|
FBR PHARYNX
|
Facility
|
IP
|
$658.00
|
|
| Hospital Charge Code |
8142809
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$179.63 |
| Max. Negotiated Rate |
$625.10 |
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: Cigna Commercial |
$559.30
|
| Rate for Payer: First Health Commercial |
$592.20
|
| Rate for Payer: First Health Workers Compensation |
$254.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$592.20
|
| Rate for Payer: GEHA Commercial |
$460.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$592.20
|
| Rate for Payer: Multiplan All |
$598.78
|
| Rate for Payer: OMNI Networks Commercial |
$460.60
|
| Rate for Payer: One Health Plan PPO/POS |
$592.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$625.10
|
| Rate for Payer: Three Rivers Provider Network All |
$493.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$611.94
|
| Rate for Payer: Zelis Auto |
$263.20
|
| Rate for Payer: Zelis Worker's Compensation |
$179.63
|
|
|
FBR PHARYNX
|
Facility
|
OP
|
$658.00
|
|
| Hospital Charge Code |
8142809
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$625.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$394.80
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: Cigna Commercial |
$559.30
|
| Rate for Payer: First Health Commercial |
$592.20
|
| Rate for Payer: First Health Workers Compensation |
$254.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$592.20
|
| Rate for Payer: GEHA Commercial |
$526.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$592.20
|
| Rate for Payer: Humana ChoiceCare |
$171.08
|
| Rate for Payer: Multiplan All |
$598.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$394.80
|
| Rate for Payer: OMNI Networks Commercial |
$460.60
|
| Rate for Payer: One Health Plan PPO/POS |
$592.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$625.10
|
| Rate for Payer: Three Rivers Provider Network All |
$493.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$579.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$164.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$611.94
|
| Rate for Payer: Zelis Auto |
$263.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$329.00
|
| Rate for Payer: Zelis Worker's Compensation |
$179.63
|
|
|
FBRWIRE 2-0 BLUE 38"
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009276
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cigna Commercial |
$166.60
|
| Rate for Payer: First Health Commercial |
$176.40
|
| Rate for Payer: First Health Workers Compensation |
$75.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$176.40
|
| Rate for Payer: GEHA Commercial |
$156.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$176.40
|
| Rate for Payer: Humana ChoiceCare |
$50.96
|
| Rate for Payer: Multiplan All |
$178.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$117.60
|
| Rate for Payer: OMNI Networks Commercial |
$137.20
|
| Rate for Payer: One Health Plan PPO/POS |
$176.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$186.20
|
| Rate for Payer: Three Rivers Provider Network All |
$147.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$172.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$49.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$182.28
|
| Rate for Payer: Zelis Auto |
$78.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$98.00
|
| Rate for Payer: Zelis Worker's Compensation |
$53.51
|
|
|
FBRWIRE 2-0 BLUE 38"
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009276
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cigna Commercial |
$166.60
|
| Rate for Payer: First Health Commercial |
$176.40
|
| Rate for Payer: First Health Workers Compensation |
$75.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$176.40
|
| Rate for Payer: GEHA Commercial |
$137.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$176.40
|
| Rate for Payer: Multiplan All |
$178.36
|
| Rate for Payer: OMNI Networks Commercial |
$137.20
|
| Rate for Payer: One Health Plan PPO/POS |
$176.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$186.20
|
| Rate for Payer: Three Rivers Provider Network All |
$147.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$182.28
|
| Rate for Payer: Zelis Auto |
$78.40
|
| Rate for Payer: Zelis Worker's Compensation |
$53.51
|
|
|
FBRWIRE 2-0 T-13 TAPER 3/8C
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009275
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cigna Commercial |
$166.60
|
| Rate for Payer: First Health Commercial |
$176.40
|
| Rate for Payer: First Health Workers Compensation |
$75.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$176.40
|
| Rate for Payer: GEHA Commercial |
$156.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$176.40
|
| Rate for Payer: Humana ChoiceCare |
$50.96
|
| Rate for Payer: Multiplan All |
$178.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$117.60
|
| Rate for Payer: OMNI Networks Commercial |
$137.20
|
| Rate for Payer: One Health Plan PPO/POS |
$176.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$186.20
|
| Rate for Payer: Three Rivers Provider Network All |
$147.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$172.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$49.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$182.28
|
| Rate for Payer: Zelis Auto |
$78.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$98.00
|
| Rate for Payer: Zelis Worker's Compensation |
$53.51
|
|
