|
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
|
|
|
CT ORBITS/TEMP BONE W/WO
|
Facility
|
IP
|
$3,549.00
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
2300145
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$308.76 |
| Max. Negotiated Rate |
$3,371.55 |
| Rate for Payer: Cash Price |
$2,129.40
|
| Rate for Payer: Cash Price |
$2,129.40
|
| Rate for Payer: Cigna Commercial |
$3,016.65
|
| Rate for Payer: First Health Commercial |
$3,194.10
|
| Rate for Payer: First Health Workers Compensation |
$436.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,194.10
|
| Rate for Payer: GEHA Commercial |
$2,484.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,194.10
|
| Rate for Payer: Multiplan All |
$3,229.59
|
| Rate for Payer: OMNI Networks Commercial |
$2,484.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,194.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,371.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,661.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,300.57
|
| Rate for Payer: Zelis Auto |
$1,419.60
|
| Rate for Payer: Zelis Worker's Compensation |
$308.76
|
|
|
CT ORBITS/TEMP BONE W/WO
|
Facility
|
OP
|
$3,549.00
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
2300145
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,371.55 |
| 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 |
$2,129.40
|
| 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 |
$2,129.40
|
| Rate for Payer: Cash Price |
$2,129.40
|
| Rate for Payer: Cigna Commercial |
$3,016.65
|
| Rate for Payer: First Health Commercial |
$3,194.10
|
| Rate for Payer: First Health Workers Compensation |
$436.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,194.10
|
| Rate for Payer: GEHA Commercial |
$2,839.20
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,194.10
|
| 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 |
$3,229.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,484.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,194.10
|
| 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 |
$3,371.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,661.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$3,016.65
|
| 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 |
$3,300.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,419.60
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$308.76
|
|
|
CT PELVIS W/CON
|
Facility
|
OP
|
$3,265.00
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
2300146
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,101.75 |
| 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 |
$1,959.00
|
| 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 |
$1,959.00
|
| Rate for Payer: Cash Price |
$1,959.00
|
| Rate for Payer: Cigna Commercial |
$2,775.25
|
| Rate for Payer: First Health Commercial |
$2,938.50
|
| Rate for Payer: First Health Workers Compensation |
$334.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,938.50
|
| Rate for Payer: GEHA Commercial |
$2,612.00
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,938.50
|
| 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 |
$2,971.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,285.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,938.50
|
| 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 |
$3,101.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,448.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$2,775.25
|
| 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 |
$3,036.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,306.00
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$236.83
|
|
|
CT PELVIS W/CON
|
Facility
|
IP
|
$3,265.00
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
2300146
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$236.83 |
| Max. Negotiated Rate |
$3,101.75 |
| Rate for Payer: Cash Price |
$1,959.00
|
| Rate for Payer: Cash Price |
$1,959.00
|
| Rate for Payer: Cigna Commercial |
$2,775.25
|
| Rate for Payer: First Health Commercial |
$2,938.50
|
| Rate for Payer: First Health Workers Compensation |
$334.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,938.50
|
| Rate for Payer: GEHA Commercial |
$2,285.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,938.50
|
| Rate for Payer: Multiplan All |
$2,971.15
|
| Rate for Payer: OMNI Networks Commercial |
$2,285.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,938.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,101.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,448.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,036.45
|
| Rate for Payer: Zelis Auto |
$1,306.00
|
| Rate for Payer: Zelis Worker's Compensation |
$236.83
|
|
|
CT PELVIS W/O
|
Facility
|
IP
|
$2,887.00
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
2300147
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$199.20 |
| Max. Negotiated Rate |
$2,742.65 |
| Rate for Payer: Cash Price |
$1,732.20
|
| Rate for Payer: Cash Price |
$1,732.20
|
| Rate for Payer: Cigna Commercial |
$2,453.95
|
| Rate for Payer: First Health Commercial |
$2,598.30
|
| Rate for Payer: First Health Workers Compensation |
$281.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,598.30
|
| Rate for Payer: GEHA Commercial |
$2,020.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,598.30
|
| Rate for Payer: Multiplan All |
$2,627.17
|
| Rate for Payer: OMNI Networks Commercial |
$2,020.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,598.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,742.65
|
| Rate for Payer: Three Rivers Provider Network All |
$2,165.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,684.91
|
| Rate for Payer: Zelis Auto |
$1,154.80
|
| Rate for Payer: Zelis Worker's Compensation |
$199.20
