Humana ChoiceCare |
$166.77
|
| Rate for Payer: Humana Medicare Advantage |
$151.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$254.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$131.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$151.61
|
| Rate for Payer: Multiplan All |
$1,151.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$257.74
|
| Rate for Payer: OMNI Networks Commercial |
$885.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,138.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$151.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$131.39
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$151.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,201.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$303.22
|
| Rate for Payer: Three Rivers Provider Network All |
$948.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$148.58
|
| Rate for Payer: United Healthcare Commercial |
$1,075.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$131.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,176.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$151.61
|
| Rate for Payer: Zelis Auto |
$506.00
|
| Rate for Payer: Zelis Medicare |
$128.87
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$181.93
|
| Rate for Payer: Zelis Worker's Compensation |
$345.35
|
|
|
CB US UPR/LXTR ART STDY 3+ LVLS
|
Facility
|
IP
|
$1,265.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
2100003
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$345.35 |
| Max. Negotiated Rate |
$1,201.75 |
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$1,075.25
|
| Rate for Payer: First Health Commercial |
$1,138.50
|
| Rate for Payer: First Health Workers Compensation |
$488.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,138.50
|
| Rate for Payer: GEHA Commercial |
$885.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,138.50
|
| Rate for Payer: Multiplan All |
$1,151.15
|
| Rate for Payer: OMNI Networks Commercial |
$885.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,138.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,201.75
|
| Rate for Payer: Three Rivers Provider Network All |
$948.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,176.45
|
| Rate for Payer: Zelis Auto |
$506.00
|
| Rate for Payer: Zelis Worker's Compensation |
$345.35
|
|
|
CB US VASCULAR STUDY
|
Facility
|
OP
|
$1,845.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
2100024
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$184.27 |
| Max. Negotiated Rate |
$1,752.75 |
| 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 |
$1,107.00
|
| 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 |
$234.22
|
| Rate for Payer: Cash Price |
$1,107.00
|
| Rate for Payer: Cash Price |
$1,107.00
|
| Rate for Payer: Cigna Commercial |
$1,568.25
|
| Rate for Payer: First Health Commercial |
$1,660.50
|
| Rate for Payer: First Health Workers Compensation |
$712.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,660.50
|
| Rate for Payer: GEHA Commercial |
$1,476.00
|
| Rate for Payer: GEHA Medicare |
$234.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,660.50
|
| Rate for Payer: Humana ChoiceCare |
$257.64
|
| Rate for Payer: Humana Medicare Advantage |
$234.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$393.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$188.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$234.22
|
| Rate for Payer: Multiplan All |
$1,678.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$398.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,291.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,660.50
|
| 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 |
$234.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,752.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$468.44
|
| Rate for Payer: Three Rivers Provider Network All |
$1,383.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.54
|
| Rate for Payer: United Healthcare Commercial |
$1,568.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$188.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,715.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$234.22
|
| Rate for Payer: Zelis Auto |
$738.00
|
| Rate for Payer: Zelis Medicare |
$199.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$281.06
|
| Rate for Payer: Zelis Worker's Compensation |
$503.69
|
|
|
CB US VASCULAR STUDY
|
Facility
|
IP
|
$1,845.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
2100024
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$503.69 |
| Max. Negotiated Rate |
$1,752.75 |
| Rate for Payer: Cash Price |
$1,107.00
|
| Rate for Payer: Cigna Commercial |
$1,568.25
|
| Rate for Payer: First Health Commercial |
$1,660.50
|
| Rate for Payer: First Health Workers Compensation |
$712.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,660.50
|
| Rate for Payer: GEHA Commercial |
$1,291.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,660.50
|
| Rate for Payer: Multiplan All |
$1,678.95
|
| Rate for Payer: OMNI Networks Commercial |
$1,291.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,660.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,752.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,383.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,715.85
|
| Rate for Payer: Zelis Auto |
$738.00
|
| Rate for Payer: Zelis Worker's Compensation |
$503.69
|
|
|
CB US VEN DOPP BIL LE
|
Facility
|
IP
|
$2,059.70
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
2193970
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$562.30 |
| Max. Negotiated Rate |
$1,956.71 |
| Rate for Payer: Cash Price |
$1,235.82
|
| Rate for Payer: Cigna Commercial |
