|
CT SOFT TISSUE NECK W/WO
|
Facility
|
IP
|
$3,834.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
2300149
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$287.82 |
| Max. Negotiated Rate |
$3,642.30 |
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cigna Commercial |
$3,258.90
|
| Rate for Payer: First Health Commercial |
$3,450.60
|
| Rate for Payer: First Health Workers Compensation |
$407.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,450.60
|
| Rate for Payer: GEHA Commercial |
$2,683.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,450.60
|
| Rate for Payer: Multiplan All |
$3,488.94
|
| Rate for Payer: OMNI Networks Commercial |
$2,683.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,450.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,642.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,875.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,565.62
|
| Rate for Payer: Zelis Auto |
$1,533.60
|
| Rate for Payer: Zelis Worker's Compensation |
$287.82
|
|
|
CT SOFT TISSUE NECK W/WO
|
Facility
|
OP
|
$3,834.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
2300149
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,642.30 |
| 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 |
$2,300.40
|
| 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 |
$2,300.40
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cigna Commercial |
$3,258.90
|
| Rate for Payer: First Health Commercial |
$3,450.60
|
| Rate for Payer: First Health Workers Compensation |
$407.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,450.60
|
| Rate for Payer: GEHA Commercial |
$3,067.20
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,450.60
|
| 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 |
$3,488.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,683.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,450.60
|
| 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 |
$3,642.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,875.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$3,258.90
|
| 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 |
$3,565.62
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,533.60
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$287.82
|
|
|
CT T-SPINE W/CON
|
Facility
|
OP
|
$3,453.00
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
2351011
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,280.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$445.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,071.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$445.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$352.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$169.04
|
| Rate for Payer: Cash Price |
$2,071.80
|
| Rate for Payer: Cash Price |
$2,071.80
|
| Rate for Payer: Cigna Commercial |
$2,935.05
|
| Rate for Payer: First Health Commercial |
$3,107.70
|
| Rate for Payer: First Health Workers Compensation |
$344.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,107.70
|
| Rate for Payer: GEHA Commercial |
$2,762.40
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,107.70
|
| Rate for Payer: Humana ChoiceCare |
$185.94
|
| Rate for Payer: Humana Medicare Advantage |
$169.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$283.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$360.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$3,142.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,417.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,107.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$415.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$360.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$169.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,280.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,589.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$2,935.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$360.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,211.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,381.20
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$243.84
|
|
|
CT T-SPINE W/CON
|
Facility
|
IP
|
$3,453.00
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
2351011
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$243.84 |
| Max. Negotiated Rate |
$3,280.35 |
| Rate for Payer: Cash Price |
$2,071.80
|
| Rate for Payer: Cash Price |
$2,071.80
|
| Rate for Payer: Cigna Commercial |
$2,935.05
|
| Rate for Payer: First Health Commercial |
$3,107.70
|
| Rate for Payer: First Health Workers Compensation |
$344.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,107.70
|
| Rate for Payer: GEHA Commercial |
$2,417.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,107.70
|
| Rate for Payer: Multiplan All |
$3,142.23
|
| Rate for Payer: OMNI Networks Commercial |
$2,417.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,107.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,280.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,589.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,211.29
|
| Rate for Payer: Zelis Auto |
$1,381.20
|
| Rate for Payer: Zelis Worker's Compensation |
$243.84
|
|
|
CT T-SPINE W/O
|
Facility
|
OP
|
$3,136.00
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
2300155
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$2,979.20 |
| 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 |
$1,881.60
|
| 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 |
$1,881.60
|
| Rate for Payer: Cash Price |
$1,881.60
|
| Rate for Payer: Cigna Commercial |
$2,665.60
|
| Rate for Payer: First Health Commercial |
$2,822.40
|
| Rate for Payer: First Health Workers Compensation |
$291.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,822.40
|
| Rate for Payer: GEHA Commercial |
$2,508.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,822.40
|
| 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 |
$2,853.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$2,195.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,822.40
