|
EXPLORATION BEHIND ABDOMEN
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
CPT 49010
|
| Hospital Charge Code |
6149010
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$536.45 |
| Max. Negotiated Rate |
$1,866.75 |
| Rate for Payer: Cash Price |
$1,179.00
|
| Rate for Payer: Cigna Commercial |
$1,670.25
|
| Rate for Payer: First Health Commercial |
$1,768.50
|
| Rate for Payer: First Health Workers Compensation |
$758.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,768.50
|
| Rate for Payer: GEHA Commercial |
$1,375.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,768.50
|
| Rate for Payer: Multiplan All |
$1,788.15
|
| Rate for Payer: OMNI Networks Commercial |
$1,375.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,768.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,866.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,473.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,827.45
|
| Rate for Payer: Zelis Auto |
$786.00
|
| Rate for Payer: Zelis Worker's Compensation |
$536.45
|
|
|
EXPLORATION BEHIND UPPER JAW
|
Facility
|
OP
|
$1,543.00
|
|
|
Service Code
|
CPT 31040
|
| Hospital Charge Code |
6131040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$421.24 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$925.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$925.80
|
| Rate for Payer: Cash Price |
$925.80
|
| Rate for Payer: Cigna Commercial |
$1,311.55
|
| Rate for Payer: First Health Commercial |
$1,388.70
|
| Rate for Payer: First Health Workers Compensation |
$595.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,388.70
|
| Rate for Payer: GEHA Commercial |
$1,234.40
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,388.70
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$1,404.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,080.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,388.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,465.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,157.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,434.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$617.20
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$421.24
|
|
|
EXPLORATION BEHIND UPPER JAW
|
Facility
|
IP
|
$1,543.00
|
|
|
Service Code
|
CPT 31040
|
| Hospital Charge Code |
6131040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$421.24 |
| Max. Negotiated Rate |
$1,465.85 |
| Rate for Payer: Cash Price |
$925.80
|
| Rate for Payer: Cigna Commercial |
$1,311.55
|
| Rate for Payer: First Health Commercial |
$1,388.70
|
| Rate for Payer: First Health Workers Compensation |
$595.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,388.70
|
| Rate for Payer: GEHA Commercial |
$1,080.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,388.70
|
| Rate for Payer: Multiplan All |
$1,404.13
|
| Rate for Payer: OMNI Networks Commercial |
$1,080.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,388.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,465.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,157.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,434.99
|
| Rate for Payer: Zelis Auto |
$617.20
|
| Rate for Payer: Zelis Worker's Compensation |
$421.24
|
|
|
EXPLORATION FOR TESTIS
|
Facility
|
IP
|
$1,414.00
|
|
|
Service Code
|
CPT 54560
|
| Hospital Charge Code |
6154560
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$386.02 |
| Max. Negotiated Rate |
$1,343.30 |
| Rate for Payer: Cash Price |
$848.40
|
| Rate for Payer: Cigna Commercial |
$1,201.90
|
| Rate for Payer: First Health Commercial |
$1,272.60
|
| Rate for Payer: First Health Workers Compensation |
$545.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,272.60
|
| Rate for Payer: GEHA Commercial |
$989.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,272.60
|
| Rate for Payer: Multiplan All |
$1,286.74
|
| Rate for Payer: OMNI Networks Commercial |
$989.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,272.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,343.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,060.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,315.02
|
| Rate for Payer: Zelis Auto |
$565.60
|
| Rate for Payer: Zelis Worker's Compensation |
$386.02
|
|
|
EXPLORATION FOR TESTIS
|
Facility
|
OP
|
$1,414.00
|
|
|
Service Code
|
CPT 54560
|
| Hospital Charge Code |
6154560
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$386.02 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$848.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$848.40
|
| Rate for Payer: Cash Price |
$848.40
|
| Rate for Payer: Cigna Commercial |
$1,201.90
|
| Rate for Payer: First Health Commercial |
$1,272.60
|
| Rate for Payer: First Health Workers Compensation |
$545.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,272.60
|
| Rate for Payer: GEHA Commercial |
$1,131.20
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,272.60
