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Service Code CPT 10004
Hospital Charge Code 21600294
Hospital Revenue Code 517
Min. Negotiated Rate $43.95
Max. Negotiated Rate $152.95
Rate for Payer: Cash Price $96.60
Rate for Payer: Cigna Commercial $136.85
Rate for Payer: First Health Commercial $144.90
Rate for Payer: First Health Workers Compensation $62.16
Rate for Payer: Galaxy Health Commercial/Workers Compensation $144.90
Rate for Payer: GEHA Commercial $112.70
Rate for Payer: Great West Healthcare (Cigna) Commercial $144.90
Rate for Payer: Multiplan All $146.51
Rate for Payer: OMNI Networks Commercial $112.70
Rate for Payer: One Health Plan PPO/POS $144.90
Rate for Payer: Providence Risk & Insurance Services Commercial $152.95
Rate for Payer: Three Rivers Provider Network All $120.75
Rate for Payer: United Payors & United Providers UP&UP $149.73
Rate for Payer: Zelis Auto $64.40
Rate for Payer: Zelis Worker's Compensation $43.95
Service Code CPT 10004
Hospital Charge Code 8511114
Hospital Revenue Code 521
Min. Negotiated Rate $43.95
Max. Negotiated Rate $152.95
Rate for Payer: Cash Price $96.60
Rate for Payer: Cigna Commercial $136.85
Rate for Payer: First Health Commercial $144.90
Rate for Payer: First Health Workers Compensation $62.16
Rate for Payer: Galaxy Health Commercial/Workers Compensation $144.90
Rate for Payer: GEHA Commercial $112.70
Rate for Payer: Great West Healthcare (Cigna) Commercial $144.90
Rate for Payer: Multiplan All $146.51
Rate for Payer: OMNI Networks Commercial $112.70
Rate for Payer: One Health Plan PPO/POS $144.90
Rate for Payer: Providence Risk & Insurance Services Commercial $152.95
Rate for Payer: Three Rivers Provider Network All $120.75
Rate for Payer: United Payors & United Providers UP&UP $149.73
Rate for Payer: Zelis Auto $64.40
Rate for Payer: Zelis Worker's Compensation $43.95
Service Code CPT 10004
Hospital Charge Code 8511114
Hospital Revenue Code 521
Min. Negotiated Rate $40.25
Max. Negotiated Rate $152.95
Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO $96.60
Rate for Payer: Cash Price $96.60
Rate for Payer: Cigna Commercial $136.85
Rate for Payer: First Health Commercial $144.90
Rate for Payer: First Health Workers Compensation $62.16
Rate for Payer: Galaxy Health Commercial/Workers Compensation $144.90
Rate for Payer: GEHA Commercial $128.80
Rate for Payer: Great West Healthcare (Cigna) Commercial $144.90
Rate for Payer: Humana ChoiceCare $41.86
Rate for Payer: Multiplan All $146.51
Rate for Payer: New Mexico Health Connections Medicare $96.60
Rate for Payer: OMNI Networks Commercial $112.70
Rate for Payer: One Health Plan PPO/POS $144.90
Rate for Payer: Providence Risk & Insurance Services Commercial $152.95
Rate for Payer: Three Rivers Provider Network All $120.75
Rate for Payer: TriWest Veterans Administration/VAPC3 $141.68
Rate for Payer: United Healthcare Managed Medicaid $40.25
Rate for Payer: United Payors & United Providers UP&UP $149.73
Rate for Payer: Zelis Auto $64.40
Rate for Payer: Zelis Primary Direct / Supplemental Network $80.50
Rate for Payer: Zelis Worker's Compensation $43.95
Service Code CPT 10004
Hospital Charge Code 7210004
Hospital Revenue Code 517
Min. Negotiated Rate $40.25
Max. Negotiated Rate $152.95
Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO $96.60
Rate for Payer: Cash Price $96.60
Rate for Payer: Cigna Commercial $136.85
Rate for Payer: First Health Commercial $144.90
Rate for Payer: First Health Workers Compensation $62.16
Rate for Payer: Galaxy Health Commercial/Workers Compensation $144.90
Rate for Payer: GEHA Commercial $128.80
Rate for Payer: Great West Healthcare (Cigna) Commercial $144.90
Rate for Payer: Humana ChoiceCare $41.86
Rate for Payer: Multiplan All $146.51
Rate for Payer: New Mexico Health Connections Medicare $96.60
Rate for Payer: OMNI Networks Commercial $112.70
Rate for Payer: One Health Plan PPO/POS $144.90
Rate for Payer: Providence Risk & Insurance Services Commercial $152.95
Rate for Payer: Three Rivers Provider Network All $120.75
