|
EXPLORE ADRENAL GLAND
|
Facility
|
IP
|
$2,543.00
|
|
|
Service Code
|
CPT 60545
|
| Hospital Charge Code |
6160545
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$694.24 |
| Max. Negotiated Rate |
$2,415.85 |
| Rate for Payer: Cash Price |
$1,525.80
|
| Rate for Payer: Cigna Commercial |
$2,161.55
|
| Rate for Payer: First Health Commercial |
$2,288.70
|
| Rate for Payer: First Health Workers Compensation |
$981.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,288.70
|
| Rate for Payer: GEHA Commercial |
$1,780.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,288.70
|
| Rate for Payer: Multiplan All |
$2,314.13
|
| Rate for Payer: OMNI Networks Commercial |
$1,780.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,288.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,415.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,907.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,364.99
|
| Rate for Payer: Zelis Auto |
$1,017.20
|
| Rate for Payer: Zelis Worker's Compensation |
$694.24
|
|
|
EXPLORE ADRENAL GLAND
|
Facility
|
OP
|
$2,543.00
|
|
|
Service Code
|
CPT 60545
|
| Hospital Charge Code |
6160545
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$635.75 |
| Max. Negotiated Rate |
$2,415.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,525.80
|
| Rate for Payer: Cash Price |
$1,525.80
|
| Rate for Payer: Cigna Commercial |
$2,161.55
|
| Rate for Payer: First Health Commercial |
$2,288.70
|
| Rate for Payer: First Health Workers Compensation |
$981.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,288.70
|
| Rate for Payer: GEHA Commercial |
$2,034.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,288.70
|
| Rate for Payer: Humana ChoiceCare |
$661.18
|
| Rate for Payer: Multiplan All |
$2,314.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,525.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,780.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,288.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,415.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,907.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,237.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$635.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,364.99
|
| Rate for Payer: Zelis Auto |
$1,017.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,271.50
|
| Rate for Payer: Zelis Worker's Compensation |
$694.24
|
|
|
EXPLORE CHEST FREE ADHESIONS
|
Facility
|
OP
|
$1,949.00
|
|
|
Service Code
|
CPT 32124
|
| Hospital Charge Code |
6132124
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$487.25 |
| Max. Negotiated Rate |
$1,851.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,169.40
|
| Rate for Payer: Cash Price |
$1,169.40
|
| Rate for Payer: Cigna Commercial |
$1,656.65
|
| Rate for Payer: First Health Commercial |
$1,754.10
|
| Rate for Payer: First Health Workers Compensation |
$752.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,754.10
|
| Rate for Payer: GEHA Commercial |
$1,559.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,754.10
|
| Rate for Payer: Humana ChoiceCare |
$506.74
|
| Rate for Payer: Multiplan All |
$1,773.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,169.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,364.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,754.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,851.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,461.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,715.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$487.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,812.57
|
| Rate for Payer: Zelis Auto |
$779.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$974.50
|
| Rate for Payer: Zelis Worker's Compensation |
$532.08
|
|
|
EXPLORE CHEST FREE ADHESIONS
|
Facility
|
IP
|
$1,949.00
|
|
|
Service Code
|
CPT 32124
|
| Hospital Charge Code |
6132124
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$532.08 |
| Max. Negotiated Rate |
$1,851.55 |
| Rate for Payer: Cash Price |
$1,169.40
|
| Rate for Payer: Cigna Commercial |
$1,656.65
|
| Rate for Payer: First Health Commercial |
$1,754.10
|
| Rate for Payer: First Health Workers Compensation |
$752.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,754.10
|
| Rate for Payer: GEHA Commercial |
$1,364.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,754.10
|
| Rate for Payer: Multiplan All |
$1,773.59
|
| Rate for Payer: OMNI Networks Commercial |
$1,364.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,754.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,851.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,461.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,812.57
|
| Rate for Payer: Zelis Auto |
$779.60
|
| Rate for Payer: Zelis Worker's Compensation |
$532.08
|
|
|
EXPLORE EPIDIDYMIS
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT 54865
|
| Hospital Charge Code |
6154865
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$250.34 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: First Health Workers Compensation |
$354.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$641.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
| Rate for Payer: Zelis Worker's Compensation |
$250.34
|
|
|
EXPLORE EPIDIDYMIS
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT 54865
|
| Hospital Charge Code |
6154865
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$250.34 |
| Max. Negotiated Rate |
$6,549.86 |
| 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 |