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$1,286.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$989.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,272.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,343.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$1,060.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,315.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$565.60
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$386.02
|
|
|
EXPLORATION FOR TESTIS
|
Facility
|
IP
|
$1,014.00
|
|
|
Service Code
|
CPT 54550
|
| Hospital Charge Code |
6154550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$276.82 |
| Max. Negotiated Rate |
$963.30 |
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna Commercial |
$861.90
|
| Rate for Payer: First Health Commercial |
$912.60
|
| Rate for Payer: First Health Workers Compensation |
$391.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$912.60
|
| Rate for Payer: GEHA Commercial |
$709.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$912.60
|
| Rate for Payer: Multiplan All |
$922.74
|
| Rate for Payer: OMNI Networks Commercial |
$709.80
|
| Rate for Payer: One Health Plan PPO/POS |
$912.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$963.30
|
| Rate for Payer: Three Rivers Provider Network All |
$760.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$943.02
|
| Rate for Payer: Zelis Auto |
$405.60
|
| Rate for Payer: Zelis Worker's Compensation |
$276.82
|
|
|
EXPLORATION FOR TESTIS
|
Facility
|
OP
|
$1,014.00
|
|
|
Service Code
|
CPT 54550
|
| Hospital Charge Code |
6154550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$276.82 |
| Max. Negotiated Rate |
$6,701.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$608.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,560.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,350.98
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna Commercial |
$861.90
|
| Rate for Payer: First Health Commercial |
$912.60
|
| Rate for Payer: First Health Workers Compensation |
$391.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$912.60
|
| Rate for Payer: GEHA Commercial |
$811.20
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$912.60
|
| Rate for Payer: Humana ChoiceCare |
$3,686.08
|
| Rate for Payer: Humana Medicare Advantage |
$3,350.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,629.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,612.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,350.98
|
| Rate for Payer: Multiplan All |
$922.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: OMNI Networks Commercial |
$709.80
|
| Rate for Payer: One Health Plan PPO/POS |
$912.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,016.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,612.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,350.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$963.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: Three Rivers Provider Network All |
$760.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,283.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,612.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$943.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Auto |
$405.60
|
| Rate for Payer: Zelis Medicare |
$2,848.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,021.18
|
| Rate for Payer: Zelis Worker's Compensation |
$276.82
|
|
|
EXPLORATION MAXILLARY SINUS
|
Facility
|
IP
|
$893.00
|
|
|
Service Code
|
CPT 31020
|
| Hospital Charge Code |
6131020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$243.79 |
| Max. Negotiated Rate |
$848.35 |
| Rate for Payer: Cash Price |
$535.80
|
| Rate for Payer: Cigna Commercial |
$759.05
|
| Rate for Payer: First Health Commercial |
$803.70
|
| Rate for Payer: First Health Workers Compensation |
$344.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$803.70
|
| Rate for Payer: GEHA Commercial |
$625.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$803.70
|
| Rate for Payer: Multiplan All |
$812.63
|
| Rate for Payer: OMNI Networks Commercial |
$625.10
|
| Rate for Payer: One Health Plan PPO/POS |
$803.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$848.35
|
| Rate for Payer: Three Rivers Provider Network All |
$669.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$830.49
|
| Rate for Payer: Zelis Auto |
$357.20
|
| Rate for Payer: Zelis Worker's Compensation |
$243.79
|
|
|
EXPLORATION MAXILLARY SINUS
|
Facility
|
IP
|
$512.00
|
|
|
Service Code
|
CPT 31256
|
| Hospital Charge Code |
6131256
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$139.78 |
| Max. Negotiated Rate |
$486.40 |
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cigna Commercial |
$435.20
|
| Rate for Payer: First Health Commercial |
$460.80
|
| Rate for Payer: First Health Workers Compensation |
$197.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$460.80
|
| Rate for Payer: GEHA Commercial |
$358.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$460.80
|
| Rate for Payer: Multiplan All |
$465.92
|
| Rate for Payer: OMNI Networks Commercial |
$358.40
|
| Rate for Payer: One Health Plan PPO/POS |