Rate for Payer: TriWest Veterans Administration/VAPC3 $141.68
Rate for Payer: United Healthcare Managed Medicaid $40.25
Rate for Payer: United Payors & United Providers UP&UP $149.73
Rate for Payer: Zelis Auto $64.40
Rate for Payer: Zelis Primary Direct / Supplemental Network $80.50
Rate for Payer: Zelis Worker's Compensation $43.95
Service Code CPT 10004
Hospital Charge Code 20300143
Hospital Revenue Code 510
Min. Negotiated Rate $43.95
Max. Negotiated Rate $152.95
Rate for Payer: Cash Price $96.60
Rate for Payer: Cigna Commercial $136.85
Rate for Payer: First Health Commercial $144.90
Rate for Payer: First Health Workers Compensation $62.16
Rate for Payer: Galaxy Health Commercial/Workers Compensation $144.90
Rate for Payer: GEHA Commercial $112.70
Rate for Payer: Great West Healthcare (Cigna) Commercial $144.90
Rate for Payer: Multiplan All $146.51
Rate for Payer: OMNI Networks Commercial $112.70
Rate for Payer: One Health Plan PPO/POS $144.90
Rate for Payer: Providence Risk & Insurance Services Commercial $152.95
Rate for Payer: Three Rivers Provider Network All $120.75
Rate for Payer: United Payors & United Providers UP&UP $149.73
Rate for Payer: Zelis Auto $64.40
Rate for Payer: Zelis Worker's Compensation $43.95
Service Code CPT 10004
Hospital Charge Code 21600294
Hospital Revenue Code 517
Min. Negotiated Rate $40.25
Max. Negotiated Rate $152.95
Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO $96.60
Rate for Payer: Cash Price $96.60
Rate for Payer: Cigna Commercial $136.85
Rate for Payer: First Health Commercial $144.90
Rate for Payer: First Health Workers Compensation $62.16
Rate for Payer: Galaxy Health Commercial/Workers Compensation $144.90
Rate for Payer: GEHA Commercial $128.80
Rate for Payer: Great West Healthcare (Cigna) Commercial $144.90
Rate for Payer: Humana ChoiceCare $41.86
Rate for Payer: Multiplan All $146.51
Rate for Payer: New Mexico Health Connections Medicare $96.60
Rate for Payer: OMNI Networks Commercial $112.70
Rate for Payer: One Health Plan PPO/POS $144.90
Rate for Payer: Providence Risk & Insurance Services Commercial $152.95
Rate for Payer: Three Rivers Provider Network All $120.75
Rate for Payer: TriWest Veterans Administration/VAPC3 $141.68
Rate for Payer: United Healthcare Managed Medicaid $40.25
Rate for Payer: United Payors & United Providers UP&UP $149.73
Rate for Payer: Zelis Auto $64.40
Rate for Payer: Zelis Primary Direct / Supplemental Network $80.50
Rate for Payer: Zelis Worker's Compensation $43.95
Service Code CPT 10005
Hospital Charge Code 8899216
Hospital Revenue Code 519
Min. Negotiated Rate $440.89
Max. Negotiated Rate $1,534.25
Rate for Payer: Cash Price $969.00
Rate for Payer: Cigna Commercial $1,372.75
Rate for Payer: First Health Commercial $1,453.50
Rate for Payer: First Health Workers Compensation $623.55
Rate for Payer: Galaxy Health Commercial/Workers Compensation $1,453.50
Rate for Payer: GEHA Commercial $1,130.50
Rate for Payer: Great West Healthcare (Cigna) Commercial $1,453.50
Rate for Payer: Multiplan All $1,469.65
Rate for Payer: OMNI Networks Commercial $1,130.50
Rate for Payer: One Health Plan PPO/POS $1,453.50
Rate for Payer: Providence Risk & Insurance Services Commercial $1,534.25
Rate for Payer: Three Rivers Provider Network All $1,211.25
Rate for Payer: United Payors & United Providers UP&UP $1,501.95
Rate for Payer: Zelis Auto $646.00
Rate for Payer: Zelis Worker's Compensation $440.89
Service Code CPT 10005
Hospital Charge Code 8899216
Hospital Revenue Code 519
Min. Negotiated Rate $440.89
Max. Negotiated Rate $1,534.25
Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO $869.01
Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO $969.00
Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred $869.01
Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid $688.43
Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage $668.09
Rate for Payer: Cash Price $969.00
Rate for Payer: Cash Price $969.00
Rate for Payer: Cigna Commercial $1,372.75
Rate for Payer: First Health Commercial $1,453.50
