|
5' nucleotidase REF001701
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 83915
|
| Hospital Charge Code |
2200720
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$78.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$15.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$11.15
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$20.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$104.80
|
| Rate for Payer: GEHA Medicare |
$11.15
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Humana ChoiceCare |
$12.27
|
| Rate for Payer: Humana Medicare Advantage |
$11.15
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$18.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$11.15
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.95
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$18.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.22
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$11.15
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$22.30
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.93
|
| Rate for Payer: United Healthcare Commercial |
$111.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.15
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$11.15
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Medicare |
$9.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.38
|
| Rate for Payer: Zelis Worker's Compensation |
$14.53
|
|
|
602569
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
2299203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$100.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$18.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$63.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$18.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10.50
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$90.10
|
| Rate for Payer: First Health Commercial |
$95.40
|
| Rate for Payer: First Health Workers Compensation |
$15.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$95.40
|
| Rate for Payer: GEHA Commercial |
$84.80
|
| Rate for Payer: GEHA Medicare |
$10.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$95.40
|
| Rate for Payer: Humana ChoiceCare |
$11.55
|
| Rate for Payer: Humana Medicare Advantage |
$10.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$17.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$15.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10.50
|
| Rate for Payer: Multiplan All |
$96.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17.85
|
| Rate for Payer: OMNI Networks Commercial |
$74.20
|
| Rate for Payer: One Health Plan PPO/POS |
$95.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$17.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$15.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$100.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$21.00
|
| Rate for Payer: Three Rivers Provider Network All |
$79.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.29
|
| Rate for Payer: United Healthcare Commercial |
$90.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$98.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10.50
|
| Rate for Payer: Zelis Auto |
$42.40
|
| Rate for Payer: Zelis Medicare |
$8.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.60
|
| Rate for Payer: Zelis Worker's Compensation |
$10.68
|
|
|
602569
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
2299203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$100.70 |
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$90.10
|
| Rate for Payer: First Health Commercial |
$95.40
|
| Rate for Payer: First Health Workers Compensation |
$15.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$95.40
|
| Rate for Payer: GEHA Commercial |
$74.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$95.40
|
| Rate for Payer: Multiplan All |
$96.46
|
| Rate for Payer: OMNI Networks Commercial |
$74.20
|
| Rate for Payer: One Health Plan PPO/POS |
$95.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$100.70
|
| Rate for Payer: Three Rivers Provider Network All |
$79.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$98.58
|
| Rate for Payer: Zelis Auto |
$42.40
|
| Rate for Payer: Zelis Worker's Compensation |
$10.68
|
|
|
6.5MM CORTICAL SCREWS 34MM
|
Facility
|
OP
|
$1,380.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,311.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$828.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cigna Commercial |
$1,173.00
|
| Rate for Payer: First Health Commercial |
$1,242.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,242.00
|
| Rate for Payer: GEHA Commercial |
$1,104.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,242.00
|
| Rate for Payer: Humana ChoiceCare |
$358.80
|
| Rate for Payer: Multiplan All |
$1,255.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$828.00
|
| Rate for Payer: OMNI Networks Commercial |
$966.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,242.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,311.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,035.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,214.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$345.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,283.40
|
| Rate for Payer: Zelis Auto |
$552.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$690.00
|
|
|
6.5MM CORTICAL SCREWS 34MM
|
Facility
|
IP
|
$1,380.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$552.00 |
| Max. Negotiated Rate |
$1,311.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,104.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cigna Commercial |
$1,173.00
|
| Rate for Payer: First Health Commercial |
$1,242.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,242.00
|
| Rate for Payer: GEHA Commercial |
$966.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,242.00
|
| Rate for Payer: Multiplan All |
$1,255.80
|
| Rate for Payer: OMNI Networks Commercial |
$966.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,242.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,311.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,035.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,283.40
