|
INJECTION FOR BLADDER X-RAY
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
6151600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$38.49 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$119.85
|
| Rate for Payer: First Health Commercial |
$126.90
|
| Rate for Payer: First Health Workers Compensation |
$54.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$126.90
|
| Rate for Payer: GEHA Commercial |
$98.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$126.90
|
| Rate for Payer: Multiplan All |
$128.31
|
| Rate for Payer: OMNI Networks Commercial |
$98.70
|
| Rate for Payer: One Health Plan PPO/POS |
$126.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$133.95
|
| Rate for Payer: Three Rivers Provider Network All |
$105.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$131.13
|
| Rate for Payer: Zelis Auto |
$56.40
|
| Rate for Payer: Zelis Worker's Compensation |
$38.49
|
|
|
INJECTION FOR BLADDER X-RAY
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
6151600
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$35.25 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$119.85
|
| Rate for Payer: First Health Commercial |
$126.90
|
| Rate for Payer: First Health Workers Compensation |
$54.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$126.90
|
| Rate for Payer: GEHA Commercial |
$112.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$126.90
|
| Rate for Payer: Humana ChoiceCare |
$36.66
|
| Rate for Payer: Multiplan All |
$128.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$84.60
|
| Rate for Payer: OMNI Networks Commercial |
$98.70
|
| Rate for Payer: One Health Plan PPO/POS |
$126.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$133.95
|
| Rate for Payer: Three Rivers Provider Network All |
$105.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$124.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$35.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$131.13
|
| Rate for Payer: Zelis Auto |
$56.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$70.50
|
| Rate for Payer: Zelis Worker's Compensation |
$38.49
|
|
|
INJECTION FOR BREAST X-RAY
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
6119030
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$66.34 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$206.55
|
| Rate for Payer: First Health Commercial |
$218.70
|
| Rate for Payer: First Health Workers Compensation |
$93.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$218.70
|
| Rate for Payer: GEHA Commercial |
$170.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$218.70
|
| Rate for Payer: Multiplan All |
$221.13
|
| Rate for Payer: OMNI Networks Commercial |
$170.10
|
| Rate for Payer: One Health Plan PPO/POS |
$218.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$230.85
|
| Rate for Payer: Three Rivers Provider Network All |
$182.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.99
|
| Rate for Payer: Zelis Auto |
$97.20
|
| Rate for Payer: Zelis Worker's Compensation |
$66.34
|
|
|
INJECTION FOR BREAST X-RAY
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
6119030
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$60.75 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$206.55
|
| Rate for Payer: First Health Commercial |
$218.70
|
| Rate for Payer: First Health Workers Compensation |
$93.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$218.70
|
| Rate for Payer: GEHA Commercial |
$194.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$218.70
|
| Rate for Payer: Humana ChoiceCare |
$63.18
|
| Rate for Payer: Multiplan All |
$221.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.80
|
| Rate for Payer: OMNI Networks Commercial |
$170.10
|
| Rate for Payer: One Health Plan PPO/POS |
$218.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$230.85
|
| Rate for Payer: Three Rivers Provider Network All |
$182.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$213.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.99
|
| Rate for Payer: Zelis Auto |
$97.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.50
|
| Rate for Payer: Zelis Worker's Compensation |
$66.34
|
|
|
INJECTION FOR MYELOGRAM
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
6107257
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$72.89 |
| Max. Negotiated Rate |
$253.65 |
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$226.95
|
| Rate for Payer: First Health Commercial |
$240.30
|
| Rate for Payer: First Health Workers Compensation |
$103.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.30
|
| Rate for Payer: GEHA Commercial |
$186.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.30
|
| Rate for Payer: Multiplan All |
$242.97
|
| Rate for Payer: OMNI Networks Commercial |
$186.90
|
| Rate for Payer: One Health Plan PPO/POS |
$240.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.65
|
| Rate for Payer: Three Rivers Provider Network All |
$200.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.31
|
| Rate for Payer: Zelis Auto |
$106.80
|
| Rate for Payer: Zelis Worker's Compensation |
$72.89
|
|
|
INJECTION FOR MYELOGRAM
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
6107257
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$66.75 |
| Max. Negotiated Rate |
$542.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$226.95
|
| Rate for Payer: First Health Commercial |
$240.30
|
| Rate for Payer: First Health Workers Compensation |
$542.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$240.30
|
| Rate for Payer: GEHA Commercial |
$213.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$240.30
|
| Rate for Payer: Humana ChoiceCare |
$69.42
|
| Rate for Payer: Multiplan All |
$242.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$160.20
|
| Rate for Payer: OMNI Networks Commercial |
$186.90
|
| Rate for Payer: One Health Plan PPO/POS |
$240.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$253.65
|
| Rate for Payer: Three Rivers Provider Network All |