|
| 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 |
$2,979.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$2,352.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$2,665.60
|
| 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 |
$2,916.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$1,254.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$205.87
|
|
|
CT T-SPINE W/O
|
Facility
|
IP
|
$3,136.00
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
2300155
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$205.87 |
| Max. Negotiated Rate |
$2,979.20 |
| Rate for Payer: Cash Price |
$1,881.60
|
| Rate for Payer: Cash Price |
$1,881.60
|
| Rate for Payer: Cigna Commercial |
$2,665.60
|
| Rate for Payer: First Health Commercial |
$2,822.40
|
| Rate for Payer: First Health Workers Compensation |
$291.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,822.40
|
| Rate for Payer: GEHA Commercial |
$2,195.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,822.40
|
| Rate for Payer: Multiplan All |
$2,853.76
|
| Rate for Payer: OMNI Networks Commercial |
$2,195.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,822.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,979.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,352.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,916.48
|
| Rate for Payer: Zelis Auto |
$1,254.40
|
| Rate for Payer: Zelis Worker's Compensation |
$205.87
|
|
|
CT T-SPINE W/WO
|
Facility
|
IP
|
$3,790.00
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
2351012
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$294.12 |
| Max. Negotiated Rate |
$3,600.50 |
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$3,221.50
|
| Rate for Payer: First Health Commercial |
$3,411.00
|
| Rate for Payer: First Health Workers Compensation |
$415.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,411.00
|
| Rate for Payer: GEHA Commercial |
$2,653.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,411.00
|
| Rate for Payer: Multiplan All |
$3,448.90
|
| Rate for Payer: OMNI Networks Commercial |
$2,653.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,411.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,600.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,842.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,524.70
|
| Rate for Payer: Zelis Auto |
$1,516.00
|
| Rate for Payer: Zelis Worker's Compensation |
$294.12
|
|
|
CT T-SPINE W/WO
|
Facility
|
OP
|
$3,790.00
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
2351012
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,600.50 |
| 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 |
$2,274.00
|
| 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 |
$2,274.00
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$3,221.50
|
| Rate for Payer: First Health Commercial |
$3,411.00
|
| Rate for Payer: First Health Workers Compensation |
$415.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,411.00
|
| Rate for Payer: GEHA Commercial |
$3,032.00
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,411.00
|
| 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 |
$3,448.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,653.00
|
| Rate for Payer: One Health Plan PPO/POS |
$3,411.00
|
| 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 |
$3,600.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,842.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$3,221.50
|
| 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 |
$3,524.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,516.00
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$294.12
|
|
|
CT UE W/CON
|
Facility
|
IP
|
$3,063.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
2410102
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$230.19 |
| Max. Negotiated Rate |
$2,909.85 |
| Rate for Payer: Cash Price |
$1,837.80
|
| Rate for Payer: Cash Price |
$1,837.80
|
| Rate for Payer: Cigna Commercial |
$2,603.55
|
| Rate for Payer: First Health Commercial |
$2,756.70
|
| Rate for Payer: First Health Workers Compensation |
$325.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,756.70
|
| Rate for Payer: GEHA Commercial |
$2,144.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,756.70
|
| Rate for Payer: Multiplan All |
$2,787.33
|
| Rate for Payer: OMNI Networks Commercial |
$2,144.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,756.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,909.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,297.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,848.59
|
| Rate for Payer: Zelis Auto |
$1,225.20
|
| Rate for Payer: Zelis Worker's Compensation |
$230.19
|
|
|
CT UE W/CON
|
Facility
|
OP
|
$3,063.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
2410102
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$230.19 |
| Max. Negotiated Rate |
$2,909.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$445.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,837.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$445.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$352.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$1,837.80
|
| Rate for Payer: Cash Price |
$1,837.80
|
| Rate for Payer: Cigna Commercial |
$2,603.55
|
| Rate for Payer: First Health Commercial |
$2,756.70
|
| Rate for Payer: First Health Workers Compensation |
$325.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,756.70
|
| Rate for Payer: GEHA Commercial |
$2,450.40
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,756.70
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$360.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$2,787.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$2,144.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,756.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$415.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$360.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,909.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$2,297.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$2,603.55