|
| Rate for Payer: Zelis Auto |
$552.00
|
|
|
6.5MM CORTICAL SCREWS 36MM
|
Facility
|
OP
|
$1,380.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,311.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$828.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cigna Commercial |
$1,173.00
|
| Rate for Payer: First Health Commercial |
$1,242.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,242.00
|
| Rate for Payer: GEHA Commercial |
$1,104.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,242.00
|
| Rate for Payer: Humana ChoiceCare |
$358.80
|
| Rate for Payer: Multiplan All |
$1,255.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$828.00
|
| Rate for Payer: OMNI Networks Commercial |
$966.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,242.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,311.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,035.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,214.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$345.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,283.40
|
| Rate for Payer: Zelis Auto |
$552.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$690.00
|
|
|
6.5MM CORTICAL SCREWS 36MM
|
Facility
|
IP
|
$1,380.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$552.00 |
| Max. Negotiated Rate |
$1,311.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,104.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cigna Commercial |
$1,173.00
|
| Rate for Payer: First Health Commercial |
$1,242.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,242.00
|
| Rate for Payer: GEHA Commercial |
$966.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,242.00
|
| Rate for Payer: Multiplan All |
$1,255.80
|
| Rate for Payer: OMNI Networks Commercial |
$966.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,242.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,311.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,035.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,283.40
|
| Rate for Payer: Zelis Auto |
$552.00
|
|
|
65 YRS AND OVER
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
CPT 99397
|
| Hospital Charge Code |
8599397
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$290.70
|
| Rate for Payer: First Health Commercial |
$307.80
|
| Rate for Payer: First Health Workers Compensation |
$132.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$307.80
|
| Rate for Payer: GEHA Commercial |
$239.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$307.80
|
| Rate for Payer: Multiplan All |
$311.22
|
| Rate for Payer: OMNI Networks Commercial |
$239.40
|
| Rate for Payer: One Health Plan PPO/POS |
$307.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$324.90
|
| Rate for Payer: Three Rivers Provider Network All |
$256.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$318.06
|
| Rate for Payer: Zelis Auto |
$136.80
|
| Rate for Payer: Zelis Worker's Compensation |
$93.37
|
|
|
65 YRS AND OVER
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
7299387
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$114.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
65 YRS AND OVER
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
8599387
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$111.38 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$285.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
65 YRS AND OVER
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
CPT 99397
|
| Hospital Charge Code |
8599397
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$85.50 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$290.70
|
| Rate for Payer: First Health Commercial |
$307.80
|
| Rate for Payer: First Health Workers Compensation |
$132.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$307.80
|
| Rate for Payer: GEHA Commercial |
$273.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$307.80
|
| Rate for Payer: Humana ChoiceCare |
$88.92
|
| Rate for Payer: Multiplan All |
$311.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$205.20
|
| Rate for Payer: OMNI Networks Commercial |
$239.40
|
| Rate for Payer: One Health Plan PPO/POS |
$307.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$324.90
|
| Rate for Payer: Three Rivers Provider Network All |
$256.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$300.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$85.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$318.06
|
| Rate for Payer: Zelis Auto |
$136.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$171.00
|
| Rate for Payer: Zelis Worker's Compensation |
$93.37
|
|
|
65 YRS AND OVER
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
8599387
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$326.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Humana ChoiceCare |
$106.08
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$244.80
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$359.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$204.00
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
65 YRS AND OVER
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 99387
|
| Hospital Charge Code |
7299387
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$40.75 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$130.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Humana ChoiceCare |
$42.38
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.80
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$143.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$40.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.50
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
69210 REMOVAL IMPACTED CERUMEN
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
21569210
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.04 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$55.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$114.40
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Humana ChoiceCare |
$62.04
|
| Rate for Payer: Humana Medicare Advantage |