Rate for Payer: First Health Workers Compensation $623.55
Rate for Payer: Galaxy Health Commercial/Workers Compensation $1,453.50
Rate for Payer: GEHA Commercial $1,292.00
Rate for Payer: GEHA Medicare $668.09
Rate for Payer: Great West Healthcare (Cigna) Commercial $1,453.50
Rate for Payer: Humana ChoiceCare $734.90
Rate for Payer: Humana Medicare Advantage $668.09
Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace $1,122.39
Rate for Payer: Molina Healthcare of New Mexico Medicaid $702.45
Rate for Payer: Molina Healthcare of New Mexico Medicare $668.09
Rate for Payer: Multiplan All $1,469.65
Rate for Payer: New Mexico Health Connections Medicare $1,135.75
Rate for Payer: OMNI Networks Commercial $1,130.50
Rate for Payer: One Health Plan PPO/POS $1,453.50
Rate for Payer: Presbyterian Health Plan Exchange $811.08
Rate for Payer: Presbyterian Health Plan Medicaid $702.45
Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS $668.09
Rate for Payer: Providence Risk & Insurance Services Commercial $1,534.25
Rate for Payer: Providence Risk & Insurance Services Worker's Compensation $1,336.18
Rate for Payer: Three Rivers Provider Network All $1,211.25
Rate for Payer: TriWest Veterans Administration/VAPC3 $654.73
Rate for Payer: United Healthcare Managed Medicaid $702.45
Rate for Payer: United Healthcare Medicare Advantage $668.09
Rate for Payer: United Payors & United Providers UP&UP $1,501.95
Rate for Payer: VistaCare Hospice Medicaid/Medicare $668.09
Rate for Payer: Zelis Auto $646.00
Rate for Payer: Zelis Medicare $567.88
Rate for Payer: Zelis Primary Direct / Supplemental Network $801.71
Rate for Payer: Zelis Worker's Compensation $440.89
Service Code CPT 10005
Hospital Charge Code 21099501
Hospital Revenue Code 510
Min. Negotiated Rate $440.89
Max. Negotiated Rate $1,534.25
Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO $869.01
Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO $969.00
Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred $869.01
Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid $688.43
Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage $668.09
Rate for Payer: Cash Price $969.00
Rate for Payer: Cash Price $969.00
Rate for Payer: Cigna Commercial $1,372.75
Rate for Payer: First Health Commercial $1,453.50
Rate for Payer: First Health Workers Compensation $623.55
Rate for Payer: Galaxy Health Commercial/Workers Compensation $1,453.50
Rate for Payer: GEHA Commercial $1,292.00
Rate for Payer: GEHA Medicare $668.09
Rate for Payer: Great West Healthcare (Cigna) Commercial $1,453.50
Rate for Payer: Humana ChoiceCare $734.90
Rate for Payer: Humana Medicare Advantage $668.09
Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace $1,122.39
Rate for Payer: Molina Healthcare of New Mexico Medicaid $702.45
Rate for Payer: Molina Healthcare of New Mexico Medicare $668.09
Rate for Payer: Multiplan All $1,469.65
Rate for Payer: New Mexico Health Connections Medicare $1,135.75
Rate for Payer: OMNI Networks Commercial $1,130.50
Rate for Payer: One Health Plan PPO/POS $1,453.50
Rate for Payer: Presbyterian Health Plan Exchange $811.08
Rate for Payer: Presbyterian Health Plan Medicaid $702.45
Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS $668.09
Rate for Payer: Providence Risk & Insurance Services Commercial $1,534.25
Rate for Payer: Providence Risk & Insurance Services Worker's Compensation $1,336.18
Rate for Payer: Three Rivers Provider Network All $1,211.25
Rate for Payer: TriWest Veterans Administration/VAPC3 $654.73
Rate for Payer: United Healthcare Managed Medicaid $702.45
Rate for Payer: United Healthcare Medicare Advantage $668.09
Rate for Payer: United Payors & United Providers UP&UP $1,501.95
Rate for Payer: VistaCare Hospice Medicaid/Medicare $668.09
Rate for Payer: Zelis Auto $646.00
Rate for Payer: Zelis Medicare $567.88
Rate for Payer: Zelis Primary Direct / Supplemental Network $801.71
Rate for Payer: Zelis Worker's Compensation $440.89
Service Code CPT 10005
Hospital Charge Code 8999218
Hospital Revenue Code 510