|
|
|
CT PELVIS W/O
|
Facility
|
OP
|
$2,887.00
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
2300147
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$2,742.65 |
| 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 |
$1,732.20
|
| 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 |
$1,732.20
|
| Rate for Payer: Cash Price |
$1,732.20
|
| Rate for Payer: Cigna Commercial |
$2,453.95
|
| Rate for Payer: First Health Commercial |
$2,598.30
|
| Rate for Payer: First Health Workers Compensation |
$281.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,598.30
|
| Rate for Payer: GEHA Commercial |
$2,309.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,598.30
|
| 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 |
$2,627.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$2,020.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,598.30
|
| 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 |
$2,742.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$2,165.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$2,453.95
|
| 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 |
$2,684.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$1,154.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$199.20
|
|
|
CT PELVIS W/WO
|
Facility
|
OP
|
$4,060.00
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
2300148
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,857.00 |
| 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 |
$2,436.00
|
| 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 |
$2,436.00
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cigna Commercial |
$3,451.00
|
| Rate for Payer: First Health Commercial |
$3,654.00
|
| Rate for Payer: First Health Workers Compensation |
$396.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,654.00
|
| Rate for Payer: GEHA Commercial |
$3,248.00
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,654.00
|
| Rate for Payer: Humana ChoiceCare |
$185.94
|
| Rate for Payer: Humana Medicare Advantage |
$169.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$283.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$404.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$3,694.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,842.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,654.00
|
| 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 |
$3,857.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$3,045.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$3,451.00
|
| 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 |
$3,775.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,624.00
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$280.17
|
|
|
CT PELVIS W/WO
|
Facility
|
IP
|
$4,060.00
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
2300148
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$280.17 |
| Max. Negotiated Rate |
$3,857.00 |
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cigna Commercial |
$3,451.00
|
| Rate for Payer: First Health Commercial |
$3,654.00
|
| Rate for Payer: First Health Workers Compensation |
$396.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,654.00
|
| Rate for Payer: GEHA Commercial |
$2,842.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,654.00
|
| Rate for Payer: Multiplan All |
$3,694.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,842.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,654.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,857.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,045.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,775.80
|
| Rate for Payer: Zelis Auto |
$1,624.00
|
| Rate for Payer: Zelis Worker's Compensation |
$280.17
|
|
|
CT POST PROCESSING MIP/3D
|
Facility
|
OP
|
$992.00
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
2476376
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$92.08 |
| Max. Negotiated Rate |
$942.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$595.20
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Cigna Commercial |
$843.20
|
| Rate for Payer: First Health Commercial |
$892.80
|
| Rate for Payer: First Health Workers Compensation |
$130.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$892.80
|
| Rate for Payer: GEHA Commercial |
$793.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$892.80
|
| Rate for Payer: Humana ChoiceCare |
$257.92
|
| Rate for Payer: Multiplan All |
$902.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$595.20
|
| Rate for Payer: OMNI Networks Commercial |
$694.40
|
| Rate for Payer: One Health Plan PPO/POS |
$892.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$942.40
|
| Rate for Payer: Three Rivers Provider Network All |
$744.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$872.96
|
| Rate for Payer: United Healthcare Commercial |
$843.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$248.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$922.56
|
| Rate for Payer: Zelis Auto |
$396.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$496.00
|
| Rate for Payer: Zelis Worker's Compensation |
$92.08
|
|
|
CT POST PROCESSING MIP/3D
|
Facility
|
IP
|
$992.00
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
2476376
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$92.08 |
| Max. Negotiated Rate |
$942.40 |
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Cigna Commercial |
$843.20
|
| Rate for Payer: First Health Commercial |
$892.80
|
| Rate for Payer: First Health Workers Compensation |
$130.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$892.80
|
| Rate for Payer: GEHA Commercial |
$694.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$892.80
|
| Rate for Payer: Multiplan All |
$902.72
|
| Rate for Payer: OMNI Networks Commercial |