$550.20
|
| 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 |
$3,274.93
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: First Health Workers Compensation |
$354.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$733.60
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| 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 |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$366.80
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$250.34
|
|
|
EXPLORE INNER EAR
|
Facility
|
IP
|
$2,161.00
|
|
|
Service Code
|
CPT 69805
|
| Hospital Charge Code |
6169805
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$589.95 |
| Max. Negotiated Rate |
$2,052.95 |
| Rate for Payer: Cash Price |
$1,296.60
|
| Rate for Payer: Cigna Commercial |
$1,836.85
|
| Rate for Payer: First Health Commercial |
$1,944.90
|
| Rate for Payer: First Health Workers Compensation |
$834.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,944.90
|
| Rate for Payer: GEHA Commercial |
$1,512.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,944.90
|
| Rate for Payer: Multiplan All |
$1,966.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,512.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,944.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,052.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,620.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,009.73
|
| Rate for Payer: Zelis Auto |
$864.40
|
| Rate for Payer: Zelis Worker's Compensation |
$589.95
|
|
|
EXPLORE INNER EAR
|
Facility
|
OP
|
$2,161.00
|
|
|
Service Code
|
CPT 69805
|
| Hospital Charge Code |
6169805
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$589.95 |
| 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 |
$1,296.60
|
| 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 |
$1,296.60
|
| Rate for Payer: Cash Price |
$1,296.60
|
| Rate for Payer: Cigna Commercial |
$1,836.85
|
| Rate for Payer: First Health Commercial |
$1,944.90
|
| Rate for Payer: First Health Workers Compensation |
$834.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,944.90
|
| Rate for Payer: GEHA Commercial |
$1,728.80
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,944.90
|
| 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 |
$1,966.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,512.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,944.90
|
| 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 |
$2,052.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,620.75
|
| 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 |
$2,009.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$864.40
|
| 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 |
$589.95
|
|
|
EXPLORE PARATHYROID GLANDS
|
Facility
|
OP
|
$2,014.00
|
|
|
Service Code
|
CPT 60500
|
| Hospital Charge Code |
6160500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$549.82 |
| 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 |
$1,208.40
|
| 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 |
$1,208.40
|
| Rate for Payer: Cash Price |
$1,208.40
|
| Rate for Payer: Cigna Commercial |
$1,711.90
|
| Rate for Payer: First Health Commercial |
$1,812.60
|
| Rate for Payer: First Health Workers Compensation |
$777.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,812.60
|
| Rate for Payer: GEHA Commercial |
$1,611.20
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,812.60
|
| 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 |
$1,832.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,409.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,812.60
|
| 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 |
$1,913.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,510.50
|
| 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 |
$1,873.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$805.60
|
| 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 |
$549.82
|
|
|
EXPLORE PARATHYROID GLANDS
|
Facility
|
IP
|
$2,014.00
|
|
|
Service Code
|
CPT 60500
|
| Hospital Charge Code |
6160500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$549.82 |
| Max. Negotiated Rate |
$1,913.30 |
| Rate for Payer: Cash Price |
$1,208.40
|
| Rate for Payer: Cigna Commercial |
$1,711.90
|
| Rate for Payer: First Health Commercial |
$1,812.60
|
| Rate for Payer: First Health Workers Compensation |
$777.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,812.60
|
| Rate for Payer: GEHA Commercial |
$1,409.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,812.60
|
| Rate for Payer: Multiplan All |
$1,832.74
|
| Rate for Payer: OMNI Networks Commercial |
$1,409.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,812.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,913.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,510.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,873.02
|
| Rate for Payer: Zelis Auto |
$805.60
|
| Rate for Payer: Zelis Worker's Compensation |
$549.82
|
|
|
EXPLORE PARATHYROID GLANDS
|
Facility
|
IP
|
$2,894.00
|
|
|
Service Code
|
CPT 60505
|
| Hospital Charge Code |
6160505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$790.06 |
| Max. Negotiated Rate |
$2,749.30 |
| Rate for Payer: Cash Price |
$1,736.40
|
| Rate for Payer: Cigna Commercial |
$2,459.90
|
| Rate for Payer: First Health Commercial |
$2,604.60
|
| Rate for Payer: First Health Workers Compensation |
$1,117.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,604.60
|
| Rate for Payer: GEHA Commercial |
