|
CSF PROTEIN (Vitros)
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
2232237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$146.20
|
| Rate for Payer: First Health Commercial |
$154.80
|
| Rate for Payer: First Health Workers Compensation |
$7.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$154.80
|
| Rate for Payer: GEHA Commercial |
$120.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$154.80
|
| Rate for Payer: Multiplan All |
$156.52
|
| Rate for Payer: OMNI Networks Commercial |
$120.40
|
| Rate for Payer: One Health Plan PPO/POS |
$154.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$163.40
|
| Rate for Payer: Three Rivers Provider Network All |
$129.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$159.96
|
| Rate for Payer: Zelis Auto |
$68.80
|
| Rate for Payer: Zelis Worker's Compensation |
$5.57
|
|
|
CSF REF ALBUMIN REF
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
2299810
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$71.40
|
| Rate for Payer: First Health Commercial |
$75.60
|
| Rate for Payer: First Health Workers Compensation |
$9.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$75.60
|
| Rate for Payer: GEHA Commercial |
$58.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$75.60
|
| Rate for Payer: Multiplan All |
$76.44
|
| Rate for Payer: OMNI Networks Commercial |
$58.80
|
| Rate for Payer: One Health Plan PPO/POS |
$75.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$79.80
|
| Rate for Payer: Three Rivers Provider Network All |
$63.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$78.12
|
| Rate for Payer: Zelis Auto |
$33.60
|
| Rate for Payer: Zelis Worker's Compensation |
$6.41
|
|
|
CSF REF ALBUMIN REF
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
2299810
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$14.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$50.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$14.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$11.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7.78
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$71.40
|
| Rate for Payer: First Health Commercial |
$75.60
|
| Rate for Payer: First Health Workers Compensation |
$9.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$75.60
|
| Rate for Payer: GEHA Commercial |
$67.20
|
| Rate for Payer: GEHA Medicare |
$7.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$75.60
|
| Rate for Payer: Humana ChoiceCare |
$8.56
|
| Rate for Payer: Humana Medicare Advantage |
$7.78
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$13.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7.78
|
| Rate for Payer: Multiplan All |
$76.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.23
|
| Rate for Payer: OMNI Networks Commercial |
$58.80
|
| Rate for Payer: One Health Plan PPO/POS |
$75.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11.32
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$79.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$15.56
|
| Rate for Payer: Three Rivers Provider Network All |
$63.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.62
|
| Rate for Payer: United Healthcare Commercial |
$71.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$78.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7.78
|
| Rate for Payer: Zelis Auto |
$33.60
|
| Rate for Payer: Zelis Medicare |
$6.61
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$9.34
|
| Rate for Payer: Zelis Worker's Compensation |
$6.41
|
|
|
CSF REF LYME DISEASE AB IGM REF
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
2299807
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cigna Commercial |
$158.10
|
| Rate for Payer: First Health Commercial |
$167.40
|
| Rate for Payer: First Health Workers Compensation |
$25.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$167.40
|
| Rate for Payer: GEHA Commercial |
$130.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$167.40
|
| Rate for Payer: Multiplan All |
$169.26
|
| Rate for Payer: OMNI Networks Commercial |
$130.20
|
| Rate for Payer: One Health Plan PPO/POS |
$167.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$176.70
|
| Rate for Payer: Three Rivers Provider Network All |
$139.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.98
|
| Rate for Payer: Zelis Auto |
$74.40
|
| Rate for Payer: Zelis Worker's Compensation |
$18.36
|
|
|
CSF REF LYME DISEASE AB IGM REF
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
2299807
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$111.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.03
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cigna Commercial |
$158.10
|
| Rate for Payer: First Health Commercial |
$167.40
|
| Rate for Payer: First Health Workers Compensation |
$25.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$167.40
|
| Rate for Payer: GEHA Commercial |
$148.80
|
| Rate for Payer: GEHA Medicare |
$17.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$167.40
|
| Rate for Payer: Humana ChoiceCare |
$18.73
|
| Rate for Payer: Humana Medicare Advantage |
$17.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.03
|
| Rate for Payer: Multiplan All |
$169.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.95
|
| Rate for Payer: OMNI Networks Commercial |
$130.20
|
| Rate for Payer: One Health Plan PPO/POS |
$167.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$176.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34.06
|
| Rate for Payer: Three Rivers Provider Network All |
$139.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.69
|
