|
A 10-50 EMP MRO REF
|
Facility
|
IP
|
$51.00
|
|
| Hospital Charge Code |
22990380
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$43.35
|
| Rate for Payer: First Health Commercial |
$45.90
|
| Rate for Payer: First Health Workers Compensation |
$19.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.90
|
| Rate for Payer: GEHA Commercial |
$35.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.90
|
| Rate for Payer: Multiplan All |
$46.41
|
| Rate for Payer: OMNI Networks Commercial |
$35.70
|
| Rate for Payer: One Health Plan PPO/POS |
$45.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$48.45
|
| Rate for Payer: Three Rivers Provider Network All |
$38.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$47.43
|
| Rate for Payer: Zelis Auto |
$20.40
|
| Rate for Payer: Zelis Worker's Compensation |
$13.92
|
|
|
A 10-50 EMP MRO REF
|
Facility
|
OP
|
$51.00
|
|
| Hospital Charge Code |
22990380
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$43.35
|
| Rate for Payer: First Health Commercial |
$45.90
|
| Rate for Payer: First Health Workers Compensation |
$19.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.90
|
| Rate for Payer: GEHA Commercial |
$40.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.90
|
| Rate for Payer: Humana ChoiceCare |
$13.26
|
| Rate for Payer: Multiplan All |
$46.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.60
|
| Rate for Payer: OMNI Networks Commercial |
$35.70
|
| Rate for Payer: One Health Plan PPO/POS |
$45.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$48.45
|
| Rate for Payer: Three Rivers Provider Network All |
$38.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$44.88
|
| Rate for Payer: United Healthcare Commercial |
$43.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$47.43
|
| Rate for Payer: Zelis Auto |
$20.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$25.50
|
| Rate for Payer: Zelis Worker's Compensation |
$13.92
|
|
|
ABDOMINAL SUPPORT,UNIVERSAL
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
7000003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$68.85
|
| Rate for Payer: First Health Commercial |
$72.90
|
| Rate for Payer: First Health Workers Compensation |
$31.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$64.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Humana ChoiceCare |
$21.06
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.60
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$71.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$40.50
|
| Rate for Payer: Zelis Worker's Compensation |
$22.11
|
|
|
ABDOMINAL SUPPORT,UNIVERSAL
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
7000003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$68.85
|
| Rate for Payer: First Health Commercial |
$72.90
|
| Rate for Payer: First Health Workers Compensation |
$31.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$56.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Worker's Compensation |
$22.11
|
|
|
ABDOM PARACENTESIS DX/THER W/IMAG GDNCE
|
Facility
|
IP
|
$2,577.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
1000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$703.52 |
| Max. Negotiated Rate |
$2,448.15 |
| Rate for Payer: Cash Price |
$1,546.20
|
| Rate for Payer: Cigna Commercial |
$2,190.45
|
| Rate for Payer: First Health Commercial |
$2,319.30
|
| Rate for Payer: First Health Workers Compensation |
$994.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,319.30
|
| Rate for Payer: GEHA Commercial |
$1,803.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,319.30
|
| Rate for Payer: Multiplan All |
$2,345.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,803.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,319.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,448.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,932.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,396.61
|
| Rate for Payer: Zelis Auto |
$1,030.80
|
| Rate for Payer: Zelis Worker's Compensation |
$703.52
|
|
|
ABDOM PARACENTESIS DX/THER W/IMAG GDNCE
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
6149083
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$92.55 |
| Max. Negotiated Rate |
$1,780.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$556.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$203.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$556.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$440.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$890.25
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$288.15
|
| Rate for Payer: First Health Commercial |
$305.10
|
| Rate for Payer: First Health Workers Compensation |
$130.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$305.10
|
| Rate for Payer: GEHA Commercial |
$271.20
|
| Rate for Payer: GEHA Medicare |
$890.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$305.10
|
| Rate for Payer: Humana ChoiceCare |
$979.27
|
| Rate for Payer: Humana Medicare Advantage |
$890.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,495.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$449.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$890.25
|
| Rate for Payer: Multiplan All |
$308.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,513.42
|
| Rate for Payer: OMNI Networks Commercial |
$237.30
|
| Rate for Payer: One Health Plan PPO/POS |
$305.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$519.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$449.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$890.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$322.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,780.50