$2,025.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,604.60
|
| Rate for Payer: Multiplan All |
$2,633.54
|
| Rate for Payer: OMNI Networks Commercial |
$2,025.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,604.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,749.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,170.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,691.42
|
| Rate for Payer: Zelis Auto |
$1,157.60
|
| Rate for Payer: Zelis Worker's Compensation |
$790.06
|
|
|
EXPLORE PARATHYROID GLANDS
|
Facility
|
OP
|
$2,894.00
|
|
|
Service Code
|
CPT 60505
|
| Hospital Charge Code |
6160505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$723.50 |
| Max. Negotiated Rate |
$2,749.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,736.40
|
| Rate for Payer: Cash Price |
$1,736.40
|
| Rate for Payer: Cigna Commercial |
$2,459.90
|
| Rate for Payer: First Health Commercial |
$2,604.60
|
| Rate for Payer: First Health Workers Compensation |
$1,117.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,604.60
|
| Rate for Payer: GEHA Commercial |
$2,315.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,604.60
|
| Rate for Payer: Humana ChoiceCare |
$752.44
|
| Rate for Payer: Multiplan All |
$2,633.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,736.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,025.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,604.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,749.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,170.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,546.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$723.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,691.42
|
| Rate for Payer: Zelis Auto |
$1,157.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,447.00
|
| Rate for Payer: Zelis Worker's Compensation |
$790.06
|
|
|
EXPLORE/REPAIR CHEST
|
Facility
|
IP
|
$3,086.00
|
|
|
Service Code
|
CPT 32110
|
| Hospital Charge Code |
6132110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$842.48 |
| Max. Negotiated Rate |
$2,931.70 |
| Rate for Payer: Cash Price |
$1,851.60
|
| Rate for Payer: Cigna Commercial |
$2,623.10
|
| Rate for Payer: First Health Commercial |
$2,777.40
|
| Rate for Payer: First Health Workers Compensation |
$1,191.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,777.40
|
| Rate for Payer: GEHA Commercial |
$2,160.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,777.40
|
| Rate for Payer: Multiplan All |
$2,808.26
|
| Rate for Payer: OMNI Networks Commercial |
$2,160.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,777.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,931.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,314.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,869.98
|
| Rate for Payer: Zelis Auto |
$1,234.40
|
| Rate for Payer: Zelis Worker's Compensation |
$842.48
|
|
|
EXPLORE/REPAIR CHEST
|
Facility
|
OP
|
$3,086.00
|
|
|
Service Code
|
CPT 32110
|
| Hospital Charge Code |
6132110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$771.50 |
| Max. Negotiated Rate |
$2,931.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,851.60
|
| Rate for Payer: Cash Price |
$1,851.60
|
| Rate for Payer: Cigna Commercial |
$2,623.10
|
| Rate for Payer: First Health Commercial |
$2,777.40
|
| Rate for Payer: First Health Workers Compensation |
$1,191.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,777.40
|
| Rate for Payer: GEHA Commercial |
$2,468.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,777.40
|
| Rate for Payer: Humana ChoiceCare |
$802.36
|
| Rate for Payer: Multiplan All |
$2,808.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,851.60
|
| Rate for Payer: OMNI Networks Commercial |
$2,160.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,777.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,931.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,314.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,715.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$771.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,869.98
|
| Rate for Payer: Zelis Auto |
$1,234.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,543.00
|
| Rate for Payer: Zelis Worker's Compensation |
$842.48
|
|
|
EXPLORE SCROTUM
|
Facility
|
OP
|
$994.00
|
|
|
Service Code
|
CPT 55110
|
| Hospital Charge Code |
6155110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$271.36 |
| Max. Negotiated Rate |
$6,549.86 |
| 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 |
$596.40
|
| 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 |
$3,274.93
|
| Rate for Payer: Cash Price |
$596.40
|
| Rate for Payer: Cash Price |
$596.40
|
| Rate for Payer: Cigna Commercial |
$844.90
|
| Rate for Payer: First Health Commercial |
$894.60
|
| Rate for Payer: First Health Workers Compensation |
$383.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$894.60
|
| Rate for Payer: GEHA Commercial |
$795.20
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$894.60
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$904.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$695.80
|
| Rate for Payer: One Health Plan PPO/POS |
$894.60
|
| 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 |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$944.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$745.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$924.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$397.60