| Rate for Payer: United Healthcare Commercial |
$158.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.03
|
| Rate for Payer: Zelis Auto |
$74.40
|
| Rate for Payer: Zelis Medicare |
$14.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.44
|
| Rate for Payer: Zelis Worker's Compensation |
$18.36
|
|
|
CSF RER LYME DISEASE AB IGG REF
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
2299806
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cigna Commercial |
$158.10
|
| Rate for Payer: First Health Commercial |
$167.40
|
| Rate for Payer: First Health Workers Compensation |
$25.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$167.40
|
| Rate for Payer: GEHA Commercial |
$130.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$167.40
|
| Rate for Payer: Multiplan All |
$169.26
|
| Rate for Payer: OMNI Networks Commercial |
$130.20
|
| Rate for Payer: One Health Plan PPO/POS |
$167.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$176.70
|
| Rate for Payer: Three Rivers Provider Network All |
$139.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.98
|
| Rate for Payer: Zelis Auto |
$74.40
|
| Rate for Payer: Zelis Worker's Compensation |
$18.36
|
|
|
CSF RER LYME DISEASE AB IGG REF
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
2299806
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$111.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$24.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.03
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cigna Commercial |
$158.10
|
| Rate for Payer: First Health Commercial |
$167.40
|
| Rate for Payer: First Health Workers Compensation |
$25.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$167.40
|
| Rate for Payer: GEHA Commercial |
$148.80
|
| Rate for Payer: GEHA Medicare |
$17.03
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$167.40
|
| Rate for Payer: Humana ChoiceCare |
$18.73
|
| Rate for Payer: Humana Medicare Advantage |
$17.03
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.61
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.03
|
| Rate for Payer: Multiplan All |
$169.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.95
|
| Rate for Payer: OMNI Networks Commercial |
$130.20
|
| Rate for Payer: One Health Plan PPO/POS |
$167.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.03
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$176.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34.06
|
| Rate for Payer: Three Rivers Provider Network All |
$139.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.69
|
| Rate for Payer: United Healthcare Commercial |
$158.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.03
|
| Rate for Payer: United Payors & United Providers UP&UP |
$172.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.03
|
| Rate for Payer: Zelis Auto |
$74.40
|
| Rate for Payer: Zelis Medicare |
$14.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.44
|
| Rate for Payer: Zelis Worker's Compensation |
$18.36
|
|
|
CTA ABD
|
Facility
|
IP
|
$4,019.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
2351018
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$322.69 |
| Max. Negotiated Rate |
$3,818.05 |
| Rate for Payer: Cash Price |
$2,411.40
|
| Rate for Payer: Cash Price |
$2,411.40
|
| Rate for Payer: Cigna Commercial |
$3,416.15
|
| Rate for Payer: First Health Commercial |
$3,617.10
|
| Rate for Payer: First Health Workers Compensation |
$456.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,617.10
|
| Rate for Payer: GEHA Commercial |
$2,813.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,617.10
|
| Rate for Payer: Multiplan All |
$3,657.29
|
| Rate for Payer: OMNI Networks Commercial |
$2,813.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,617.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,818.05
|
| Rate for Payer: Three Rivers Provider Network All |
$3,014.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,737.67
|
| Rate for Payer: Zelis Auto |
$1,607.60
|
| Rate for Payer: Zelis Worker's Compensation |
$322.69
|
|
|
CTA ABD
|
Facility
|
OP
|
$4,019.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
2351018
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,818.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$510.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,411.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$510.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$404.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$169.04
|
| Rate for Payer: Cash Price |
$2,411.40
|
| Rate for Payer: Cash Price |
$2,411.40
|
| Rate for Payer: Cigna Commercial |
$3,416.15
|
| Rate for Payer: First Health Commercial |
$3,617.10
|
| Rate for Payer: First Health Workers Compensation |
$456.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,617.10
|
| Rate for Payer: GEHA Commercial |
$3,215.20
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,617.10
|
| Rate for Payer: Humana ChoiceCare |
$185.94
|
| Rate for Payer: Humana Medicare Advantage |
$169.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$283.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$412.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$3,657.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,813.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,617.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$476.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$412.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$169.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,818.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$3,014.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$3,416.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$412.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,737.67
