|
FIXATION OF KNEE JOINT
|
Facility
|
IP
|
$461.00
|
|
|
Service Code
|
CPT 27570
|
| Hospital Charge Code |
6127570
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$125.85 |
| Max. Negotiated Rate |
$437.95 |
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cigna Commercial |
$391.85
|
| Rate for Payer: First Health Commercial |
$414.90
|
| Rate for Payer: First Health Workers Compensation |
$177.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$414.90
|
| Rate for Payer: GEHA Commercial |
$322.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$414.90
|
| Rate for Payer: Multiplan All |
$419.51
|
| Rate for Payer: OMNI Networks Commercial |
$322.70
|
| Rate for Payer: One Health Plan PPO/POS |
$414.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$437.95
|
| Rate for Payer: Three Rivers Provider Network All |
$345.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$428.73
|
| Rate for Payer: Zelis Auto |
$184.40
|
| Rate for Payer: Zelis Worker's Compensation |
$125.85
|
|
|
FIXATION OF SHOULDER
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
6123700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$164.35 |
| Max. Negotiated Rate |
$571.90 |
| Rate for Payer: Cash Price |
$361.20
|
| Rate for Payer: Cigna Commercial |
$511.70
|
| Rate for Payer: First Health Commercial |
$541.80
|
| Rate for Payer: First Health Workers Compensation |
$232.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$541.80
|
| Rate for Payer: GEHA Commercial |
$421.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$541.80
|
| Rate for Payer: Multiplan All |
$547.82
|
| Rate for Payer: OMNI Networks Commercial |
$421.40
|
| Rate for Payer: One Health Plan PPO/POS |
$541.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$571.90
|
| Rate for Payer: Three Rivers Provider Network All |
$451.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$559.86
|
| Rate for Payer: Zelis Auto |
$240.80
|
| Rate for Payer: Zelis Worker's Compensation |
$164.35
|
|
|
FIXATION OF SHOULDER
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
6123700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$164.35 |
| Max. Negotiated Rate |
$3,039.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$361.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,546.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,224.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,519.65
|
| Rate for Payer: Cash Price |
$361.20
|
| Rate for Payer: Cash Price |
$361.20
|
| Rate for Payer: Cigna Commercial |
$511.70
|
| Rate for Payer: First Health Commercial |
$541.80
|
| Rate for Payer: First Health Workers Compensation |
$232.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$541.80
|
| Rate for Payer: GEHA Commercial |
$481.60
|
| Rate for Payer: GEHA Medicare |
$1,519.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$541.80
|
| Rate for Payer: Humana ChoiceCare |
$1,671.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,519.65
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,553.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,249.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,519.65
|
| Rate for Payer: Multiplan All |
$547.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,583.41
|
| Rate for Payer: OMNI Networks Commercial |
$421.40
|
| Rate for Payer: One Health Plan PPO/POS |
$541.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,443.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,249.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,519.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$571.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,039.30
|
| Rate for Payer: Three Rivers Provider Network All |
$451.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,489.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,249.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,519.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$559.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,519.65
|
| Rate for Payer: Zelis Auto |
$240.80
|
| Rate for Payer: Zelis Medicare |
$1,291.70
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,823.58
|
| Rate for Payer: Zelis Worker's Compensation |
$164.35
|
|
|
FIXATION OF SHOULDER BLADE
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
CPT 23400
|
| Hospital Charge Code |
6123400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$546.00 |
| 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 |
$1,200.00
|
| 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 |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,700.00
|
| Rate for Payer: First Health Commercial |
$1,800.00
|
| Rate for Payer: First Health Workers Compensation |
$772.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,800.00
|
| Rate for Payer: GEHA Commercial |
$1,600.00
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,800.00
|
| 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 |
$1,820.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,400.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,800.00
|
| 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 |
$1,900.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,500.00
|
| 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 |
$1,860.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$800.00
|
| 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 |
$546.00
|
|
|
FIXATION OF SHOULDER BLADE
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
CPT 23400
|
| Hospital Charge Code |
6123400
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,700.00
|
| Rate for Payer: First Health Commercial |
$1,800.00
|
| Rate for Payer: First Health Workers Compensation |
$772.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,800.00
|
| Rate for Payer: GEHA Commercial |
$1,400.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,800.00
|
| Rate for Payer: Multiplan All |
$1,820.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,400.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,800.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,900.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,500.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,860.00
|
| Rate for Payer: Zelis Auto |
$800.00
|
| Rate for Payer: Zelis Worker's Compensation |
$546.00
|
|
|
FL BARIUM ENEMA
|
Facility
|
OP
|
$1,280.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
2400058