$460.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$486.40
|
| Rate for Payer: Three Rivers Provider Network All |
$384.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$476.16
|
| Rate for Payer: Zelis Auto |
$204.80
|
| Rate for Payer: Zelis Worker's Compensation |
$139.78
|
|
|
EXPLORATION MAXILLARY SINUS
|
Facility
|
OP
|
$1,067.00
|
|
|
Service Code
|
CPT 31030
|
| Hospital Charge Code |
6131030
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$291.29 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$640.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Cigna Commercial |
$906.95
|
| Rate for Payer: First Health Commercial |
$960.30
|
| Rate for Payer: First Health Workers Compensation |
$411.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$960.30
|
| Rate for Payer: GEHA Commercial |
$853.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$960.30
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$970.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$746.90
|
| Rate for Payer: One Health Plan PPO/POS |
$960.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,013.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$800.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$992.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$426.80
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$291.29
|
|
|
EXPLORATION MAXILLARY SINUS
|
Facility
|
OP
|
$893.00
|
|
|
Service Code
|
CPT 31020
|
| Hospital Charge Code |
6131020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$243.79 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$535.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,524.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,999.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$535.80
|
| Rate for Payer: Cash Price |
$535.80
|
| Rate for Payer: Cigna Commercial |
$759.05
|
| Rate for Payer: First Health Commercial |
$803.70
|
| Rate for Payer: First Health Workers Compensation |
$344.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$803.70
|
| Rate for Payer: GEHA Commercial |
$714.40
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$803.70
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,040.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$812.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$625.10
|
| Rate for Payer: One Health Plan PPO/POS |
$803.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,355.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,040.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$848.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$669.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,040.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$830.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$357.20
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$243.79
|
|
|
EXPLORATION MAXILLARY SINUS
|
Facility
|
IP
|
$1,067.00
|
|
|
Service Code
|
CPT 31030
|
| Hospital Charge Code |
6131030
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$291.29 |
| Max. Negotiated Rate |
$1,013.65 |
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Cigna Commercial |
$906.95
|
| Rate for Payer: First Health Commercial |
$960.30
|
| Rate for Payer: First Health Workers Compensation |
$411.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$960.30
|
| Rate for Payer: GEHA Commercial |
$746.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$960.30
|
| Rate for Payer: Multiplan All |
$970.97
|
| Rate for Payer: OMNI Networks Commercial |
$746.90
|
| Rate for Payer: One Health Plan PPO/POS |
$960.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,013.65
|
| Rate for Payer: Three Rivers Provider Network All |
$800.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$992.31
|
| Rate for Payer: Zelis Auto |
$426.80
|
| Rate for Payer: Zelis Worker's Compensation |
$291.29
|
|
|
EXPLORATION MAXILLARY SINUS
|
Facility
|
OP
|
$512.00
|
|
|
Service Code
|
CPT 31256
|
| Hospital Charge Code |
6131256
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$139.78 |
| Max. Negotiated Rate |
$7,001.82 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,959.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$307.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,959.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,344.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,500.91
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cigna Commercial |
$435.20
|
| Rate for Payer: First Health Commercial |
$460.80
|
| Rate for Payer: First Health Workers Compensation |
$197.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$460.80
|
| Rate for Payer: GEHA Commercial |
$409.60
|
| Rate for Payer: GEHA Medicare |
$3,500.91
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$460.80
|
| Rate for Payer: Humana ChoiceCare |
$3,851.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,500.91
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,881.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,392.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,500.91