|
| Rate for Payer: Three Rivers Provider Network All |
$254.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$872.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$449.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$890.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$315.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$890.25
|
| Rate for Payer: Zelis Auto |
$135.60
|
| Rate for Payer: Zelis Medicare |
$756.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,068.30
|
| Rate for Payer: Zelis Worker's Compensation |
$92.55
|
|
|
ABDOM PARACENTESIS DX/THER W/IMAG GDNCE
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
6149083
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$92.55 |
| Max. Negotiated Rate |
$322.05 |
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$288.15
|
| Rate for Payer: First Health Commercial |
$305.10
|
| Rate for Payer: First Health Workers Compensation |
$130.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$305.10
|
| Rate for Payer: GEHA Commercial |
$237.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$305.10
|
| Rate for Payer: Multiplan All |
$308.49
|
| Rate for Payer: OMNI Networks Commercial |
$237.30
|
| Rate for Payer: One Health Plan PPO/POS |
$305.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$322.05
|
| Rate for Payer: Three Rivers Provider Network All |
$254.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$315.27
|
| Rate for Payer: Zelis Auto |
$135.60
|
| Rate for Payer: Zelis Worker's Compensation |
$92.55
|
|
|
ABDOM PARACENTESIS DX/THER W/O IMAG GUI
|
Facility
|
IP
|
$2,521.00
|
|
| Hospital Charge Code |
1000018
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$688.23 |
| Max. Negotiated Rate |
$2,394.95 |
| Rate for Payer: Cash Price |
$1,512.60
|
| Rate for Payer: Cigna Commercial |
$2,142.85
|
| Rate for Payer: First Health Commercial |
$2,268.90
|
| Rate for Payer: First Health Workers Compensation |
$973.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,268.90
|
| Rate for Payer: GEHA Commercial |
$1,764.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,268.90
|
| Rate for Payer: Multiplan All |
$2,294.11
|
| Rate for Payer: OMNI Networks Commercial |
$1,764.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,268.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,394.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,890.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,344.53
|
| Rate for Payer: Zelis Auto |
$1,008.40
|
| Rate for Payer: Zelis Worker's Compensation |
$688.23
|
|
|
ABD PARACENTESIS
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
6149082
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$63.06 |
| Max. Negotiated Rate |
$1,780.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$556.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$138.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$556.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$440.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$890.25
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna Commercial |
$196.35
|
| Rate for Payer: First Health Commercial |
$207.90
|
| Rate for Payer: First Health Workers Compensation |
$89.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.90
|
| Rate for Payer: GEHA Commercial |
$184.80
|
| Rate for Payer: GEHA Medicare |
$890.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.90
|
| Rate for Payer: Humana ChoiceCare |
$979.27
|
| Rate for Payer: Humana Medicare Advantage |
$890.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,495.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$449.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$890.25
|
| Rate for Payer: Multiplan All |
$210.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,513.42
|
| Rate for Payer: OMNI Networks Commercial |
$161.70
|
| Rate for Payer: One Health Plan PPO/POS |
$207.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$519.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$449.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$890.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$219.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,780.50
|
| Rate for Payer: Three Rivers Provider Network All |
$173.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$872.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$449.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$890.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$214.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$890.25
|
| Rate for Payer: Zelis Auto |
$92.40
|
| Rate for Payer: Zelis Medicare |
$756.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,068.30
|
| Rate for Payer: Zelis Worker's Compensation |
$63.06
|
|
|
ABD PARACENTESIS
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
6149082
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$63.06 |
| Max. Negotiated Rate |
$219.45 |
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna Commercial |
$196.35
|
| Rate for Payer: First Health Commercial |
$207.90
|
| Rate for Payer: First Health Workers Compensation |
$89.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.90
|
| Rate for Payer: GEHA Commercial |
$161.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.90
|
| Rate for Payer: Multiplan All |
$210.21
|
| Rate for Payer: OMNI Networks Commercial |
$161.70
|
| Rate for Payer: One Health Plan PPO/POS |
$207.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$219.45
|
| Rate for Payer: Three Rivers Provider Network All |
