|
FUSION OF URETER & KIDNEY
|
Facility
|
IP
|
$2,574.00
|
|
|
Service Code
|
CPT 50740
|
| Hospital Charge Code |
6150740
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$702.70 |
| Max. Negotiated Rate |
$2,445.30 |
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Cigna Commercial |
$2,187.90
|
| Rate for Payer: First Health Commercial |
$2,316.60
|
| Rate for Payer: First Health Workers Compensation |
$993.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,316.60
|
| Rate for Payer: GEHA Commercial |
$1,801.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,316.60
|
| Rate for Payer: Multiplan All |
$2,342.34
|
| Rate for Payer: OMNI Networks Commercial |
$1,801.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,316.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,445.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,930.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,393.82
|
| Rate for Payer: Zelis Auto |
$1,029.60
|
| Rate for Payer: Zelis Worker's Compensation |
$702.70
|
|
|
FUSION OF URETER & KIDNEY
|
Facility
|
OP
|
$2,382.00
|
|
|
Service Code
|
CPT 50750
|
| Hospital Charge Code |
6150750
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$595.50 |
| Max. Negotiated Rate |
$2,262.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,429.20
|
| Rate for Payer: Cash Price |
$1,429.20
|
| Rate for Payer: Cigna Commercial |
$2,024.70
|
| Rate for Payer: First Health Commercial |
$2,143.80
|
| Rate for Payer: First Health Workers Compensation |
$919.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,143.80
|
| Rate for Payer: GEHA Commercial |
$1,905.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,143.80
|
| Rate for Payer: Humana ChoiceCare |
$619.32
|
| Rate for Payer: Multiplan All |
$2,167.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,429.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,667.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,143.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,262.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,786.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,096.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$595.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,215.26
|
| Rate for Payer: Zelis Auto |
$952.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,191.00
|
| Rate for Payer: Zelis Worker's Compensation |
$650.29
|
|
|
FUSION OF URETER & KIDNEY
|
Facility
|
IP
|
$2,382.00
|
|
|
Service Code
|
CPT 50750
|
| Hospital Charge Code |
6150750
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$650.29 |
| Max. Negotiated Rate |
$2,262.90 |
| Rate for Payer: Cash Price |
$1,429.20
|
| Rate for Payer: Cigna Commercial |
$2,024.70
|
| Rate for Payer: First Health Commercial |
$2,143.80
|
| Rate for Payer: First Health Workers Compensation |
$919.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,143.80
|
| Rate for Payer: GEHA Commercial |
$1,667.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,143.80
|
| Rate for Payer: Multiplan All |
$2,167.62
|
| Rate for Payer: OMNI Networks Commercial |
$1,667.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,143.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,262.90
|
| Rate for Payer: Three Rivers Provider Network All |
$1,786.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,215.26
|
| Rate for Payer: Zelis Auto |
$952.80
|
| Rate for Payer: Zelis Worker's Compensation |
$650.29
|
|
|
FUSION OF URETER & KIDNEY
|
Facility
|
OP
|
$2,574.00
|
|
|
Service Code
|
CPT 50740
|
| Hospital Charge Code |
6150740
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$643.50 |
| Max. Negotiated Rate |
$2,445.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,544.40
|
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Cigna Commercial |
$2,187.90
|
| Rate for Payer: First Health Commercial |
$2,316.60
|
| Rate for Payer: First Health Workers Compensation |
$993.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,316.60
|
| Rate for Payer: GEHA Commercial |
$2,059.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,316.60
|
| Rate for Payer: Humana ChoiceCare |
$669.24
|
| Rate for Payer: Multiplan All |
$2,342.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,544.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,801.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,316.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,445.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,930.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,265.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$643.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,393.82
|
| Rate for Payer: Zelis Auto |
$1,029.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,287.00
|
| Rate for Payer: Zelis Worker's Compensation |
$702.70
|
|
|
FUSION OF URETERS
|
Facility
|
OP
|
$2,345.00
|
|
|
Service Code
|
CPT 50760
|
| Hospital Charge Code |
6150760
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$586.25 |
| Max. Negotiated Rate |
$2,227.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,407.00
|
| Rate for Payer: Cash Price |
$1,407.00
|
| Rate for Payer: Cigna Commercial |
$1,993.25
|
| Rate for Payer: First Health Commercial |
$2,110.50
|
| Rate for Payer: First Health Workers Compensation |
$905.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,110.50
|
| Rate for Payer: GEHA Commercial |
$1,876.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,110.50
|
| Rate for Payer: Humana ChoiceCare |
$609.70
|
| Rate for Payer: Multiplan All |
$2,133.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,407.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,641.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,110.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,227.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,758.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,063.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$586.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,180.85