$694.40
|
| Rate for Payer: One Health Plan PPO/POS |
$892.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$942.40
|
| Rate for Payer: Three Rivers Provider Network All |
$744.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$922.56
|
| Rate for Payer: Zelis Auto |
$396.80
|
| Rate for Payer: Zelis Worker's Compensation |
$92.08
|
|
|
CT RENAL STONE LOW DOSE
|
Facility
|
OP
|
$3,901.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
2474176
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$178.28 |
| Max. Negotiated Rate |
$3,705.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$284.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,340.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$284.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$225.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$229.52
|
| Rate for Payer: Cash Price |
$2,340.60
|
| Rate for Payer: Cash Price |
$2,340.60
|
| Rate for Payer: Cigna Commercial |
$3,315.85
|
| Rate for Payer: First Health Commercial |
$3,510.90
|
| Rate for Payer: First Health Workers Compensation |
$252.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,510.90
|
| Rate for Payer: GEHA Commercial |
$3,120.80
|
| Rate for Payer: GEHA Medicare |
$229.52
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,510.90
|
| Rate for Payer: Humana ChoiceCare |
$252.47
|
| Rate for Payer: Humana Medicare Advantage |
$229.52
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$385.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$230.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$229.52
|
| Rate for Payer: Multiplan All |
$3,549.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$390.18
|
| Rate for Payer: OMNI Networks Commercial |
$2,730.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,510.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$265.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$230.02
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$229.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,705.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$459.04
|
| Rate for Payer: Three Rivers Provider Network All |
$2,925.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$224.93
|
| Rate for Payer: United Healthcare Commercial |
$3,315.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$230.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,627.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$229.52
|
| Rate for Payer: Zelis Auto |
$1,560.40
|
| Rate for Payer: Zelis Medicare |
$195.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$275.42
|
| Rate for Payer: Zelis Worker's Compensation |
$178.28
|
|
|
CT RENAL STONE LOW DOSE
|
Facility
|
IP
|
$3,901.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
2474176
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$178.28 |
| Max. Negotiated Rate |
$3,705.95 |
| Rate for Payer: Cash Price |
$2,340.60
|
| Rate for Payer: Cash Price |
$2,340.60
|
| Rate for Payer: Cigna Commercial |
$3,315.85
|
| Rate for Payer: First Health Commercial |
$3,510.90
|
| Rate for Payer: First Health Workers Compensation |
$252.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,510.90
|
| Rate for Payer: GEHA Commercial |
$2,730.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,510.90
|
| Rate for Payer: Multiplan All |
$3,549.91
|
| Rate for Payer: OMNI Networks Commercial |
$2,730.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,510.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,705.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,925.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,627.93
|
| Rate for Payer: Zelis Auto |
$1,560.40
|
| Rate for Payer: Zelis Worker's Compensation |
$178.28
|
|
|
CTRL NASOPHARYNG HEMRRG SMPL W/PST NSL P
|
Facility
|
OP
|
$1,244.00
|
|
|
Service Code
|
CPT 42970
|
| Hospital Charge Code |
8300051
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$92.30 |
| Max. Negotiated Rate |
$1,181.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$746.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$92.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$220.50
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cigna Commercial |
$1,057.40
|
| Rate for Payer: First Health Commercial |
$1,119.60
|
| Rate for Payer: First Health Workers Compensation |
$480.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,119.60
|
| Rate for Payer: GEHA Commercial |
$995.20
|
| Rate for Payer: GEHA Medicare |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,119.60
|
| Rate for Payer: Humana ChoiceCare |
$242.55
|
| Rate for Payer: Humana Medicare Advantage |
$220.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$370.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$94.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$220.50
|
| Rate for Payer: Multiplan All |
$1,132.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$374.85
|
| Rate for Payer: OMNI Networks Commercial |
$870.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,119.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$108.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$94.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,181.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$441.00
|
| Rate for Payer: Three Rivers Provider Network All |
$933.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$216.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,156.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$220.50
|
| Rate for Payer: Zelis Auto |
$497.60
|
| Rate for Payer: Zelis Medicare |
$187.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.60
|
| Rate for Payer: Zelis Worker's Compensation |
$339.61
|
|
|
CTRL NASOPHARYNG HEMRRG SMPL W/PST NSL P
|
