|
CT CHEST LOW DOSE
|
Facility
|
IP
|
$1,192.00
|
|
|
Service Code
|
CPT 71271
|
| Hospital Charge Code |
2300297
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$127.18 |
| Max. Negotiated Rate |
$1,132.40 |
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Cigna Commercial |
$1,013.20
|
| Rate for Payer: First Health Commercial |
$1,072.80
|
| Rate for Payer: First Health Workers Compensation |
$179.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,072.80
|
| Rate for Payer: GEHA Commercial |
$834.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,072.80
|
| Rate for Payer: Multiplan All |
$1,084.72
|
| Rate for Payer: OMNI Networks Commercial |
$834.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,072.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,132.40
|
| Rate for Payer: Three Rivers Provider Network All |
$894.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,108.56
|
| Rate for Payer: Zelis Auto |
$476.80
|
| Rate for Payer: Zelis Worker's Compensation |
$127.18
|
|
|
CT CHEST W/CON
|
Facility
|
IP
|
$3,531.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
2300132
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$242.51 |
| Max. Negotiated Rate |
$3,354.45 |
| Rate for Payer: Cash Price |
$2,118.60
|
| Rate for Payer: Cash Price |
$2,118.60
|
| Rate for Payer: Cigna Commercial |
$3,001.35
|
| Rate for Payer: First Health Commercial |
$3,177.90
|
| Rate for Payer: First Health Workers Compensation |
$342.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,177.90
|
| Rate for Payer: GEHA Commercial |
$2,471.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,177.90
|
| Rate for Payer: Multiplan All |
$3,213.21
|
| Rate for Payer: OMNI Networks Commercial |
$2,471.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,177.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,354.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,648.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,283.83
|
| Rate for Payer: Zelis Auto |
$1,412.40
|
| Rate for Payer: Zelis Worker's Compensation |
$242.51
|
|
|
CT CHEST W/CON
|
Facility
|
OP
|
$3,531.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
2300132
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,354.45 |
| 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 |
$2,118.60
|
| 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 |
$2,118.60
|
| Rate for Payer: Cash Price |
$2,118.60
|
| Rate for Payer: Cigna Commercial |
$3,001.35
|
| Rate for Payer: First Health Commercial |
$3,177.90
|
| Rate for Payer: First Health Workers Compensation |
$342.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,177.90
|
| Rate for Payer: GEHA Commercial |
$2,824.80
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,177.90
|
| 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 |
$3,213.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,471.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,177.90
|
| 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 |
$3,354.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,648.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$3,001.35
|
| 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 |
$3,283.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,412.40
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$242.51
|
|
|
CT CHEST W/O
|
Facility
|
OP
|
$3,016.90
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
2300133
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$2,866.05 |
| 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 |
$1,810.14
|
| 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 |
$1,810.14
|
| Rate for Payer: Cash Price |
$1,810.14
|
| Rate for Payer: Cigna Commercial |
$2,564.36
|
| Rate for Payer: First Health Commercial |
$2,715.21
|
| Rate for Payer: First Health Workers Compensation |
$281.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,715.21
|
| Rate for Payer: GEHA Commercial |
$2,413.52
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,715.21
|
| 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 |
$2,745.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$2,111.83
|
| Rate for Payer: One Health Plan PPO/POS |
$2,715.21
|
| 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 |
$2,866.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$2,262.68
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$2,564.36
|
| 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 |
$2,805.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$1,206.76
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$199.14
|
|
|
CT CHEST W/O
|
Facility
|
IP
|
$3,016.90
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
2300133
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$199.14 |
| Max. Negotiated Rate |
$2,866.05 |
| Rate for Payer: Cash Price |
$1,810.14
|
| Rate for Payer: Cash Price |
$1,810.14
|
| Rate for Payer: Cigna Commercial |
$2,564.36
|
| Rate for Payer: First Health Commercial |
$2,715.21
|
| Rate for Payer: First Health Workers Compensation |
$281.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,715.21
|
| Rate for Payer: GEHA Commercial |
$2,111.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,715.21
|
| Rate for Payer: Multiplan All |
$2,745.38
|
| Rate for Payer: OMNI Networks Commercial |
$2,111.83
|
| Rate for Payer: One Health Plan PPO/POS |
$2,715.21
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,866.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,262.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,805.72
|
| Rate for Payer: Zelis Auto |
$1,206.76
|
| Rate for Payer: Zelis Worker's Compensation |
$199.14
|
|
|
CT CHEST W/WO
|
Facility
|
OP
|
$4,139.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
2300134
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,932.05 |
| 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 |