Min. Negotiated Rate $440.89
Max. Negotiated Rate $1,534.25
Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO $869.01
Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO $969.00
Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred $869.01
Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid $688.43
Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage $668.09
Rate for Payer: Cash Price $969.00
Rate for Payer: Cash Price $969.00
Rate for Payer: Cigna Commercial $1,372.75
Rate for Payer: First Health Commercial $1,453.50
Rate for Payer: First Health Workers Compensation $623.55
Rate for Payer: Galaxy Health Commercial/Workers Compensation $1,453.50
Rate for Payer: GEHA Commercial $1,292.00
Rate for Payer: GEHA Medicare $668.09
Rate for Payer: Great West Healthcare (Cigna) Commercial $1,453.50
Rate for Payer: Humana ChoiceCare $734.90
Rate for Payer: Humana Medicare Advantage $668.09
Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace $1,122.39
Rate for Payer: Molina Healthcare of New Mexico Medicaid $702.45
Rate for Payer: Molina Healthcare of New Mexico Medicare $668.09
Rate for Payer: Multiplan All $1,469.65
Rate for Payer: New Mexico Health Connections Medicare $1,135.75
Rate for Payer: OMNI Networks Commercial $1,130.50
Rate for Payer: One Health Plan PPO/POS $1,453.50
Rate for Payer: Presbyterian Health Plan Exchange $811.08
Rate for Payer: Presbyterian Health Plan Medicaid $702.45
Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS $668.09
Rate for Payer: Providence Risk & Insurance Services Commercial $1,534.25
Rate for Payer: Providence Risk & Insurance Services Worker's Compensation $1,336.18
Rate for Payer: Three Rivers Provider Network All $1,211.25
Rate for Payer: TriWest Veterans Administration/VAPC3 $654.73
Rate for Payer: United Healthcare Managed Medicaid $702.45
Rate for Payer: United Healthcare Medicare Advantage $668.09
Rate for Payer: United Payors & United Providers UP&UP $1,501.95
Rate for Payer: VistaCare Hospice Medicaid/Medicare $668.09
Rate for Payer: Zelis Auto $646.00
Rate for Payer: Zelis Medicare $567.88
Rate for Payer: Zelis Primary Direct / Supplemental Network $801.71
Rate for Payer: Zelis Worker's Compensation $440.89
Service Code CPT 10005
Hospital Charge Code 21099501
Hospital Revenue Code 510
Min. Negotiated Rate $440.89
Max. Negotiated Rate $1,534.25
Rate for Payer: Cash Price $969.00
Rate for Payer: Cigna Commercial $1,372.75
Rate for Payer: First Health Commercial $1,453.50
Rate for Payer: First Health Workers Compensation $623.55
Rate for Payer: Galaxy Health Commercial/Workers Compensation $1,453.50
Rate for Payer: GEHA Commercial $1,130.50
Rate for Payer: Great West Healthcare (Cigna) Commercial $1,453.50
Rate for Payer: Multiplan All $1,469.65
Rate for Payer: OMNI Networks Commercial $1,130.50
Rate for Payer: One Health Plan PPO/POS $1,453.50
Rate for Payer: Providence Risk & Insurance Services Commercial $1,534.25
Rate for Payer: Three Rivers Provider Network All $1,211.25
Rate for Payer: United Payors & United Providers UP&UP $1,501.95
Rate for Payer: Zelis Auto $646.00
Rate for Payer: Zelis Worker's Compensation $440.89
Service Code CPT 10005
Hospital Charge Code 8999218
Hospital Revenue Code 510
Min. Negotiated Rate $440.89
Max. Negotiated Rate $1,534.25
Rate for Payer: Cash Price $969.00
Rate for Payer: Cigna Commercial $1,372.75
Rate for Payer: First Health Commercial $1,453.50
Rate for Payer: First Health Workers Compensation $623.55
Rate for Payer: Galaxy Health Commercial/Workers Compensation $1,453.50
Rate for Payer: GEHA Commercial $1,130.50
Rate for Payer: Great West Healthcare (Cigna) Commercial $1,453.50
Rate for Payer: Multiplan All $1,469.65
Rate for Payer: OMNI Networks Commercial $1,130.50
Rate for Payer: One Health Plan PPO/POS $1,453.50
Rate for Payer: Providence Risk & Insurance Services Commercial $1,534.25
Rate for Payer: Three Rivers Provider Network All $1,211.25
Rate for Payer: United Payors & United Providers UP&UP $1,501.95
Rate for Payer: Zelis Auto $646.00
Rate for Payer: Zelis Worker's Compensation $440.89
