|
CT HEAD W/O
|
Facility
|
OP
|
$2,899.90
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
2300140
|
|
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 W/O
|
Facility
|
IP
|
$2,899.90
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
2300140
|
|
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/WO
|
Facility
|
IP
|
$3,754.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
2300141
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$242.75 |
| Max. Negotiated Rate |
$3,566.30 |
| Rate for Payer: Cash Price |
$2,252.40
|
| Rate for Payer: Cash Price |
$2,252.40
|
| Rate for Payer: Cigna Commercial |
$3,190.90
|
| Rate for Payer: First Health Commercial |
$3,378.60
|
| Rate for Payer: First Health Workers Compensation |
$343.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,378.60
|
| Rate for Payer: GEHA Commercial |
$2,627.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,378.60
|
| Rate for Payer: Multiplan All |
$3,416.14
|
| Rate for Payer: OMNI Networks Commercial |
$2,627.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,378.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,566.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,815.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,491.22
|
| Rate for Payer: Zelis Auto |
$1,501.60
|
| Rate for Payer: Zelis Worker's Compensation |
$242.75
|
|
|
CT HEAD W/WO
|
Facility
|
OP
|
$3,754.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
2300141
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,566.30 |
| 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 |
$2,252.40
|
| 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 |
$2,252.40
|
| Rate for Payer: Cash Price |
$2,252.40
|
| Rate for Payer: Cigna Commercial |
$3,190.90
|
| Rate for Payer: First Health Commercial |
$3,378.60
|
| Rate for Payer: First Health Workers Compensation |
$343.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,378.60
|
| Rate for Payer: GEHA Commercial |
$3,003.20
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,378.60
|
| 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 |
$3,416.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,627.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,378.60
|
| 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 |
$3,566.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,815.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$3,190.90
|
| 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 |
$3,491.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,501.60
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$242.75
|
|
|
CT LE W/CON
|
Facility
|
IP
|
$3,211.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
2410101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$231.53 |
| Max. Negotiated Rate |
$3,050.45 |
| Rate for Payer: Cash Price |
$1,926.60
|
| Rate for Payer: Cash Price |
$1,926.60
|
| Rate for Payer: Cigna Commercial |
$2,729.35
|
| Rate for Payer: First Health Commercial |
$2,889.90
|
| Rate for Payer: First Health Workers Compensation |
$327.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,889.90
|
| Rate for Payer: GEHA Commercial |
$2,247.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,889.90
|
| Rate for Payer: Multiplan All |
$2,922.01
|
| Rate for Payer: OMNI Networks Commercial |
$2,247.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,889.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,050.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,408.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,986.23
|
| Rate for Payer: Zelis Auto |
$1,284.40
|
| Rate for Payer: Zelis Worker's Compensation |
$231.53
|
|
|
CT LE W/CON
|
Facility
|
OP
|
$3,211.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
2410101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,050.45 |
| 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 |
$1,926.60
|
| 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 |
$1,926.60
|
| Rate for Payer: Cash Price |
$1,926.60
|
| Rate for Payer: Cigna Commercial |
$2,729.35
|
| Rate for Payer: First Health Commercial |
$2,889.90
|
| Rate for Payer: First Health Workers Compensation |
$327.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,889.90
|
| Rate for Payer: GEHA Commercial |
$2,568.80
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,889.90
|
| 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 |
$2,922.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,247.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,889.90
|
| 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 |
$3,050.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,408.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$2,729.35
|
| 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 |
$2,986.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,284.40
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$231.53
|
|
|
CT LE W/CON RIGHT
|
Facility
|
OP
|
$3,211.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
2351431
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,050.45 |
| 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 |
$1,926.60
|
| 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 |
$1,926.60
|
| Rate for Payer: Cash Price |
$1,926.60
|
| Rate for Payer: Cigna Commercial |
$2,729.35
|
| Rate for Payer: First Health Commercial |
$2,889.90
|
| Rate for Payer: First Health Workers Compensation |
$327.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,889.90