|
| Rate for Payer: Zelis Auto |
$938.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,172.50
|
| Rate for Payer: Zelis Worker's Compensation |
$640.18
|
|
|
FUSION OF URETERS
|
Facility
|
IP
|
$2,345.00
|
|
|
Service Code
|
CPT 50760
|
| Hospital Charge Code |
6150760
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$640.18 |
| Max. Negotiated Rate |
$2,227.75 |
| Rate for Payer: Cash Price |
$1,407.00
|
| Rate for Payer: Cigna Commercial |
$1,993.25
|
| Rate for Payer: First Health Commercial |
$2,110.50
|
| Rate for Payer: First Health Workers Compensation |
$905.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,110.50
|
| Rate for Payer: GEHA Commercial |
$1,641.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,110.50
|
| Rate for Payer: Multiplan All |
$2,133.95
|
| Rate for Payer: OMNI Networks Commercial |
$1,641.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,110.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,227.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,758.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,180.85
|
| Rate for Payer: Zelis Auto |
$938.00
|
| Rate for Payer: Zelis Worker's Compensation |
$640.18
|
|
|
FUSION OF WRIST JOINT
|
Facility
|
IP
|
$2,158.32
|
|
|
Service Code
|
CPT 25800
|
| Hospital Charge Code |
6125800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$589.22 |
| Max. Negotiated Rate |
$2,050.40 |
| Rate for Payer: Cash Price |
$1,294.99
|
| Rate for Payer: Cigna Commercial |
$1,834.57
|
| Rate for Payer: First Health Commercial |
$1,942.49
|
| Rate for Payer: First Health Workers Compensation |
$833.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,942.49
|
| Rate for Payer: GEHA Commercial |
$1,510.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,942.49
|
| Rate for Payer: Multiplan All |
$1,964.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,510.82
|
| Rate for Payer: One Health Plan PPO/POS |
$1,942.49
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,050.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,618.74
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,007.24
|
| Rate for Payer: Zelis Auto |
$863.33
|
| Rate for Payer: Zelis Worker's Compensation |
$589.22
|
|
|
FUSION OF WRIST JOINT
|
Facility
|
OP
|
$2,158.32
|
|
|
Service Code
|
CPT 25800
|
| Hospital Charge Code |
6125800
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$589.22 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,294.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7,100.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,294.99
|
| Rate for Payer: Cash Price |
$1,294.99
|
| Rate for Payer: Cigna Commercial |
$1,834.57
|
| Rate for Payer: First Health Commercial |
$1,942.49
|
| Rate for Payer: First Health Workers Compensation |
$833.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,942.49
|
| Rate for Payer: GEHA Commercial |
$1,726.66
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,942.49
|
| 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 |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,964.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,510.82
|
| Rate for Payer: One Health Plan PPO/POS |
$1,942.49
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8,365.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7,245.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,050.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,618.74
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,007.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$863.33
|
| 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 |
$589.22
|
|
|
FUSION RADIOULNAR JNT/ULNA
|
Facility
|
OP
|
$1,906.00
|
|
|
Service Code
|
CPT 25830
|
| Hospital Charge Code |
6125830
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$520.34 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,143.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8,963.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7,100.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,143.60
|
| Rate for Payer: Cash Price |
$1,143.60
|
| Rate for Payer: Cigna Commercial |
$1,620.10
|
| Rate for Payer: First Health Commercial |
$1,715.40
|
| Rate for Payer: First Health Workers Compensation |
$735.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,715.40
|
| Rate for Payer: GEHA Commercial |
$1,524.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,715.40
|
| 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 |
$7,245.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,734.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,334.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,715.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8,365.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7,245.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,810.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,429.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,245.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,772.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$762.40
|
| 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 |
$520.34
|
|
|
FUSION RADIOULNAR JNT/ULNA
|
Facility
|
IP
|
$1,906.00
|
|
|
Service Code
|
CPT 25830
|
| Hospital Charge Code |
6125830
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$520.34 |
| Max. Negotiated Rate |
$1,810.70 |
| Rate for Payer: Cash Price |
$1,143.60
|
| Rate for Payer: Cigna Commercial |
$1,620.10
|
| Rate for Payer: First Health Commercial |
$1,715.40
|
| Rate for Payer: First Health Workers Compensation |
$735.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,715.40
|
| Rate for Payer: GEHA Commercial |
$1,334.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,715.40