$173.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$214.83
|
| Rate for Payer: Zelis Auto |
$92.40
|
| Rate for Payer: Zelis Worker's Compensation |
$63.06
|
|
|
ABD PARACENTESIS W/IMAGING
|
Facility
|
OP
|
$1,810.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
8149083
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$440.79 |
| Max. Negotiated Rate |
$1,780.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$556.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,086.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$556.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$440.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$890.25
|
| Rate for Payer: Cash Price |
$1,086.00
|
| Rate for Payer: Cash Price |
$1,086.00
|
| Rate for Payer: Cigna Commercial |
$1,538.50
|
| Rate for Payer: First Health Commercial |
$1,629.00
|
| Rate for Payer: First Health Workers Compensation |
$698.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,629.00
|
| Rate for Payer: GEHA Commercial |
$1,448.00
|
| Rate for Payer: GEHA Medicare |
$890.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,629.00
|
| Rate for Payer: Humana ChoiceCare |
$979.27
|
| Rate for Payer: Humana Medicare Advantage |
$890.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,495.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$449.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$890.25
|
| Rate for Payer: Multiplan All |
$1,647.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,513.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,267.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,629.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$519.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$449.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$890.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,719.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,780.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,357.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$872.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$449.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$890.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,683.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$890.25
|
| Rate for Payer: Zelis Auto |
$724.00
|
| Rate for Payer: Zelis Medicare |
$756.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,068.30
|
| Rate for Payer: Zelis Worker's Compensation |
$494.13
|
|
|
ABD PARACENTESIS W/IMAGING
|
Facility
|
IP
|
$1,810.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
8149083
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$494.13 |
| Max. Negotiated Rate |
$1,719.50 |
| Rate for Payer: Cash Price |
$1,086.00
|
| Rate for Payer: Cigna Commercial |
$1,538.50
|
| Rate for Payer: First Health Commercial |
$1,629.00
|
| Rate for Payer: First Health Workers Compensation |
$698.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,629.00
|
| Rate for Payer: GEHA Commercial |
$1,267.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,629.00
|
| Rate for Payer: Multiplan All |
$1,647.10
|
| Rate for Payer: OMNI Networks Commercial |
$1,267.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,629.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,719.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,357.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,683.30
|
| Rate for Payer: Zelis Auto |
$724.00
|
| Rate for Payer: Zelis Worker's Compensation |
$494.13
|
|
|
ABD PARACENTESIS W/O IMAGING
|
Facility
|
OP
|
$1,701.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
8149082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$440.79 |
| Max. Negotiated Rate |
$1,780.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$556.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,020.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$556.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$440.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$890.25
|
| Rate for Payer: Cash Price |
$1,020.60
|
| Rate for Payer: Cash Price |
$1,020.60
|
| Rate for Payer: Cigna Commercial |
$1,445.85
|
| Rate for Payer: First Health Commercial |
$1,530.90
|
| Rate for Payer: First Health Workers Compensation |
$656.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,530.90
|
| Rate for Payer: GEHA Commercial |
$1,360.80
|
| Rate for Payer: GEHA Medicare |
$890.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,530.90
|
| Rate for Payer: Humana ChoiceCare |
$979.27
|
| Rate for Payer: Humana Medicare Advantage |
$890.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,495.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$449.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$890.25
|
| Rate for Payer: Multiplan All |
$1,547.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,513.42
|
| Rate for Payer: OMNI Networks Commercial |
$1,190.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,530.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$519.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$449.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$890.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,615.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,780.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,275.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$872.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$449.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$890.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,581.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$890.25
|