|
| 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 |
$2,848.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$1,225.20
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$230.19
|
|
|
CT UE W/CON RIGHT
|
Facility
|
IP
|
$3,063.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
2367180
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$230.19 |
| Max. Negotiated Rate |
$2,909.85 |
| Rate for Payer: Cash Price |
$1,837.80
|
| Rate for Payer: Cash Price |
$1,837.80
|
| Rate for Payer: Cigna Commercial |
$2,603.55
|
| Rate for Payer: First Health Commercial |
$2,756.70
|
| Rate for Payer: First Health Workers Compensation |
$325.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,756.70
|
| Rate for Payer: GEHA Commercial |
$2,144.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,756.70
|
| Rate for Payer: Multiplan All |
$2,787.33
|
| Rate for Payer: OMNI Networks Commercial |
$2,144.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,756.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,909.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,297.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,848.59
|
| Rate for Payer: Zelis Auto |
$1,225.20
|
| Rate for Payer: Zelis Worker's Compensation |
$230.19
|
|
|
CT UE W/CON RIGHT
|
Facility
|
OP
|
$3,063.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
2367180
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$230.19 |
| Max. Negotiated Rate |
$2,909.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$445.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,837.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$445.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$352.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$1,837.80
|
| Rate for Payer: Cash Price |
$1,837.80
|
| Rate for Payer: Cigna Commercial |
$2,603.55
|
| Rate for Payer: First Health Commercial |
$2,756.70
|
| Rate for Payer: First Health Workers Compensation |
$325.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,756.70
|
| Rate for Payer: GEHA Commercial |
$2,450.40
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,756.70
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$360.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$2,787.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$2,144.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,756.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$415.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$360.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,909.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$2,297.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$2,603.55
|
| 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 |
$2,848.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$1,225.20
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$230.19
|
|
|
CT UE W/O
|
Facility
|
OP
|
$2,689.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
2410089
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$2,554.55 |
| 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 |
$1,613.40
|
| 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 |
$1,613.40
|
| Rate for Payer: Cash Price |
$1,613.40
|
| Rate for Payer: Cigna Commercial |
$2,285.65
|
| Rate for Payer: First Health Commercial |
$2,420.10
|
| Rate for Payer: First Health Workers Compensation |
$266.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,420.10
|
| Rate for Payer: GEHA Commercial |
$2,151.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,420.10
|
| 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 |
$2,446.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$1,882.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,420.10
|
| 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 |
$2,554.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$2,016.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$2,285.65
|
| 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 |
$2,500.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$1,075.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$188.09
|
|
|
CT UE W/O
|
Facility
|
IP
|
$2,689.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
2410089
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$188.09 |
| Max. Negotiated Rate |
$2,554.55 |
| Rate for Payer: Cash Price |
$1,613.40
|
| Rate for Payer: Cash Price |
$1,613.40
|
| Rate for Payer: Cigna Commercial |
$2,285.65
|
| Rate for Payer: First Health Commercial |
$2,420.10
|
| Rate for Payer: First Health Workers Compensation |
$266.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,420.10
|
| Rate for Payer: GEHA Commercial |
$1,882.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,420.10
|
| Rate for Payer: Multiplan All |
$2,446.99
|
| Rate for Payer: OMNI Networks Commercial |
$1,882.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,420.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,554.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,016.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,500.77
|
| Rate for Payer: Zelis Auto |
$1,075.60
|
| Rate for Payer: Zelis Worker's Compensation |
$188.09
|
|
|
CT UE W/O RIGHT
|
Facility
|
OP
|
$2,689.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
2351124
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$2,554.55 |
| 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 |
$1,613.40
|
| 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 |
$1,613.40
|
| Rate for Payer: Cash Price |
$1,613.40
|
| Rate for Payer: Cigna Commercial |
$2,285.65
|
| Rate for Payer: First Health Commercial |
$2,420.10
|
| Rate for Payer: First Health Workers Compensation |
$266.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,420.10
|
| Rate for Payer: GEHA Commercial |
$2,151.20
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,420.10
|
