|
CB XR T-SPINE 2V
|
Facility
|
IP
|
$628.00
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
2900128
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.99 |
| Max. Negotiated Rate |
$596.60 |
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$533.80
|
| Rate for Payer: First Health Commercial |
$565.20
|
| Rate for Payer: First Health Workers Compensation |
$39.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$565.20
|
| Rate for Payer: GEHA Commercial |
$439.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$565.20
|
| Rate for Payer: Multiplan All |
$571.48
|
| Rate for Payer: OMNI Networks Commercial |
$439.60
|
| Rate for Payer: One Health Plan PPO/POS |
$565.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$596.60
|
| Rate for Payer: Three Rivers Provider Network All |
$471.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$584.04
|
| Rate for Payer: Zelis Auto |
$251.20
|
| Rate for Payer: Zelis Worker's Compensation |
$27.99
|
|
|
CB XR T-SPINE 3V
|
Facility
|
OP
|
$734.00
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
2900131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$697.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$440.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cigna Commercial |
$623.90
|
| Rate for Payer: First Health Commercial |
$660.60
|
| Rate for Payer: First Health Workers Compensation |
$47.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$660.60
|
| Rate for Payer: GEHA Commercial |
$587.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$660.60
|
| 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 |
$115.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$667.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$513.80
|
| Rate for Payer: One Health Plan PPO/POS |
$660.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$697.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$550.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$623.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$682.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$293.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$33.36
|
|
|
CB XR T-SPINE 3V
|
Facility
|
IP
|
$734.00
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
2900131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$697.30 |
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cigna Commercial |
$623.90
|
| Rate for Payer: First Health Commercial |
$660.60
|
| Rate for Payer: First Health Workers Compensation |
$47.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$660.60
|
| Rate for Payer: GEHA Commercial |
$513.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$660.60
|
| Rate for Payer: Multiplan All |
$667.94
|
| Rate for Payer: OMNI Networks Commercial |
$513.80
|
| Rate for Payer: One Health Plan PPO/POS |
$660.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$697.30
|
| Rate for Payer: Three Rivers Provider Network All |
$550.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$682.62
|
| Rate for Payer: Zelis Auto |
$293.60
|
| Rate for Payer: Zelis Worker's Compensation |
$33.36
|
|
|
CB XR WRIST 2 VIEWS
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
2900143
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$483.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$305.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cigna Commercial |
$432.65
|
| Rate for Payer: First Health Commercial |
$458.10
|
| Rate for Payer: First Health Workers Compensation |
$40.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$458.10
|
| Rate for Payer: GEHA Commercial |
$407.20
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$458.10
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$463.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$356.30
|
| Rate for Payer: One Health Plan PPO/POS |
$458.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$483.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$381.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$432.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$473.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$203.60
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$28.84
|
|
|
CB XR WRIST 2 VIEWS
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
2900143
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$483.55 |
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cigna Commercial |
$432.65
|
| Rate for Payer: First Health Commercial |
$458.10
|
| Rate for Payer: First Health Workers Compensation |
$40.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$458.10
|
| Rate for Payer: GEHA Commercial |
$356.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$458.10
|
| Rate for Payer: Multiplan All |
$463.19
|
| Rate for Payer: OMNI Networks Commercial |
$356.30
|
| Rate for Payer: One Health Plan PPO/POS |
$458.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$483.55
|
| Rate for Payer: Three Rivers Provider Network All |
$381.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$473.37
|
| Rate for Payer: Zelis Auto |
$203.60
|
| Rate for Payer: Zelis Worker's Compensation |
$28.84
|
|
|
CB XR WRIST COMP
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
2900145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.78 |
| Max. Negotiated Rate |
$590.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$373.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$89.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$83.61
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cigna Commercial |
$528.70
|
| Rate for Payer: First Health Commercial |
$559.80
|
| Rate for Payer: First Health Workers Compensation |
$49.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$559.80
|
| Rate for Payer: GEHA Commercial |
$497.60
|
| Rate for Payer: GEHA Medicare |
$83.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$559.80
|
| Rate for Payer: Humana ChoiceCare |
$91.97
|
| Rate for Payer: Humana Medicare Advantage |
$83.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$140.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$83.61