| Rate for Payer: Zelis Auto |
$680.40
|
| Rate for Payer: Zelis Medicare |
$756.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,068.30
|
| Rate for Payer: Zelis Worker's Compensation |
$464.37
|
|
|
ABD PARACENTESIS W/O IMAGING
|
Facility
|
IP
|
$1,701.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
8149082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$464.37 |
| Max. Negotiated Rate |
$1,615.95 |
| Rate for Payer: Cash Price |
$1,020.60
|
| Rate for Payer: Cigna Commercial |
$1,445.85
|
| Rate for Payer: First Health Commercial |
$1,530.90
|
| Rate for Payer: First Health Workers Compensation |
$656.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,530.90
|
| Rate for Payer: GEHA Commercial |
$1,190.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,530.90
|
| Rate for Payer: Multiplan All |
$1,547.91
|
| Rate for Payer: OMNI Networks Commercial |
$1,190.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,530.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,615.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,275.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,581.93
|
| Rate for Payer: Zelis Auto |
$680.40
|
| Rate for Payer: Zelis Worker's Compensation |
$464.37
|
|
|
ABG COMPLETE
|
Facility
|
OP
|
$488.50
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
4020002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.86 |
| Max. Negotiated Rate |
$464.07 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$141.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$293.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$141.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$78.77
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cigna Commercial |
$415.23
|
| Rate for Payer: First Health Commercial |
$439.65
|
| Rate for Payer: First Health Workers Compensation |
$88.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$439.65
|
| Rate for Payer: GEHA Commercial |
$390.80
|
| Rate for Payer: GEHA Medicare |
$78.77
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$439.65
|
| Rate for Payer: Humana ChoiceCare |
$86.65
|
| Rate for Payer: Humana Medicare Advantage |
$78.77
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$132.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$114.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$78.77
|
| Rate for Payer: Multiplan All |
$444.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$133.91
|
| Rate for Payer: OMNI Networks Commercial |
$341.95
|
| Rate for Payer: One Health Plan PPO/POS |
$439.65
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$114.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$78.77
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$464.07
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$157.54
|
| Rate for Payer: Three Rivers Provider Network All |
$366.38
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$77.19
|
| Rate for Payer: United Healthcare Commercial |
$415.23
|
| Rate for Payer: United Healthcare Managed Medicaid |
$114.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.77
|
| Rate for Payer: United Payors & United Providers UP&UP |
$454.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$78.77
|
| Rate for Payer: Zelis Auto |
$195.40
|
| Rate for Payer: Zelis Medicare |
$66.95
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$94.52
|
| Rate for Payer: Zelis Worker's Compensation |
$62.86
|
|
|
ABG COMPLETE
|
Facility
|
IP
|
$488.50
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
4020002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.86 |
| Max. Negotiated Rate |
$464.07 |
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cigna Commercial |
$415.23
|
| Rate for Payer: First Health Commercial |
$439.65
|
| Rate for Payer: First Health Workers Compensation |
$88.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$439.65
|
| Rate for Payer: GEHA Commercial |
$341.95
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$439.65
|
| Rate for Payer: Multiplan All |
$444.54
|
| Rate for Payer: OMNI Networks Commercial |
$341.95
|
| Rate for Payer: One Health Plan PPO/POS |
$439.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$464.07
|
| Rate for Payer: Three Rivers Provider Network All |
$366.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$454.31
|
| Rate for Payer: Zelis Auto |
$195.40
|
| Rate for Payer: Zelis Worker's Compensation |
$62.86
|
|
|
ABHR GEL
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
NDC 00409677802
|
| Hospital Charge Code |
3301769
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$31.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$28.05
|
| Rate for Payer: First Health Commercial |
$29.70
|
| Rate for Payer: First Health Workers Compensation |
$12.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$29.70
|
| Rate for Payer: GEHA Commercial |
$26.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$29.70
|
| Rate for Payer: Humana ChoiceCare |
$8.58
|
| Rate for Payer: Multiplan All |
$30.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$19.80
|
| Rate for Payer: OMNI Networks Commercial |
$23.10
|
| Rate for Payer: One Health Plan PPO/POS |
$29.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$31.35
|
| Rate for Payer: Three Rivers Provider Network All |
$24.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$29.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$30.69
|
| Rate for Payer: Zelis Auto |
$13.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$16.50
|
| Rate for Payer: Zelis Worker's Compensation |
$9.01
|
|
|
ABHR GEL
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
