|
NJX ANES&/STRD W/IMG TFRML EDRL L/S 1LVL
|
Facility
|
OP
|
$673.00
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
7664483
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$183.73 |
| Max. Negotiated Rate |
$1,690.74 |
| 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 |
$403.80
|
| 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 |
$845.37
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$572.05
|
| Rate for Payer: First Health Commercial |
$605.70
|
| Rate for Payer: First Health Workers Compensation |
$259.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$605.70
|
| Rate for Payer: GEHA Commercial |
$538.40
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$605.70
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$612.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$471.10
|
| Rate for Payer: One Health Plan PPO/POS |
$605.70
|
| 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 |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$639.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$504.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$625.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$269.20
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$183.73
|
|
|
NJX ANES&/STRD W/IMG TFRML EDRL L/S 1LVL
|
Facility
|
OP
|
$693.21
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
6164483
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$189.25 |
| Max. Negotiated Rate |
$1,690.74 |
| 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 |
$415.93
|
| 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 |
$845.37
|
| Rate for Payer: Cash Price |
$415.93
|
| Rate for Payer: Cash Price |
$415.93
|
| Rate for Payer: Cigna Commercial |
$589.23
|
| Rate for Payer: First Health Commercial |
$623.89
|
| Rate for Payer: First Health Workers Compensation |
$267.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$623.89
|
| Rate for Payer: GEHA Commercial |
$554.57
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$623.89
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$630.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$485.25
|
| Rate for Payer: One Health Plan PPO/POS |
$623.89
|
| 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 |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$658.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$519.91
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$644.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$277.28
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$189.25
|
|
|
NJX ANES&/STRD W/IMG TFRML EDRL L/S 1LVL
|
Facility
|
IP
|
$673.00
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
21764483
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$183.73 |
| Max. Negotiated Rate |
$639.35 |
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$572.05
|
| Rate for Payer: First Health Commercial |
$605.70
|
| Rate for Payer: First Health Workers Compensation |
$259.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$605.70
|
| Rate for Payer: GEHA Commercial |
$471.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$605.70
|
| Rate for Payer: Multiplan All |
$612.43
|
| Rate for Payer: OMNI Networks Commercial |
$471.10
|
| Rate for Payer: One Health Plan PPO/POS |
$605.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$639.35
|
| Rate for Payer: Three Rivers Provider Network All |
$504.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$625.89
|
| Rate for Payer: Zelis Auto |
$269.20
|
| Rate for Payer: Zelis Worker's Compensation |
$183.73
|
|
|
NJX ANES&/STRD W/IMG TFRML EDRL L/S 1LVL
|
Facility
|
OP
|
$673.00
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
21900150
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$183.73 |
| Max. Negotiated Rate |
$1,690.74 |
| 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 |
$403.80
|
| 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 |
$845.37
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$572.05
|
| Rate for Payer: First Health Commercial |
$605.70
|
| Rate for Payer: First Health Workers Compensation |
$259.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$605.70
|
| Rate for Payer: GEHA Commercial |
$538.40
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$605.70
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$612.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$471.10
|
| Rate for Payer: One Health Plan PPO/POS |
$605.70
|
| 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 |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$639.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$504.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$625.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$269.20
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$183.73
|
|
|
NJX ANES&/STRD W/IMG TFRML EDRL L/S 1LVL
|
Facility
|
IP
|
$693.21
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
6164483
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$189.25 |
| Max. Negotiated Rate |
$658.55 |
| Rate for Payer: Cash Price |
$415.93
|
| Rate for Payer: Cigna Commercial |
$589.23
|
| Rate for Payer: First Health Commercial |
$623.89
|
| Rate for Payer: First Health Workers Compensation |
$267.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$623.89
|
| Rate for Payer: GEHA Commercial |
$485.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$623.89
|
| Rate for Payer: Multiplan All |
$630.82
|
| Rate for Payer: OMNI Networks Commercial |
$485.25
|
| Rate for Payer: One Health Plan PPO/POS |
$623.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$658.55
|
| Rate for Payer: Three Rivers Provider Network All |
$519.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$644.69
|
| Rate for Payer: Zelis Auto |
$277.28
|
| Rate for Payer: Zelis Worker's Compensation |
$189.25
|
|
|
NJX ANES&/STRD W/IMG TFRML EDRL L/S 1LVL
|
Facility
|
IP
|
$673.00
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
7664483
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$183.73 |
| Max. Negotiated Rate |
$639.35 |
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$572.05
|
| Rate for Payer: First Health Commercial |
$605.70
|
| Rate for Payer: First Health Workers Compensation |
$259.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$605.70
|
| Rate for Payer: GEHA Commercial |
$471.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$605.70
|
| Rate for Payer: Multiplan All |
$612.43
|
| Rate for Payer: OMNI Networks Commercial |
$471.10
|
| Rate for Payer: One Health Plan PPO/POS |
$605.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$639.35
|
| Rate for Payer: Three Rivers Provider Network All |
