|
LASER SURGERY OF PROSTATE
|
Facility
|
OP
|
$2,172.00
|
|
|
Service Code
|
CPT 52648
|
| Hospital Charge Code |
6152648
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$592.96 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,719.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,303.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,719.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,739.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Cigna Commercial |
$1,846.20
|
| Rate for Payer: First Health Commercial |
$1,954.80
|
| Rate for Payer: First Health Workers Compensation |
$838.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,954.80
|
| Rate for Payer: GEHA Commercial |
$1,737.60
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,954.80
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,815.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: Multiplan All |
$1,976.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,520.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,954.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,405.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,815.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,063.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,629.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,815.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,019.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Auto |
$868.80
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$592.96
|
|
|
LASER SURG PENIS LESION(S)
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT 54057
|
| Hospital Charge Code |
6154057
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$78.62 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cigna Commercial |
$244.80
|
| Rate for Payer: First Health Commercial |
$259.20
|
| Rate for Payer: First Health Workers Compensation |
$111.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$259.20
|
| Rate for Payer: GEHA Commercial |
$201.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$259.20
|
| Rate for Payer: Multiplan All |
$262.08
|
| Rate for Payer: OMNI Networks Commercial |
$201.60
|
| Rate for Payer: One Health Plan PPO/POS |
$259.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$273.60
|
| Rate for Payer: Three Rivers Provider Network All |
$216.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$267.84
|
| Rate for Payer: Zelis Auto |
$115.20
|
| Rate for Payer: Zelis Worker's Compensation |
$78.62
|
|
|
LASER SURG PENIS LESION(S)
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT 54057
|
| Hospital Charge Code |
6154057
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$78.62 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,150.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$172.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,150.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,703.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cigna Commercial |
$244.80
|
| Rate for Payer: First Health Commercial |
$259.20
|
| Rate for Payer: First Health Workers Compensation |
$111.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$259.20
|
| Rate for Payer: GEHA Commercial |
$230.40
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$259.20
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,738.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$262.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$201.60
|
| Rate for Payer: One Health Plan PPO/POS |
$259.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,006.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,738.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$273.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$216.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,738.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$267.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$115.20
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$78.62
|
|
|
LASER VAPORIZATION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, INTERNAL URETHROTOMY AND TRANSURETHRAL RESECTION OF PROSTATE ARE INCLUDED IF PERFORMED)
|
Facility
|
OP
|
$9,654.20
|
|
|
Service Code
|
CPT 52648
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,739.00 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,719.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,719.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,739.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: First Health Workers Compensation |
$6,212.48
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,815.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,405.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,815.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,815.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$4,392.66
|
|
|
LATANOPROST 0.005% EYE DROPS
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
NDC 61314054701
|
| Hospital Charge Code |
3300495
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$45.90
|
| Rate for Payer: First Health Commercial |
$48.60
|
| Rate for Payer: First Health Workers Compensation |
$20.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$48.60
|
| Rate for Payer: GEHA Commercial |
$43.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$48.60
|
| Rate for Payer: Humana ChoiceCare |
$14.04
|
| Rate for Payer: Multiplan All |
$49.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$32.40
|
| Rate for Payer: OMNI Networks Commercial |
$37.80
|
| Rate for Payer: One Health Plan PPO/POS |
$48.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$51.30
|
| Rate for Payer: Three Rivers Provider Network All |
$40.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$47.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$50.22
|
| Rate for Payer: Zelis Auto |
$21.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$27.00
|
| Rate for Payer: Zelis Worker's Compensation |
$14.74
|
|
|
LATANOPROST 0.005% EYE DROPS
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