Facility
|
IP
|
$1,244.00
|
|
|
Service Code
|
CPT 42970
|
| Hospital Charge Code |
6142970
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$339.61 |
| Max. Negotiated Rate |
$1,181.80 |
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cigna Commercial |
$1,057.40
|
| Rate for Payer: First Health Commercial |
$1,119.60
|
| Rate for Payer: First Health Workers Compensation |
$480.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,119.60
|
| Rate for Payer: GEHA Commercial |
$870.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,119.60
|
| Rate for Payer: Multiplan All |
$1,132.04
|
| Rate for Payer: OMNI Networks Commercial |
$870.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,119.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,181.80
|
| Rate for Payer: Three Rivers Provider Network All |
$933.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,156.92
|
| Rate for Payer: Zelis Auto |
$497.60
|
| Rate for Payer: Zelis Worker's Compensation |
$339.61
|
|
|
CTRL NASOPHARYNG HEMRRG SMPL W/PST NSL P
|
Facility
|
IP
|
$1,244.00
|
|
|
Service Code
|
CPT 42970
|
| Hospital Charge Code |
8300051
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$339.61 |
| Max. Negotiated Rate |
$1,181.80 |
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cigna Commercial |
$1,057.40
|
| Rate for Payer: First Health Commercial |
$1,119.60
|
| Rate for Payer: First Health Workers Compensation |
$480.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,119.60
|
| Rate for Payer: GEHA Commercial |
$870.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,119.60
|
| Rate for Payer: Multiplan All |
$1,132.04
|
| Rate for Payer: OMNI Networks Commercial |
$870.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,119.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,181.80
|
| Rate for Payer: Three Rivers Provider Network All |
$933.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,156.92
|
| Rate for Payer: Zelis Auto |
$497.60
|
| Rate for Payer: Zelis Worker's Compensation |
$339.61
|
|
|
CTRL NASOPHARYNG HEMRRG SMPL W/PST NSL P
|
Facility
|
OP
|
$1,244.00
|
|
|
Service Code
|
CPT 42970
|
| Hospital Charge Code |
6142970
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$92.30 |
| Max. Negotiated Rate |
$1,181.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$746.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$116.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$92.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$220.50
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cigna Commercial |
$1,057.40
|
| Rate for Payer: First Health Commercial |
$1,119.60
|
| Rate for Payer: First Health Workers Compensation |
$480.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,119.60
|
| Rate for Payer: GEHA Commercial |
$995.20
|
| Rate for Payer: GEHA Medicare |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,119.60
|
| Rate for Payer: Humana ChoiceCare |
$242.55
|
| Rate for Payer: Humana Medicare Advantage |
$220.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$370.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$94.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$220.50
|
| Rate for Payer: Multiplan All |
$1,132.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$374.85
|
| Rate for Payer: OMNI Networks Commercial |
$870.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,119.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$108.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$94.17
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,181.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$441.00
|
| Rate for Payer: Three Rivers Provider Network All |
$933.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$216.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,156.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$220.50
|
| Rate for Payer: Zelis Auto |
$497.60
|
| Rate for Payer: Zelis Medicare |
$187.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.60
|
| Rate for Payer: Zelis Worker's Compensation |
$339.61
|
|
|
CT SINUS W/O
|
Facility
|
OP
|
$2,790.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
2300200
|
|
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 SINUS W/O
|
Facility
|
IP
|
$2,790.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
2300200
|
|
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 SINUS W/WO
|
Facility
|
IP
|
$5,042.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
2470488
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$287.91 |
| Max. Negotiated Rate |
$4,789.90 |
| Rate for Payer: Cash Price |
$3,025.20
|
| Rate for Payer: Cash Price |
$3,025.20
|
| Rate for Payer: Cigna Commercial |
$4,285.70
|
| Rate for Payer: First Health Commercial |
$4,537.80
|
| Rate for Payer: First Health Workers Compensation |
$407.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,537.80
|
| Rate for Payer: GEHA Commercial |
$3,529.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,537.80
|
| Rate for Payer: Multiplan All |
$4,588.22
|
| Rate for Payer: OMNI Networks Commercial |
$3,529.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,537.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,789.90
|
| Rate for Payer: Three Rivers Provider Network All |
$3,781.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,689.06
|
| Rate for Payer: Zelis Auto |
$2,016.80
|
| Rate for Payer: Zelis Worker's Compensation |
$287.91
|
|
|
CT SINUS W/WO
|
Facility
|
OP
|
$5,042.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
2470488
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$4,789.90 |
| 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 |
$3,025.20
|
| 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 |
$3,025.20
|
| Rate for Payer: Cash Price |