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,607.60
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$322.69
|
|
|
CTA ABD AORTA W/RUN
|
Facility
|
OP
|
$4,240.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
2351019
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$4,028.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$510.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,544.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$510.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$404.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$169.04
|
| Rate for Payer: Cash Price |
$2,544.00
|
| Rate for Payer: Cash Price |
$2,544.00
|
| Rate for Payer: Cigna Commercial |
$3,604.00
|
| Rate for Payer: First Health Commercial |
$3,816.00
|
| Rate for Payer: First Health Workers Compensation |
$565.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,816.00
|
| Rate for Payer: GEHA Commercial |
$3,392.00
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,816.00
|
| Rate for Payer: Humana ChoiceCare |
$185.94
|
| Rate for Payer: Humana Medicare Advantage |
$169.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$283.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$412.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$3,858.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,968.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,816.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$476.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$412.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$169.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,028.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$3,180.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$3,604.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$412.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,943.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,696.00
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$400.07
|
|
|
CTA ABD AORTA W/RUN
|
Facility
|
IP
|
$4,240.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
2351019
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$400.07 |
| Max. Negotiated Rate |
$4,028.00 |
| Rate for Payer: Cash Price |
$2,544.00
|
| Rate for Payer: Cash Price |
$2,544.00
|
| Rate for Payer: Cigna Commercial |
$3,604.00
|
| Rate for Payer: First Health Commercial |
$3,816.00
|
| Rate for Payer: First Health Workers Compensation |
$565.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,816.00
|
| Rate for Payer: GEHA Commercial |
$2,968.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,816.00
|
| Rate for Payer: Multiplan All |
$3,858.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,968.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,816.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,028.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,180.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,943.20
|
| Rate for Payer: Zelis Auto |
$1,696.00
|
| Rate for Payer: Zelis Worker's Compensation |
$400.07
|
|
|
CTA ABD/PELV
|
Facility
|
OP
|
$6,549.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
2380024
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$6,221.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$838.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,929.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$838.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$664.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$3,929.40
|
| Rate for Payer: Cash Price |
$3,929.40
|
| Rate for Payer: Cigna Commercial |
$5,566.65
|
| Rate for Payer: First Health Commercial |
$5,894.10
|
| Rate for Payer: First Health Workers Compensation |
$606.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,894.10
|
| Rate for Payer: GEHA Commercial |
$5,239.20
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,894.10
|
| 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 |
$677.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$5,959.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$4,584.30
|
| Rate for Payer: One Health Plan PPO/POS |
$5,894.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$782.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$677.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,221.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$4,911.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$5,566.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$677.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,090.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,619.60
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$428.94
|
|
|
CTA ABD/PELV
|
Facility
|
IP
|
$6,549.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
2380024
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$428.94 |
| Max. Negotiated Rate |
$6,221.55 |
| Rate for Payer: Cash Price |
$3,929.40
|
| Rate for Payer: Cash Price |
$3,929.40
|
| Rate for Payer: Cigna Commercial |
$5,566.65
|
| Rate for Payer: First Health Commercial |
$5,894.10
|
| Rate for Payer: First Health Workers Compensation |
$606.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,894.10
|
| Rate for Payer: GEHA Commercial |
$4,584.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,894.10
|
| Rate for Payer: Multiplan All |
$5,959.59
|
| Rate for Payer: OMNI Networks Commercial |
$4,584.30
|
| Rate for Payer: One Health Plan PPO/POS |
$5,894.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,221.55