Service Code CPT 10006
Hospital Charge Code 8899217
Hospital Revenue Code 519
Min. Negotiated Rate $202.00
Max. Negotiated Rate $767.60
Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO $484.80
Rate for Payer: Cash Price $484.80
Rate for Payer: Cigna Commercial $686.80
Rate for Payer: First Health Commercial $727.20
Rate for Payer: First Health Workers Compensation $311.97
Rate for Payer: Galaxy Health Commercial/Workers Compensation $727.20
Rate for Payer: GEHA Commercial $646.40
Rate for Payer: Great West Healthcare (Cigna) Commercial $727.20
Rate for Payer: Humana ChoiceCare $210.08
Rate for Payer: Multiplan All $735.28
Rate for Payer: New Mexico Health Connections Medicare $484.80
Rate for Payer: OMNI Networks Commercial $565.60
Rate for Payer: One Health Plan PPO/POS $727.20
Rate for Payer: Providence Risk & Insurance Services Commercial $767.60
Rate for Payer: Three Rivers Provider Network All $606.00
Rate for Payer: TriWest Veterans Administration/VAPC3 $711.04
Rate for Payer: United Healthcare Managed Medicaid $202.00
Rate for Payer: United Payors & United Providers UP&UP $751.44
Rate for Payer: Zelis Auto $323.20
Rate for Payer: Zelis Primary Direct / Supplemental Network $404.00
Rate for Payer: Zelis Worker's Compensation $220.58
Service Code CPT 10006
Hospital Charge Code 8999219
Hospital Revenue Code 510
Min. Negotiated Rate $202.00
Max. Negotiated Rate $767.60
Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO $484.80
Rate for Payer: Cash Price $484.80
Rate for Payer: Cigna Commercial $686.80
Rate for Payer: First Health Commercial $727.20
Rate for Payer: First Health Workers Compensation $311.97
Rate for Payer: Galaxy Health Commercial/Workers Compensation $727.20
Rate for Payer: GEHA Commercial $646.40
Rate for Payer: Great West Healthcare (Cigna) Commercial $727.20
Rate for Payer: Humana ChoiceCare $210.08
Rate for Payer: Multiplan All $735.28
Rate for Payer: New Mexico Health Connections Medicare $484.80
Rate for Payer: OMNI Networks Commercial $565.60
Rate for Payer: One Health Plan PPO/POS $727.20
Rate for Payer: Providence Risk & Insurance Services Commercial $767.60
Rate for Payer: Three Rivers Provider Network All $606.00
Rate for Payer: TriWest Veterans Administration/VAPC3 $711.04
Rate for Payer: United Healthcare Managed Medicaid $202.00
Rate for Payer: United Payors & United Providers UP&UP $751.44
Rate for Payer: Zelis Auto $323.20
Rate for Payer: Zelis Primary Direct / Supplemental Network $404.00
Rate for Payer: Zelis Worker's Compensation $220.58
Service Code CPT 10006
Hospital Charge Code 8999219
Hospital Revenue Code 510
Min. Negotiated Rate $220.58
Max. Negotiated Rate $767.60
Rate for Payer: Cash Price $484.80
Rate for Payer: Cigna Commercial $686.80
Rate for Payer: First Health Commercial $727.20
Rate for Payer: First Health Workers Compensation $311.97
Rate for Payer: Galaxy Health Commercial/Workers Compensation $727.20
Rate for Payer: GEHA Commercial $565.60
Rate for Payer: Great West Healthcare (Cigna) Commercial $727.20
Rate for Payer: Multiplan All $735.28
Rate for Payer: OMNI Networks Commercial $565.60
Rate for Payer: One Health Plan PPO/POS $727.20
Rate for Payer: Providence Risk & Insurance Services Commercial $767.60
Rate for Payer: Three Rivers Provider Network All $606.00
Rate for Payer: United Payors & United Providers UP&UP $751.44
Rate for Payer: Zelis Auto $323.20
Rate for Payer: Zelis Worker's Compensation $220.58
Service Code CPT 10006
Hospital Charge Code 21099502
Hospital Revenue Code 510
Min. Negotiated Rate $202.00
Max. Negotiated Rate $767.60
Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO $484.80
Rate for Payer: Cash Price $484.80
Rate for Payer: Cigna Commercial $686.80
Rate for Payer: First Health Commercial $727.20
Rate for Payer: First Health Workers Compensation $311.97
Rate for Payer: Galaxy Health Commercial/Workers Compensation $727.20
Rate for Payer: GEHA Commercial $646.40
Rate for Payer: Great West Healthcare (Cigna) Commercial $727.20
Rate for Payer: Humana ChoiceCare $210.08