| 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 |
$2,446.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$1,882.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,420.10
|
| 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 |
$2,554.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$2,016.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$2,285.65
|
| 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 |
$2,500.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$1,075.60
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$188.09
|
|
|
CT UE W/O RIGHT
|
Facility
|
IP
|
$2,689.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
2351124
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$188.09 |
| Max. Negotiated Rate |
$2,554.55 |
| Rate for Payer: Cash Price |
$1,613.40
|
| Rate for Payer: Cash Price |
$1,613.40
|
| Rate for Payer: Cigna Commercial |
$2,285.65
|
| Rate for Payer: First Health Commercial |
$2,420.10
|
| Rate for Payer: First Health Workers Compensation |
$266.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,420.10
|
| Rate for Payer: GEHA Commercial |
$1,882.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,420.10
|
| Rate for Payer: Multiplan All |
$2,446.99
|
| Rate for Payer: OMNI Networks Commercial |
$1,882.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,420.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,554.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,016.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,500.77
|
| Rate for Payer: Zelis Auto |
$1,075.60
|
| Rate for Payer: Zelis Worker's Compensation |
$188.09
|
|
|
CT UE W/WO
|
Facility
|
OP
|
$3,565.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
2410090
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,386.75 |
| 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 |
$2,139.00
|
| 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 |
$2,139.00
|
| Rate for Payer: Cash Price |
$2,139.00
|
| Rate for Payer: Cigna Commercial |
$3,030.25
|
| Rate for Payer: First Health Commercial |
$3,208.50
|
| Rate for Payer: First Health Workers Compensation |
$404.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,208.50
|
| Rate for Payer: GEHA Commercial |
$2,852.00
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,208.50
|
| 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 |
$404.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$3,244.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,495.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,208.50
|
| 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 |
$3,386.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,673.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$3,030.25
|
| 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 |
$3,315.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,426.00
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$286.22
|
|
|
CT UE W/WO
|
Facility
|
IP
|
$3,565.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
2410090
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$286.22 |
| Max. Negotiated Rate |
$3,386.75 |
| Rate for Payer: Cash Price |
$2,139.00
|
| Rate for Payer: Cash Price |
$2,139.00
|
| Rate for Payer: Cigna Commercial |
$3,030.25
|
| Rate for Payer: First Health Commercial |
$3,208.50
|
| Rate for Payer: First Health Workers Compensation |
$404.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,208.50
|
| Rate for Payer: GEHA Commercial |
$2,495.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,208.50
|
| Rate for Payer: Multiplan All |
$3,244.15
|
| Rate for Payer: OMNI Networks Commercial |
$2,495.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,208.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,386.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,673.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,315.45
|
| Rate for Payer: Zelis Auto |
$1,426.00
|
| Rate for Payer: Zelis Worker's Compensation |
$286.22
|
|
|
CT UE W/WO RIGHT
|
Facility
|
IP
|
$3,565.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
2351429
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$286.22 |
| Max. Negotiated Rate |
$3,386.75 |
| Rate for Payer: Cash Price |
$2,139.00
|
| Rate for Payer: Cash Price |
$2,139.00
|
| Rate for Payer: Cigna Commercial |
$3,030.25
|
| Rate for Payer: First Health Commercial |
$3,208.50
|
| Rate for Payer: First Health Workers Compensation |
$404.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,208.50
|
| Rate for Payer: GEHA Commercial |
$2,495.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,208.50
|
| Rate for Payer: Multiplan All |
$3,244.15
|
| Rate for Payer: OMNI Networks Commercial |
$2,495.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,208.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,386.75
|
| Rate for Payer: Three Rivers Provider Network All |
$2,673.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,315.45
|
| Rate for Payer: Zelis Auto |
$1,426.00
|
| Rate for Payer: Zelis Worker's Compensation |
$286.22
|
|
|
CT UE W/WO RIGHT
|
Facility
|
OP
|
$3,565.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
2351429
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$3,386.75 |
| 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 |
$2,139.00
|
| 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 |
$2,139.00
|
| Rate for Payer: Cash Price |
$2,139.00
|
| Rate for Payer: Cigna Commercial |
$3,030.25
|
| Rate for Payer: First Health Commercial |
$3,208.50
|
| Rate for Payer: First Health Workers Compensation |
$404.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,208.50
|
| Rate for Payer: GEHA Commercial |
$2,852.00
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,208.50
|
| 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 |
$404.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$3,244.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$2,495.50
|
| Rate for Payer: One Health Plan PPO/POS |
$3,208.50
|