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$1,216.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$131.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$768.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$131.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$104.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$169.04
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cigna Commercial |
$1,088.00
|
| Rate for Payer: First Health Commercial |
$1,152.00
|
| Rate for Payer: First Health Workers Compensation |
$189.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,152.00
|
| Rate for Payer: GEHA Commercial |
$1,024.00
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,152.00
|
| Rate for Payer: Humana ChoiceCare |
$185.94
|
| Rate for Payer: Humana Medicare Advantage |
$169.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$283.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$106.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$1,164.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$896.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,152.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$122.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$106.13
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$169.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,216.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$960.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$1,088.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$106.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,190.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$512.00
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$133.64
|
|
|
FL BARIUM ENEMA
|
Facility
|
IP
|
$1,280.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
2400058
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$133.64 |
| Max. Negotiated Rate |
$1,216.00 |
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cigna Commercial |
$1,088.00
|
| Rate for Payer: First Health Commercial |
$1,152.00
|
| Rate for Payer: First Health Workers Compensation |
$189.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,152.00
|
| Rate for Payer: GEHA Commercial |
$896.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,152.00
|
| Rate for Payer: Multiplan All |
$1,164.80
|
| Rate for Payer: OMNI Networks Commercial |
$896.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,152.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,216.00
|
| Rate for Payer: Three Rivers Provider Network All |
$960.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,190.40
|
| Rate for Payer: Zelis Auto |
$512.00
|
| Rate for Payer: Zelis Worker's Compensation |
$133.64
|
|
|
FL BARIUM ENEMA W/AIR
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
2400059
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$143.68 |
| Max. Negotiated Rate |
$1,517.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$212.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$958.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$212.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$168.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$169.04
|
| Rate for Payer: Cash Price |
$958.20
|
| Rate for Payer: Cash Price |
$958.20
|
| Rate for Payer: Cigna Commercial |
$1,357.45
|
| Rate for Payer: First Health Commercial |
$1,437.30
|
| Rate for Payer: First Health Workers Compensation |
$273.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,437.30
|
| Rate for Payer: GEHA Commercial |
$1,277.60
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,437.30
|
| Rate for Payer: Humana ChoiceCare |
$185.94
|
| Rate for Payer: Humana Medicare Advantage |
$169.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$283.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$171.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$1,453.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$1,117.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,437.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$198.18
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$171.64
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$169.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,517.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$1,197.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$1,357.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$171.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,485.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$638.80
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$193.05
|
|
|
FL BARIUM ENEMA W/AIR
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
2400059
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$193.05 |
| Max. Negotiated Rate |
$1,517.15 |
| Rate for Payer: Cash Price |
$958.20
|
| Rate for Payer: Cash Price |
$958.20
|
| Rate for Payer: Cigna Commercial |
$1,357.45
|
| Rate for Payer: First Health Commercial |
$1,437.30
|
| Rate for Payer: First Health Workers Compensation |
$273.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,437.30
|
| Rate for Payer: GEHA Commercial |
$1,117.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,437.30
|
| Rate for Payer: Multiplan All |
$1,453.27
|
| Rate for Payer: OMNI Networks Commercial |
$1,117.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,437.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,517.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,197.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,485.21
|
| Rate for Payer: Zelis Auto |
$638.80
|
| Rate for Payer: Zelis Worker's Compensation |
$193.05
|
|
|
FL CHOLANGIOGRAM PERCU EXISTING CATH
|
Facility
|
IP
|
$4,963.00
|
|
|
Service Code
|
CPT 47531
|
| Hospital Charge Code |
2447531
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,354.90 |
| Max. Negotiated Rate |
$4,714.85 |
| Rate for Payer: Cash Price |
$2,977.80
|
| Rate for Payer: Cigna Commercial |
$4,218.55
|
| Rate for Payer: First Health Commercial |
$4,466.70
|
| Rate for Payer: First Health Workers Compensation |
$1,916.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,466.70
|
| Rate for Payer: GEHA Commercial |
$3,474.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,466.70
|
| Rate for Payer: Multiplan All |
$4,516.33
|
| Rate for Payer: OMNI Networks Commercial |
$3,474.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,466.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,714.85
|