Rate for Payer: Multiplan All $735.28
Rate for Payer: New Mexico Health Connections Medicare $484.80
Rate for Payer: OMNI Networks Commercial $565.60
Rate for Payer: One Health Plan PPO/POS $727.20
Rate for Payer: Providence Risk & Insurance Services Commercial $767.60
Rate for Payer: Three Rivers Provider Network All $606.00
Rate for Payer: TriWest Veterans Administration/VAPC3 $711.04
Rate for Payer: United Healthcare Managed Medicaid $202.00
Rate for Payer: United Payors & United Providers UP&UP $751.44
Rate for Payer: Zelis Auto $323.20
Rate for Payer: Zelis Primary Direct / Supplemental Network $404.00
Rate for Payer: Zelis Worker's Compensation $220.58
Service Code CPT 10006
Hospital Charge Code 21099502
Hospital Revenue Code 510
Min. Negotiated Rate $220.58
Max. Negotiated Rate $767.60
Rate for Payer: Cash Price $484.80
Rate for Payer: Cigna Commercial $686.80
Rate for Payer: First Health Commercial $727.20
Rate for Payer: First Health Workers Compensation $311.97
Rate for Payer: Galaxy Health Commercial/Workers Compensation $727.20
Rate for Payer: GEHA Commercial $565.60
Rate for Payer: Great West Healthcare (Cigna) Commercial $727.20
Rate for Payer: Multiplan All $735.28
Rate for Payer: OMNI Networks Commercial $565.60
Rate for Payer: One Health Plan PPO/POS $727.20
Rate for Payer: Providence Risk & Insurance Services Commercial $767.60
Rate for Payer: Three Rivers Provider Network All $606.00
Rate for Payer: United Payors & United Providers UP&UP $751.44
Rate for Payer: Zelis Auto $323.20
Rate for Payer: Zelis Worker's Compensation $220.58
Service Code CPT 10006
Hospital Charge Code 8899217
Hospital Revenue Code 519
Min. Negotiated Rate $220.58
Max. Negotiated Rate $767.60
Rate for Payer: Cash Price $484.80
Rate for Payer: Cigna Commercial $686.80
Rate for Payer: First Health Commercial $727.20
Rate for Payer: First Health Workers Compensation $311.97
Rate for Payer: Galaxy Health Commercial/Workers Compensation $727.20
Rate for Payer: GEHA Commercial $565.60
Rate for Payer: Great West Healthcare (Cigna) Commercial $727.20
Rate for Payer: Multiplan All $735.28
Rate for Payer: OMNI Networks Commercial $565.60
Rate for Payer: One Health Plan PPO/POS $727.20
Rate for Payer: Providence Risk & Insurance Services Commercial $767.60
Rate for Payer: Three Rivers Provider Network All $606.00
Rate for Payer: United Payors & United Providers UP&UP $751.44
Rate for Payer: Zelis Auto $323.20
Rate for Payer: Zelis Worker's Compensation $220.58
Hospital Charge Code 8129131
Hospital Revenue Code 450
Min. Negotiated Rate $68.00
Max. Negotiated Rate $258.40
Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO $163.20
Rate for Payer: Cash Price $163.20
Rate for Payer: Cigna Commercial $231.20
Rate for Payer: First Health Commercial $244.80
Rate for Payer: First Health Workers Compensation $105.02
Rate for Payer: Galaxy Health Commercial/Workers Compensation $244.80
Rate for Payer: GEHA Commercial $217.60
Rate for Payer: Great West Healthcare (Cigna) Commercial $244.80
Rate for Payer: Humana ChoiceCare $70.72
Rate for Payer: Multiplan All $247.52
Rate for Payer: New Mexico Health Connections Medicare $163.20
Rate for Payer: OMNI Networks Commercial $190.40
Rate for Payer: One Health Plan PPO/POS $244.80
Rate for Payer: Providence Risk & Insurance Services Commercial $258.40
Rate for Payer: Three Rivers Provider Network All $204.00
Rate for Payer: TriWest Veterans Administration/VAPC3 $239.36
Rate for Payer: United Healthcare Managed Medicaid $68.00
Rate for Payer: United Payors & United Providers UP&UP $252.96
Rate for Payer: Zelis Auto $108.80
Rate for Payer: Zelis Primary Direct / Supplemental Network $136.00
Rate for Payer: Zelis Worker's Compensation $74.26
Hospital Charge Code 8129131
Hospital Revenue Code 450
Min. Negotiated Rate $74.26
Max. Negotiated Rate $258.40
Rate for Payer: Cash Price $163.20
Rate for Payer: Cigna Commercial $231.20
Rate for Payer: First Health Commercial $244.80
Rate for Payer: First Health Workers Compensation $105.02