|
| Rate for Payer: GEHA Commercial |
$2,568.80
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,889.90
|
| 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 |
$2,922.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,247.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,889.90
|
| 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 |
$3,050.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,408.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$2,729.35
|
| 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 |
$2,986.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,284.40
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$231.53
|
|
|
CT LE W/CON RIGHT
|
Facility
|
IP
|
$3,211.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
2351431
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$231.53 |
| Max. Negotiated Rate |
$3,050.45 |
| Rate for Payer: Cash Price |
$1,926.60
|
| Rate for Payer: Cash Price |
$1,926.60
|
| Rate for Payer: Cigna Commercial |
$2,729.35
|
| Rate for Payer: First Health Commercial |
$2,889.90
|
| Rate for Payer: First Health Workers Compensation |
$327.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,889.90
|
| Rate for Payer: GEHA Commercial |
$2,247.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,889.90
|
| Rate for Payer: Multiplan All |
$2,922.01
|
| Rate for Payer: OMNI Networks Commercial |
$2,247.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,889.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,050.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,408.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,986.23
|
| Rate for Payer: Zelis Auto |
$1,284.40
|
| Rate for Payer: Zelis Worker's Compensation |
$231.53
|
|
|
CT LE W/O
|
Facility
|
IP
|
$2,739.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
2410100
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$188.41 |
| Max. Negotiated Rate |
$2,602.05 |
| Rate for Payer: Cash Price |
$1,643.40
|
| Rate for Payer: Cash Price |
$1,643.40
|
| Rate for Payer: Cigna Commercial |
$2,328.15
|
| Rate for Payer: First Health Commercial |
$2,465.10
|
| Rate for Payer: First Health Workers Compensation |
$266.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,465.10
|
| Rate for Payer: GEHA Commercial |
$1,917.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,465.10
|
| Rate for Payer: Multiplan All |
$2,492.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,917.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,465.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,602.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,054.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,547.27
|
| Rate for Payer: Zelis Auto |
$1,095.60
|
| Rate for Payer: Zelis Worker's Compensation |
$188.41
|
|
|
CT LE W/O
|
Facility
|
OP
|
$2,739.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
2410100
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$2,602.05 |
| 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 |
$1,643.40
|
| 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 |
$1,643.40
|
| Rate for Payer: Cash Price |
$1,643.40
|
| Rate for Payer: Cigna Commercial |
$2,328.15
|
| Rate for Payer: First Health Commercial |
$2,465.10
|
| Rate for Payer: First Health Workers Compensation |
$266.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,465.10
|
| Rate for Payer: GEHA Commercial |
$2,191.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,465.10
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$236.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$2,492.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$1,917.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,465.10
|
| 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 |
$2,602.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$2,054.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$2,328.15
|
| 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 |
$2,547.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$1,095.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$188.41
|
|
|
CT LE W/O RIGHT
|
Facility
|
OP
|
$2,739.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
2351430
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$2,602.05 |
| 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 |
$1,643.40
|
| 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 |
$1,643.40
|
| Rate for Payer: Cash Price |
$1,643.40
|
| Rate for Payer: Cigna Commercial |
$2,328.15
|
| Rate for Payer: First Health Commercial |
$2,465.10
|
| Rate for Payer: First Health Workers Compensation |
$266.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,465.10
|
| Rate for Payer: GEHA Commercial |
$2,191.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,465.10
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$236.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$2,492.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$1,917.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,465.10
|
| 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 |
$2,602.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$2,054.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$2,328.15
|
| 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 |
$2,547.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$1,095.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$188.41
|
|
|
CT LE W/O RIGHT
|
Facility
|
IP
|