$504.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$625.89
|
| Rate for Payer: Zelis Auto |
$269.20
|
| Rate for Payer: Zelis Worker's Compensation |
$183.73
|
|
|
NJX ANES&/STRD W/IMG TFRML EDRL L/S 1LVL
|
Facility
|
IP
|
$673.00
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
21900150
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$183.73 |
| Max. Negotiated Rate |
$639.35 |
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$572.05
|
| Rate for Payer: First Health Commercial |
$605.70
|
| Rate for Payer: First Health Workers Compensation |
$259.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$605.70
|
| Rate for Payer: GEHA Commercial |
$471.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$605.70
|
| Rate for Payer: Multiplan All |
$612.43
|
| Rate for Payer: OMNI Networks Commercial |
$471.10
|
| Rate for Payer: One Health Plan PPO/POS |
$605.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$639.35
|
| Rate for Payer: Three Rivers Provider Network All |
$504.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$625.89
|
| Rate for Payer: Zelis Auto |
$269.20
|
| Rate for Payer: Zelis Worker's Compensation |
$183.73
|
|
|
NJX ANES&/STRD W/IMG TFRML EDRL L/S 1LVL
|
Facility
|
OP
|
$673.00
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
21764483
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$183.73 |
| Max. Negotiated Rate |
$1,690.74 |
| 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 |
$403.80
|
| 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 |
$845.37
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$572.05
|
| Rate for Payer: First Health Commercial |
$605.70
|
| Rate for Payer: First Health Workers Compensation |
$259.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$605.70
|
| Rate for Payer: GEHA Commercial |
$538.40
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$605.70
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$612.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$471.10
|
| Rate for Payer: One Health Plan PPO/POS |
$605.70
|
| 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 |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$639.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$504.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$625.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$269.20
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$183.73
|
|
|
NJX ANE&/STRD W/IMG TFRML EDRL C/T 1 LVL
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
6164479
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$111.11 |
| Max. Negotiated Rate |
$386.65 |
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$345.95
|
| Rate for Payer: First Health Commercial |
$366.30
|
| Rate for Payer: First Health Workers Compensation |
$157.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$366.30
|
| Rate for Payer: GEHA Commercial |
$284.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$366.30
|
| Rate for Payer: Multiplan All |
$370.37
|
| Rate for Payer: OMNI Networks Commercial |
$284.90
|
| Rate for Payer: One Health Plan PPO/POS |
$366.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$386.65
|
| Rate for Payer: Three Rivers Provider Network All |
$305.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$378.51
|
| Rate for Payer: Zelis Auto |
$162.80
|
| Rate for Payer: Zelis Worker's Compensation |
$111.11
|
|
|
NJX ANE&/STRD W/IMG TFRML EDRL C/T 1 LVL
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
6164479
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$111.11 |
| Max. Negotiated Rate |
$1,690.74 |
| 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 |
$244.20
|
| 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 |
$845.37
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$345.95
|
| Rate for Payer: First Health Commercial |
$366.30
|
| Rate for Payer: First Health Workers Compensation |
$157.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$366.30
|
| Rate for Payer: GEHA Commercial |
$325.60
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$366.30
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$370.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$284.90
|
| Rate for Payer: One Health Plan PPO/POS |
$366.30
|
| 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 |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$386.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$305.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$378.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$162.80
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$111.11
|
|
|
NJX ANE&/STRD W/IMG TFRML EDRL C/T 1 LVL
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
21764479
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$199.29 |
| Max. Negotiated Rate |
$693.50 |
| Rate for Payer: Cash Price |
$438.00
|
| Rate for Payer: Cigna Commercial |
$620.50
|
| Rate for Payer: First Health Commercial |
$657.00
|
| Rate for Payer: First Health Workers Compensation |
$281.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$657.00
|
| Rate for Payer: GEHA Commercial |
$511.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$657.00
|
| Rate for Payer: Multiplan All |
$664.30
|
| Rate for Payer: OMNI Networks Commercial |
$511.00
|
| Rate for Payer: One Health Plan PPO/POS |
$657.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$693.50
|
| Rate for Payer: Three Rivers Provider Network All |
$547.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$678.90
|
| Rate for Payer: Zelis Auto |
$292.00
|
| Rate for Payer: Zelis Worker's Compensation |
$199.29
|
|
|
NJX ANE&/STRD W/IMG TFRML EDRL C/T 1 LVL
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
21764479
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$199.29 |
| Max. Negotiated Rate |
$1,690.74 |
| 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 |
$438.00
|
| 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 |
$845.37
|
| Rate for Payer: Cash Price |
$438.00
|
| Rate for Payer: Cash Price |
$438.00
|
| Rate for Payer: Cigna Commercial |
$620.50
|
| Rate for Payer: First Health Commercial |
$657.00
|
| Rate for Payer: First Health Workers Compensation |
$281.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$657.00
|
| Rate for Payer: GEHA Commercial |
$584.00
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$657.00
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$664.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$511.00
|
| Rate for Payer: One Health Plan PPO/POS |
$657.00
|
| 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 |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$693.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$547.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$678.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$292.00