Rate for Payer: Galaxy Health Commercial/Workers Compensation $244.80
Rate for Payer: GEHA Commercial $190.40
Rate for Payer: Great West Healthcare (Cigna) Commercial $244.80
Rate for Payer: Multiplan All $247.52
Rate for Payer: OMNI Networks Commercial $190.40
Rate for Payer: One Health Plan PPO/POS $244.80
Rate for Payer: Providence Risk & Insurance Services Commercial $258.40
Rate for Payer: Three Rivers Provider Network All $204.00
Rate for Payer: United Payors & United Providers UP&UP $252.96
Rate for Payer: Zelis Auto $108.80
Rate for Payer: Zelis Worker's Compensation $74.26
Service Code CPT 26498
Hospital Charge Code 6126498
Hospital Revenue Code 975
Min. Negotiated Rate $628.72
Max. Negotiated Rate $2,187.85
Rate for Payer: Cash Price $1,381.80
Rate for Payer: Cigna Commercial $1,957.55
Rate for Payer: First Health Commercial $2,072.70
Rate for Payer: First Health Workers Compensation $889.19
Rate for Payer: Galaxy Health Commercial/Workers Compensation $2,072.70
Rate for Payer: GEHA Commercial $1,612.10
Rate for Payer: Great West Healthcare (Cigna) Commercial $2,072.70
Rate for Payer: Multiplan All $2,095.73
Rate for Payer: OMNI Networks Commercial $1,612.10
Rate for Payer: One Health Plan PPO/POS $2,072.70
Rate for Payer: Providence Risk & Insurance Services Commercial $2,187.85
Rate for Payer: Three Rivers Provider Network All $1,727.25
Rate for Payer: United Payors & United Providers UP&UP $2,141.79
Rate for Payer: Zelis Auto $921.20
Rate for Payer: Zelis Worker's Compensation $628.72
Service Code CPT 26497
Hospital Charge Code 6126497
Hospital Revenue Code 975
Min. Negotiated Rate $472.84
Max. Negotiated Rate $6,161.78
Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO $2,855.07
Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO $1,039.20
Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred $2,855.07
Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid $2,261.79
Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage $3,080.89
Rate for Payer: Cash Price $1,039.20
Rate for Payer: Cash Price $1,039.20
Rate for Payer: Cigna Commercial $1,472.20
Rate for Payer: First Health Commercial $1,558.80
Rate for Payer: First Health Workers Compensation $668.73
Rate for Payer: Galaxy Health Commercial/Workers Compensation $1,558.80
Rate for Payer: GEHA Commercial $1,385.60
Rate for Payer: GEHA Medicare $3,080.89
Rate for Payer: Great West Healthcare (Cigna) Commercial $1,558.80
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 $2,307.85
Rate for Payer: Molina Healthcare of New Mexico Medicare $3,080.89
Rate for Payer: Multiplan All $1,576.12
Rate for Payer: New Mexico Health Connections Medicare $5,237.51
Rate for Payer: OMNI Networks Commercial $1,212.40
Rate for Payer: One Health Plan PPO/POS $1,558.80
Rate for Payer: Presbyterian Health Plan Exchange $2,664.73
Rate for Payer: Presbyterian Health Plan Medicaid $2,307.85
Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS $3,080.89
Rate for Payer: Providence Risk & Insurance Services Commercial $1,645.40
Rate for Payer: Providence Risk & Insurance Services Worker's Compensation $6,161.78
Rate for Payer: Three Rivers Provider Network All $1,299.00
Rate for Payer: TriWest Veterans Administration/VAPC3 $3,019.27
Rate for Payer: United Healthcare Managed Medicaid $2,307.85
Rate for Payer: United Healthcare Medicare Advantage $3,080.89
Rate for Payer: United Payors & United Providers UP&UP $1,610.76
Rate for Payer: VistaCare Hospice Medicaid/Medicare $3,080.89
Rate for Payer: Zelis Auto $692.80
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 $472.84
Service Code CPT 26497
Hospital Charge Code 6126497
Hospital Revenue Code 975
Min. Negotiated Rate $472.84
Max. Negotiated Rate $1,645.40
Rate for Payer: Cash Price $1,039.20
Rate for Payer: Cigna Commercial $1,472.20
Rate for Payer: First Health Commercial $1,558.80
Rate for Payer: First Health Workers Compensation $668.73
Rate for Payer: Galaxy Health Commercial/Workers Compensation $1,558.80
Rate for Payer: GEHA Commercial $1,212.40
Rate for Payer: Great West Healthcare (Cigna) Commercial $1,558.80