|
FBRWIRE 2-0 T-13 TAPER 3/8C
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009275
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cigna Commercial |
$166.60
|
| Rate for Payer: First Health Commercial |
$176.40
|
| Rate for Payer: First Health Workers Compensation |
$75.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$176.40
|
| Rate for Payer: GEHA Commercial |
$137.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$176.40
|
| Rate for Payer: Multiplan All |
$178.36
|
| Rate for Payer: OMNI Networks Commercial |
$137.20
|
| Rate for Payer: One Health Plan PPO/POS |
$176.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$186.20
|
| Rate for Payer: Three Rivers Provider Network All |
$147.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$182.28
|
| Rate for Payer: Zelis Auto |
$78.40
|
| Rate for Payer: Zelis Worker's Compensation |
$53.51
|
|
|
FBRWIRE #2 W/TPR NDL 1/2 CIR
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009273
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cigna Commercial |
$166.60
|
| Rate for Payer: First Health Commercial |
$176.40
|
| Rate for Payer: First Health Workers Compensation |
$75.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$176.40
|
| Rate for Payer: GEHA Commercial |
$156.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$176.40
|
| Rate for Payer: Humana ChoiceCare |
$50.96
|
| Rate for Payer: Multiplan All |
$178.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$117.60
|
| Rate for Payer: OMNI Networks Commercial |
$137.20
|
| Rate for Payer: One Health Plan PPO/POS |
$176.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$186.20
|
| Rate for Payer: Three Rivers Provider Network All |
$147.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$172.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$49.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$182.28
|
| Rate for Payer: Zelis Auto |
$78.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$98.00
|
| Rate for Payer: Zelis Worker's Compensation |
$53.51
|
|
|
FBRWIRE #2 W/TPR NDL 1/2 CIR
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009273
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cigna Commercial |
$166.60
|
| Rate for Payer: First Health Commercial |
$176.40
|
| Rate for Payer: First Health Workers Compensation |
$75.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$176.40
|
| Rate for Payer: GEHA Commercial |
$137.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$176.40
|
| Rate for Payer: Multiplan All |
$178.36
|
| Rate for Payer: OMNI Networks Commercial |
$137.20
|
| Rate for Payer: One Health Plan PPO/POS |
$176.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$186.20
|
| Rate for Payer: Three Rivers Provider Network All |
$147.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$182.28
|
| Rate for Payer: Zelis Auto |
$78.40
|
| Rate for Payer: Zelis Worker's Compensation |
$53.51
|
|
|
FBRWIRE #2 W/TPR NDL 1/2 CIR
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009278
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cigna Commercial |
$166.60
|
| Rate for Payer: First Health Commercial |
$176.40
|
| Rate for Payer: First Health Workers Compensation |
$75.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$176.40
|
| Rate for Payer: GEHA Commercial |
$156.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$176.40
|
| Rate for Payer: Humana ChoiceCare |
$50.96
|
| Rate for Payer: Multiplan All |
$178.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$117.60
|
| Rate for Payer: OMNI Networks Commercial |
$137.20
|
| Rate for Payer: One Health Plan PPO/POS |
$176.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$186.20
|
| Rate for Payer: Three Rivers Provider Network All |
$147.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$172.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$49.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$182.28
|
| Rate for Payer: Zelis Auto |
$78.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$98.00
|
| Rate for Payer: Zelis Worker's Compensation |
$53.51
|
|
|
FBRWIRE #2 W/TPR NDL 1/2 CIR
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009278
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cigna Commercial |
$166.60
|
| Rate for Payer: First Health Commercial |
$176.40
|
| Rate for Payer: First Health Workers Compensation |
$75.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$176.40
|
| Rate for Payer: GEHA Commercial |
$137.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$176.40
|
| Rate for Payer: Multiplan All |
$178.36
|
| Rate for Payer: OMNI Networks Commercial |
$137.20
|
| Rate for Payer: One Health Plan PPO/POS |
$176.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$186.20
|
| Rate for Payer: Three Rivers Provider Network All |
$147.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$182.28
|
| Rate for Payer: Zelis Auto |
$78.40
|
| Rate for Payer: Zelis Worker's Compensation |
$53.51
|
|
|
FBRWIRE #5 W/CIR&TAP NEEDLE
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009274
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$263.50
|
| Rate for Payer: First Health Commercial |
$279.00
|
| Rate for Payer: First Health Workers Compensation |
$119.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.00
|
| Rate for Payer: GEHA Commercial |
$217.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.00
|
| Rate for Payer: Multiplan All |