$2,739.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
2351430
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$188.41 |
| Max. Negotiated Rate |
$2,602.05 |
| Rate for Payer: Cash Price |
$1,643.40
|
| Rate for Payer: Cash Price |
$1,643.40
|
| Rate for Payer: Cigna Commercial |
$2,328.15
|
| Rate for Payer: First Health Commercial |
$2,465.10
|
| Rate for Payer: First Health Workers Compensation |
$266.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,465.10
|
| Rate for Payer: GEHA Commercial |
$1,917.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,465.10
|
| Rate for Payer: Multiplan All |
$2,492.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,917.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,465.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,602.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,054.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,547.27
|
| Rate for Payer: Zelis Auto |
$1,095.60
|
| Rate for Payer: Zelis Worker's Compensation |
$188.41
|
|
|
CT LE W/WO
|
Facility
|
OP
|
$3,427.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
2410103
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,255.65 |
| 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 |
$2,056.20
|
| 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 |
$2,056.20
|
| Rate for Payer: Cash Price |
$2,056.20
|
| Rate for Payer: Cigna Commercial |
$2,912.95
|
| Rate for Payer: First Health Commercial |
$3,084.30
|
| Rate for Payer: First Health Workers Compensation |
$401.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,084.30
|
| Rate for Payer: GEHA Commercial |
$2,741.60
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,084.30
|
| 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 |
$404.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$3,118.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,398.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,084.30
|
| 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 |
$3,255.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,570.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$2,912.95
|
| 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 |
$3,187.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,370.80
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$283.72
|
|
|
CT LE W/WO
|
Facility
|
IP
|
$3,427.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
2410103
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$283.72 |
| Max. Negotiated Rate |
$3,255.65 |
| Rate for Payer: Cash Price |
$2,056.20
|
| Rate for Payer: Cash Price |
$2,056.20
|
| Rate for Payer: Cigna Commercial |
$2,912.95
|
| Rate for Payer: First Health Commercial |
$3,084.30
|
| Rate for Payer: First Health Workers Compensation |
$401.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,084.30
|
| Rate for Payer: GEHA Commercial |
$2,398.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,084.30
|
| Rate for Payer: Multiplan All |
$3,118.57
|
| Rate for Payer: OMNI Networks Commercial |
$2,398.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,084.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,255.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,570.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,187.11
|
| Rate for Payer: Zelis Auto |
$1,370.80
|
| Rate for Payer: Zelis Worker's Compensation |
$283.72
|
|
|
CT LE W/WO RIGHT
|
Facility
|
OP
|
$3,427.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
2351428
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,255.65 |
| 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 |
$2,056.20
|
| 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 |
$2,056.20
|
| Rate for Payer: Cash Price |
$2,056.20
|
| Rate for Payer: Cigna Commercial |
$2,912.95
|
| Rate for Payer: First Health Commercial |
$3,084.30
|
| Rate for Payer: First Health Workers Compensation |
$401.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,084.30
|
| Rate for Payer: GEHA Commercial |
$2,741.60
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,084.30
|
| 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 |
$404.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$3,118.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,398.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,084.30
|
| 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 |
$3,255.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,570.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$2,912.95
|
| 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 |
$3,187.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,370.80
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$283.72
|
|
|
CT LE W/WO RIGHT
|
Facility
|
IP
|
$3,427.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
2351428
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$283.72 |
| Max. Negotiated Rate |
$3,255.65 |
| Rate for Payer: Cash Price |
$2,056.20
|
| Rate for Payer: Cash Price |
$2,056.20
|
| Rate for Payer: Cigna Commercial |
$2,912.95
|
| Rate for Payer: First Health Commercial |
$3,084.30
|
| Rate for Payer: First Health Workers Compensation |
$401.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,084.30
|
| Rate for Payer: GEHA Commercial |
$2,398.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,084.30
|
| Rate for Payer: Multiplan All |
$3,118.57
|
| Rate for Payer: OMNI Networks Commercial |