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$199.29
|
|
|
NJX ANE&/STRD W/IMG TFRML EDRL C/T 1 LVL
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
7664479
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$199.29 |
| Max. Negotiated Rate |
$1,690.74 |
| 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 |
$438.00
|
| 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 |
$845.37
|
| Rate for Payer: Cash Price |
$438.00
|
| Rate for Payer: Cash Price |
$438.00
|
| Rate for Payer: Cigna Commercial |
$620.50
|
| Rate for Payer: First Health Commercial |
$657.00
|
| Rate for Payer: First Health Workers Compensation |
$281.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$657.00
|
| Rate for Payer: GEHA Commercial |
$584.00
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$657.00
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$664.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$511.00
|
| Rate for Payer: One Health Plan PPO/POS |
$657.00
|
| 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 |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$693.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$547.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$678.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$292.00
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$199.29
|
|
|
NJX ANE&/STRD W/IMG TFRML EDRL C/T 1 LVL
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
21900148
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$199.29 |
| Max. Negotiated Rate |
$693.50 |
| Rate for Payer: Cash Price |
$438.00
|
| Rate for Payer: Cigna Commercial |
$620.50
|
| Rate for Payer: First Health Commercial |
$657.00
|
| Rate for Payer: First Health Workers Compensation |
$281.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$657.00
|
| Rate for Payer: GEHA Commercial |
$511.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$657.00
|
| Rate for Payer: Multiplan All |
$664.30
|
| Rate for Payer: OMNI Networks Commercial |
$511.00
|
| Rate for Payer: One Health Plan PPO/POS |
$657.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$693.50
|
| Rate for Payer: Three Rivers Provider Network All |
$547.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$678.90
|
| Rate for Payer: Zelis Auto |
$292.00
|
| Rate for Payer: Zelis Worker's Compensation |
$199.29
|
|
|
NJX ANE&/STRD W/IMG TFRML EDRL C/T 1 LVL
|
Facility
|
IP
|
$2,866.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
3763210
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$782.42 |
| Max. Negotiated Rate |
$2,722.70 |
| Rate for Payer: Cash Price |
$1,719.60
|
| Rate for Payer: Cigna Commercial |
$2,436.10
|
| Rate for Payer: First Health Commercial |
$2,579.40
|
| Rate for Payer: First Health Workers Compensation |
$1,106.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,579.40
|
| Rate for Payer: GEHA Commercial |
$2,006.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,579.40
|
| Rate for Payer: Multiplan All |
$2,608.06
|
| Rate for Payer: OMNI Networks Commercial |
$2,006.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,579.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,722.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,149.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,665.38
|
| Rate for Payer: Zelis Auto |
$1,146.40
|
| Rate for Payer: Zelis Worker's Compensation |
$782.42
|
|
|
NJX ANE&/STRD W/IMG TFRML EDRL C/T 1 LVL
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
7664479
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$199.29 |
| Max. Negotiated Rate |
$693.50 |
| Rate for Payer: Cash Price |
$438.00
|
| Rate for Payer: Cigna Commercial |
$620.50
|
| Rate for Payer: First Health Commercial |
$657.00
|
| Rate for Payer: First Health Workers Compensation |
$281.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$657.00
|
| Rate for Payer: GEHA Commercial |
$511.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$657.00
|
| Rate for Payer: Multiplan All |
$664.30
|
| Rate for Payer: OMNI Networks Commercial |
$511.00
|
| Rate for Payer: One Health Plan PPO/POS |
$657.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$693.50
|
| Rate for Payer: Three Rivers Provider Network All |
$547.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$678.90
|
| Rate for Payer: Zelis Auto |
$292.00
|
| Rate for Payer: Zelis Worker's Compensation |
$199.29
|
|
|
NJX ANE&/STRD W/IMG TFRML EDRL C/T 1 LVL
|
Facility
|
OP
|
$2,866.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
3763210
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$576.73 |
| Max. Negotiated Rate |
$2,722.70 |
| 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 |
$1,719.60
|
| 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 |
$845.37
|
| Rate for Payer: Cash Price |
$1,719.60
|
| Rate for Payer: Cash Price |
$1,719.60
|
| Rate for Payer: Cigna Commercial |
$2,436.10
|
| Rate for Payer: First Health Commercial |
$2,579.40
|
| Rate for Payer: First Health Workers Compensation |
$1,106.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,579.40
|
| Rate for Payer: GEHA Commercial |
$2,292.80
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,579.40
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$2,608.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$2,006.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,579.40
|
| 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 |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,722.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$2,149.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,665.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$1,146.40
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$782.42
|
|
|
NJX ANE&/STRD W/IMG TFRML EDRL C/T 1 LVL
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
21900148
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$199.29 |
| Max. Negotiated Rate |
$1,690.74 |
| 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 |
$438.00
|
| 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 |
$845.37
|
| Rate for Payer: Cash Price |
$438.00
|
| Rate for Payer: Cash Price |
$438.00
|
| Rate for Payer: Cigna Commercial |
$620.50
|
| Rate for Payer: First Health Commercial |
$657.00
|
| Rate for Payer: First Health Workers Compensation |
$281.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$657.00
|
| Rate for Payer: GEHA Commercial |
$584.00
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$657.00
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$664.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$511.00