Rate for Payer: Multiplan All $1,576.12
Rate for Payer: OMNI Networks Commercial $1,212.40
Rate for Payer: One Health Plan PPO/POS $1,558.80
Rate for Payer: Providence Risk & Insurance Services Commercial $1,645.40
Rate for Payer: Three Rivers Provider Network All $1,299.00
Rate for Payer: United Payors & United Providers UP&UP $1,610.76
Rate for Payer: Zelis Auto $692.80
Rate for Payer: Zelis Worker's Compensation $472.84
Service Code CPT 26498
Hospital Charge Code 6126498
Hospital Revenue Code 975
Min. Negotiated Rate $628.72
Max. Negotiated Rate $6,161.78
Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO $2,855.07
Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO $1,381.80
Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred $2,855.07
Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid $2,261.79
Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage $3,080.89
Rate for Payer: Cash Price $1,381.80
Rate for Payer: Cash Price $1,381.80
Rate for Payer: Cigna Commercial $1,957.55
Rate for Payer: First Health Commercial $2,072.70
Rate for Payer: First Health Workers Compensation $889.19
Rate for Payer: Galaxy Health Commercial/Workers Compensation $2,072.70
Rate for Payer: GEHA Commercial $1,842.40
Rate for Payer: GEHA Medicare $3,080.89
Rate for Payer: Great West Healthcare (Cigna) Commercial $2,072.70
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 $2,307.85
Rate for Payer: Molina Healthcare of New Mexico Medicare $3,080.89
Rate for Payer: Multiplan All $2,095.73
Rate for Payer: New Mexico Health Connections Medicare $5,237.51
Rate for Payer: OMNI Networks Commercial $1,612.10
Rate for Payer: One Health Plan PPO/POS $2,072.70
Rate for Payer: Presbyterian Health Plan Exchange $2,664.73
Rate for Payer: Presbyterian Health Plan Medicaid $2,307.85
Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS $3,080.89
Rate for Payer: Providence Risk & Insurance Services Commercial $2,187.85
Rate for Payer: Providence Risk & Insurance Services Worker's Compensation $6,161.78
Rate for Payer: Three Rivers Provider Network All $1,727.25
Rate for Payer: TriWest Veterans Administration/VAPC3 $3,019.27
Rate for Payer: United Healthcare Managed Medicaid $2,307.85
Rate for Payer: United Healthcare Medicare Advantage $3,080.89
Rate for Payer: United Payors & United Providers UP&UP $2,141.79
Rate for Payer: VistaCare Hospice Medicaid/Medicare $3,080.89
Rate for Payer: Zelis Auto $921.20
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 $628.72
Service Code CPT 46200
Hospital Revenue Code 360
Min. Negotiated Rate $1,919.98
Max. Negotiated Rate $5,208.02
Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO $2,423.61
Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred $2,423.61
Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid $1,919.98
Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage $2,604.01
Rate for Payer: First Health Workers Compensation $3,351.36
Rate for Payer: GEHA Medicare $2,604.01
Rate for Payer: Humana ChoiceCare $2,864.41
Rate for Payer: Humana Medicare Advantage $2,604.01
Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace $4,374.74
Rate for Payer: Molina Healthcare of New Mexico Medicaid $1,959.08
Rate for Payer: Molina Healthcare of New Mexico Medicare $2,604.01
Rate for Payer: New Mexico Health Connections Medicare $4,426.82
Rate for Payer: Presbyterian Health Plan Exchange $2,262.04
Rate for Payer: Presbyterian Health Plan Medicaid $1,959.08
Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS $2,604.01
Rate for Payer: Providence Risk & Insurance Services Worker's Compensation $5,208.02
Rate for Payer: TriWest Veterans Administration/VAPC3 $2,551.93
Rate for Payer: United Healthcare Managed Medicaid $1,959.08
Rate for Payer: United Healthcare Medicare Advantage $2,604.01
Rate for Payer: VistaCare Hospice Medicaid/Medicare $2,604.01
Rate for Payer: Zelis Medicare $2,213.41
Rate for Payer: Zelis Primary Direct / Supplemental Network $3,124.81
Rate for Payer: Zelis Worker's Compensation $2,369.65