|
| Rate for Payer: Multiplan All |
$465.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,951.55
|
| Rate for Payer: OMNI Networks Commercial |
$358.40
|
| Rate for Payer: One Health Plan PPO/POS |
$460.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,762.33
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,392.37
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,500.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$486.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,001.82
|
| Rate for Payer: Three Rivers Provider Network All |
$384.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,430.89
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,392.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,500.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$476.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,500.91
|
| Rate for Payer: Zelis Auto |
$204.80
|
| Rate for Payer: Zelis Medicare |
$2,975.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,201.09
|
| Rate for Payer: Zelis Worker's Compensation |
$139.78
|
|
|
EXPLORATION OF ABDOMEN
|
Facility
|
IP
|
$1,617.00
|
|
|
Service Code
|
CPT 49000
|
| Hospital Charge Code |
6149000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$441.44 |
| Max. Negotiated Rate |
$1,536.15 |
| Rate for Payer: Cash Price |
$970.20
|
| Rate for Payer: Cigna Commercial |
$1,374.45
|
| Rate for Payer: First Health Commercial |
$1,455.30
|
| Rate for Payer: First Health Workers Compensation |
$624.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,455.30
|
| Rate for Payer: GEHA Commercial |
$1,131.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,455.30
|
| Rate for Payer: Multiplan All |
$1,471.47
|
| Rate for Payer: OMNI Networks Commercial |
$1,131.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,455.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,536.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,212.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,503.81
|
| Rate for Payer: Zelis Auto |
$646.80
|
| Rate for Payer: Zelis Worker's Compensation |
$441.44
|
|
|
EXPLORATION OF ABDOMEN
|
Facility
|
OP
|
$1,617.00
|
|
|
Service Code
|
CPT 49000
|
| Hospital Charge Code |
6149000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$404.25 |
| Max. Negotiated Rate |
$1,536.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$970.20
|
| Rate for Payer: Cash Price |
$970.20
|
| Rate for Payer: Cigna Commercial |
$1,374.45
|
| Rate for Payer: First Health Commercial |
$1,455.30
|
| Rate for Payer: First Health Workers Compensation |
$624.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,455.30
|
| Rate for Payer: GEHA Commercial |
$1,293.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,455.30
|
| Rate for Payer: Humana ChoiceCare |
$420.42
|
| Rate for Payer: Multiplan All |
$1,471.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$970.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,131.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,455.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,536.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,212.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,422.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$404.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,503.81
|
| Rate for Payer: Zelis Auto |
$646.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$808.50
|
| Rate for Payer: Zelis Worker's Compensation |
$441.44
|
|
|
EXPLORATION OF ANKLE JOINT
|
Facility
|
IP
|
$1,137.00
|
|
|
Service Code
|
CPT 27612
|
| Hospital Charge Code |
6127612
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$310.40 |
| Max. Negotiated Rate |
$1,080.15 |
| Rate for Payer: Cash Price |
$682.20
|
| Rate for Payer: Cigna Commercial |
$966.45
|
| Rate for Payer: First Health Commercial |
$1,023.30
|
| Rate for Payer: First Health Workers Compensation |
$439.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,023.30
|
| Rate for Payer: GEHA Commercial |
$795.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,023.30
|
| Rate for Payer: Multiplan All |
$1,034.67
|
| Rate for Payer: OMNI Networks Commercial |
$795.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,023.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,080.15
|
| Rate for Payer: Three Rivers Provider Network All |
$852.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,057.41
|
| Rate for Payer: Zelis Auto |
$454.80
|
| Rate for Payer: Zelis Worker's Compensation |
$310.40
|
|
|
EXPLORATION OF ANKLE JOINT
|
Facility
|
OP
|
$1,137.00
|
|
|
Service Code
|
CPT 27612
|
| Hospital Charge Code |
6127612
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$310.40 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$682.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$682.20
|
| Rate for Payer: Cash Price |
$682.20
|
| Rate for Payer: Cigna Commercial |
$966.45
|
| Rate for Payer: First Health Commercial |
$1,023.30
|
| Rate for Payer: First Health Workers Compensation |