| Rate for Payer: Three Rivers Provider Network All |
$3,722.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,615.59
|
| Rate for Payer: Zelis Auto |
$1,985.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,354.90
|
|
|
FL CHOLANGIOGRAM PERCU EXISTING CATH
|
Facility
|
OP
|
$4,963.00
|
|
|
Service Code
|
CPT 47531
|
| Hospital Charge Code |
2447531
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$417.94 |
| Max. Negotiated Rate |
$6,701.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$527.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,977.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$527.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$417.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,350.98
|
| Rate for Payer: Cash Price |
$2,977.80
|
| Rate for Payer: Cash Price |
$2,977.80
|
| Rate for Payer: Cigna Commercial |
$4,218.55
|
| Rate for Payer: First Health Commercial |
$4,466.70
|
| Rate for Payer: First Health Workers Compensation |
$4,312.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,466.70
|
| Rate for Payer: GEHA Commercial |
$3,970.40
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,466.70
|
| Rate for Payer: Humana ChoiceCare |
$3,686.08
|
| Rate for Payer: Humana Medicare Advantage |
$3,350.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,629.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$426.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,350.98
|
| Rate for Payer: Multiplan All |
$4,516.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: OMNI Networks Commercial |
$3,474.10
|
| Rate for Payer: One Health Plan PPO/POS |
$4,466.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$492.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$426.45
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,350.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,714.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: Three Rivers Provider Network All |
$3,722.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,283.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$426.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,615.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Auto |
$1,985.20
|
| Rate for Payer: Zelis Medicare |
$2,848.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,021.18
|
| Rate for Payer: Zelis Worker's Compensation |
$3,049.39
|
|
|
FL CHOLECYSTO ORAL
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
CPT 74290
|
| Hospital Charge Code |
2400060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.42 |
| Max. Negotiated Rate |
$527.25 |
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna Commercial |
$471.75
|
| Rate for Payer: First Health Commercial |
$499.50
|
| Rate for Payer: First Health Workers Compensation |
$105.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$499.50
|
| Rate for Payer: GEHA Commercial |
$388.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$499.50
|
| Rate for Payer: Multiplan All |
$505.05
|
| Rate for Payer: OMNI Networks Commercial |
$388.50
|
| Rate for Payer: One Health Plan PPO/POS |
$499.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$527.25
|
| Rate for Payer: Three Rivers Provider Network All |
$416.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$516.15
|
| Rate for Payer: Zelis Auto |
$222.00
|
| Rate for Payer: Zelis Worker's Compensation |
$74.42
|
|
|
FL CHOLECYSTO ORAL
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT 74290
|
| Hospital Charge Code |
2400060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.42 |
| Max. Negotiated Rate |
$527.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$131.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$333.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$131.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$104.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$169.04
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna Commercial |
$471.75
|
| Rate for Payer: First Health Commercial |
$499.50
|
| Rate for Payer: First Health Workers Compensation |
$105.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$499.50
|
| Rate for Payer: GEHA Commercial |
$444.00
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$499.50
|
| Rate for Payer: Humana ChoiceCare |
$185.94
|
| Rate for Payer: Humana Medicare Advantage |
$169.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$283.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$106.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$505.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$388.50
|
| Rate for Payer: One Health Plan PPO/POS |
$499.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$122.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$106.13
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$169.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$527.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$416.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$471.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$106.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$516.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$222.00
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$74.42
|
|
|
FL CYSTOGRAM COMPLETE
|
Facility
|
IP
|
$1,156.00
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
2400063
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.96 |
| Max. Negotiated Rate |
$1,098.20 |
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cigna Commercial |
$982.60
|
| Rate for Payer: First Health Commercial |
$1,040.40
|
| Rate for Payer: First Health Workers Compensation |
$65.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,040.40
|
| Rate for Payer: GEHA Commercial |
$809.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,040.40
|
| Rate for Payer: Multiplan All |
$1,051.96
|
| Rate for Payer: OMNI Networks Commercial |
$809.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,040.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,098.20
|
| Rate for Payer: Three Rivers Provider Network All |
$867.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,075.08
|
| Rate for Payer: Zelis Auto |
$462.40
|
| Rate for Payer: Zelis Worker's Compensation |
$45.96
|
|
|
FL CYSTOGRAM COMPLETE
|
Facility
|
OP
|
$1,156.00
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
2400063
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.96 |
| Max. Negotiated Rate |