|
| Rate for Payer: Multiplan All |
$1,734.46
|
| Rate for Payer: OMNI Networks Commercial |
$1,334.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,715.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,810.70
|
| Rate for Payer: Three Rivers Provider Network All |
$1,429.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,772.58
|
| Rate for Payer: Zelis Auto |
$762.40
|
| Rate for Payer: Zelis Worker's Compensation |
$520.34
|
|
|
G0101 CERV/VAG CANCR SCR;PEL&CLN BRST EX
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
21600002
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$99.45
|
| Rate for Payer: First Health Commercial |
$105.30
|
| Rate for Payer: First Health Workers Compensation |
$45.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$105.30
|
| Rate for Payer: GEHA Commercial |
$81.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$105.30
|
| Rate for Payer: Multiplan All |
$106.47
|
| Rate for Payer: OMNI Networks Commercial |
$81.90
|
| Rate for Payer: One Health Plan PPO/POS |
$105.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$111.15
|
| Rate for Payer: Three Rivers Provider Network All |
$87.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$108.81
|
| Rate for Payer: Zelis Auto |
$46.80
|
| Rate for Payer: Zelis Worker's Compensation |
$31.94
|
|
|
G0101 CERV/VAG CANCR SCR;PEL&CLN BRST EX
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
21500002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$99.45
|
| Rate for Payer: First Health Commercial |
$105.30
|
| Rate for Payer: First Health Workers Compensation |
$45.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$105.30
|
| Rate for Payer: GEHA Commercial |
$81.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$105.30
|
| Rate for Payer: Multiplan All |
$106.47
|
| Rate for Payer: OMNI Networks Commercial |
$81.90
|
| Rate for Payer: One Health Plan PPO/POS |
$105.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$111.15
|
| Rate for Payer: Three Rivers Provider Network All |
$87.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$108.81
|
| Rate for Payer: Zelis Auto |
$46.80
|
| Rate for Payer: Zelis Worker's Compensation |
$31.94
|
|
|
G0101 CERV/VAG CANCR SCR;PEL&CLN BRST EX
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
21500002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$175.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.83
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$99.45
|
| Rate for Payer: First Health Commercial |
$105.30
|
| Rate for Payer: First Health Workers Compensation |
$45.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$105.30
|
| Rate for Payer: GEHA Commercial |
$93.60
|
| Rate for Payer: GEHA Medicare |
$87.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$105.30
|
| Rate for Payer: Humana ChoiceCare |
$96.61
|
| Rate for Payer: Humana Medicare Advantage |
$87.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$147.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.83
|
| Rate for Payer: Multiplan All |
$106.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.31
|
| Rate for Payer: OMNI Networks Commercial |
$81.90
|
| Rate for Payer: One Health Plan PPO/POS |
$105.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$111.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$175.66
|
| Rate for Payer: Three Rivers Provider Network All |
$87.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.07
|
| Rate for Payer: United Healthcare Managed Medicaid |
$29.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$108.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.83
|
| Rate for Payer: Zelis Auto |
$46.80
|
| Rate for Payer: Zelis Medicare |
$74.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.40
|
| Rate for Payer: Zelis Worker's Compensation |
$31.94
|
|
|
G0101 CERV/VAG CANCR SCR;PEL&CLN BRST EX
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
25500002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$175.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.83
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$99.45
|
| Rate for Payer: First Health Commercial |
$105.30
|
| Rate for Payer: First Health Workers Compensation |
$45.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$105.30
|
| Rate for Payer: GEHA Commercial |
$93.60
|
| Rate for Payer: GEHA Medicare |
$87.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$105.30
|
| Rate for Payer: Humana ChoiceCare |
$96.61
|
| Rate for Payer: Humana Medicare Advantage |
$87.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$147.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.83
|
| Rate for Payer: Multiplan All |
$106.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.31
|
| Rate for Payer: OMNI Networks Commercial |
$81.90
|
| Rate for Payer: One Health Plan PPO/POS |
$105.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$111.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$175.66
|
| Rate for Payer: Three Rivers Provider Network All |
$87.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.07
|
| Rate for Payer: United Healthcare Managed Medicaid |
$29.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$108.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.83
|
| Rate for Payer: Zelis Auto |
$46.80
|
| Rate for Payer: Zelis Medicare |
$74.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.40
|
| Rate for Payer: Zelis Worker's Compensation |
$31.94
|
|
|
G0101 CERV/VAG CANCR SCR;PEL&CLN BRST EX
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
25500002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$99.45
|
| Rate for Payer: First Health Commercial |
$105.30
|
| Rate for Payer: First Health Workers Compensation |
$45.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$105.30
|
| Rate for Payer: GEHA Commercial |