$2,483.40
|
| 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 |
$2,483.40
|
| Rate for Payer: Cash Price |
$2,483.40
|
| Rate for Payer: Cigna Commercial |
$3,518.15
|
| Rate for Payer: First Health Commercial |
$3,725.10
|
| Rate for Payer: First Health Workers Compensation |
$412.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,725.10
|
| Rate for Payer: GEHA Commercial |
$3,311.20
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,725.10
|
| 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 |
$404.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$3,766.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,897.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,725.10
|
| 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 |
$3,932.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$3,104.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$3,518.15
|
| 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 |
$3,849.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,655.60
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$291.49
|
|
|
CT CHEST W/WO
|
Facility
|
IP
|
$4,139.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
2300134
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$291.49 |
| Max. Negotiated Rate |
$3,932.05 |
| Rate for Payer: Cash Price |
$2,483.40
|
| Rate for Payer: Cash Price |
$2,483.40
|
| Rate for Payer: Cigna Commercial |
$3,518.15
|
| Rate for Payer: First Health Commercial |
$3,725.10
|
| Rate for Payer: First Health Workers Compensation |
$412.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,725.10
|
| Rate for Payer: GEHA Commercial |
$2,897.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,725.10
|
| Rate for Payer: Multiplan All |
$3,766.49
|
| Rate for Payer: OMNI Networks Commercial |
$2,897.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,725.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,932.05
|
| Rate for Payer: Three Rivers Provider Network All |
$3,104.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,849.27
|
| Rate for Payer: Zelis Auto |
$1,655.60
|
| Rate for Payer: Zelis Worker's Compensation |
$291.49
|
|
|
CT C-SPINE W/CON
|
Facility
|
IP
|
$3,667.00
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
2300152
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$243.82 |
| Max. Negotiated Rate |
$3,483.65 |
| Rate for Payer: Cash Price |
$2,200.20
|
| Rate for Payer: Cash Price |
$2,200.20
|
| Rate for Payer: Cigna Commercial |
$3,116.95
|
| Rate for Payer: First Health Commercial |
$3,300.30
|
| Rate for Payer: First Health Workers Compensation |
$344.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,300.30
|
| Rate for Payer: GEHA Commercial |
$2,566.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,300.30
|
| Rate for Payer: Multiplan All |
$3,336.97
|
| Rate for Payer: OMNI Networks Commercial |
$2,566.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,300.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,483.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,750.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,410.31
|
| Rate for Payer: Zelis Auto |
$1,466.80
|
| Rate for Payer: Zelis Worker's Compensation |
$243.82
|
|
|
CT C-SPINE W/CON
|
Facility
|
OP
|
$3,667.00
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
2300152
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$243.82 |
| Max. Negotiated Rate |
$3,483.65 |
| 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 |
$2,200.20
|
| 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 |
$339.11
|
| Rate for Payer: Cash Price |
$2,200.20
|
| Rate for Payer: Cash Price |
$2,200.20
|
| Rate for Payer: Cigna Commercial |
$3,116.95
|
| Rate for Payer: First Health Commercial |
$3,300.30
|
| Rate for Payer: First Health Workers Compensation |
$344.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,300.30
|
| Rate for Payer: GEHA Commercial |
$2,933.60
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,300.30
|
| 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 |
$360.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$3,336.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$2,566.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,300.30
|
| 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 |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,483.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$2,750.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$3,116.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$360.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,410.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$1,466.80
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$243.82
|
|
|
CT C-SPINE W/O
|
Facility
|
IP
|
$3,446.40
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
2300153
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$206.42 |
| Max. Negotiated Rate |
$3,274.08 |
| Rate for Payer: Cash Price |
$2,067.84
|
| Rate for Payer: Cash Price |
$2,067.84
|
| Rate for Payer: Cigna Commercial |
$2,929.44
|
| Rate for Payer: First Health Commercial |
$3,101.76
|
| Rate for Payer: First Health Workers Compensation |
$291.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,101.76
|
| Rate for Payer: GEHA Commercial |
$2,412.48
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,101.76
|
| Rate for Payer: Multiplan All |
$3,136.22
|
| Rate for Payer: OMNI Networks Commercial |
$2,412.48
|
| Rate for Payer: One Health Plan PPO/POS |
$3,101.76
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,274.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,584.80
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,205.15
|
| Rate for Payer: Zelis Auto |
$1,378.56
|
| Rate for Payer: Zelis Worker's Compensation |
$206.42
|
|
|
CT C-SPINE W/O
|
Facility
|
OP
|
$3,446.40