$1,098.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$257.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$693.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$257.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$203.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$339.11
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cigna Commercial |
$982.60
|
| Rate for Payer: First Health Commercial |
$1,040.40
|
| Rate for Payer: First Health Workers Compensation |
$65.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,040.40
|
| Rate for Payer: GEHA Commercial |
$924.80
|
| Rate for Payer: GEHA Medicare |
$339.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,040.40
|
| Rate for Payer: Humana ChoiceCare |
$373.02
|
| Rate for Payer: Humana Medicare Advantage |
$339.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$569.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$208.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$339.11
|
| Rate for Payer: Multiplan All |
$1,051.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.49
|
| Rate for Payer: OMNI Networks Commercial |
$809.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,040.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$240.27
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$208.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$339.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,098.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$678.22
|
| Rate for Payer: Three Rivers Provider Network All |
$867.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$332.33
|
| Rate for Payer: United Healthcare Commercial |
$982.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,075.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$339.11
|
| Rate for Payer: Zelis Auto |
$462.40
|
| Rate for Payer: Zelis Medicare |
$288.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$406.93
|
| Rate for Payer: Zelis Worker's Compensation |
$45.96
|
|
|
FLECAINIDE 50 MG TAB
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 00054001020
|
| Hospital Charge Code |
3303001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$1.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$4.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Humana ChoiceCare |
$1.30
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3.00
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1.36
|
|
|
FLECAINIDE 50 MG TAB
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 00054001020
|
| Hospital Charge Code |
3303001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$1.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$3.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.36
|
|
|
FL ESOPHAGUS
|
Facility
|
IP
|
$926.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
2400056
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.86 |
| Max. Negotiated Rate |
$879.70 |
| Rate for Payer: Cash Price |
$555.60
|
| Rate for Payer: Cash Price |
$555.60
|
| Rate for Payer: Cigna Commercial |
$787.10
|
| Rate for Payer: First Health Commercial |
$833.40
|
| Rate for Payer: First Health Workers Compensation |
$120.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$833.40
|
| Rate for Payer: GEHA Commercial |
$648.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$833.40
|
| Rate for Payer: Multiplan All |
$842.66
|
| Rate for Payer: OMNI Networks Commercial |
$648.20
|
| Rate for Payer: One Health Plan PPO/POS |
$833.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$879.70
|
| Rate for Payer: Three Rivers Provider Network All |
$694.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$861.18
|
| Rate for Payer: Zelis Auto |
$370.40
|
| Rate for Payer: Zelis Worker's Compensation |
$84.86
|
|
|
FL ESOPHAGUS
|
Facility
|
OP
|
$926.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
2400056
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.86 |
| Max. Negotiated Rate |
$879.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$131.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$555.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$131.29
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$104.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$169.04
|
| Rate for Payer: Cash Price |
$555.60
|
| Rate for Payer: Cash Price |
$555.60
|
| Rate for Payer: Cigna Commercial |
$787.10
|
| Rate for Payer: First Health Commercial |
$833.40
|
| Rate for Payer: First Health Workers Compensation |
$120.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$833.40
|
| Rate for Payer: GEHA Commercial |
$740.80
|
| Rate for Payer: GEHA Medicare |
$169.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$833.40
|
| Rate for Payer: Humana ChoiceCare |
$185.94
|
| Rate for Payer: Humana Medicare Advantage |
$169.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$283.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$106.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$169.04
|
| Rate for Payer: Multiplan All |
$842.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$287.37
|
| Rate for Payer: OMNI Networks Commercial |
$648.20
|
| Rate for Payer: One Health Plan PPO/POS |
$833.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$122.54
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$106.13
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$169.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$879.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$338.08
|
| Rate for Payer: Three Rivers Provider Network All |
$694.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$165.66
|
| Rate for Payer: United Healthcare Commercial |
$787.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$106.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$861.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$169.04
|
| Rate for Payer: Zelis Auto |
$370.40
|
| Rate for Payer: Zelis Medicare |
$143.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$202.85
|
| Rate for Payer: Zelis Worker's Compensation |
$84.86
|
|
|
FLEX.COMPRESS.PLATE 18X24CM
|
Facility
|
IP
|
$4,708.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,883.20 |
| Max. Negotiated Rate |
$4,472.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,766.40
|
| Rate for Payer: Cash Price |
$2,824.80
|
| Rate for Payer: Cash Price |
$2,824.80
|
| Rate for Payer: Cigna Commercial |
$4,001.80
|
| Rate for Payer: First Health Commercial |
$4,237.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,237.20