$439.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,023.30
|
| Rate for Payer: GEHA Commercial |
$909.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,023.30
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,034.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$795.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,023.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,080.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$852.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,057.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$454.80
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$310.40
|
|
|
EXPLORATION OF BILE DUCTS
|
Facility
|
OP
|
$2,175.00
|
|
|
Service Code
|
CPT 47700
|
| Hospital Charge Code |
6147700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$543.75 |
| Max. Negotiated Rate |
$2,066.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,305.00
|
| Rate for Payer: Cash Price |
$1,305.00
|
| Rate for Payer: Cigna Commercial |
$1,848.75
|
| Rate for Payer: First Health Commercial |
$1,957.50
|
| Rate for Payer: First Health Workers Compensation |
$839.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,957.50
|
| Rate for Payer: GEHA Commercial |
$1,740.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,957.50
|
| Rate for Payer: Humana ChoiceCare |
$565.50
|
| Rate for Payer: Multiplan All |
$1,979.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,305.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,522.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,957.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,066.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,631.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,914.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$543.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,022.75
|
| Rate for Payer: Zelis Auto |
$870.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,087.50
|
| Rate for Payer: Zelis Worker's Compensation |
$593.77
|
|
|
EXPLORATION OF BILE DUCTS
|
Facility
|
IP
|
$2,175.00
|
|
|
Service Code
|
CPT 47700
|
| Hospital Charge Code |
6147700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$593.77 |
| Max. Negotiated Rate |
$2,066.25 |
| Rate for Payer: Cash Price |
$1,305.00
|
| Rate for Payer: Cigna Commercial |
$1,848.75
|
| Rate for Payer: First Health Commercial |
$1,957.50
|
| Rate for Payer: First Health Workers Compensation |
$839.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,957.50
|
| Rate for Payer: GEHA Commercial |
$1,522.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,957.50
|
| Rate for Payer: Multiplan All |
$1,979.25
|
| Rate for Payer: OMNI Networks Commercial |
$1,522.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,957.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,066.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,631.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,022.75
|
| Rate for Payer: Zelis Auto |
$870.00
|
| Rate for Payer: Zelis Worker's Compensation |
$593.77
|
|
|
EXPLORATION OF CHEST
|
Facility
|
OP
|
$1,625.00
|
|
|
Service Code
|
CPT 32036
|
| Hospital Charge Code |
6132036
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$406.25 |
| Max. Negotiated Rate |
$1,543.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,381.25
|
| Rate for Payer: First Health Commercial |
$1,462.50
|
| Rate for Payer: First Health Workers Compensation |
$627.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,462.50
|
| Rate for Payer: GEHA Commercial |
$1,300.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,462.50
|
| Rate for Payer: Humana ChoiceCare |
$422.50
|
| Rate for Payer: Multiplan All |
$1,478.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$975.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,137.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,462.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,543.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,218.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,430.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$406.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,511.25
|
| Rate for Payer: Zelis Auto |
$650.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$812.50
|
| Rate for Payer: Zelis Worker's Compensation |
$443.62
|
|
|
EXPLORATION OF CHEST
|
Facility
|
IP
|
$1,625.00
|
|
|
Service Code
|
CPT 32036
|
| Hospital Charge Code |
6132036
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$443.62 |
| Max. Negotiated Rate |
$1,543.75 |
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,381.25
|
| Rate for Payer: First Health Commercial |
$1,462.50
|
| Rate for Payer: First Health Workers Compensation |
$627.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,462.50
|
| Rate for Payer: GEHA Commercial |
$1,137.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,462.50
|
| Rate for Payer: Multiplan All |
$1,478.75
|
| Rate for Payer: OMNI Networks Commercial |