$282.10
|
| Rate for Payer: OMNI Networks Commercial |
$217.00
|
| Rate for Payer: One Health Plan PPO/POS |
$279.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.50
|
| Rate for Payer: Three Rivers Provider Network All |
$232.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$288.30
|
| Rate for Payer: Zelis Auto |
$124.00
|
| Rate for Payer: Zelis Worker's Compensation |
$84.63
|
|
|
FBRWIRE #5 W/CIR&TAP NEEDLE
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7009274
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$77.50 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$263.50
|
| Rate for Payer: First Health Commercial |
$279.00
|
| Rate for Payer: First Health Workers Compensation |
$119.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.00
|
| Rate for Payer: GEHA Commercial |
$248.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.00
|
| Rate for Payer: Humana ChoiceCare |
$80.60
|
| Rate for Payer: Multiplan All |
$282.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$186.00
|
| Rate for Payer: OMNI Networks Commercial |
$217.00
|
| Rate for Payer: One Health Plan PPO/POS |
$279.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$294.50
|
| Rate for Payer: Three Rivers Provider Network All |
$232.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$272.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$77.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$288.30
|
| Rate for Payer: Zelis Auto |
$124.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$155.00
|
| Rate for Payer: Zelis Worker's Compensation |
$84.63
|
|
|
FCT JNT INJ CER/TH 2
|
Facility
|
OP
|
$753.00
|
|
| Hospital Charge Code |
2407220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$188.25 |
| Max. Negotiated Rate |
$715.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$451.80
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cigna Commercial |
$640.05
|
| Rate for Payer: First Health Commercial |
$677.70
|
| Rate for Payer: First Health Workers Compensation |
$290.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$677.70
|
| Rate for Payer: GEHA Commercial |
$602.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$677.70
|
| Rate for Payer: Humana ChoiceCare |
$195.78
|
| Rate for Payer: Multiplan All |
$685.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$451.80
|
| Rate for Payer: OMNI Networks Commercial |
$527.10
|
| Rate for Payer: One Health Plan PPO/POS |
$677.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$715.35
|
| Rate for Payer: Three Rivers Provider Network All |
$564.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$662.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$188.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$700.29
|
| Rate for Payer: Zelis Auto |
$301.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$376.50
|
| Rate for Payer: Zelis Worker's Compensation |
$205.57
|
|
|
FCT JNT INJ CER/TH 2
|
Facility
|
IP
|
$753.00
|
|
| Hospital Charge Code |
2407220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$205.57 |
| Max. Negotiated Rate |
$715.35 |
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cigna Commercial |
$640.05
|
| Rate for Payer: First Health Commercial |
$677.70
|
| Rate for Payer: First Health Workers Compensation |
$290.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$677.70
|
| Rate for Payer: GEHA Commercial |
$527.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$677.70
|
| Rate for Payer: Multiplan All |
$685.23
|
| Rate for Payer: OMNI Networks Commercial |
$527.10
|
| Rate for Payer: One Health Plan PPO/POS |
$677.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$715.35
|
| Rate for Payer: Three Rivers Provider Network All |
$564.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$700.29
|
| Rate for Payer: Zelis Auto |
$301.20
|
| Rate for Payer: Zelis Worker's Compensation |
$205.57
|
|
|
FCT JNT INJ CRV/THR1
|
Facility
|
OP
|
$1,363.00
|
|
| Hospital Charge Code |
2407219
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.75 |
| Max. Negotiated Rate |
$1,294.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$817.80
|
| Rate for Payer: Cash Price |
$817.80
|
| Rate for Payer: Cigna Commercial |
$1,158.55
|
| Rate for Payer: First Health Commercial |
$1,226.70
|
| Rate for Payer: First Health Workers Compensation |
$526.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,226.70
|
| Rate for Payer: GEHA Commercial |
$1,090.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,226.70
|
| Rate for Payer: Humana ChoiceCare |
$354.38
|
| Rate for Payer: Multiplan All |
$1,240.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$817.80
|
| Rate for Payer: OMNI Networks Commercial |
$954.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,226.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,294.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,022.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,199.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$340.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,267.59
|
| Rate for Payer: Zelis Auto |
$545.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$681.50
|
| Rate for Payer: Zelis Worker's Compensation |
$372.10
|
|
|
FCT JNT INJ CRV/THR1
|
Facility
|
IP
|
$1,363.00
|
|
| Hospital Charge Code |
2407219
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$372.10 |
| Max. Negotiated Rate |
$1,294.85 |
| Rate for Payer: Cash Price |