|
| Rate for Payer: Multiplan All |
$566.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$142.14
|
| Rate for Payer: OMNI Networks Commercial |
$435.40
|
| Rate for Payer: One Health Plan PPO/POS |
$559.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$83.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$83.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$590.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$167.22
|
| Rate for Payer: Three Rivers Provider Network All |
$466.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$81.94
|
| Rate for Payer: United Healthcare Commercial |
$528.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$578.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$83.61
|
| Rate for Payer: Zelis Auto |
$248.80
|
| Rate for Payer: Zelis Medicare |
$71.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$100.33
|
| Rate for Payer: Zelis Worker's Compensation |
$34.78
|
|
|
CB XR WRIST COMP
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
2900145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.78 |
| Max. Negotiated Rate |
$590.90 |
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cigna Commercial |
$528.70
|
| Rate for Payer: First Health Commercial |
$559.80
|
| Rate for Payer: First Health Workers Compensation |
$49.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$559.80
|
| Rate for Payer: GEHA Commercial |
$435.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$559.80
|
| Rate for Payer: Multiplan All |
$566.02
|
| Rate for Payer: OMNI Networks Commercial |
$435.40
|
| Rate for Payer: One Health Plan PPO/POS |
$559.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$590.90
|
| Rate for Payer: Three Rivers Provider Network All |
$466.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$578.46
|
| Rate for Payer: Zelis Auto |
$248.80
|
| Rate for Payer: Zelis Worker's Compensation |
$34.78
|
|
|
CCM 60 MINS COMPLEX
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT G0511
|
| Hospital Charge Code |
9199511
|
|
Hospital Revenue Code
|
529
|
| Min. Negotiated Rate |
$34.67 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$49.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$88.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Worker's Compensation |
$34.67
|
|
|
CCM 60 MINS COMPLEX
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT G0511
|
| Hospital Charge Code |
9199511
|
|
Hospital Revenue Code
|
529
|
| Min. Negotiated Rate |
$31.75 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$49.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$101.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Humana ChoiceCare |
$33.02
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$76.20
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$111.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$63.50
|
| Rate for Payer: Zelis Worker's Compensation |
$34.67
|
|
|
CCM/BHI BY RHC/FQHC 20MIN MO
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT G0511
|
| Hospital Charge Code |
8500511
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$49.96 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$155.55
|
| Rate for Payer: First Health Commercial |
$164.70
|
| Rate for Payer: First Health Workers Compensation |
$70.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$164.70
|
| Rate for Payer: GEHA Commercial |
$128.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$164.70
|
| Rate for Payer: Multiplan All |
$166.53
|
| Rate for Payer: OMNI Networks Commercial |
$128.10
|
| Rate for Payer: One Health Plan PPO/POS |
$164.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$173.85
|
| Rate for Payer: Three Rivers Provider Network All |
$137.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$170.19
|
| Rate for Payer: Zelis Auto |
$73.20
|
| Rate for Payer: Zelis Worker's Compensation |
$49.96
|
|
|
CCM/BHI BY RHC/FQHC 20MIN MO
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT G0511
|
| Hospital Charge Code |
8500511
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$45.75 |
| Max. Negotiated Rate |
$173.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna Commercial |
$155.55
|
| Rate for Payer: First Health Commercial |
$164.70
|
| Rate for Payer: First Health Workers Compensation |
$70.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$164.70
|
| Rate for Payer: GEHA Commercial |
$146.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$164.70
|
| Rate for Payer: Humana ChoiceCare |
$47.58
|
| Rate for Payer: Multiplan All |
$166.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$109.80
|
| Rate for Payer: OMNI Networks Commercial |
$128.10
|
| Rate for Payer: One Health Plan PPO/POS |
$164.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$173.85
|
| Rate for Payer: Three Rivers Provider Network All |
$137.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$161.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$170.19
|
| Rate for Payer: Zelis Auto |
$73.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$91.50
|
| Rate for Payer: Zelis Worker's Compensation |
$49.96
|
|
|
ccp abs (IgA, IgG) REF164914
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
2246182
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.01 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$142.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$23.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.95
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$201.45
|
| Rate for Payer: First Health Commercial |
$213.30
|
| Rate for Payer: First Health Workers Compensation |
$22.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$213.30
|
| Rate for Payer: GEHA Commercial |
$189.60
|
| Rate for Payer: GEHA Medicare |
$12.95
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$213.30
|
| Rate for Payer: Humana ChoiceCare |
$14.24
|
| Rate for Payer: Humana Medicare Advantage |
$12.95
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$21.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.95
|
| Rate for Payer: Multiplan All |
$215.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$22.02