$2,398.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,084.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,255.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,570.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,187.11
|
| Rate for Payer: Zelis Auto |
$1,370.80
|
| Rate for Payer: Zelis Worker's Compensation |
$283.72
|
|
|
CT L-SPINE W/CON
|
Facility
|
IP
|
$3,671.00
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
2367179
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$243.69 |
| Max. Negotiated Rate |
$3,487.45 |
| Rate for Payer: Cash Price |
$2,202.60
|
| Rate for Payer: Cash Price |
$2,202.60
|
| Rate for Payer: Cigna Commercial |
$3,120.35
|
| Rate for Payer: First Health Commercial |
$3,303.90
|
| Rate for Payer: First Health Workers Compensation |
$344.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,303.90
|
| Rate for Payer: GEHA Commercial |
$2,569.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,303.90
|
| Rate for Payer: Multiplan All |
$3,340.61
|
| Rate for Payer: OMNI Networks Commercial |
$2,569.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,303.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,487.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,753.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,414.03
|
| Rate for Payer: Zelis Auto |
$1,468.40
|
| Rate for Payer: Zelis Worker's Compensation |
$243.69
|
|
|
CT L-SPINE W/CON
|
Facility
|
OP
|
$3,671.00
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
2367179
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$243.69 |
| Max. Negotiated Rate |
$3,487.45 |
| 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 |
$2,202.60
|
| 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 |
$339.11
|
| Rate for Payer: Cash Price |
$2,202.60
|
| Rate for Payer: Cash Price |
$2,202.60
|
| Rate for Payer: Cigna Commercial |
$3,120.35
|
| Rate for Payer: First Health Commercial |
$3,303.90
|
| Rate for Payer: First Health Workers Compensation |
$344.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,303.90
|
| Rate for Payer: GEHA Commercial |
$2,936.80
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,303.90
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$360.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$3,340.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$2,569.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,303.90
|
| 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 |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,487.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$2,753.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$3,120.35
|
| 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 |
$3,414.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$1,468.40
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$243.69
|
|
|
CT L-SPINE W/O
|
Facility
|
OP
|
$3,240.00
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
2300151
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$3,078.00 |
| 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 |
$1,944.00
|
| 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 |
$1,944.00
|
| Rate for Payer: Cash Price |
$1,944.00
|
| Rate for Payer: Cigna Commercial |
$2,754.00
|
| Rate for Payer: First Health Commercial |
$2,916.00
|
| Rate for Payer: First Health Workers Compensation |
$290.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,916.00
|
| Rate for Payer: GEHA Commercial |
$2,592.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,916.00
|
| 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 |
$2,948.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$2,268.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,916.00
|
| 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 |
$3,078.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$2,430.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$2,754.00
|
| 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 |
$3,013.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$1,296.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$205.53
|
|
|
CT L-SPINE W/O
|
Facility
|
IP
|
$3,240.00
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
2300151
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$205.53 |
| Max. Negotiated Rate |
$3,078.00 |
| Rate for Payer: Cash Price |
$1,944.00
|
| Rate for Payer: Cash Price |
$1,944.00
|
| Rate for Payer: Cigna Commercial |
$2,754.00
|
| Rate for Payer: First Health Commercial |
$2,916.00
|
| Rate for Payer: First Health Workers Compensation |
$290.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,916.00
|
| Rate for Payer: GEHA Commercial |
$2,268.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,916.00
|
| Rate for Payer: Multiplan All |
$2,948.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,268.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,916.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,078.00
|
| Rate for Payer: Three Rivers Provider Network All |
$2,430.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,013.20
|
| Rate for Payer: Zelis Auto |
$1,296.00
|
| Rate for Payer: Zelis Worker's Compensation |
$205.53
|
|
|
CT L-SPINE W/WO
|
Facility
|
IP
|
$4,092.00
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
2300154
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$293.82 |
| Max. Negotiated Rate |
$3,887.40 |
| Rate for Payer: Cash Price |
$2,455.20
|
| Rate for Payer: Cash Price |
$2,455.20
|
| Rate for Payer: Cigna Commercial |
$3,478.20
|