$1,750.74
|
| Rate for Payer: First Health Commercial |
$1,853.73
|
| Rate for Payer: First Health Workers Compensation |
$795.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,853.73
|
| Rate for Payer: GEHA Commercial |
$1,441.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,853.73
|
| Rate for Payer: Multiplan All |
$1,874.33
|
| Rate for Payer: OMNI Networks Commercial |
$1,441.79
|
| Rate for Payer: One Health Plan PPO/POS |
$1,853.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,956.71
|
| Rate for Payer: Three Rivers Provider Network All |
$1,544.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,915.52
|
| Rate for Payer: Zelis Auto |
$823.88
|
| Rate for Payer: Zelis Worker's Compensation |
$562.30
|
|
|
CB US VEN DOPP BIL LE
|
Facility
|
OP
|
$2,059.70
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
2193970
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$184.27 |
| Max. Negotiated Rate |
$1,956.71 |
| 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 |
$1,235.82
|
| 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 |
$234.22
|
| Rate for Payer: Cash Price |
$1,235.82
|
| Rate for Payer: Cash Price |
$1,235.82
|
| Rate for Payer: Cigna Commercial |
$1,750.74
|
| Rate for Payer: First Health Commercial |
$1,853.73
|
| Rate for Payer: First Health Workers Compensation |
$795.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,853.73
|
| Rate for Payer: GEHA Commercial |
$1,647.76
|
| Rate for Payer: GEHA Medicare |
$234.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,853.73
|
| Rate for Payer: Humana ChoiceCare |
$257.64
|
| Rate for Payer: Humana Medicare Advantage |
$234.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$393.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$188.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$234.22
|
| Rate for Payer: Multiplan All |
$1,874.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$398.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,441.79
|
| Rate for Payer: One Health Plan PPO/POS |
$1,853.73
|
| 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 |
$234.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,956.71
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$468.44
|
| Rate for Payer: Three Rivers Provider Network All |
$1,544.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.54
|
| Rate for Payer: United Healthcare Commercial |
$1,750.74
|
| Rate for Payer: United Healthcare Managed Medicaid |
$188.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,915.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$234.22
|
| Rate for Payer: Zelis Auto |
$823.88
|
| Rate for Payer: Zelis Medicare |
$199.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$281.06
|
| Rate for Payer: Zelis Worker's Compensation |
$562.30
|
|
|
CB US VEN DOPP BIL UE
|
Facility
|
IP
|
$2,059.70
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
2100073
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$562.30 |
| Max. Negotiated Rate |
$1,956.71 |
| Rate for Payer: Cash Price |
$1,235.82
|
| Rate for Payer: Cigna Commercial |
$1,750.74
|
| Rate for Payer: First Health Commercial |
$1,853.73
|
| Rate for Payer: First Health Workers Compensation |
$795.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,853.73
|
| Rate for Payer: GEHA Commercial |
$1,441.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,853.73
|
| Rate for Payer: Multiplan All |
$1,874.33
|
| Rate for Payer: OMNI Networks Commercial |
$1,441.79
|
| Rate for Payer: One Health Plan PPO/POS |
$1,853.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,956.71
|
| Rate for Payer: Three Rivers Provider Network All |
$1,544.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,915.52
|
| Rate for Payer: Zelis Auto |
$823.88
|
| Rate for Payer: Zelis Worker's Compensation |
$562.30
|
|
|
CB US VEN DOPP BIL UE
|
Facility
|
OP
|
$2,059.70
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
2100073
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$184.27 |
| Max. Negotiated Rate |
$1,956.71 |
| 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 |
$1,235.82
|
| 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 |
$234.22
|
| Rate for Payer: Cash Price |
$1,235.82
|
| Rate for Payer: Cash Price |
$1,235.82
|
| Rate for Payer: Cigna Commercial |
$1,750.74
|
| Rate for Payer: First Health Commercial |
$1,853.73
|
| Rate for Payer: First Health Workers Compensation |
$795.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,853.73
|
| Rate for Payer: GEHA Commercial |
$1,647.76
|
| Rate for Payer: GEHA Medicare |
$234.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,853.73
|
| Rate for Payer: Humana ChoiceCare |
$257.64
|
| Rate for Payer: Humana Medicare Advantage |
$234.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$393.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$188.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$234.22
|
| Rate for Payer: Multiplan All |
$1,874.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$398.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,441.79
|
| Rate for Payer: One Health Plan PPO/POS |
$1,853.73
|
| 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 |
$234.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,956.71
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$468.44
|
| Rate for Payer: Three Rivers Provider Network All |
$1,544.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.54
|
| Rate for Payer: United Healthcare Commercial |
$1,750.74
|
| Rate for Payer: United Healthcare Managed Medicaid |
$188.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,915.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$234.22