|
| Rate for Payer: Three Rivers Provider Network All |
$4,911.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,090.57
|
| Rate for Payer: Zelis Auto |
$2,619.60
|
| Rate for Payer: Zelis Worker's Compensation |
$428.94
|
|
|
CT ABD/PELV W/CON
|
Facility
|
IP
|
$6,568.90
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
2367176
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$284.05 |
| Max. Negotiated Rate |
$6,240.45 |
| Rate for Payer: Cash Price |
$3,941.34
|
| Rate for Payer: Cash Price |
$3,941.34
|
| Rate for Payer: Cigna Commercial |
$5,583.56
|
| Rate for Payer: First Health Commercial |
$5,912.01
|
| Rate for Payer: First Health Workers Compensation |
$401.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,912.01
|
| Rate for Payer: GEHA Commercial |
$4,598.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,912.01
|
| Rate for Payer: Multiplan All |
$5,977.70
|
| Rate for Payer: OMNI Networks Commercial |
$4,598.23
|
| Rate for Payer: One Health Plan PPO/POS |
$5,912.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,240.45
|
| Rate for Payer: Three Rivers Provider Network All |
$4,926.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,109.08
|
| Rate for Payer: Zelis Auto |
$2,627.56
|
| Rate for Payer: Zelis Worker's Compensation |
$284.05
|
|
|
CT ABD/PELV W/CON
|
Facility
|
OP
|
$6,568.90
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
2367176
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$284.05 |
| Max. Negotiated Rate |
$6,240.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$440.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,941.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$440.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$348.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$3,941.34
|
| Rate for Payer: Cash Price |
$3,941.34
|
| Rate for Payer: Cigna Commercial |
$5,583.56
|
| Rate for Payer: First Health Commercial |
$5,912.01
|
| Rate for Payer: First Health Workers Compensation |
$401.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,912.01
|
| Rate for Payer: GEHA Commercial |
$5,255.12
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,912.01
|
| 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 |
$355.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$5,977.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$4,598.23
|
| Rate for Payer: One Health Plan PPO/POS |
$5,912.01
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$410.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$355.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,240.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$4,926.68
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$5,583.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$355.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,109.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,627.56
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$284.05
|
|
|
CT ABD/PELV W/O
|
Facility
|
OP
|
$5,435.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
2367175
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$178.28 |
| Max. Negotiated Rate |
$5,163.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$284.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,261.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$284.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$225.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$3,261.00
|
| Rate for Payer: Cash Price |
$3,261.00
|
| Rate for Payer: Cigna Commercial |
$4,619.75
|
| Rate for Payer: First Health Commercial |
$4,891.50
|
| Rate for Payer: First Health Workers Compensation |
$252.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,891.50
|
| Rate for Payer: GEHA Commercial |
$4,348.00
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,891.50
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$230.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$4,945.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$3,804.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,891.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$265.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$230.02
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,163.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$4,076.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$4,619.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$230.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,054.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$2,174.00
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$178.28
|
|
|
CT ABD/PELV W/O
|
Facility
|
IP
|
$5,435.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
2367175
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$178.28 |
| Max. Negotiated Rate |
$5,163.25 |
| Rate for Payer: Cash Price |
$3,261.00
|
| Rate for Payer: Cash Price |
$3,261.00
|
| Rate for Payer: Cigna Commercial |
$4,619.75
|
| Rate for Payer: First Health Commercial |
$4,891.50
|
| Rate for Payer: First Health Workers Compensation |
$252.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,891.50
|
| Rate for Payer: GEHA Commercial |
$3,804.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,891.50
|
| Rate for Payer: Multiplan All |
$4,945.85
|
| Rate for Payer: OMNI Networks Commercial |
$3,804.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4,891.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,163.25
|
| Rate for Payer: Three Rivers Provider Network All |
$4,076.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,054.55
|
| Rate for Payer: Zelis Auto |