|
| Rate for Payer: OMNI Networks Commercial |
$165.90
|
| Rate for Payer: One Health Plan PPO/POS |
$213.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$21.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.95
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$225.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$25.90
|
| Rate for Payer: Three Rivers Provider Network All |
$177.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.69
|
| Rate for Payer: United Healthcare Commercial |
$201.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.95
|
| Rate for Payer: United Payors & United Providers UP&UP |
$220.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.95
|
| Rate for Payer: Zelis Auto |
$94.80
|
| Rate for Payer: Zelis Medicare |
$11.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.54
|
| Rate for Payer: Zelis Worker's Compensation |
$16.25
|
|
|
ccp abs (IgA, IgG) REF164914
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
2246182
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$201.45
|
| Rate for Payer: First Health Commercial |
$213.30
|
| Rate for Payer: First Health Workers Compensation |
$22.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$213.30
|
| Rate for Payer: GEHA Commercial |
$165.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$213.30
|
| Rate for Payer: Multiplan All |
$215.67
|
| Rate for Payer: OMNI Networks Commercial |
$165.90
|
| Rate for Payer: One Health Plan PPO/POS |
$213.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$225.15
|
| Rate for Payer: Three Rivers Provider Network All |
$177.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$220.41
|
| Rate for Payer: Zelis Auto |
$94.80
|
| Rate for Payer: Zelis Worker's Compensation |
$16.25
|
|
|
CCTA ART/GRAPH/MORPH
|
Facility
|
IP
|
$3,411.00
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
2407238
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$428.08 |
| Max. Negotiated Rate |
$3,240.45 |
| Rate for Payer: Cash Price |
$2,046.60
|
| Rate for Payer: Cash Price |
$2,046.60
|
| Rate for Payer: Cigna Commercial |
$2,899.35
|
| Rate for Payer: First Health Commercial |
$3,069.90
|
| Rate for Payer: First Health Workers Compensation |
$605.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,069.90
|
| Rate for Payer: GEHA Commercial |
$2,387.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,069.90
|
| Rate for Payer: Multiplan All |
$3,104.01
|
| Rate for Payer: OMNI Networks Commercial |
$2,387.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,069.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,240.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,558.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,172.23
|
| Rate for Payer: Zelis Auto |
$1,364.40
|
| Rate for Payer: Zelis Worker's Compensation |
$428.08
|
|
|
CCTA ART/GRAPH/MORPH
|
Facility
|
OP
|
$3,411.00
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
2407238
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$3,240.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$403.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,046.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$403.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$319.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$2,046.60
|
| Rate for Payer: Cash Price |
$2,046.60
|
| Rate for Payer: Cigna Commercial |
$2,899.35
|
| Rate for Payer: First Health Commercial |
$3,069.90
|
| Rate for Payer: First Health Workers Compensation |
$605.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,069.90
|
| Rate for Payer: GEHA Commercial |
$2,728.80
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,069.90
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$326.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$3,104.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$2,387.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,069.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$376.81
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$326.34
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,240.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$2,558.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$2,899.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$326.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,172.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$1,364.40
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$428.08
|
|
|
CCTA STRUCTURE/MORPH
|
Facility
|
OP
|
$2,895.00
|
|
|
Service Code
|
CPT 75572
|
| Hospital Charge Code |
2407236
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$2,750.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$403.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,737.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$403.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$319.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$1,737.00
|
| Rate for Payer: Cash Price |
$1,737.00
|
| Rate for Payer: Cigna Commercial |
$2,460.75
|
| Rate for Payer: First Health Commercial |
$2,605.50
|
| Rate for Payer: First Health Workers Compensation |
$419.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,605.50
|
| Rate for Payer: GEHA Commercial |
$2,316.00
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,605.50
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$326.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$2,634.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$2,026.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,605.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$376.81
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$326.34
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,750.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$2,171.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$2,460.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$326.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,692.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$1,158.00
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$296.66