| 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 |
$3,386.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$2,673.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$3,030.25
|
| 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 |
$3,315.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$1,426.00
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$286.22
|
|
|
CT UROGRAM
|
Facility
|
IP
|
$7,023.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
2300157
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$348.06 |
| Max. Negotiated Rate |
$6,671.85 |
| Rate for Payer: Cash Price |
$4,213.80
|
| Rate for Payer: Cash Price |
$4,213.80
|
| Rate for Payer: Cigna Commercial |
$5,969.55
|
| Rate for Payer: First Health Commercial |
$6,320.70
|
| Rate for Payer: First Health Workers Compensation |
$492.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,320.70
|
| Rate for Payer: GEHA Commercial |
$4,916.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,320.70
|
| Rate for Payer: Multiplan All |
$6,390.93
|
| Rate for Payer: OMNI Networks Commercial |
$4,916.10
|
| Rate for Payer: One Health Plan PPO/POS |
$6,320.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,671.85
|
| Rate for Payer: Three Rivers Provider Network All |
$5,267.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,531.39
|
| Rate for Payer: Zelis Auto |
$2,809.20
|
| Rate for Payer: Zelis Worker's Compensation |
$348.06
|
|
|
CT UROGRAM
|
Facility
|
OP
|
$7,023.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
2300157
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$6,671.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$490.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,213.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$490.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$388.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$4,213.80
|
| Rate for Payer: Cash Price |
$4,213.80
|
| Rate for Payer: Cigna Commercial |
$5,969.55
|
| Rate for Payer: First Health Commercial |
$6,320.70
|
| Rate for Payer: First Health Workers Compensation |
$492.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,320.70
|
| Rate for Payer: GEHA Commercial |
$5,618.40
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,320.70
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$396.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$6,390.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$4,916.10
|
| Rate for Payer: One Health Plan PPO/POS |
$6,320.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$457.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$396.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,671.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$5,267.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$5,969.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$396.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,531.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$2,809.20
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$348.06
|
|
|
ctx c-telopeptide REF500089
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
2299620
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.88 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$33.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$152.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$33.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$26.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$18.68
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$33.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$203.20
|
| Rate for Payer: GEHA Medicare |
$18.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Humana ChoiceCare |
$20.55
|
| Rate for Payer: Humana Medicare Advantage |
$18.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$31.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$27.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$18.68
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.76
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$31.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$27.18
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$18.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$37.36
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.31
|
| Rate for Payer: United Healthcare Commercial |
$215.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$27.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$18.68
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Medicare |
$15.88
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.42
|
| Rate for Payer: Zelis Worker's Compensation |
$23.37
|
|
|
ctx c-telopeptide REF500089
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
2299620
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.37 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$33.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$177.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Worker's Compensation |
$23.37
|
|
|
CULT EPIDERM GRFT F/N/HFG +%
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
CPT 15157
|
| Hospital Charge Code |
6115157
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$137.87 |
| Max. Negotiated Rate |
$479.75 |
| Rate for Payer: Cash Price |
$303.00
|
| Rate for Payer: Cigna Commercial |
$429.25
|
| Rate for Payer: First Health Commercial |
$454.50
|
| Rate for Payer: First Health Workers Compensation |
$194.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$454.50
|
| Rate for Payer: GEHA Commercial |
$353.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$454.50
|
| Rate for Payer: Multiplan All |
$459.55
|
| Rate for Payer: OMNI Networks Commercial |
$353.50
|
| Rate for Payer: One Health Plan PPO/POS |
$454.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$479.75
|
| Rate for Payer: Three Rivers Provider Network All |
$378.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$469.65
|
| Rate for Payer: Zelis Auto |
$202.00
|
| Rate for Payer: Zelis Worker's Compensation |
$137.87
|
|