NDC 61314054701
|
| Hospital Charge Code |
3300495
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.74 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$45.90
|
| Rate for Payer: First Health Commercial |
$48.60
|
| Rate for Payer: First Health Workers Compensation |
$20.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$48.60
|
| Rate for Payer: GEHA Commercial |
$37.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$48.60
|
| Rate for Payer: Multiplan All |
$49.14
|
| Rate for Payer: OMNI Networks Commercial |
$37.80
|
| Rate for Payer: One Health Plan PPO/POS |
$48.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$51.30
|
| Rate for Payer: Three Rivers Provider Network All |
$40.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$50.22
|
| Rate for Payer: Zelis Auto |
$21.60
|
| Rate for Payer: Zelis Worker's Compensation |
$14.74
|
|
|
LATEX AG ID EACH
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT 87451
|
| Hospital Charge Code |
2299061
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$150.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$15.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$94.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$15.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$12.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10.51
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$134.30
|
| Rate for Payer: First Health Commercial |
$142.20
|
| Rate for Payer: First Health Workers Compensation |
$15.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$142.20
|
| Rate for Payer: GEHA Commercial |
$126.40
|
| Rate for Payer: GEHA Medicare |
$10.51
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$142.20
|
| Rate for Payer: Humana ChoiceCare |
$11.56
|
| Rate for Payer: Humana Medicare Advantage |
$10.51
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$17.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$12.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10.51
|
| Rate for Payer: Multiplan All |
$143.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17.87
|
| Rate for Payer: OMNI Networks Commercial |
$110.60
|
| Rate for Payer: One Health Plan PPO/POS |
$142.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$14.71
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$12.74
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10.51
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$150.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$21.02
|
| Rate for Payer: Three Rivers Provider Network All |
$118.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.30
|
| Rate for Payer: United Healthcare Commercial |
$134.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.51
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10.51
|
| Rate for Payer: Zelis Auto |
$63.20
|
| Rate for Payer: Zelis Medicare |
$8.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.61
|
| Rate for Payer: Zelis Worker's Compensation |
$10.70
|
|
|
LATEX AG ID EACH
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT 87451
|
| Hospital Charge Code |
2299061
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$150.10 |
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$134.30
|
| Rate for Payer: First Health Commercial |
$142.20
|
| Rate for Payer: First Health Workers Compensation |
$15.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$142.20
|
| Rate for Payer: GEHA Commercial |
$110.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$142.20
|
| Rate for Payer: Multiplan All |
$143.78
|
| Rate for Payer: OMNI Networks Commercial |
$110.60
|
| Rate for Payer: One Health Plan PPO/POS |
$142.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$150.10
|
| Rate for Payer: Three Rivers Provider Network All |
$118.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.94
|
| Rate for Payer: Zelis Auto |
$63.20
|
| Rate for Payer: Zelis Worker's Compensation |
$10.70
|
|
|
latex, IgE REF602669
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2200784
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
latex, IgE REF602669
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2200784
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
LAT RETINACULAR RELEASE OPEN
|
Facility
|
OP
|
$910.00
|
|
|
Service Code
|
CPT 27425
|
| Hospital Charge Code |
6127425
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$248.43 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$546.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Cigna Commercial |
$773.50
|
| Rate for Payer: First Health Commercial |
$819.00
|
| Rate for Payer: First Health Workers Compensation |
$351.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$819.00
|
| Rate for Payer: GEHA Commercial |
$728.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$819.00
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$828.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$637.00
|
| Rate for Payer: One Health Plan PPO/POS |
$819.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$864.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$682.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$846.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$364.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$248.43
|
|
|
LAT RETINACULAR RELEASE OPEN
|
Facility
|
IP
|
$910.00
|
|
|
Service Code
|
CPT 27425
|
| Hospital Charge Code |
6127425
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$248.43 |
| Max. Negotiated Rate |
$864.50 |
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Cigna Commercial |
$773.50
|
| Rate for Payer: First Health Commercial |
$819.00
|
| Rate for Payer: First Health Workers Compensation |
$351.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$819.00
|
| Rate for Payer: GEHA Commercial |
$637.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$819.00
|
| Rate for Payer: Multiplan All |
$828.10
|
| Rate for Payer: OMNI Networks Commercial |
$637.00
|
| Rate for Payer: One Health Plan PPO/POS |
$819.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$864.50