|
|
|
CCTA STRUCTURE/MORPH
|
Facility
|
IP
|
$2,895.00
|
|
|
Service Code
|
CPT 75572
|
| Hospital Charge Code |
2407236
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$296.66 |
| Max. Negotiated Rate |
$2,750.25 |
| Rate for Payer: Cash Price |
$1,737.00
|
| Rate for Payer: Cash Price |
$1,737.00
|
| Rate for Payer: Cigna Commercial |
$2,460.75
|
| Rate for Payer: First Health Commercial |
$2,605.50
|
| Rate for Payer: First Health Workers Compensation |
$419.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,605.50
|
| Rate for Payer: GEHA Commercial |
$2,026.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,605.50
|
| Rate for Payer: Multiplan All |
$2,634.45
|
| Rate for Payer: OMNI Networks Commercial |
$2,026.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,605.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,750.25
|
| Rate for Payer: Three Rivers Provider Network All |
$2,171.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,692.35
|
| Rate for Payer: Zelis Auto |
$1,158.00
|
| Rate for Payer: Zelis Worker's Compensation |
$296.66
|
|
|
CCULTURE BLD
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
2207041
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$18.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$120.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$18.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10.32
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$170.85
|
| Rate for Payer: First Health Commercial |
$180.90
|
| Rate for Payer: First Health Workers Compensation |
$16.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.90
|
| Rate for Payer: GEHA Commercial |
$160.80
|
| Rate for Payer: GEHA Medicare |
$10.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.90
|
| Rate for Payer: Humana ChoiceCare |
$11.35
|
| Rate for Payer: Humana Medicare Advantage |
$10.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$17.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$15.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10.32
|
| Rate for Payer: Multiplan All |
$182.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17.54
|
| Rate for Payer: OMNI Networks Commercial |
$140.70
|
| Rate for Payer: One Health Plan PPO/POS |
$180.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$17.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$15.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$190.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$20.64
|
| Rate for Payer: Three Rivers Provider Network All |
$150.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.11
|
| Rate for Payer: United Healthcare Commercial |
$170.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10.32
|
| Rate for Payer: Zelis Auto |
$80.40
|
| Rate for Payer: Zelis Medicare |
$8.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.38
|
| Rate for Payer: Zelis Worker's Compensation |
$12.01
|
|
|
CCULTURE BLD
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
2207041
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$170.85
|
| Rate for Payer: First Health Commercial |
$180.90
|
| Rate for Payer: First Health Workers Compensation |
$16.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.90
|
| Rate for Payer: GEHA Commercial |
$140.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.90
|
| Rate for Payer: Multiplan All |
$182.91
|
| Rate for Payer: OMNI Networks Commercial |
$140.70
|
| Rate for Payer: One Health Plan PPO/POS |
$180.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$190.95
|
| Rate for Payer: Three Rivers Provider Network All |
$150.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.93
|
| Rate for Payer: Zelis Auto |
$80.40
|
| Rate for Payer: Zelis Worker's Compensation |
$12.01
|
|
|
cd4:cd8 ratio profile REF505271
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
2200337
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.93 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$84.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$84.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$66.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$46.98
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$276.25
|
| Rate for Payer: First Health Commercial |
$292.50
|
| Rate for Payer: First Health Workers Compensation |
$79.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$292.50
|
| Rate for Payer: GEHA Commercial |
$260.00
|
| Rate for Payer: GEHA Medicare |
$46.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$292.50
|
| Rate for Payer: Humana ChoiceCare |
$51.68
|
| Rate for Payer: Humana Medicare Advantage |
$46.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$78.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$68.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$46.98
|
| Rate for Payer: Multiplan All |
$295.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$79.87
|
| Rate for Payer: OMNI Networks Commercial |
$227.50
|
| Rate for Payer: One Health Plan PPO/POS |
$292.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$78.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$68.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$46.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$308.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$93.96
|
| Rate for Payer: Three Rivers Provider Network All |
$243.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$46.04
|
| Rate for Payer: United Healthcare Commercial |
$276.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$68.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$302.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$46.98
|
| Rate for Payer: Zelis Auto |
$130.00
|
| Rate for Payer: Zelis Medicare |
$39.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.38
|
| Rate for Payer: Zelis Worker's Compensation |
$56.19
|
|
|
cd4:cd8 ratio profile REF505271
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
2200337
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.19 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$276.25
|
| Rate for Payer: First Health Commercial |