NDC 00409677802
|
| Hospital Charge Code |
3301769
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$31.35 |
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$28.05
|
| Rate for Payer: First Health Commercial |
$29.70
|
| Rate for Payer: First Health Workers Compensation |
$12.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$29.70
|
| Rate for Payer: GEHA Commercial |
$23.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$29.70
|
| Rate for Payer: Multiplan All |
$30.03
|
| Rate for Payer: OMNI Networks Commercial |
$23.10
|
| Rate for Payer: One Health Plan PPO/POS |
$29.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$31.35
|
| Rate for Payer: Three Rivers Provider Network All |
$24.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$30.69
|
| Rate for Payer: Zelis Auto |
$13.20
|
| Rate for Payer: Zelis Worker's Compensation |
$9.01
|
|
|
ABLATE BONE TUMOR(S) PERQ
|
Facility
|
OP
|
$1,160.00
|
|
|
Service Code
|
CPT 20982
|
| Hospital Charge Code |
6120982
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$316.68 |
| Max. Negotiated Rate |
$24,435.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$696.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,217.56
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$986.00
|
| Rate for Payer: First Health Commercial |
$1,044.00
|
| Rate for Payer: First Health Workers Compensation |
$447.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.00
|
| Rate for Payer: GEHA Commercial |
$928.00
|
| Rate for Payer: GEHA Medicare |
$12,217.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.00
|
| Rate for Payer: Humana ChoiceCare |
$13,439.32
|
| Rate for Payer: Humana Medicare Advantage |
$12,217.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,525.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,217.56
|
| Rate for Payer: Multiplan All |
$1,055.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,769.85
|
| Rate for Payer: OMNI Networks Commercial |
$812.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,217.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,102.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,435.12
|
| Rate for Payer: Three Rivers Provider Network All |
$870.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,973.21
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,217.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,078.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,217.56
|
| Rate for Payer: Zelis Auto |
$464.00
|
| Rate for Payer: Zelis Medicare |
$10,384.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,661.07
|
| Rate for Payer: Zelis Worker's Compensation |
$316.68
|
|
|
ABLATE BONE TUMOR(S) PERQ
|
Facility
|
IP
|
$1,160.00
|
|
|
Service Code
|
CPT 20982
|
| Hospital Charge Code |
6120982
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$316.68 |
| Max. Negotiated Rate |
$1,102.00 |
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$986.00
|
| Rate for Payer: First Health Commercial |
$1,044.00
|
| Rate for Payer: First Health Workers Compensation |
$447.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,044.00
|
| Rate for Payer: GEHA Commercial |
$812.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,044.00
|
| Rate for Payer: Multiplan All |
$1,055.60
|
| Rate for Payer: OMNI Networks Commercial |
$812.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,044.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,102.00
|
| Rate for Payer: Three Rivers Provider Network All |
$870.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,078.80
|
| Rate for Payer: Zelis Auto |
$464.00
|
| Rate for Payer: Zelis Worker's Compensation |
$316.68
|
|
|
ABLATE INF TURBINATE SUBMUC
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
CPT 30802
|
| Hospital Charge Code |
6130802
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$156.16 |
| Max. Negotiated Rate |
$543.40 |
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$486.20
|
| Rate for Payer: First Health Commercial |
$514.80
|
| Rate for Payer: First Health Workers Compensation |
$220.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$514.80
|
| Rate for Payer: GEHA Commercial |
$400.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$514.80
|
| Rate for Payer: Multiplan All |
$520.52
|
| Rate for Payer: OMNI Networks Commercial |
$400.40
|
| Rate for Payer: One Health Plan PPO/POS |
$514.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$543.40
|
| Rate for Payer: Three Rivers Provider Network All |
$429.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.96
|
| Rate for Payer: Zelis Auto |
$228.80
|
| Rate for Payer: Zelis Worker's Compensation |
$156.16
|
|
|
ABLATE INF TURBINATE SUBMUC
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
CPT 30802
|
| Hospital Charge Code |
6130802
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$156.16 |
| Max. Negotiated Rate |
$2,813.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$343.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,406.53
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$486.20
|
| Rate for Payer: First Health Commercial |
$514.80
|
| Rate for Payer: First Health Workers Compensation |
$220.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$514.80
|
| Rate for Payer: GEHA Commercial |
$457.60
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$514.80
|
| Rate for Payer: Humana ChoiceCare |
$1,547.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,406.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,362.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,406.53
|
| Rate for Payer: Multiplan All |