|
| Rate for Payer: Three Rivers Provider Network All |
$682.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$846.30
|
| Rate for Payer: Zelis Auto |
$364.00
|
| Rate for Payer: Zelis Worker's Compensation |
$248.43
|
|
|
LAT THOR/LUMB ADDL SEG
|
Facility
|
OP
|
$960.00
|
|
|
Service Code
|
CPT 22534
|
| Hospital Charge Code |
6122534
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$816.00
|
| Rate for Payer: First Health Commercial |
$864.00
|
| Rate for Payer: First Health Workers Compensation |
$370.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$864.00
|
| Rate for Payer: GEHA Commercial |
$768.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$864.00
|
| Rate for Payer: Humana ChoiceCare |
$249.60
|
| Rate for Payer: Multiplan All |
$873.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$576.00
|
| Rate for Payer: OMNI Networks Commercial |
$672.00
|
| Rate for Payer: One Health Plan PPO/POS |
$864.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$912.00
|
| Rate for Payer: Three Rivers Provider Network All |
$720.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$844.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$240.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$892.80
|
| Rate for Payer: Zelis Auto |
$384.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$480.00
|
| Rate for Payer: Zelis Worker's Compensation |
$262.08
|
|
|
LAT THOR/LUMB ADDL SEG
|
Facility
|
IP
|
$960.00
|
|
|
Service Code
|
CPT 22534
|
| Hospital Charge Code |
6122534
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$262.08 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$816.00
|
| Rate for Payer: First Health Commercial |
$864.00
|
| Rate for Payer: First Health Workers Compensation |
$370.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$864.00
|
| Rate for Payer: GEHA Commercial |
$672.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$864.00
|
| Rate for Payer: Multiplan All |
$873.60
|
| Rate for Payer: OMNI Networks Commercial |
$672.00
|
| Rate for Payer: One Health Plan PPO/POS |
$864.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$912.00
|
| Rate for Payer: Three Rivers Provider Network All |
$720.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$892.80
|
| Rate for Payer: Zelis Auto |
$384.00
|
| Rate for Payer: Zelis Worker's Compensation |
$262.08
|
|
|
L COLECTOMY/COLOPROCTOSTOMY
|
Facility
|
IP
|
$4,173.00
|
|
|
Service Code
|
CPT 44208
|
| Hospital Charge Code |
6144208
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,139.23 |
| Max. Negotiated Rate |
$3,964.35 |
| Rate for Payer: Cash Price |
$2,503.80
|
| Rate for Payer: Cigna Commercial |
$3,547.05
|
| Rate for Payer: First Health Commercial |
$3,755.70
|
| Rate for Payer: First Health Workers Compensation |
$1,611.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,755.70
|
| Rate for Payer: GEHA Commercial |
$2,921.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,755.70
|
| Rate for Payer: Multiplan All |
$3,797.43
|
| Rate for Payer: OMNI Networks Commercial |
$2,921.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,755.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,964.35
|
| Rate for Payer: Three Rivers Provider Network All |
$3,129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,880.89
|
| Rate for Payer: Zelis Auto |
$1,669.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,139.23
|
|
|
L COLECTOMY/COLOPROCTOSTOMY
|
Facility
|
OP
|
$4,173.00
|
|
|
Service Code
|
CPT 44208
|
| Hospital Charge Code |
6144208
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,043.25 |
| Max. Negotiated Rate |
$3,964.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,503.80
|
| Rate for Payer: Cash Price |
$2,503.80
|
| Rate for Payer: Cigna Commercial |
$3,547.05
|
| Rate for Payer: First Health Commercial |
$3,755.70
|
| Rate for Payer: First Health Workers Compensation |
$1,611.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,755.70
|
| Rate for Payer: GEHA Commercial |
$3,338.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,755.70
|
| Rate for Payer: Humana ChoiceCare |
$1,084.98
|
| Rate for Payer: Multiplan All |
$3,797.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,503.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,921.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,755.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,964.35
|
| Rate for Payer: Three Rivers Provider Network All |
$3,129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,672.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,043.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,880.89
|
| Rate for Payer: Zelis Auto |
$1,669.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,086.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,139.23
|
|
|
L COLECTOMY/COLOPROCTOSTOMY
|
Facility
|
OP
|
$3,833.00
|
|
|
Service Code
|
CPT 44207
|
| Hospital Charge Code |
6144207
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$958.25 |
| Max. Negotiated Rate |
$3,641.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,299.80
|
| Rate for Payer: Cash Price |
$2,299.80
|
| Rate for Payer: Cigna Commercial |
$3,258.05
|
| Rate for Payer: First Health Commercial |
$3,449.70
|
| Rate for Payer: First Health Workers Compensation |
$1,479.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,449.70
|
| Rate for Payer: GEHA Commercial |
$3,066.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,449.70
|
| Rate for Payer: Humana ChoiceCare |
$996.58
|
| Rate for Payer: Multiplan All |
$3,488.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,299.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,683.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,449.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,641.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,874.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,373.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$958.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,564.69