$200.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$234.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$66.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$248.31
|
| Rate for Payer: Zelis Auto |
$106.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$133.50
|
| Rate for Payer: Zelis Worker's Compensation |
$383.42
|
|
|
INJECTION FOR SALIVARY X-RAY
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
6142550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: First Health Workers Compensation |
$76.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$158.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| Rate for Payer: Humana ChoiceCare |
$51.48
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$118.80
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$174.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$49.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: Zelis Auto |
$79.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$99.00
|
| Rate for Payer: Zelis Worker's Compensation |
$54.05
|
|
|
INJECTION FOR SALIVARY X-RAY
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
6142550
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$54.05 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$168.30
|
| Rate for Payer: First Health Commercial |
$178.20
|
| Rate for Payer: First Health Workers Compensation |
$76.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$178.20
|
| Rate for Payer: GEHA Commercial |
$138.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$178.20
|
| Rate for Payer: Multiplan All |
$180.18
|
| Rate for Payer: OMNI Networks Commercial |
$138.60
|
| Rate for Payer: One Health Plan PPO/POS |
$178.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$188.10
|
| Rate for Payer: Three Rivers Provider Network All |
$148.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$184.14
|
| Rate for Payer: Zelis Auto |
$79.20
|
| Rate for Payer: Zelis Worker's Compensation |
$54.05
|
|
|
INJECTION FOR URETER X-RAY
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 50684
|
| Hospital Charge Code |
6150684
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$130.90
|
| Rate for Payer: First Health Commercial |
$138.60
|
| Rate for Payer: First Health Workers Compensation |
$59.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$138.60
|
| Rate for Payer: GEHA Commercial |
$123.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$138.60
|
| Rate for Payer: Humana ChoiceCare |
$40.04
|
| Rate for Payer: Multiplan All |
$140.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$92.40
|
| Rate for Payer: OMNI Networks Commercial |
$107.80
|
| Rate for Payer: One Health Plan PPO/POS |
$138.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$146.30
|
| Rate for Payer: Three Rivers Provider Network All |
$115.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$135.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$38.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$143.22
|
| Rate for Payer: Zelis Auto |
$61.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$77.00
|
| Rate for Payer: Zelis Worker's Compensation |
$42.04
|
|
|
INJECTION FOR URETER X-RAY
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 50690
|
| Hospital Charge Code |
6150690
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$59.24 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$184.45
|
| Rate for Payer: First Health Commercial |
$195.30
|
| Rate for Payer: First Health Workers Compensation |
$83.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$195.30
|
| Rate for Payer: GEHA Commercial |
$151.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$195.30
|
| Rate for Payer: Multiplan All |
$197.47
|
| Rate for Payer: OMNI Networks Commercial |
$151.90
|
| Rate for Payer: One Health Plan PPO/POS |
$195.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$206.15
|
| Rate for Payer: Three Rivers Provider Network All |
$162.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$201.81
|
| Rate for Payer: Zelis Auto |
$86.80
|
| Rate for Payer: Zelis Worker's Compensation |
$59.24
|
|
|
INJECTION FOR URETER X-RAY
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 50690
|
| Hospital Charge Code |
6150690
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$54.25 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$184.45
|
| Rate for Payer: First Health Commercial |
$195.30
|
| Rate for Payer: First Health Workers Compensation |
$83.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$195.30
|
| Rate for Payer: GEHA Commercial |
$173.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$195.30
|
| Rate for Payer: Humana ChoiceCare |
$56.42
|
| Rate for Payer: Multiplan All |
$197.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$130.20
|
| Rate for Payer: OMNI Networks Commercial |
$151.90
|
| Rate for Payer: One Health Plan PPO/POS |
$195.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$206.15
|
| Rate for Payer: Three Rivers Provider Network All |
$162.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$190.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$54.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$201.81
|
| Rate for Payer: Zelis Auto |
$86.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$108.50
|
| Rate for Payer: Zelis Worker's Compensation |
$59.24
|
|
|
INJECTION FOR URETER X-RAY
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT 50684
|
| Hospital Charge Code |
6150684
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$130.90
|
| Rate for Payer: First Health Commercial |
$138.60
|
| Rate for Payer: First Health Workers Compensation |
$59.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$138.60
|
| Rate for Payer: GEHA Commercial |
$107.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$138.60
|
| Rate for Payer: Multiplan All |
$140.14
|
| Rate for Payer: OMNI Networks Commercial |
$107.80
|
| Rate for Payer: One Health Plan PPO/POS |
$138.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$146.30
|