$817.80
|
| Rate for Payer: Cigna Commercial |
$1,158.55
|
| Rate for Payer: First Health Commercial |
$1,226.70
|
| Rate for Payer: First Health Workers Compensation |
$526.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,226.70
|
| Rate for Payer: GEHA Commercial |
$954.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,226.70
|
| Rate for Payer: Multiplan All |
$1,240.33
|
| Rate for Payer: OMNI Networks Commercial |
$954.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,226.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,294.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,022.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,267.59
|
| Rate for Payer: Zelis Auto |
$545.20
|
| Rate for Payer: Zelis Worker's Compensation |
$372.10
|
|
|
FCT JNT INJ CRV/THR3
|
Facility
|
IP
|
$753.00
|
|
| Hospital Charge Code |
2407221
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$205.57 |
| Max. Negotiated Rate |
$715.35 |
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cigna Commercial |
$640.05
|
| Rate for Payer: First Health Commercial |
$677.70
|
| Rate for Payer: First Health Workers Compensation |
$290.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$677.70
|
| Rate for Payer: GEHA Commercial |
$527.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$677.70
|
| Rate for Payer: Multiplan All |
$685.23
|
| Rate for Payer: OMNI Networks Commercial |
$527.10
|
| Rate for Payer: One Health Plan PPO/POS |
$677.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$715.35
|
| Rate for Payer: Three Rivers Provider Network All |
$564.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$700.29
|
| Rate for Payer: Zelis Auto |
$301.20
|
| Rate for Payer: Zelis Worker's Compensation |
$205.57
|
|
|
FCT JNT INJ CRV/THR3
|
Facility
|
OP
|
$753.00
|
|
| Hospital Charge Code |
2407221
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$188.25 |
| Max. Negotiated Rate |
$715.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$451.80
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cigna Commercial |
$640.05
|
| Rate for Payer: First Health Commercial |
$677.70
|
| Rate for Payer: First Health Workers Compensation |
$290.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$677.70
|
| Rate for Payer: GEHA Commercial |
$602.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$677.70
|
| Rate for Payer: Humana ChoiceCare |
$195.78
|
| Rate for Payer: Multiplan All |
$685.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$451.80
|
| Rate for Payer: OMNI Networks Commercial |
$527.10
|
| Rate for Payer: One Health Plan PPO/POS |
$677.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$715.35
|
| Rate for Payer: Three Rivers Provider Network All |
$564.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$662.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$188.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$700.29
|
| Rate for Payer: Zelis Auto |
$301.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$376.50
|
| Rate for Payer: Zelis Worker's Compensation |
$205.57
|
|
|
FCT JNT INJ LMBR 2L
|
Facility
|
IP
|
$753.00
|
|
| Hospital Charge Code |
2407223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$205.57 |
| Max. Negotiated Rate |
$715.35 |
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cigna Commercial |
$640.05
|
| Rate for Payer: First Health Commercial |
$677.70
|
| Rate for Payer: First Health Workers Compensation |
$290.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$677.70
|
| Rate for Payer: GEHA Commercial |
$527.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$677.70
|
| Rate for Payer: Multiplan All |
$685.23
|
| Rate for Payer: OMNI Networks Commercial |
$527.10
|
| Rate for Payer: One Health Plan PPO/POS |
$677.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$715.35
|
| Rate for Payer: Three Rivers Provider Network All |
$564.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$700.29
|
| Rate for Payer: Zelis Auto |
$301.20
|
| Rate for Payer: Zelis Worker's Compensation |
$205.57
|
|
|
FCT JNT INJ LMBR 2L
|
Facility
|
OP
|
$753.00
|
|
| Hospital Charge Code |
2407223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$188.25 |
| Max. Negotiated Rate |
$715.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$451.80
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cigna Commercial |
$640.05
|
| Rate for Payer: First Health Commercial |
$677.70
|
| Rate for Payer: First Health Workers Compensation |
$290.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$677.70
|
| Rate for Payer: GEHA Commercial |
$602.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$677.70
|
| Rate for Payer: Humana ChoiceCare |
$195.78
|
| Rate for Payer: Multiplan All |
$685.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$451.80
|
| Rate for Payer: OMNI Networks Commercial |
$527.10
|
| Rate for Payer: One Health Plan PPO/POS |
$677.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$715.35
|
| Rate for Payer: Three Rivers Provider Network All |
$564.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$662.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$188.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$700.29
|
| Rate for Payer: Zelis Auto |
$301.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$376.50
|
| Rate for Payer: Zelis Worker's Compensation |
$205.57
|
|
|
FCT JNT INJ LMBR 3L
|
Facility
|
IP
|
$753.00
|
|
| Hospital Charge Code |