$2,174.00
|
| Rate for Payer: Zelis Worker's Compensation |
$178.28
|
|
|
CT ABD/PELV W/WO
|
Facility
|
IP
|
$7,023.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
2367177
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$348.06 |
| Max. Negotiated Rate |
$6,671.85 |
| Rate for Payer: Cash Price |
$4,213.80
|
| Rate for Payer: Cash Price |
$4,213.80
|
| Rate for Payer: Cigna Commercial |
$5,969.55
|
| Rate for Payer: First Health Commercial |
$6,320.70
|
| Rate for Payer: First Health Workers Compensation |
$492.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,320.70
|
| Rate for Payer: GEHA Commercial |
$4,916.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,320.70
|
| Rate for Payer: Multiplan All |
$6,390.93
|
| Rate for Payer: OMNI Networks Commercial |
$4,916.10
|
| Rate for Payer: One Health Plan PPO/POS |
$6,320.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,671.85
|
| Rate for Payer: Three Rivers Provider Network All |
$5,267.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,531.39
|
| Rate for Payer: Zelis Auto |
$2,809.20
|
| Rate for Payer: Zelis Worker's Compensation |
$348.06
|
|
|
CT ABD/PELV W/WO
|
Facility
|
OP
|
$7,023.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
2367177
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$6,671.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$490.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,213.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$490.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$388.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$4,213.80
|
| Rate for Payer: Cash Price |
$4,213.80
|
| Rate for Payer: Cigna Commercial |
$5,969.55
|
| Rate for Payer: First Health Commercial |
$6,320.70
|
| Rate for Payer: First Health Workers Compensation |
$492.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,320.70
|
| Rate for Payer: GEHA Commercial |
$5,618.40
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,320.70
|
| 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 |
$396.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$6,390.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$4,916.10
|
| Rate for Payer: One Health Plan PPO/POS |
$6,320.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$457.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$396.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,671.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$5,267.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$5,969.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$396.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,531.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,809.20
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$348.06
|
|
|
CT ABD W/CON
|
Facility
|
OP
|
$3,513.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
2300129
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,337.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$445.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,107.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$445.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$352.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$169.04
|
| Rate for Payer: Cash Price |
$2,107.80
|
| Rate for Payer: Cash Price |
$2,107.80
|
| Rate for Payer: Cigna Commercial |
$2,986.05
|
| Rate for Payer: First Health Commercial |
$3,161.70
|
| Rate for Payer: First Health Workers Compensation |
$344.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,161.70
|
| Rate for Payer: GEHA Commercial |
$2,810.40
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,161.70
|
| Rate for Payer: Humana ChoiceCare |
$185.94
|
| Rate for Payer: Humana Medicare Advantage |
$169.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$283.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$360.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$3,196.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,459.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,161.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$415.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$360.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$169.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,337.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,634.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$2,986.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$360.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,267.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,405.20
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$243.38
|
|
|
CT ABD W/CON
|
Facility
|
IP
|
$3,513.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
2300129
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$243.38 |
| Max. Negotiated Rate |
$3,337.35 |
| Rate for Payer: Cash Price |
$2,107.80
|
| Rate for Payer: Cash Price |
$2,107.80
|
| Rate for Payer: Cigna Commercial |
$2,986.05
|
| Rate for Payer: First Health Commercial |
$3,161.70
|
| Rate for Payer: First Health Workers Compensation |
$344.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,161.70
|
| Rate for Payer: GEHA Commercial |
$2,459.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,161.70
|
| Rate for Payer: Multiplan All |
$3,196.83
|
| Rate for Payer: OMNI Networks Commercial |
$2,459.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,161.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,337.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,634.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,267.09
|
| Rate for Payer: Zelis Auto |
$1,405.20
|