|
| Rate for Payer: GEHA Commercial |
$3,295.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,237.20
|
| Rate for Payer: Multiplan All |
$4,284.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,295.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,237.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,472.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,531.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,378.44
|
| Rate for Payer: Zelis Auto |
$1,883.20
|
|
|
FLEX.COMPRESS.PLATE 18X24CM
|
Facility
|
OP
|
$4,708.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,177.00 |
| Max. Negotiated Rate |
$4,472.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,824.80
|
| Rate for Payer: Cash Price |
$2,824.80
|
| Rate for Payer: Cash Price |
$2,824.80
|
| Rate for Payer: Cigna Commercial |
$4,001.80
|
| Rate for Payer: First Health Commercial |
$4,237.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,237.20
|
| Rate for Payer: GEHA Commercial |
$3,766.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,237.20
|
| Rate for Payer: Humana ChoiceCare |
$1,224.08
|
| Rate for Payer: Multiplan All |
$4,284.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,824.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,295.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,237.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,472.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,531.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,143.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,177.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,378.44
|
| Rate for Payer: Zelis Auto |
$1,883.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,354.00
|
|
|
FLEX.COMPRESS.PLATE 24X30CM
|
Facility
|
IP
|
$4,708.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,883.20 |
| Max. Negotiated Rate |
$4,472.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,766.40
|
| Rate for Payer: Cash Price |
$2,824.80
|
| Rate for Payer: Cash Price |
$2,824.80
|
| Rate for Payer: Cigna Commercial |
$4,001.80
|
| Rate for Payer: First Health Commercial |
$4,237.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,237.20
|
| Rate for Payer: GEHA Commercial |
$3,295.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,237.20
|
| Rate for Payer: Multiplan All |
$4,284.28
|
| Rate for Payer: OMNI Networks Commercial |
$3,295.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,237.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,472.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,531.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,378.44
|
| Rate for Payer: Zelis Auto |
$1,883.20
|
|
|
FLEX.COMPRESS.PLATE 24X30CM
|
Facility
|
OP
|
$4,708.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,177.00 |
| Max. Negotiated Rate |
$4,472.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,824.80
|
| Rate for Payer: Cash Price |
$2,824.80
|
| Rate for Payer: Cash Price |
$2,824.80
|
| Rate for Payer: Cigna Commercial |
$4,001.80
|
| Rate for Payer: First Health Commercial |
$4,237.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,237.20
|
| Rate for Payer: GEHA Commercial |
$3,766.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,237.20
|
| Rate for Payer: Humana ChoiceCare |
$1,224.08
|
| Rate for Payer: Multiplan All |
$4,284.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,824.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,295.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,237.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,472.60
|
| Rate for Payer: Three Rivers Provider Network All |
$3,531.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,143.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,177.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,378.44
|
| Rate for Payer: Zelis Auto |
$1,883.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,354.00
|
|
|
FL FLUORO FOR NEEDLE PLACEMNT - ADD ON
|
Facility
|
IP
|
$1,051.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
2407207
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.97 |
| Max. Negotiated Rate |
$998.45 |
| Rate for Payer: Cash Price |
$630.60
|
| Rate for Payer: Cash Price |
$630.60
|
| Rate for Payer: Cigna Commercial |
$893.35
|
| Rate for Payer: First Health Commercial |
$945.90
|
| Rate for Payer: First Health Workers Compensation |
$139.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$945.90
|
| Rate for Payer: GEHA Commercial |
$735.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$945.90
|
| Rate for Payer: Multiplan All |
$956.41
|
| Rate for Payer: OMNI Networks Commercial |
$735.70
|
| Rate for Payer: One Health Plan PPO/POS |
$945.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$998.45
|
| Rate for Payer: Three Rivers Provider Network All |
$788.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$977.43
|
| Rate for Payer: Zelis Auto |
$420.40
|
| Rate for Payer: Zelis Worker's Compensation |
$98.97
|
|
|
FL FLUORO FOR NEEDLE PLACEMNT - ADD ON
|
Facility
|
OP
|
$1,051.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
2407207
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.97 |
| Max. Negotiated Rate |
$998.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$630.60
|
| Rate for Payer: Cash Price |
$630.60
|
| Rate for Payer: Cash Price |
$630.60
|
| Rate for Payer: Cigna Commercial |
$893.35
|
| Rate for Payer: First Health Commercial |
$945.90
|
| Rate for Payer: First Health Workers Compensation |
$139.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$945.90
|
| Rate for Payer: GEHA Commercial |
$840.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$945.90
|
| Rate for Payer: Humana ChoiceCare |
$273.26
|
| Rate for Payer: Multiplan All |
$956.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$630.60
|
| Rate for Payer: OMNI Networks Commercial |
$735.70
|
| Rate for Payer: One Health Plan PPO/POS |
$945.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$998.45
|
| Rate for Payer: Three Rivers Provider Network All |
$788.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$924.88
|
| Rate for Payer: United Healthcare Commercial |
$893.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$262.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$977.43
|
| Rate for Payer: Zelis Auto |
$420.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$525.50
|
| Rate for Payer: Zelis Worker's Compensation |
$98.97
|
|