$56.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$94.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$39.04
|
|
|
69210 REMOVAL IMPACTED CERUMEN
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
21569210
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.04 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$121.55
|
| Rate for Payer: First Health Commercial |
$128.70
|
| Rate for Payer: First Health Workers Compensation |
$55.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$128.70
|
| Rate for Payer: GEHA Commercial |
$100.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$128.70
|
| Rate for Payer: Multiplan All |
$130.13
|
| Rate for Payer: OMNI Networks Commercial |
$100.10
|
| Rate for Payer: One Health Plan PPO/POS |
$128.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$135.85
|
| Rate for Payer: Three Rivers Provider Network All |
$107.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.99
|
| Rate for Payer: Zelis Auto |
$57.20
|
| Rate for Payer: Zelis Worker's Compensation |
$39.04
|
|
|
69220 CLEAR MASTOID CAVITY
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
7969220
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$197.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$279.65
|
| Rate for Payer: First Health Commercial |
$296.10
|
| Rate for Payer: First Health Workers Compensation |
$127.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$296.10
|
| Rate for Payer: GEHA Commercial |
$263.20
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$296.10
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$299.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$230.30
|
| Rate for Payer: One Health Plan PPO/POS |
$296.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$312.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$246.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$305.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$131.60
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$89.82
|
|
|
69220 CLEAR MASTOID CAVITY
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
7969220
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$279.65
|
| Rate for Payer: First Health Commercial |
$296.10
|
| Rate for Payer: First Health Workers Compensation |
$127.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$296.10
|
| Rate for Payer: GEHA Commercial |
$230.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$296.10
|
| Rate for Payer: Multiplan All |
$299.39
|
| Rate for Payer: OMNI Networks Commercial |
$230.30
|
| Rate for Payer: One Health Plan PPO/POS |
$296.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$312.55
|
| Rate for Payer: Three Rivers Provider Network All |
$246.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$305.97
|
| Rate for Payer: Zelis Auto |
$131.60
|
| Rate for Payer: Zelis Worker's Compensation |
$89.82
|
|
|
69420 INCISION OF EARDRUM
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
7969420
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$155.34 |
| Max. Negotiated Rate |
$540.55 |
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$483.65
|
| Rate for Payer: First Health Commercial |
$512.10
|
| Rate for Payer: First Health Workers Compensation |
$219.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$512.10
|
| Rate for Payer: GEHA Commercial |
$398.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$512.10
|
| Rate for Payer: Multiplan All |
$517.79
|
| Rate for Payer: OMNI Networks Commercial |
$398.30
|
| Rate for Payer: One Health Plan PPO/POS |
$512.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$540.55
|
| Rate for Payer: Three Rivers Provider Network All |
$426.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$529.17
|
| Rate for Payer: Zelis Auto |
$227.60
|
| Rate for Payer: Zelis Worker's Compensation |
$155.34
|
|
|
69420 INCISION OF EARDRUM
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
7969420
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$155.34 |
| Max. Negotiated Rate |
$540.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$341.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$346.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$274.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$220.50
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$483.65
|
| Rate for Payer: First Health Commercial |
$512.10
|
| Rate for Payer: First Health Workers Compensation |
$219.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$512.10
|
| Rate for Payer: GEHA Commercial |
$455.20
|
| Rate for Payer: GEHA Medicare |
$220.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$512.10
|
| Rate for Payer: Humana ChoiceCare |
$242.55
|
| Rate for Payer: Humana Medicare Advantage |
$220.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$370.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$279.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$220.50
|
| Rate for Payer: Multiplan All |
$517.79
|
| Rate for Payer: New Mexico Health Connections Medicare |
$374.85
|
| Rate for Payer: OMNI Networks Commercial |
$398.30
|
| Rate for Payer: One Health Plan PPO/POS |
$512.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$323.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$279.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$540.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$441.00
|
| Rate for Payer: Three Rivers Provider Network All |
$426.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$216.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$279.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$529.17
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$220.50
|
| Rate for Payer: Zelis Auto |
$227.60
|
| Rate for Payer: Zelis Medicare |
$187.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$264.60
|
| Rate for Payer: Zelis Worker's Compensation |
$155.34
|
|
|
76536 US SOFT TISSUE HEAD & NECK RE TIME
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
21076536
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$98.06 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$289.00
|