| Rate for Payer: Zelis Worker's Compensation |
$243.38
|
|
|
CT ABD W/O
|
Facility
|
OP
|
$2,964.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
2300130
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$2,815.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$292.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,778.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$292.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$231.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$1,778.40
|
| Rate for Payer: Cash Price |
$1,778.40
|
| Rate for Payer: Cigna Commercial |
$2,519.40
|
| Rate for Payer: First Health Commercial |
$2,667.60
|
| Rate for Payer: First Health Workers Compensation |
$272.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,667.60
|
| Rate for Payer: GEHA Commercial |
$2,371.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,667.60
|
| 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 |
$236.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$2,697.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$2,074.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,667.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$273.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$236.52
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,815.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$2,223.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$2,519.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$236.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,756.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$1,185.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$192.54
|
|
|
CT ABD W/O
|
Facility
|
IP
|
$2,964.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
2300130
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$192.54 |
| Max. Negotiated Rate |
$2,815.80 |
| Rate for Payer: Cash Price |
$1,778.40
|
| Rate for Payer: Cash Price |
$1,778.40
|
| Rate for Payer: Cigna Commercial |
$2,519.40
|
| Rate for Payer: First Health Commercial |
$2,667.60
|
| Rate for Payer: First Health Workers Compensation |
$272.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,667.60
|
| Rate for Payer: GEHA Commercial |
$2,074.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,667.60
|
| Rate for Payer: Multiplan All |
$2,697.24
|
| Rate for Payer: OMNI Networks Commercial |
$2,074.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,667.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,815.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,223.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,756.52
|
| Rate for Payer: Zelis Auto |
$1,185.60
|
| Rate for Payer: Zelis Worker's Compensation |
$192.54
|
|
|
CT ABD W/WO
|
Facility
|
OP
|
$4,248.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
2300158
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$4,035.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$500.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,548.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$500.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$396.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$169.04
|
| Rate for Payer: Cash Price |
$2,548.80
|
| Rate for Payer: Cash Price |
$2,548.80
|
| Rate for Payer: Cigna Commercial |
$3,610.80
|
| Rate for Payer: First Health Commercial |
$3,823.20
|
| Rate for Payer: First Health Workers Compensation |
$428.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,823.20
|
| Rate for Payer: GEHA Commercial |
$3,398.40
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,823.20
|
| Rate for Payer: Humana ChoiceCare |
$185.94
|
| Rate for Payer: Humana Medicare Advantage |
$169.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$283.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$404.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$3,865.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,973.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,823.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$466.93
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$404.39
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$169.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,035.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$3,186.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$3,610.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$404.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,950.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,699.20
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$303.13
|
|
|
CT ABD W/WO
|
Facility
|
IP
|
$4,248.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
2300158
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$303.13 |
| Max. Negotiated Rate |
$4,035.60 |
| Rate for Payer: Cash Price |
$2,548.80
|
| Rate for Payer: Cash Price |
$2,548.80
|
| Rate for Payer: Cigna Commercial |
$3,610.80
|
| Rate for Payer: First Health Commercial |
$3,823.20
|
| Rate for Payer: First Health Workers Compensation |
$428.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,823.20
|
| Rate for Payer: GEHA Commercial |
$2,973.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,823.20
|
| Rate for Payer: Multiplan All |
$3,865.68
|
| Rate for Payer: OMNI Networks Commercial |
$2,973.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,823.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,035.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,186.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,950.64
|
| Rate for Payer: Zelis Auto |
$1,699.20
|
| Rate for Payer: Zelis Worker's Compensation |
$303.13
|
|