$1,137.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,462.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,543.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,218.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,511.25
|
| Rate for Payer: Zelis Auto |
$650.00
|
| Rate for Payer: Zelis Worker's Compensation |
$443.62
|
|
|
EXPLORATION OF CHEST
|
Facility
|
IP
|
$1,503.00
|
|
|
Service Code
|
CPT 32035
|
| Hospital Charge Code |
6132035
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$410.32 |
| Max. Negotiated Rate |
$1,427.85 |
| Rate for Payer: Cash Price |
$901.80
|
| Rate for Payer: Cigna Commercial |
$1,277.55
|
| Rate for Payer: First Health Commercial |
$1,352.70
|
| Rate for Payer: First Health Workers Compensation |
$580.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,352.70
|
| Rate for Payer: GEHA Commercial |
$1,052.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,352.70
|
| Rate for Payer: Multiplan All |
$1,367.73
|
| Rate for Payer: OMNI Networks Commercial |
$1,052.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,352.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,427.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,127.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,397.79
|
| Rate for Payer: Zelis Auto |
$601.20
|
| Rate for Payer: Zelis Worker's Compensation |
$410.32
|
|
|
EXPLORATION OF CHEST
|
Facility
|
IP
|
$1,706.00
|
|
|
Service Code
|
CPT 32100
|
| Hospital Charge Code |
6132100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$465.74 |
| Max. Negotiated Rate |
$1,620.70 |
| Rate for Payer: Cash Price |
$1,023.60
|
| Rate for Payer: Cigna Commercial |
$1,450.10
|
| Rate for Payer: First Health Commercial |
$1,535.40
|
| Rate for Payer: First Health Workers Compensation |
$658.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,535.40
|
| Rate for Payer: GEHA Commercial |
$1,194.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,535.40
|
| Rate for Payer: Multiplan All |
$1,552.46
|
| Rate for Payer: OMNI Networks Commercial |
$1,194.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,535.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,620.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,279.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,586.58
|
| Rate for Payer: Zelis Auto |
$682.40
|
| Rate for Payer: Zelis Worker's Compensation |
$465.74
|
|
|
EXPLORATION OF CHEST
|
Facility
|
OP
|
$1,706.00
|
|
|
Service Code
|
CPT 32100
|
| Hospital Charge Code |
6132100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$426.50 |
| Max. Negotiated Rate |
$1,620.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,023.60
|
| Rate for Payer: Cash Price |
$1,023.60
|
| Rate for Payer: Cigna Commercial |
$1,450.10
|
| Rate for Payer: First Health Commercial |
$1,535.40
|
| Rate for Payer: First Health Workers Compensation |
$658.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,535.40
|
| Rate for Payer: GEHA Commercial |
$1,364.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,535.40
|
| Rate for Payer: Humana ChoiceCare |
$443.56
|
| Rate for Payer: Multiplan All |
$1,552.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,023.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,194.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,535.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,620.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,279.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,501.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$426.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,586.58
|
| Rate for Payer: Zelis Auto |
$682.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$853.00
|
| Rate for Payer: Zelis Worker's Compensation |
$465.74
|
|
|
EXPLORATION OF CHEST
|
Facility
|
OP
|
$1,503.00
|
|
|
Service Code
|
CPT 32035
|
| Hospital Charge Code |
6132035
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$375.75 |
| Max. Negotiated Rate |
$1,427.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$901.80
|
| Rate for Payer: Cash Price |
$901.80
|
| Rate for Payer: Cigna Commercial |
$1,277.55
|
| Rate for Payer: First Health Commercial |
$1,352.70
|
| Rate for Payer: First Health Workers Compensation |
$580.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,352.70
|
| Rate for Payer: GEHA Commercial |
$1,202.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,352.70
|
| Rate for Payer: Humana ChoiceCare |
$390.78
|
| Rate for Payer: Multiplan All |
$1,367.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$901.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,052.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,352.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,427.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,127.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,322.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$375.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,397.79
|
| Rate for Payer: Zelis Auto |
$601.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$751.50
|
| Rate for Payer: Zelis Worker's Compensation |
$410.32
|
|