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
2300153
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$3,274.08 |
| 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 |
$2,067.84
|
| 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 |
$2,067.84
|
| Rate for Payer: Cash Price |
$2,067.84
|
| Rate for Payer: Cigna Commercial |
$2,929.44
|
| Rate for Payer: First Health Commercial |
$3,101.76
|
| Rate for Payer: First Health Workers Compensation |
$291.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,101.76
|
| Rate for Payer: GEHA Commercial |
$2,757.12
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,101.76
|
| 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 |
$3,136.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$2,412.48
|
| Rate for Payer: One Health Plan PPO/POS |
$3,101.76
|
| 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 |
$3,274.08
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$2,584.80
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$2,929.44
|
| 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 |
$3,205.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$1,378.56
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$206.42
|
|
|
CT C-SPINE W/WO
|
Facility
|
OP
|
$4,186.00
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
2351010
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,976.70 |
| 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 |
$2,511.60
|
| 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 |
$2,511.60
|
| Rate for Payer: Cash Price |
$2,511.60
|
| Rate for Payer: Cigna Commercial |
$3,558.10
|
| Rate for Payer: First Health Commercial |
$3,767.40
|
| Rate for Payer: First Health Workers Compensation |
$414.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,767.40
|
| Rate for Payer: GEHA Commercial |
$3,348.80
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,767.40
|
| 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 |
$3,809.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,930.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,767.40
|
| 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 |
$3,976.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$3,139.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$3,558.10
|
| 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 |
$3,892.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,674.40
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$293.40
|
|
|
CT C-SPINE W/WO
|
Facility
|
IP
|
$4,186.00
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
2351010
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$293.40 |
| Max. Negotiated Rate |
$3,976.70 |
| Rate for Payer: Cash Price |
$2,511.60
|
| Rate for Payer: Cash Price |
$2,511.60
|
| Rate for Payer: Cigna Commercial |
$3,558.10
|
| Rate for Payer: First Health Commercial |
$3,767.40
|
| Rate for Payer: First Health Workers Compensation |
$414.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,767.40
|
| Rate for Payer: GEHA Commercial |
$2,930.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,767.40
|
| Rate for Payer: Multiplan All |
$3,809.26
|
| Rate for Payer: OMNI Networks Commercial |
$2,930.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,767.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,976.70
|
| Rate for Payer: Three Rivers Provider Network All |
$3,139.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,892.98
|
| Rate for Payer: Zelis Auto |
$1,674.40
|
| Rate for Payer: Zelis Worker's Compensation |
$293.40
|
|
|
CT FACIAL W/CON
|
Facility
|
IP
|
$3,303.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
2300544
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$237.21 |
| Max. Negotiated Rate |
$3,137.85 |
| Rate for Payer: Cash Price |
$1,981.80
|
| Rate for Payer: Cash Price |
$1,981.80
|
| Rate for Payer: Cigna Commercial |
$2,807.55
|
| Rate for Payer: First Health Commercial |
$2,972.70
|
| Rate for Payer: First Health Workers Compensation |
$335.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,972.70
|
| Rate for Payer: GEHA Commercial |
$2,312.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,972.70
|
| Rate for Payer: Multiplan All |
$3,005.73
|
| Rate for Payer: OMNI Networks Commercial |
$2,312.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,972.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,137.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,477.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,071.79
|
| Rate for Payer: Zelis Auto |
$1,321.20
|
| Rate for Payer: Zelis Worker's Compensation |
$237.21
|
|
|
CT FACIAL W/CON
|
Facility
|
OP
|
$3,303.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
2300544
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,137.85 |
| 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 |
$1,981.80
|
| 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 |
$1,981.80
|
| Rate for Payer: Cash Price |
$1,981.80
|
| Rate for Payer: Cigna Commercial |
$2,807.55
|
| Rate for Payer: First Health Commercial |
$2,972.70
|
| Rate for Payer: First Health Workers Compensation |
$335.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,972.70
|
| Rate for Payer: GEHA Commercial |
$2,642.40
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,972.70
|
| 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 |
$3,005.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,312.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,972.70
|
| 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 |
$3,137.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,477.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$2,807.55
|
| 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 |
$3,071.79
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,321.20
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$237.21
|
|
|
CT FACIAL W/O
|