$81.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$105.30
|
| Rate for Payer: Multiplan All |
$106.47
|
| Rate for Payer: OMNI Networks Commercial |
$81.90
|
| Rate for Payer: One Health Plan PPO/POS |
$105.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$111.15
|
| Rate for Payer: Three Rivers Provider Network All |
$87.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$108.81
|
| Rate for Payer: Zelis Auto |
$46.80
|
| Rate for Payer: Zelis Worker's Compensation |
$31.94
|
|
|
G0101 CERV/VAG CANCR SCR;PEL&CLN BRST EX
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
21600002
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$175.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.83
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$99.45
|
| Rate for Payer: First Health Commercial |
$105.30
|
| Rate for Payer: First Health Workers Compensation |
$45.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$105.30
|
| Rate for Payer: GEHA Commercial |
$93.60
|
| Rate for Payer: GEHA Medicare |
$87.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$105.30
|
| Rate for Payer: Humana ChoiceCare |
$96.61
|
| Rate for Payer: Humana Medicare Advantage |
$87.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$147.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.83
|
| Rate for Payer: Multiplan All |
$106.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.31
|
| Rate for Payer: OMNI Networks Commercial |
$81.90
|
| Rate for Payer: One Health Plan PPO/POS |
$105.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$111.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$175.66
|
| Rate for Payer: Three Rivers Provider Network All |
$87.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.07
|
| Rate for Payer: United Healthcare Managed Medicaid |
$29.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$108.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.83
|
| Rate for Payer: Zelis Auto |
$46.80
|
| Rate for Payer: Zelis Medicare |
$74.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.40
|
| Rate for Payer: Zelis Worker's Compensation |
$31.94
|
|
|
G0101 CERV/VAG CANCR SCR;PEL&CLN BRST EX
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
9300101
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$99.45
|
| Rate for Payer: First Health Commercial |
$105.30
|
| Rate for Payer: First Health Workers Compensation |
$45.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$105.30
|
| Rate for Payer: GEHA Commercial |
$81.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$105.30
|
| Rate for Payer: Multiplan All |
$106.47
|
| Rate for Payer: OMNI Networks Commercial |
$81.90
|
| Rate for Payer: One Health Plan PPO/POS |
$105.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$111.15
|
| Rate for Payer: Three Rivers Provider Network All |
$87.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$108.81
|
| Rate for Payer: Zelis Auto |
$46.80
|
| Rate for Payer: Zelis Worker's Compensation |
$31.94
|
|
|
G0101 CERV/VAG CANCR SCR;PEL&CLN BRST EX
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
9300101
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$175.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.83
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$99.45
|
| Rate for Payer: First Health Commercial |
$105.30
|
| Rate for Payer: First Health Workers Compensation |
$45.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$105.30
|
| Rate for Payer: GEHA Commercial |
$93.60
|
| Rate for Payer: GEHA Medicare |
$87.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$105.30
|
| Rate for Payer: Humana ChoiceCare |
$96.61
|
| Rate for Payer: Humana Medicare Advantage |
$87.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$147.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.83
|
| Rate for Payer: Multiplan All |
$106.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.31
|
| Rate for Payer: OMNI Networks Commercial |
$81.90
|
| Rate for Payer: One Health Plan PPO/POS |
$105.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$111.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$175.66
|
| Rate for Payer: Three Rivers Provider Network All |
$87.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.07
|
| Rate for Payer: United Healthcare Managed Medicaid |
$29.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$108.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.83
|
| Rate for Payer: Zelis Auto |
$46.80
|
| Rate for Payer: Zelis Medicare |
$74.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.40
|
| Rate for Payer: Zelis Worker's Compensation |
$31.94
|
|
|
G0103 PSA SCREENING
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT G0103
|
| Hospital Charge Code |
21500003
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$84.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$152.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Worker's Compensation |
$59.51
|
|
|
G0103 PSA SCREENING
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT G0103
|
| Hospital Charge Code |
25500003
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$34.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$34.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$27.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$19.31
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$84.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: GEHA Medicare |
$19.31
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Humana ChoiceCare |
$21.24
|
| Rate for Payer: Humana Medicare Advantage |
$19.31
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$32.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$28.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19.31
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$32.83