|
| Rate for Payer: One Health Plan PPO/POS |
$657.00
|
| 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 |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$693.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$547.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$678.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$292.00
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$199.29
|
|
|
NJX ANE&/STRD W/IMG TFRML EDRL C/T EA LV
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
7664480
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$376.33 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$376.33
|
| 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 |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$298.13
|
| 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 |
$131.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$306.00
|
| Rate for Payer: GEHA Commercial |
$272.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$306.00
|
| Rate for Payer: Humana ChoiceCare |
$88.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$304.20
|
| Rate for Payer: Multiplan All |
$309.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$204.00
|
| 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 |
$351.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$304.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$323.00
|
| Rate for Payer: Three Rivers Provider Network All |
$255.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$299.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$316.20
|
| Rate for Payer: Zelis Auto |
$136.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$170.00
|
| Rate for Payer: Zelis Worker's Compensation |
$92.82
|
|
|
NJX ANE&/STRD W/IMG TFRML EDRL C/T EA LV
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
21900149
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.82 |
| Max. Negotiated Rate |
$323.00 |
| 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 |
$131.27
|
| 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 |
$92.82
|
|
|
NJX ANE&/STRD W/IMG TFRML EDRL C/T EA LV
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
21900149
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$376.33 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$376.33
|
| 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 |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$298.13
|
| 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 |
$131.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$306.00
|
| Rate for Payer: GEHA Commercial |
$272.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$306.00
|
| Rate for Payer: Humana ChoiceCare |
$88.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$304.20
|
| Rate for Payer: Multiplan All |
$309.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$204.00
|
| 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 |
$351.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$304.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$323.00
|
| Rate for Payer: Three Rivers Provider Network All |
$255.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$299.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$316.20
|
| Rate for Payer: Zelis Auto |
$136.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$170.00
|
| Rate for Payer: Zelis Worker's Compensation |
$92.82
|
|
|
NJX ANE&/STRD W/IMG TFRML EDRL C/T EA LV
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
6164480
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$376.33 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$376.33
|
| 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 |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$298.13
|
| 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 |
$131.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$306.00
|
| Rate for Payer: GEHA Commercial |
$272.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$306.00
|
| Rate for Payer: Humana ChoiceCare |
$88.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$304.20
|
| Rate for Payer: Multiplan All |
$309.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$204.00
|
| 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 |
$351.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$304.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$323.00
|
| Rate for Payer: Three Rivers Provider Network All |
$255.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$299.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$316.20
|
| Rate for Payer: Zelis Auto |
$136.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$170.00
|
| Rate for Payer: Zelis Worker's Compensation |
$92.82
|
|
|
NJX ANE&/STRD W/IMG TFRML EDRL C/T EA LV
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
6164480
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$92.82 |
| Max. Negotiated Rate |
$323.00 |
| 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 |
$131.27
|
| 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 |
$92.82
|
|
|
NJX ANE&/STRD W/IMG TFRML EDRL C/T EA LV
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
21764480
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.82 |
| Max. Negotiated Rate |
$323.00 |
| 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 |
$131.27
|
| 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 |
$92.82
|
|
|
NJX ANE&/STRD W/IMG TFRML EDRL C/T EA LV
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
21764480
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$376.33 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$376.33
|
| 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 |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$298.13
|
| 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 |
$131.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$306.00
|
| Rate for Payer: GEHA Commercial |
$272.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$306.00
|
| Rate for Payer: Humana ChoiceCare |
$88.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$304.20
|
| Rate for Payer: Multiplan All |
$309.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$204.00
|
| 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 |
$351.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$304.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$323.00
|
| Rate for Payer: Three Rivers Provider Network All |
$255.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$299.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$316.20
|
| Rate for Payer: Zelis Auto |
$136.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$170.00
|
| Rate for Payer: Zelis Worker's Compensation |
$92.82
|
|