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$271.36
|
|
|
EXPLORE SCROTUM
|
Facility
|
IP
|
$994.00
|
|
|
Service Code
|
CPT 55110
|
| Hospital Charge Code |
6155110
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$271.36 |
| Max. Negotiated Rate |
$944.30 |
| Rate for Payer: Cash Price |
$596.40
|
| Rate for Payer: Cigna Commercial |
$844.90
|
| Rate for Payer: First Health Commercial |
$894.60
|
| Rate for Payer: First Health Workers Compensation |
$383.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$894.60
|
| Rate for Payer: GEHA Commercial |
$695.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$894.60
|
| Rate for Payer: Multiplan All |
$904.54
|
| Rate for Payer: OMNI Networks Commercial |
$695.80
|
| Rate for Payer: One Health Plan PPO/POS |
$894.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$944.30
|
| Rate for Payer: Three Rivers Provider Network All |
$745.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$924.42
|
| Rate for Payer: Zelis Auto |
$397.60
|
| Rate for Payer: Zelis Worker's Compensation |
$271.36
|
|
|
EXPLORE SINUS REMOVE POLYPS
|
Facility
|
IP
|
$1,157.00
|
|
|
Service Code
|
CPT 31032
|
| Hospital Charge Code |
6131032
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$315.86 |
| Max. Negotiated Rate |
$1,099.15 |
| Rate for Payer: Cash Price |
$694.20
|
| Rate for Payer: Cigna Commercial |
$983.45
|
| Rate for Payer: First Health Commercial |
$1,041.30
|
| Rate for Payer: First Health Workers Compensation |
$446.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,041.30
|
| Rate for Payer: GEHA Commercial |
$809.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,041.30
|
| Rate for Payer: Multiplan All |
$1,052.87
|
| Rate for Payer: OMNI Networks Commercial |
$809.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,041.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,099.15
|
| Rate for Payer: Three Rivers Provider Network All |
$867.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,076.01
|
| Rate for Payer: Zelis Auto |
$462.80
|
| Rate for Payer: Zelis Worker's Compensation |
$315.86
|
|
|
EXPLORE SINUS REMOVE POLYPS
|
Facility
|
OP
|
$1,157.00
|
|
|
Service Code
|
CPT 31032
|
| Hospital Charge Code |
6131032
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$315.86 |
| 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 |
$694.20
|
| 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 |
$694.20
|
| Rate for Payer: Cash Price |
$694.20
|
| Rate for Payer: Cigna Commercial |
$983.45
|
| Rate for Payer: First Health Commercial |
$1,041.30
|
| Rate for Payer: First Health Workers Compensation |
$446.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,041.30
|
| Rate for Payer: GEHA Commercial |
$925.60
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,041.30
|
| 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 |
$1,052.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$809.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,041.30
|
| 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 |
$1,099.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$867.75
|
| 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 |
$1,076.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$462.80
|
| 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 |
$315.86
|
|
|
EXPLORE SMALL INTESTINE
|
Facility
|
OP
|
$2,051.00
|
|
|
Service Code
|
CPT 44020
|
| Hospital Charge Code |
6144020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$512.75 |
| Max. Negotiated Rate |
$1,948.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$1,743.35
|
| Rate for Payer: First Health Commercial |
$1,845.90
|
| Rate for Payer: First Health Workers Compensation |
$791.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,845.90
|
| Rate for Payer: GEHA Commercial |
$1,640.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,845.90
|
| Rate for Payer: Humana ChoiceCare |
$533.26
|
| Rate for Payer: Multiplan All |
$1,866.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,230.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,435.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,845.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,948.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,538.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,804.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$512.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,907.43
|
| Rate for Payer: Zelis Auto |
$820.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,025.50
|
| Rate for Payer: Zelis Worker's Compensation |
$559.92
|
|
|
EXPLORE SMALL INTESTINE
|
Facility
|
IP
|
$2,051.00
|
|
|
Service Code
|
CPT 44020
|
| Hospital Charge Code |
6144020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$559.92 |
| Max. Negotiated Rate |
$1,948.45 |
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$1,743.35
|
| Rate for Payer: First Health Commercial |
$1,845.90
|
| Rate for Payer: First Health Workers Compensation |
$791.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,845.90
|
| Rate for Payer: GEHA Commercial |
$1,435.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,845.90
|
| Rate for Payer: Multiplan All |
$1,866.41
|
| Rate for Payer: OMNI Networks Commercial |
$1,435.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,845.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,948.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,538.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,907.43
|