|
| Rate for Payer: Zelis Auto |
$1,533.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,916.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,046.41
|
|
|
L COLECTOMY/COLOPROCTOSTOMY
|
Facility
|
IP
|
$3,833.00
|
|
|
Service Code
|
CPT 44207
|
| Hospital Charge Code |
6144207
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,046.41 |
| Max. Negotiated Rate |
$3,641.35 |
| Rate for Payer: Cash Price |
$2,299.80
|
| Rate for Payer: Cigna Commercial |
$3,258.05
|
| Rate for Payer: First Health Commercial |
$3,449.70
|
| Rate for Payer: First Health Workers Compensation |
$1,479.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,449.70
|
| Rate for Payer: GEHA Commercial |
$2,683.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,449.70
|
| Rate for Payer: Multiplan All |
$3,488.03
|
| Rate for Payer: OMNI Networks Commercial |
$2,683.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,449.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,641.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,874.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,564.69
|
| Rate for Payer: Zelis Auto |
$1,533.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,046.41
|
|
|
ld body fluid REF100156
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
22990910
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$11.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$88.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Worker's Compensation |
$8.23
|
|
|
ld body fluid REF100156
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
22990910
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.04
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$11.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$100.80
|
| Rate for Payer: GEHA Medicare |
$6.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Humana ChoiceCare |
$6.64
|
| Rate for Payer: Humana Medicare Advantage |
$6.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.04
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10.27
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10.15
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12.08
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.92
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.04
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Medicare |
$5.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.25
|
| Rate for Payer: Zelis Worker's Compensation |
$8.23
|
|
|
LDH (Vitros)
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
2232222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$10.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$10.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.04
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$11.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$100.80
|
| Rate for Payer: GEHA Medicare |
$6.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Humana ChoiceCare |
$6.64
|
| Rate for Payer: Humana Medicare Advantage |
$6.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.04
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10.27
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10.15
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12.08
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.92
|
| Rate for Payer: United Healthcare Commercial |
$107.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.04
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Medicare |
$5.13
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.25
|
| Rate for Payer: Zelis Worker's Compensation |
$8.23
|
|
|
LDH (Vitros)
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
2232222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$107.10
|
| Rate for Payer: First Health Commercial |
$113.40
|
| Rate for Payer: First Health Workers Compensation |
$11.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$113.40
|
| Rate for Payer: GEHA Commercial |
$88.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$113.40
|
| Rate for Payer: Multiplan All |
$114.66
|
| Rate for Payer: OMNI Networks Commercial |
$88.20
|
| Rate for Payer: One Health Plan PPO/POS |
$113.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$119.70
|
| Rate for Payer: Three Rivers Provider Network All |
$94.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$117.18
|
| Rate for Payer: Zelis Auto |
$50.40
|
| Rate for Payer: Zelis Worker's Compensation |
$8.23
|
|
|
LDL,direct POP (Vitros)
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
2232283
|
|
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
|
|
|
LDL,direct POP (Vitros)
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
2232283
|
|
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
|
|
|
LEAD INTRAMUSCULAR GASTRIC
|
Facility
|
OP
|
$7,597.00
|
|
|
Service Code
|
CPT C1897
|
| Hospital Charge Code |
7002710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,899.25 |
| Max. Negotiated Rate |
$7,217.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,558.20
|
| Rate for Payer: Cash Price |
$4,558.20
|
| Rate for Payer: Cash Price |
$4,558.20
|
| Rate for Payer: Cigna Commercial |
$6,457.45
|
| Rate for Payer: First Health Commercial |
$6,837.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,837.30
|
| Rate for Payer: GEHA Commercial |
$6,077.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,837.30
|
| Rate for Payer: Humana ChoiceCare |
$1,975.22
|
| Rate for Payer: Multiplan All |
$6,913.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,558.20
|
| Rate for Payer: OMNI Networks Commercial |
$5,317.90
|
| Rate for Payer: One Health Plan PPO/POS |
$6,837.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,217.15
|
| Rate for Payer: Three Rivers Provider Network All |
$5,697.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,685.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,899.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,065.21
|
| Rate for Payer: Zelis Auto |
$3,038.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,798.50
|
|