$520.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$400.40
|
| Rate for Payer: One Health Plan PPO/POS |
$514.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,406.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$543.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$429.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,406.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$228.80
|
| Rate for Payer: Zelis Medicare |
$1,195.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,687.84
|
| Rate for Payer: Zelis Worker's Compensation |
$156.16
|
|
|
ABLATE INF TURBINATE SUPERF
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT 30801
|
| Hospital Charge Code |
6130801
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$2,813.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$243.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$770.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$610.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,406.53
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$345.10
|
| Rate for Payer: First Health Commercial |
$365.40
|
| Rate for Payer: First Health Workers Compensation |
$156.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$365.40
|
| Rate for Payer: GEHA Commercial |
$324.80
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$365.40
|
| Rate for Payer: Humana ChoiceCare |
$1,547.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,406.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,362.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$622.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,406.53
|
| Rate for Payer: Multiplan All |
$369.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$284.20
|
| Rate for Payer: One Health Plan PPO/POS |
$365.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$719.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$622.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,406.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$385.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$304.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$622.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,406.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$377.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$162.40
|
| Rate for Payer: Zelis Medicare |
$1,195.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,687.84
|
| Rate for Payer: Zelis Worker's Compensation |
$110.84
|
|
|
ABLATE INF TURBINATE SUPERF
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 30801
|
| Hospital Charge Code |
6130801
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$385.70 |
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$345.10
|
| Rate for Payer: First Health Commercial |
$365.40
|
| Rate for Payer: First Health Workers Compensation |
$156.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$365.40
|
| Rate for Payer: GEHA Commercial |
$284.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$365.40
|
| Rate for Payer: Multiplan All |
$369.46
|
| Rate for Payer: OMNI Networks Commercial |
$284.20
|
| Rate for Payer: One Health Plan PPO/POS |
$365.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$385.70
|
| Rate for Payer: Three Rivers Provider Network All |
$304.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$377.58
|
| Rate for Payer: Zelis Auto |
$162.40
|
| Rate for Payer: Zelis Worker's Compensation |
$110.84
|
|
|
ABLATE PULM TUMOR PERQ CRYBL
|
Facility
|
OP
|
$1,443.00
|
|
|
Service Code
|
CPT 32994
|
| Hospital Charge Code |
6169669
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$393.94 |
| Max. Negotiated Rate |
$19,771.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,732.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$865.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,732.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,333.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9,885.87
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Cigna Commercial |
$1,226.55
|
| Rate for Payer: First Health Commercial |
$1,298.70
|
| Rate for Payer: First Health Workers Compensation |
$557.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,298.70
|
| Rate for Payer: GEHA Commercial |
$1,154.40
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,298.70
|
| Rate for Payer: Humana ChoiceCare |
$10,874.46
|
| Rate for Payer: Humana Medicare Advantage |
$9,885.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16,608.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,442.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9,885.87
|
| Rate for Payer: Multiplan All |
$1,313.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,805.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,010.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,298.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,283.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,442.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9,885.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,370.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,082.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,688.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,442.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,885.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,341.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| Rate for Payer: Zelis Auto |
$577.20
|
| Rate for Payer: Zelis Medicare |
$8,402.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11,863.04
|
| Rate for Payer: Zelis Worker's Compensation |
$393.94
|
|