|
| Rate for Payer: Zelis Auto |
$823.88
|
| Rate for Payer: Zelis Medicare |
$199.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$281.06
|
| Rate for Payer: Zelis Worker's Compensation |
$562.30
|
|
|
CB US VEN DOPP LE
|
Facility
|
OP
|
$1,366.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
2193971
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$87.58 |
| Max. Negotiated Rate |
$1,297.70 |
| 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 |
$819.60
|
| 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 |
$103.04
|
| Rate for Payer: Cash Price |
$819.60
|
| Rate for Payer: Cash Price |
$819.60
|
| Rate for Payer: Cigna Commercial |
$1,161.10
|
| Rate for Payer: First Health Commercial |
$1,229.40
|
| Rate for Payer: First Health Workers Compensation |
$527.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,229.40
|
| Rate for Payer: GEHA Commercial |
$1,092.80
|
| Rate for Payer: GEHA Medicare |
$103.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,229.40
|
| Rate for Payer: Humana ChoiceCare |
$113.34
|
| Rate for Payer: Humana Medicare Advantage |
$103.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$173.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$117.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$103.04
|
| Rate for Payer: Multiplan All |
$1,243.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.17
|
| Rate for Payer: OMNI Networks Commercial |
$956.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,229.40
|
| 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 |
$103.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,297.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$206.08
|
| Rate for Payer: Three Rivers Provider Network All |
$1,024.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.98
|
| Rate for Payer: United Healthcare Commercial |
$1,161.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,270.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$103.04
|
| Rate for Payer: Zelis Auto |
$546.40
|
| Rate for Payer: Zelis Medicare |
$87.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$123.65
|
| Rate for Payer: Zelis Worker's Compensation |
$372.92
|
|
|
CB US VEN DOPP LE
|
Facility
|
IP
|
$1,366.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
2193971
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$372.92 |
| Max. Negotiated Rate |
$1,297.70 |
| Rate for Payer: Cash Price |
$819.60
|
| Rate for Payer: Cigna Commercial |
$1,161.10
|
| Rate for Payer: First Health Commercial |
$1,229.40
|
| Rate for Payer: First Health Workers Compensation |
$527.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,229.40
|
| Rate for Payer: GEHA Commercial |
$956.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,229.40
|
| Rate for Payer: Multiplan All |
$1,243.06
|
| Rate for Payer: OMNI Networks Commercial |
$956.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,229.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,297.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,024.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,270.38
|
| Rate for Payer: Zelis Auto |
$546.40
|
| Rate for Payer: Zelis Worker's Compensation |
$372.92
|
|
|
CB US VEN DOPP UE
|
Facility
|
IP
|
$1,366.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
2100047
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$372.92 |
| Max. Negotiated Rate |
$1,297.70 |
| Rate for Payer: Cash Price |
$819.60
|
| Rate for Payer: Cigna Commercial |
$1,161.10
|
| Rate for Payer: First Health Commercial |
$1,229.40
|
| Rate for Payer: First Health Workers Compensation |
$527.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,229.40
|
| Rate for Payer: GEHA Commercial |
$956.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,229.40
|
| Rate for Payer: Multiplan All |
$1,243.06
|
| Rate for Payer: OMNI Networks Commercial |
$956.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,229.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,297.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,024.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,270.38
|
| Rate for Payer: Zelis Auto |
$546.40
|
| Rate for Payer: Zelis Worker's Compensation |
$372.92
|
|
|
CB US VEN DOPP UE
|
Facility
|
OP
|
$1,366.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
2100047
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$87.58 |
| Max. Negotiated Rate |
$1,297.70 |
| 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 |
$819.60
|
| 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 |
$103.04
|
| Rate for Payer: Cash Price |
$819.60
|
| Rate for Payer: Cash Price |
$819.60
|
| Rate for Payer: Cigna Commercial |
$1,161.10
|
| Rate for Payer: First Health Commercial |
$1,229.40
|
| Rate for Payer: First Health Workers Compensation |
$527.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,229.40
|
| Rate for Payer: GEHA Commercial |
$1,092.80
|
| Rate for Payer: GEHA Medicare |
$103.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,229.40
|
| Rate for Payer: Humana ChoiceCare |
$113.34
|
| Rate for Payer: Humana Medicare Advantage |
$103.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$173.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$117.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$103.04
|
| Rate for Payer: Multiplan All |
$1,243.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.17
|
| Rate for Payer: OMNI Networks Commercial |
$956.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,229.40
|
| 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 |
$103.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,297.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$206.08
|