2407224
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$205.57 |
| Max. Negotiated Rate |
$715.35 |
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cigna Commercial |
$640.05
|
| Rate for Payer: First Health Commercial |
$677.70
|
| Rate for Payer: First Health Workers Compensation |
$290.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$677.70
|
| Rate for Payer: GEHA Commercial |
$527.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$677.70
|
| Rate for Payer: Multiplan All |
$685.23
|
| Rate for Payer: OMNI Networks Commercial |
$527.10
|
| Rate for Payer: One Health Plan PPO/POS |
$677.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$715.35
|
| Rate for Payer: Three Rivers Provider Network All |
$564.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$700.29
|
| Rate for Payer: Zelis Auto |
$301.20
|
| Rate for Payer: Zelis Worker's Compensation |
$205.57
|
|
|
FCT JNT INJ LMBR 3L
|
Facility
|
OP
|
$753.00
|
|
| Hospital Charge Code |
2407224
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$188.25 |
| Max. Negotiated Rate |
$715.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$451.80
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cigna Commercial |
$640.05
|
| Rate for Payer: First Health Commercial |
$677.70
|
| Rate for Payer: First Health Workers Compensation |
$290.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$677.70
|
| Rate for Payer: GEHA Commercial |
$602.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$677.70
|
| Rate for Payer: Humana ChoiceCare |
$195.78
|
| Rate for Payer: Multiplan All |
$685.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$451.80
|
| Rate for Payer: OMNI Networks Commercial |
$527.10
|
| Rate for Payer: One Health Plan PPO/POS |
$677.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$715.35
|
| Rate for Payer: Three Rivers Provider Network All |
$564.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$662.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$188.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$700.29
|
| Rate for Payer: Zelis Auto |
$301.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$376.50
|
| Rate for Payer: Zelis Worker's Compensation |
$205.57
|
|
|
FCT JNT INJ LMBR SNG
|
Facility
|
OP
|
$1,363.00
|
|
| Hospital Charge Code |
2407222
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.75 |
| Max. Negotiated Rate |
$1,294.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$817.80
|
| Rate for Payer: Cash Price |
$817.80
|
| Rate for Payer: Cigna Commercial |
$1,158.55
|
| Rate for Payer: First Health Commercial |
$1,226.70
|
| Rate for Payer: First Health Workers Compensation |
$526.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,226.70
|
| Rate for Payer: GEHA Commercial |
$1,090.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,226.70
|
| Rate for Payer: Humana ChoiceCare |
$354.38
|
| Rate for Payer: Multiplan All |
$1,240.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$817.80
|
| Rate for Payer: OMNI Networks Commercial |
$954.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,226.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,294.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,022.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,199.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$340.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,267.59
|
| Rate for Payer: Zelis Auto |
$545.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$681.50
|
| Rate for Payer: Zelis Worker's Compensation |
$372.10
|
|
|
FCT JNT INJ LMBR SNG
|
Facility
|
IP
|
$1,363.00
|
|
| Hospital Charge Code |
2407222
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$372.10 |
| Max. Negotiated Rate |
$1,294.85 |
| Rate for Payer: Cash Price |
$817.80
|
| Rate for Payer: Cigna Commercial |
$1,158.55
|
| Rate for Payer: First Health Commercial |
$1,226.70
|
| Rate for Payer: First Health Workers Compensation |
$526.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,226.70
|
| Rate for Payer: GEHA Commercial |
$954.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,226.70
|
| Rate for Payer: Multiplan All |
$1,240.33
|
| Rate for Payer: OMNI Networks Commercial |
$954.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,226.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,294.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,022.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,267.59
|
| Rate for Payer: Zelis Auto |
$545.20
|
| Rate for Payer: Zelis Worker's Compensation |
$372.10
|
|
|
fecal fat qual REF001677
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 82705
|
| Hospital Charge Code |
2205964
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$140.25
|
| Rate for Payer: First Health Commercial |
$148.50
|
| Rate for Payer: First Health Workers Compensation |
$9.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$148.50
|
| Rate for Payer: GEHA Commercial |
$115.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$148.50
|
| Rate for Payer: Multiplan All |
$150.15
|
| Rate for Payer: OMNI Networks Commercial |
$115.50
|
| Rate for Payer: One Health Plan PPO/POS |
$148.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$156.75
|
| Rate for Payer: Three Rivers Provider Network All |
$123.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$153.45
|
| Rate for Payer: Zelis Auto |
$66.00
|
| Rate for Payer: Zelis Worker's Compensation |
$6.75
|
|