$3,025.20
|
| Rate for Payer: Cigna Commercial |
$4,285.70
|
| Rate for Payer: First Health Commercial |
$4,537.80
|
| Rate for Payer: First Health Workers Compensation |
$407.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,537.80
|
| Rate for Payer: GEHA Commercial |
$4,033.60
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,537.80
|
| 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 |
$4,588.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$3,529.40
|
| Rate for Payer: One Health Plan PPO/POS |
$4,537.80
|
| 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 |
$4,789.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$3,781.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$4,285.70
|
| 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 |
$4,689.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$2,016.80
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$287.91
|
|
|
CT SOFT TISSUE NECK W/CON
|
Facility
|
IP
|
$3,391.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
2351079
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$243.35 |
| Max. Negotiated Rate |
$3,221.45 |
| Rate for Payer: Cash Price |
$2,034.60
|
| Rate for Payer: Cash Price |
$2,034.60
|
| Rate for Payer: Cigna Commercial |
$2,882.35
|
| Rate for Payer: First Health Commercial |
$3,051.90
|
| Rate for Payer: First Health Workers Compensation |
$344.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,051.90
|
| Rate for Payer: GEHA Commercial |
$2,373.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,051.90
|
| Rate for Payer: Multiplan All |
$3,085.81
|
| Rate for Payer: OMNI Networks Commercial |
$2,373.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,051.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,221.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,543.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,153.63
|
| Rate for Payer: Zelis Auto |
$1,356.40
|
| Rate for Payer: Zelis Worker's Compensation |
$243.35
|
|
|
CT SOFT TISSUE NECK W/CON
|
Facility
|
OP
|
$3,391.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
2351079
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,221.45 |
| 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 |
$2,034.60
|
| 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 |
$2,034.60
|
| Rate for Payer: Cash Price |
$2,034.60
|
| Rate for Payer: Cigna Commercial |
$2,882.35
|
| Rate for Payer: First Health Commercial |
$3,051.90
|
| Rate for Payer: First Health Workers Compensation |
$344.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,051.90
|
| Rate for Payer: GEHA Commercial |
$2,712.80
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,051.90
|
| 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 |
$3,085.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,373.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,051.90
|
| 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 |
$3,221.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,543.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$2,882.35
|
| 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 |
$3,153.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,356.40
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$243.35
|
|
|
CT SOFT TISSUE NECK W/O
|
Facility
|
IP
|
$2,804.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
2300143
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$201.64 |
| Max. Negotiated Rate |
$2,663.80 |
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cigna Commercial |
$2,383.40
|
| Rate for Payer: First Health Commercial |
$2,523.60
|
| Rate for Payer: First Health Workers Compensation |
$285.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,523.60
|
| Rate for Payer: GEHA Commercial |
$1,962.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,523.60
|
| Rate for Payer: Multiplan All |
$2,551.64
|
| Rate for Payer: OMNI Networks Commercial |
$1,962.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,523.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,663.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,103.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,607.72
|
| Rate for Payer: Zelis Auto |
$1,121.60
|
| Rate for Payer: Zelis Worker's Compensation |
$201.64
|
|
|
CT SOFT TISSUE NECK W/O
|
Facility
|
OP
|
$2,804.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
2300143
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$2,663.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$292.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,682.40
|
| 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 |
$1,682.40
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cigna Commercial |
$2,383.40
|
| Rate for Payer: First Health Commercial |
$2,523.60
|
| Rate for Payer: First Health Workers Compensation |
$285.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,523.60
|
| Rate for Payer: GEHA Commercial |
$2,243.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,523.60
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$236.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$2,551.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$1,962.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,523.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$273.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$236.52
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,663.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$2,103.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$2,383.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$236.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,607.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$1,121.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$201.64
|
|