Facility
|
IP
|
$2,790.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
2300137
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$196.62 |
| Max. Negotiated Rate |
$2,650.50 |
| Rate for Payer: Cash Price |
$1,674.00
|
| Rate for Payer: Cash Price |
$1,674.00
|
| Rate for Payer: Cigna Commercial |
$2,371.50
|
| Rate for Payer: First Health Commercial |
$2,511.00
|
| Rate for Payer: First Health Workers Compensation |
$278.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,511.00
|
| Rate for Payer: GEHA Commercial |
$1,953.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,511.00
|
| Rate for Payer: Multiplan All |
$2,538.90
|
| Rate for Payer: OMNI Networks Commercial |
$1,953.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,511.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,650.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,092.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,594.70
|
| Rate for Payer: Zelis Auto |
$1,116.00
|
| Rate for Payer: Zelis Worker's Compensation |
$196.62
|
|
|
CT FACIAL W/O
|
Facility
|
OP
|
$2,790.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
2300137
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$2,650.50 |
| 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 |
$1,674.00
|
| 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 |
$1,674.00
|
| Rate for Payer: Cash Price |
$1,674.00
|
| Rate for Payer: Cigna Commercial |
$2,371.50
|
| Rate for Payer: First Health Commercial |
$2,511.00
|
| Rate for Payer: First Health Workers Compensation |
$278.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,511.00
|
| Rate for Payer: GEHA Commercial |
$2,232.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,511.00
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$236.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$2,538.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$1,953.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,511.00
|
| 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 |
$2,650.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$2,092.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$2,371.50
|
| 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 |
$2,594.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$1,116.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$196.62
|
|
|
CT FACIAL W/WO
|
Facility
|
OP
|
$3,656.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
2300138
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,473.20 |
| 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 |
$2,193.60
|
| 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 |
$2,193.60
|
| Rate for Payer: Cash Price |
$2,193.60
|
| Rate for Payer: Cigna Commercial |
$3,107.60
|
| Rate for Payer: First Health Commercial |
$3,290.40
|
| Rate for Payer: First Health Workers Compensation |
$407.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,290.40
|
| Rate for Payer: GEHA Commercial |
$2,924.80
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,290.40
|
| 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 |
$3,326.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,559.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,290.40
|
| 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 |
$3,473.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,742.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$3,107.60
|
| 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 |
$3,400.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,462.40
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$287.91
|
|
|
CT FACIAL W/WO
|
Facility
|
IP
|
$3,656.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
2300138
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$287.91 |
| Max. Negotiated Rate |
$3,473.20 |
| Rate for Payer: Cash Price |
$2,193.60
|
| Rate for Payer: Cash Price |
$2,193.60
|
| Rate for Payer: Cigna Commercial |
$3,107.60
|
| Rate for Payer: First Health Commercial |
$3,290.40
|
| Rate for Payer: First Health Workers Compensation |
$407.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,290.40
|
| Rate for Payer: GEHA Commercial |
$2,559.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,290.40
|
| Rate for Payer: Multiplan All |
$3,326.96
|
| Rate for Payer: OMNI Networks Commercial |
$2,559.20
|
| Rate for Payer: One Health Plan PPO/POS |
$3,290.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,473.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,742.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,400.08
|
| Rate for Payer: Zelis Auto |
$1,462.40
|
| Rate for Payer: Zelis Worker's Compensation |
$287.91
|
|
|
CT GUIDED PLACEMENT
|
Facility
|
IP
|
$3,133.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
2300142
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$254.55 |
| Max. Negotiated Rate |
$2,976.35 |
| Rate for Payer: Cash Price |
$1,879.80
|
| Rate for Payer: Cash Price |
$1,879.80
|
| Rate for Payer: Cigna Commercial |
$2,663.05
|
| Rate for Payer: First Health Commercial |
$2,819.70
|
| Rate for Payer: First Health Workers Compensation |
$360.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,819.70
|
| Rate for Payer: GEHA Commercial |
$2,193.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,819.70
|
| Rate for Payer: Multiplan All |
$2,851.03
|
| Rate for Payer: OMNI Networks Commercial |
$2,193.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,819.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,976.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,349.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,913.69
|
| Rate for Payer: Zelis Auto |
$1,253.20
|
| Rate for Payer: Zelis Worker's Compensation |
$254.55
|
|
|
CT GUIDED PLACEMENT
|
Facility
|
OP
|
$3,133.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
2300142
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$254.55 |