| Rate for Payer: Three Rivers Provider Network All |
$1,024.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$100.98
|
| Rate for Payer: United Healthcare Commercial |
$1,161.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,270.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$103.04
|
| Rate for Payer: Zelis Auto |
$546.40
|
| Rate for Payer: Zelis Medicare |
$87.58
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$123.65
|
| Rate for Payer: Zelis Worker's Compensation |
$372.92
|
|
|
CB US VENOUS INSUFFICIENCY BILAT
|
Facility
|
OP
|
$2,082.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
2100095
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$184.27 |
| Max. Negotiated Rate |
$1,977.90 |
| 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 |
$1,249.20
|
| 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 |
$234.22
|
| Rate for Payer: Cash Price |
$1,249.20
|
| Rate for Payer: Cash Price |
$1,249.20
|
| Rate for Payer: Cigna Commercial |
$1,769.70
|
| Rate for Payer: First Health Commercial |
$1,873.80
|
| Rate for Payer: First Health Workers Compensation |
$803.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,873.80
|
| Rate for Payer: GEHA Commercial |
$1,665.60
|
| Rate for Payer: GEHA Medicare |
$234.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,873.80
|
| Rate for Payer: Humana ChoiceCare |
$257.64
|
| Rate for Payer: Humana Medicare Advantage |
$234.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$393.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$188.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$234.22
|
| Rate for Payer: Multiplan All |
$1,894.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$398.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,457.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,873.80
|
| 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 |
$234.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,977.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$468.44
|
| Rate for Payer: Three Rivers Provider Network All |
$1,561.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.54
|
| Rate for Payer: United Healthcare Commercial |
$1,769.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$188.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,936.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$234.22
|
| Rate for Payer: Zelis Auto |
$832.80
|
| Rate for Payer: Zelis Medicare |
$199.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$281.06
|
| Rate for Payer: Zelis Worker's Compensation |
$568.39
|
|
|
CB US VENOUS INSUFFICIENCY BILAT
|
Facility
|
IP
|
$2,082.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
2100095
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$568.39 |
| Max. Negotiated Rate |
$1,977.90 |
| Rate for Payer: Cash Price |
$1,249.20
|
| Rate for Payer: Cigna Commercial |
$1,769.70
|
| Rate for Payer: First Health Commercial |
$1,873.80
|
| Rate for Payer: First Health Workers Compensation |
$803.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,873.80
|
| Rate for Payer: GEHA Commercial |
$1,457.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,873.80
|
| Rate for Payer: Multiplan All |
$1,894.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,457.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,873.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,977.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,561.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,936.26
|
| Rate for Payer: Zelis Auto |
$832.80
|
| Rate for Payer: Zelis Worker's Compensation |
$568.39
|
|
|
CB XR ABD 1 VW
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
2900002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.31 |
| Max. Negotiated Rate |
$457.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$289.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$93.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$73.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$85.32
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$409.70
|
| Rate for Payer: First Health Commercial |
$433.80
|
| Rate for Payer: First Health Workers Compensation |
$37.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$433.80
|
| Rate for Payer: GEHA Commercial |
$385.60
|
| Rate for Payer: GEHA Medicare |
$85.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$433.80
|
| Rate for Payer: Humana ChoiceCare |
$93.85
|
| Rate for Payer: Humana Medicare Advantage |
$85.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$143.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$75.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$85.32
|
| Rate for Payer: Multiplan All |
$438.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.04
|
| Rate for Payer: OMNI Networks Commercial |
$337.40
|
| Rate for Payer: One Health Plan PPO/POS |
$433.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$86.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$75.31
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$85.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$457.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$170.64
|
| Rate for Payer: Three Rivers Provider Network All |
$361.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$83.61
|
| Rate for Payer: United Healthcare Commercial |
$409.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$75.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$448.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$85.32
|
| Rate for Payer: Zelis Auto |
$192.80
|
| Rate for Payer: Zelis Medicare |
$72.52
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.38
|
| Rate for Payer: Zelis Worker's Compensation |
$26.31
|
|