| Rate for Payer: Three Rivers Provider Network All |
$115.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$143.22
|
| Rate for Payer: Zelis Auto |
$61.60
|
| Rate for Payer: Zelis Worker's Compensation |
$42.04
|
|
|
INJECTION HALOPERIDOL UP TO 5 MG
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT J1630
|
| Hospital Charge Code |
8501630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$10.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
INJECTION HALOPERIDOL UP TO 5 MG
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT J1630
|
| Hospital Charge Code |
8501630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$12.75
|
| Rate for Payer: First Health Commercial |
$13.50
|
| Rate for Payer: First Health Workers Compensation |
$5.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13.50
|
| Rate for Payer: GEHA Commercial |
$0.88
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13.50
|
| Rate for Payer: Humana ChoiceCare |
$3.90
|
| Rate for Payer: Multiplan All |
$13.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.00
|
| Rate for Payer: OMNI Networks Commercial |
$10.50
|
| Rate for Payer: One Health Plan PPO/POS |
$13.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14.25
|
| Rate for Payer: Three Rivers Provider Network All |
$11.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13.95
|
| Rate for Payer: Zelis Auto |
$6.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.50
|
| Rate for Payer: Zelis Worker's Compensation |
$4.09
|
|
|
INJECTION HIP ARTHROGRAPHY W/ANESTHESIA
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 27095
|
| Hospital Charge Code |
6127095
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$224.40
|
| Rate for Payer: First Health Commercial |
$237.60
|
| Rate for Payer: First Health Workers Compensation |
$101.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$211.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Humana ChoiceCare |
$68.64
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$158.40
|
| Rate for Payer: OMNI Networks Commercial |
$184.80
|
| Rate for Payer: One Health Plan PPO/POS |
$237.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$232.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$66.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$132.00
|
| Rate for Payer: Zelis Worker's Compensation |
$72.07
|
|
|
INJECTION HIP ARTHROGRAPHY W/ANESTHESIA
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 27095
|
| Hospital Charge Code |
6127095
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$72.07 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$224.40
|
| Rate for Payer: First Health Commercial |
$237.60
|
| Rate for Payer: First Health Workers Compensation |
$101.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$184.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: OMNI Networks Commercial |
$184.80
|
| Rate for Payer: One Health Plan PPO/POS |
$237.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Worker's Compensation |
$72.07
|
|
|
INJECTION HIP ARTHROGRAPHY W/O ANESTHESI
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
6127093
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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: Great West Healthcare (Cigna) Commercial |
$196.20
|
| Rate for Payer: Humana ChoiceCare |
$56.68
|
| Rate for Payer: Multiplan All |
$198.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$130.80
|
| 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: TriWest Veterans Administration/VAPC3 |
$191.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$54.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$202.74
|
| Rate for Payer: Zelis Auto |
$87.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$109.00
|
| Rate for Payer: Zelis Worker's Compensation |
$59.51
|
|
|
INJECTION HIP ARTHROGRAPHY W/O ANESTHESI
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
6127093
|
|
Hospital Revenue Code
|
975
|
| 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
|
|
|
INJECTION INSULIN PER 5 UNITS
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
8501815
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$44.20
|
| Rate for Payer: First Health Commercial |
$46.80
|
| Rate for Payer: First Health Workers Compensation |
$20.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$46.80
|
| Rate for Payer: GEHA Commercial |
$41.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$46.80
|
| Rate for Payer: Humana ChoiceCare |
$13.52
|
| Rate for Payer: Multiplan All |
$47.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.20
|
| Rate for Payer: OMNI Networks Commercial |
$36.40
|
| Rate for Payer: One Health Plan PPO/POS |
$46.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$49.40
|
| Rate for Payer: Three Rivers Provider Network All |
$39.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$45.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$48.36
|
| Rate for Payer: Zelis Auto |
$20.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$26.00
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
INJECTION INSULIN PER 5 UNITS
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT J1815
|
| Hospital Charge Code |
8501815
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$44.20
|
| Rate for Payer: First Health Commercial |
$46.80
|
| Rate for Payer: First Health Workers Compensation |
$20.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$46.80
|
| Rate for Payer: GEHA Commercial |
$36.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$46.80
|
| Rate for Payer: Multiplan All |
$47.32
|
| Rate for Payer: OMNI Networks Commercial |
$36.40
|
| Rate for Payer: One Health Plan PPO/POS |
$46.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$49.40
|
| Rate for Payer: Three Rivers Provider Network All |
$39.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$48.36
|
| Rate for Payer: Zelis Auto |
$20.80
|
| Rate for Payer: Zelis Worker's Compensation |
$14.20
|
|
|
INJECTION INTO BRAIN CANAL
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