| Max. Negotiated Rate |
$2,976.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,879.80
|
| Rate for Payer: Cash Price |
$1,879.80
|
| Rate for Payer: Cash Price |
$1,879.80
|
| Rate for Payer: Cigna Commercial |
$2,663.05
|
| Rate for Payer: First Health Commercial |
$2,819.70
|
| Rate for Payer: First Health Workers Compensation |
$360.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,819.70
|
| Rate for Payer: GEHA Commercial |
$2,506.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,819.70
|
| Rate for Payer: Humana ChoiceCare |
$814.58
|
| Rate for Payer: Multiplan All |
$2,851.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,879.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,193.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,819.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,976.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,349.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,757.04
|
| Rate for Payer: United Healthcare Commercial |
$2,663.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$783.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,913.69
|
| Rate for Payer: Zelis Auto |
$1,253.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,566.50
|
| Rate for Payer: Zelis Worker's Compensation |
$254.55
|
|
|
CT HEAD STROKE ALERT
|
Facility
|
OP
|
$2,899.90
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
2370450
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$2,754.91 |
| 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 |
$1,739.94
|
| 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 |
$1,739.94
|
| Rate for Payer: Cash Price |
$1,739.94
|
| Rate for Payer: Cigna Commercial |
$2,464.91
|
| Rate for Payer: First Health Commercial |
$2,609.91
|
| Rate for Payer: First Health Workers Compensation |
$232.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,609.91
|
| Rate for Payer: GEHA Commercial |
$2,319.92
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,609.91
|
| 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 |
$2,638.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$2,029.93
|
| Rate for Payer: One Health Plan PPO/POS |
$2,609.91
|
| 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 |
$2,754.91
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$2,174.93
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$2,464.91
|
| 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 |
$2,696.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$1,159.96
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$164.35
|
|
|
CT HEAD STROKE ALERT
|
Facility
|
IP
|
$2,899.90
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
2370450
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$164.35 |
| Max. Negotiated Rate |
$2,754.91 |
| Rate for Payer: Cash Price |
$1,739.94
|
| Rate for Payer: Cash Price |
$1,739.94
|
| Rate for Payer: Cigna Commercial |
$2,464.91
|
| Rate for Payer: First Health Commercial |
$2,609.91
|
| Rate for Payer: First Health Workers Compensation |
$232.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,609.91
|
| Rate for Payer: GEHA Commercial |
$2,029.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,609.91
|
| Rate for Payer: Multiplan All |
$2,638.91
|
| Rate for Payer: OMNI Networks Commercial |
$2,029.93
|
| Rate for Payer: One Health Plan PPO/POS |
$2,609.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,754.91
|
| Rate for Payer: Three Rivers Provider Network All |
$2,174.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,696.91
|
| Rate for Payer: Zelis Auto |
$1,159.96
|
| Rate for Payer: Zelis Worker's Compensation |
$164.35
|
|
|
CT HEAD W/CON
|
Facility
|
OP
|
$3,097.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
2300139
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$2,942.15 |
| 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 |
$1,858.20
|
| 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 |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$2,632.45
|
| Rate for Payer: First Health Commercial |
$2,787.30
|
| Rate for Payer: First Health Workers Compensation |
$287.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,787.30
|
| Rate for Payer: GEHA Commercial |
$2,477.60
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,787.30
|
| 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 |
$2,818.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,167.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,787.30
|
| 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 |
$2,942.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,322.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$2,632.45
|
| 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 |
$2,880.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,238.80
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$203.63
|
|
|
CT HEAD W/CON
|
Facility
|
IP
|
$3,097.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
2300139
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$203.63 |
| Max. Negotiated Rate |
$2,942.15 |
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$2,632.45
|
| Rate for Payer: First Health Commercial |
$2,787.30
|
| Rate for Payer: First Health Workers Compensation |
$287.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,787.30
|
| Rate for Payer: GEHA Commercial |
$2,167.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,787.30
|
| Rate for Payer: Multiplan All |
$2,818.27
|
| Rate for Payer: OMNI Networks Commercial |
$2,167.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,787.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,942.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,322.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,880.21
|
| Rate for Payer: Zelis Auto |
$1,238.80
|
| Rate for Payer: Zelis Worker's Compensation |
$203.63
|
|