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$32.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$28.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$19.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$38.62
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$19.31
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Medicare |
$16.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.17
|
| Rate for Payer: Zelis Worker's Compensation |
$59.51
|
|
|
G0103 PSA SCREENING
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT G0103
|
| Hospital Charge Code |
21600003
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$84.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$152.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Worker's Compensation |
$59.51
|
|
|
G0103 PSA SCREENING
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT G0103
|
| Hospital Charge Code |
21500003
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$34.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$34.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$27.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$19.31
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$84.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: GEHA Medicare |
$19.31
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Humana ChoiceCare |
$21.24
|
| Rate for Payer: Humana Medicare Advantage |
$19.31
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$32.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$28.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19.31
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$32.83
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$32.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$28.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$19.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$38.62
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$19.31
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Medicare |
$16.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.17
|
| Rate for Payer: Zelis Worker's Compensation |
$59.51
|
|
|
G0103 PSA SCREENING
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT G0103
|
| Hospital Charge Code |
21600003
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$34.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$34.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$27.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$19.31
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$84.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$174.40
|
| Rate for Payer: GEHA Medicare |
$19.31
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Humana ChoiceCare |
$21.24
|
| Rate for Payer: Humana Medicare Advantage |
$19.31
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$32.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$28.09
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19.31
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$32.83
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$32.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$28.09
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$19.31
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$38.62
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.31
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$19.31
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Medicare |
$16.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.17
|
| Rate for Payer: Zelis Worker's Compensation |
$59.51
|
|
|
G0103 PSA SCREENING
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT G0103
|
| Hospital Charge Code |
25500003
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Cash Price |
$130.80
|
| Rate for Payer: Cigna Commercial |
$185.30
|
| Rate for Payer: First Health Commercial |
$196.20
|
| Rate for Payer: First Health Workers Compensation |
$84.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$196.20
|
| Rate for Payer: GEHA Commercial |
$152.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: OMNI Networks Commercial |
$152.60
|
| Rate for Payer: One Health Plan PPO/POS |
$196.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$207.10
|
| Rate for Payer: Three Rivers Provider Network All |
$163.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Worker's Compensation |
$59.51
|
|
|
G0402 WELCOME TO MEDICARE
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
21900195
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$476.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$301.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.37
|
| Rate for Payer: Cash Price |
$301.20
|
| Rate for Payer: Cash Price |
$301.20
|
| Rate for Payer: Cigna Commercial |
$426.70
|
| Rate for Payer: First Health Commercial |
$451.80
|
| Rate for Payer: First Health Workers Compensation |
$193.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$451.80
|
| Rate for Payer: GEHA Commercial |
$401.60
|
| Rate for Payer: GEHA Medicare |
$122.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$451.80
|
| Rate for Payer: Humana ChoiceCare |
$134.61
|
| Rate for Payer: Humana Medicare Advantage |
$122.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.37
|
| Rate for Payer: Multiplan All |
$456.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.03
|
| Rate for Payer: OMNI Networks Commercial |
$351.40
|
| Rate for Payer: One Health Plan PPO/POS |
$451.80
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$476.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.74
|
| Rate for Payer: Three Rivers Provider Network All |
$376.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$466.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.37
|
| Rate for Payer: Zelis Auto |
$200.80
|
| Rate for Payer: Zelis Medicare |
$104.01
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.84
|
| Rate for Payer: Zelis Worker's Compensation |
$137.05
|
|