6161055
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$103.19 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cigna Commercial |
$321.30
|
| Rate for Payer: First Health Commercial |
$340.20
|
| Rate for Payer: First Health Workers Compensation |
$145.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$340.20
|
| Rate for Payer: GEHA Commercial |
$264.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$340.20
|
| Rate for Payer: Multiplan All |
$343.98
|
| Rate for Payer: OMNI Networks Commercial |
$264.60
|
| Rate for Payer: One Health Plan PPO/POS |
$340.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$359.10
|
| Rate for Payer: Three Rivers Provider Network All |
$283.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$351.54
|
| Rate for Payer: Zelis Auto |
$151.20
|
| Rate for Payer: Zelis Worker's Compensation |
$103.19
|
|
|
INJECTION INTO BRAIN CANAL
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
6161055
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$103.19 |
| Max. Negotiated Rate |
$728.01 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$226.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$576.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$280.29
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cigna Commercial |
$321.30
|
| Rate for Payer: First Health Commercial |
$340.20
|
| Rate for Payer: First Health Workers Compensation |
$145.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$340.20
|
| Rate for Payer: GEHA Commercial |
$302.40
|
| Rate for Payer: GEHA Medicare |
$280.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$340.20
|
| Rate for Payer: Humana ChoiceCare |
$308.32
|
| Rate for Payer: Humana Medicare Advantage |
$280.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$470.89
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$280.29
|
| Rate for Payer: Multiplan All |
$343.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$476.49
|
| Rate for Payer: OMNI Networks Commercial |
$264.60
|
| Rate for Payer: One Health Plan PPO/POS |
$340.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$679.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$588.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$280.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$359.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$560.58
|
| Rate for Payer: Three Rivers Provider Network All |
$283.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$351.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$280.29
|
| Rate for Payer: Zelis Auto |
$151.20
|
| Rate for Payer: Zelis Medicare |
$238.25
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$336.35
|
| Rate for Payer: Zelis Worker's Compensation |
$103.19
|
|
|
INJECTION INTO DISK LESION
|
Facility
|
OP
|
$1,189.00
|
|
|
Service Code
|
CPT 62292
|
| Hospital Charge Code |
6162292
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$324.60 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$713.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$576.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cigna Commercial |
$1,010.65
|
| Rate for Payer: First Health Commercial |
$1,070.10
|
| Rate for Payer: First Health Workers Compensation |
$459.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,070.10
|
| Rate for Payer: GEHA Commercial |
$951.20
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,070.10
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$1,081.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$832.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,070.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$679.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$588.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,129.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$891.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,105.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$475.60
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$324.60
|
|
|
INJECTION INTO DISK LESION
|
Facility
|
IP
|
$1,189.00
|
|
|
Service Code
|
CPT 62292
|
| Hospital Charge Code |
6162292
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$324.60 |
| Max. Negotiated Rate |
$1,129.55 |
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cigna Commercial |
$1,010.65
|
| Rate for Payer: First Health Commercial |
$1,070.10
|
| Rate for Payer: First Health Workers Compensation |
$459.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,070.10
|
| Rate for Payer: GEHA Commercial |
$832.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,070.10
|
| Rate for Payer: Multiplan All |
$1,081.99
|
| Rate for Payer: OMNI Networks Commercial |
$832.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,070.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,129.55
|
| Rate for Payer: Three Rivers Provider Network All |
$891.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,105.77
|
| Rate for Payer: Zelis Auto |
$475.60
|
| Rate for Payer: Zelis Worker's Compensation |
$324.60
|
|
|
INJECTION INTO HEMORRHOID(S)
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 46500
|
| Hospital Charge Code |
6146500
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$102.10 |
| Max. Negotiated Rate |
$355.30 |
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$317.90
|
| Rate for Payer: First Health Commercial |
$336.60
|
| Rate for Payer: First Health Workers Compensation |
$144.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$336.60
|
| Rate for Payer: GEHA Commercial |
$261.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$336.60
|
| Rate for Payer: Multiplan All |
$340.34
|
| Rate for Payer: OMNI Networks Commercial |
$261.80
|
| Rate for Payer: One Health Plan PPO/POS |
$336.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$355.30
|
| Rate for Payer: Three Rivers Provider Network All |
$280.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$347.82
|
| Rate for Payer: Zelis Auto |
$149.60
|
| Rate for Payer: Zelis Worker's Compensation |
$102.10
|
|