| Rate for Payer: First Health Commercial |
$306.00
|
| Rate for Payer: First Health Workers Compensation |
$138.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$306.00
|
| Rate for Payer: GEHA Commercial |
$238.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$306.00
|
| Rate for Payer: Multiplan All |
$309.40
|
| Rate for Payer: OMNI Networks Commercial |
$238.00
|
| Rate for Payer: One Health Plan PPO/POS |
$306.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$323.00
|
| Rate for Payer: Three Rivers Provider Network All |
$255.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$316.20
|
| Rate for Payer: Zelis Auto |
$136.00
|
| Rate for Payer: Zelis Worker's Compensation |
$98.06
|
|
|
76536 US SOFT TISSUE HEAD & NECK RE TIME
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
21076536
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$204.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$115.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$289.00
|
| Rate for Payer: First Health Commercial |
$306.00
|
| Rate for Payer: First Health Workers Compensation |
$138.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$306.00
|
| Rate for Payer: GEHA Commercial |
$272.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$306.00
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$117.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$309.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$238.00
|
| Rate for Payer: One Health Plan PPO/POS |
$306.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$136.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$117.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$323.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$255.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$316.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$136.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$98.06
|
|
|
76942 US GUIDANCE NEEDLE PLACEM IMG S&I
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
21076942
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$117.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: First Health Workers Compensation |
$117.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$81.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Humana ChoiceCare |
$26.52
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$61.20
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$89.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$51.00
|
| Rate for Payer: Zelis Worker's Compensation |
$83.26
|
|
|
76942 US GUIDANCE NEEDLE PLACEM IMG S&I
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
21076942
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$117.75 |
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$86.70
|
| Rate for Payer: First Health Commercial |
$91.80
|
| Rate for Payer: First Health Workers Compensation |
$117.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.80
|
| Rate for Payer: GEHA Commercial |
$71.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.80
|
| Rate for Payer: Multiplan All |
$92.82
|
| Rate for Payer: OMNI Networks Commercial |
$71.40
|
| Rate for Payer: One Health Plan PPO/POS |
$91.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.90
|
| Rate for Payer: Three Rivers Provider Network All |
$76.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.86
|
| Rate for Payer: Zelis Auto |
$40.80
|
| Rate for Payer: Zelis Worker's Compensation |
$83.26
|
|
|
7 DAY REPORT INTERPRETATION
|
Facility
|
IP
|
$902.00
|
|
|
Service Code
|
CPT 93243
|
| Hospital Charge Code |
4093243
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$246.25 |
| Max. Negotiated Rate |
$856.90 |
| Rate for Payer: Cash Price |
$541.20
|
| Rate for Payer: Cigna Commercial |
$766.70
|
| Rate for Payer: First Health Commercial |
$811.80
|
| Rate for Payer: First Health Workers Compensation |
$348.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$811.80
|
| Rate for Payer: GEHA Commercial |
$631.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$811.80
|
| Rate for Payer: Multiplan All |
$820.82
|
| Rate for Payer: OMNI Networks Commercial |
$631.40
|
| Rate for Payer: One Health Plan PPO/POS |
$811.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$856.90
|
| Rate for Payer: Three Rivers Provider Network All |
$676.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$838.86
|
| Rate for Payer: Zelis Auto |
$360.80
|
| Rate for Payer: Zelis Worker's Compensation |
$246.25
|
|
|
7 DAY REPORT INTERPRETATION
|
Facility
|
OP
|
$902.00
|
|
|
Service Code
|
CPT 93243
|
| Hospital Charge Code |
4093243
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$66.14 |
| Max. Negotiated Rate |
$856.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$83.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$541.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$83.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$66.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$541.20
|
| Rate for Payer: Cash Price |
$541.20
|
| Rate for Payer: Cigna Commercial |
$766.70
|
| Rate for Payer: First Health Commercial |
$811.80
|
| Rate for Payer: First Health Workers Compensation |
$348.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$811.80
|
| Rate for Payer: GEHA Commercial |
$721.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$811.80
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$67.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$820.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$631.40
|
| Rate for Payer: One Health Plan PPO/POS |
$811.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$77.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$67.49
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$856.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$676.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Commercial |
$766.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$67.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$838.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$360.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$246.25
|
|