| Rate for Payer: Zelis Auto |
$820.40
|
| Rate for Payer: Zelis Worker's Compensation |
$559.92
|
|
|
EXPLORE TREAT SHOULDER JOINT
|
Facility
|
IP
|
$1,347.00
|
|
|
Service Code
|
CPT 23107
|
| Hospital Charge Code |
6123107
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$367.73 |
| Max. Negotiated Rate |
$1,279.65 |
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Cigna Commercial |
$1,144.95
|
| Rate for Payer: First Health Commercial |
$1,212.30
|
| Rate for Payer: First Health Workers Compensation |
$520.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,212.30
|
| Rate for Payer: GEHA Commercial |
$942.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,212.30
|
| Rate for Payer: Multiplan All |
$1,225.77
|
| Rate for Payer: OMNI Networks Commercial |
$942.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,212.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,279.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,010.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,252.71
|
| Rate for Payer: Zelis Auto |
$538.80
|
| Rate for Payer: Zelis Worker's Compensation |
$367.73
|
|
|
EXPLORE TREAT SHOULDER JOINT
|
Facility
|
OP
|
$1,347.00
|
|
|
Service Code
|
CPT 23107
|
| Hospital Charge Code |
6123107
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$367.73 |
| Max. Negotiated Rate |
$13,566.52 |
| 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 |
$808.20
|
| 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 |
$6,783.26
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Cigna Commercial |
$1,144.95
|
| Rate for Payer: First Health Commercial |
$1,212.30
|
| Rate for Payer: First Health Workers Compensation |
$520.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,212.30
|
| Rate for Payer: GEHA Commercial |
$1,077.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,212.30
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,225.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$942.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,212.30
|
| 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 |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,279.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,010.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,252.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$538.80
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$367.73
|
|
|
EXPLORE WOUND ABDOMEN
|
Facility
|
IP
|
$667.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
6120102
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$182.09 |
| Max. Negotiated Rate |
$633.65 |
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cigna Commercial |
$566.95
|
| Rate for Payer: First Health Commercial |
$600.30
|
| Rate for Payer: First Health Workers Compensation |
$257.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$600.30
|
| Rate for Payer: GEHA Commercial |
$466.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$600.30
|
| Rate for Payer: Multiplan All |
$606.97
|
| Rate for Payer: OMNI Networks Commercial |
$466.90
|
| Rate for Payer: One Health Plan PPO/POS |
$600.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$633.65
|
| Rate for Payer: Three Rivers Provider Network All |
$500.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$620.31
|
| Rate for Payer: Zelis Auto |
$266.80
|
| Rate for Payer: Zelis Worker's Compensation |
$182.09
|
|
|
EXPLORE WOUND ABDOMEN
|
Facility
|
OP
|
$667.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
6120102
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$182.09 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$400.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cigna Commercial |
$566.95
|
| Rate for Payer: First Health Commercial |
$600.30
|
| Rate for Payer: First Health Workers Compensation |
$257.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$600.30
|
| Rate for Payer: GEHA Commercial |
$533.60
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$600.30
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$606.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$466.90
|
| Rate for Payer: One Health Plan PPO/POS |
$600.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$633.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$500.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$620.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$266.80
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$182.09
|
|
|
EXPLORE WOUND CHEST
|
Facility
|
OP
|
$544.00
|
|
|
Service Code
|
CPT 20101
|
| Hospital Charge Code |
6120101
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$148.51 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$326.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cigna Commercial |
$462.40
|
| Rate for Payer: First Health Commercial |
$489.60
|
| Rate for Payer: First Health Workers Compensation |
$210.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$489.60
|
| Rate for Payer: GEHA Commercial |
$435.20
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$489.60
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$495.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$380.80
|
| Rate for Payer: One Health Plan PPO/POS |
$489.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$516.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$408.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$505.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$217.60
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$148.51
|
|