| Rate for Payer: First Health Commercial |
$3,682.80
|
| Rate for Payer: First Health Workers Compensation |
$415.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,682.80
|
| Rate for Payer: GEHA Commercial |
$2,864.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,682.80
|
| Rate for Payer: Multiplan All |
$3,723.72
|
| Rate for Payer: OMNI Networks Commercial |
$2,864.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,682.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,887.40
|
| Rate for Payer: Three Rivers Provider Network All |
$3,069.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,805.56
|
| Rate for Payer: Zelis Auto |
$1,636.80
|
| Rate for Payer: Zelis Worker's Compensation |
$293.82
|
|
|
CT L-SPINE W/WO
|
Facility
|
OP
|
$4,092.00
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
2300154
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,887.40 |
| 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 |
$2,455.20
|
| 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 |
$2,455.20
|
| Rate for Payer: Cash Price |
$2,455.20
|
| Rate for Payer: Cigna Commercial |
$3,478.20
|
| Rate for Payer: First Health Commercial |
$3,682.80
|
| Rate for Payer: First Health Workers Compensation |
$415.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,682.80
|
| Rate for Payer: GEHA Commercial |
$3,273.60
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,682.80
|
| 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 |
$3,723.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,864.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,682.80
|
| 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 |
$3,887.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$3,069.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$3,478.20
|
| 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 |
$3,805.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,636.80
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$293.82
|
|
|
CT MAKO SCAN LOWER EXTREMITY W/O CONTRAS
|
Facility
|
IP
|
$2,739.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
2473700
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$188.41 |
| Max. Negotiated Rate |
$2,602.05 |
| Rate for Payer: Cash Price |
$1,643.40
|
| Rate for Payer: Cash Price |
$1,643.40
|
| Rate for Payer: Cigna Commercial |
$2,328.15
|
| Rate for Payer: First Health Commercial |
$2,465.10
|
| Rate for Payer: First Health Workers Compensation |
$266.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,465.10
|
| Rate for Payer: GEHA Commercial |
$1,917.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,465.10
|
| Rate for Payer: Multiplan All |
$2,492.49
|
| Rate for Payer: OMNI Networks Commercial |
$1,917.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,465.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,602.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,054.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,547.27
|
| Rate for Payer: Zelis Auto |
$1,095.60
|
| Rate for Payer: Zelis Worker's Compensation |
$188.41
|
|
|
CT MAKO SCAN LOWER EXTREMITY W/O CONTRAS
|
Facility
|
OP
|
$2,739.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
2473700
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$2,602.05 |
| 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 |
$1,643.40
|
| 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 |
$1,643.40
|
| Rate for Payer: Cash Price |
$1,643.40
|
| Rate for Payer: Cigna Commercial |
$2,328.15
|
| Rate for Payer: First Health Commercial |
$2,465.10
|
| Rate for Payer: First Health Workers Compensation |
$266.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,465.10
|
| Rate for Payer: GEHA Commercial |
$2,191.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,465.10
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$236.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$2,492.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$1,917.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,465.10
|
| 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 |
$2,602.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$2,054.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$2,328.15
|
| 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 |
$2,547.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$1,095.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$188.41
|
|
|
CT ORBITS/TEMP BONE W/O
|
Facility
|
IP
|
$2,718.00
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
2300144
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$232.98 |
| Max. Negotiated Rate |
$2,582.10 |
| Rate for Payer: Cash Price |
$1,630.80
|
| Rate for Payer: Cash Price |
$1,630.80
|
| Rate for Payer: Cigna Commercial |
$2,310.30
|
| Rate for Payer: First Health Commercial |
$2,446.20
|
| Rate for Payer: First Health Workers Compensation |
$329.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,446.20
|
| Rate for Payer: GEHA Commercial |
$1,902.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,446.20
|
| Rate for Payer: Multiplan All |
$2,473.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,902.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,446.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,582.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,038.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,527.74
|
| Rate for Payer: Zelis Auto |
$1,087.20
|
| Rate for Payer: Zelis Worker's Compensation |
$232.98
|
|