$292.50
|
| Rate for Payer: First Health Workers Compensation |
$79.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$292.50
|
| Rate for Payer: GEHA Commercial |
$227.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$292.50
|
| Rate for Payer: Multiplan All |
$295.75
|
| Rate for Payer: OMNI Networks Commercial |
$227.50
|
| Rate for Payer: One Health Plan PPO/POS |
$292.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$308.75
|
| Rate for Payer: Three Rivers Provider Network All |
$243.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$302.25
|
| Rate for Payer: Zelis Auto |
$130.00
|
| Rate for Payer: Zelis Worker's Compensation |
$56.19
|
|
|
C DIFF TOX A/B STOOL AGH
|
Facility
|
OP
|
$436.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
2202481
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$414.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$261.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$370.60
|
| Rate for Payer: First Health Commercial |
$392.40
|
| Rate for Payer: First Health Workers Compensation |
$20.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$392.40
|
| Rate for Payer: GEHA Commercial |
$348.80
|
| Rate for Payer: GEHA Medicare |
$11.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$392.40
|
| Rate for Payer: Humana ChoiceCare |
$13.18
|
| Rate for Payer: Humana Medicare Advantage |
$11.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.98
|
| Rate for Payer: Multiplan All |
$396.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.37
|
| Rate for Payer: OMNI Networks Commercial |
$305.20
|
| Rate for Payer: One Health Plan PPO/POS |
$392.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$414.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$23.96
|
| Rate for Payer: Three Rivers Provider Network All |
$327.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.74
|
| Rate for Payer: United Healthcare Commercial |
$370.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$405.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.98
|
| Rate for Payer: Zelis Auto |
$174.40
|
| Rate for Payer: Zelis Medicare |
$10.18
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.38
|
| Rate for Payer: Zelis Worker's Compensation |
$14.73
|
|
|
C DIFF TOX A/B STOOL AGH
|
Facility
|
IP
|
$436.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
2202481
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.73 |
| Max. Negotiated Rate |
$414.20 |
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$370.60
|
| Rate for Payer: First Health Commercial |
$392.40
|
| Rate for Payer: First Health Workers Compensation |
$20.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$392.40
|
| Rate for Payer: GEHA Commercial |
$305.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$392.40
|
| Rate for Payer: Multiplan All |
$396.76
|
| Rate for Payer: OMNI Networks Commercial |
$305.20
|
| Rate for Payer: One Health Plan PPO/POS |
$392.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$414.20
|
| Rate for Payer: Three Rivers Provider Network All |
$327.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$405.48
|
| Rate for Payer: Zelis Auto |
$174.40
|
| Rate for Payer: Zelis Worker's Compensation |
$14.73
|
|
|
cea REF 002139
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
2200787
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.12 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$34.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$145.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$34.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$27.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.96
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$206.55
|
| Rate for Payer: First Health Commercial |
$218.70
|
| Rate for Payer: First Health Workers Compensation |
$28.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$218.70
|
| Rate for Payer: GEHA Commercial |
$194.40
|
| Rate for Payer: GEHA Medicare |
$18.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$218.70
|
| Rate for Payer: Humana ChoiceCare |
$20.86
|
| Rate for Payer: Humana Medicare Advantage |
$18.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$31.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$27.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.96
|
| Rate for Payer: Multiplan All |
$221.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$32.23
|
| Rate for Payer: OMNI Networks Commercial |
$170.10
|
| Rate for Payer: One Health Plan PPO/POS |
$218.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$31.85
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$27.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$230.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$37.92
|
| Rate for Payer: Three Rivers Provider Network All |
$182.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.58
|
| Rate for Payer: United Healthcare Commercial |
$206.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$27.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.96
|
| Rate for Payer: Zelis Auto |
$97.20
|
| Rate for Payer: Zelis Medicare |
$16.12
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.75
|
| Rate for Payer: Zelis Worker's Compensation |
$20.50
|
|
|
cea REF 002139
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
2200787
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$206.55
|
| Rate for Payer: First Health Commercial |
$218.70
|
| Rate for Payer: First Health Workers Compensation |
$28.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$218.70
|
| Rate for Payer: GEHA Commercial |
$170.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$218.70
|
| Rate for Payer: Multiplan All |
$221.13
|
| Rate for Payer: OMNI Networks Commercial |
$170.10
|
| Rate for Payer: One Health Plan PPO/POS |
$218.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$230.85
|
| Rate for Payer: Three Rivers Provider Network All |
$182.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.99
|
| Rate for Payer: Zelis Auto |
$97.20
|
| Rate for Payer: Zelis Worker's Compensation |
$20.50
|
|
