|
NM BONE SCAN LMTD
|
Facility
|
OP
|
$1,989.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
2410018
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$193.84 |
| Max. Negotiated Rate |
$1,889.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$371.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,193.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$371.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$294.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$381.55
|
| Rate for Payer: Cash Price |
$1,193.40
|
| Rate for Payer: Cash Price |
$1,193.40
|
| Rate for Payer: Cigna Commercial |
$1,690.65
|
| Rate for Payer: First Health Commercial |
$1,790.10
|
| Rate for Payer: First Health Workers Compensation |
$274.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,790.10
|
| Rate for Payer: GEHA Commercial |
$1,591.20
|
| Rate for Payer: GEHA Medicare |
$381.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,790.10
|
| Rate for Payer: Humana ChoiceCare |
$419.70
|
| Rate for Payer: Humana Medicare Advantage |
$381.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$641.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$300.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$381.55
|
| Rate for Payer: Multiplan All |
$1,809.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$648.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,392.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,790.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$346.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$300.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$381.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,889.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$763.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,491.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$373.92
|
| Rate for Payer: United Healthcare Commercial |
$1,690.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$300.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,849.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$381.55
|
| Rate for Payer: Zelis Auto |
$795.60
|
| Rate for Payer: Zelis Medicare |
$324.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$457.86
|
| Rate for Payer: Zelis Worker's Compensation |
$193.84
|
|
|
NM BONE SCAN LMTD
|
Facility
|
IP
|
$1,989.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
2410018
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$193.84 |
| Max. Negotiated Rate |
$1,889.55 |
| Rate for Payer: Cash Price |
$1,193.40
|
| Rate for Payer: Cash Price |
$1,193.40
|
| Rate for Payer: Cigna Commercial |
$1,690.65
|
| Rate for Payer: First Health Commercial |
$1,790.10
|
| Rate for Payer: First Health Workers Compensation |
$274.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,790.10
|
| Rate for Payer: GEHA Commercial |
$1,392.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,790.10
|
| Rate for Payer: Multiplan All |
$1,809.99
|
| Rate for Payer: OMNI Networks Commercial |
$1,392.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,790.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,889.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,491.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,849.77
|
| Rate for Payer: Zelis Auto |
$795.60
|
| Rate for Payer: Zelis Worker's Compensation |
$193.84
|
|
|
NM BONE SCAN MULT AR
|
Facility
|
OP
|
$1,864.00
|
|
|
Service Code
|
CPT 78305
|
| Hospital Charge Code |
2410019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$235.55 |
| Max. Negotiated Rate |
$1,770.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$371.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,118.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$371.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$294.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$381.55
|
| Rate for Payer: Cash Price |
$1,118.40
|
| Rate for Payer: Cash Price |
$1,118.40
|
| Rate for Payer: Cigna Commercial |
$1,584.40
|
| Rate for Payer: First Health Commercial |
$1,677.60
|
| Rate for Payer: First Health Workers Compensation |
$333.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,677.60
|
| Rate for Payer: GEHA Commercial |
$1,491.20
|
| Rate for Payer: GEHA Medicare |
$381.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,677.60
|
| Rate for Payer: Humana ChoiceCare |
$419.70
|
| Rate for Payer: Humana Medicare Advantage |
$381.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$641.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$300.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$381.55
|
| Rate for Payer: Multiplan All |
$1,696.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$648.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,304.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,677.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$346.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$300.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$381.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,770.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$763.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,398.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$373.92
|
| Rate for Payer: United Healthcare Commercial |
$1,584.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$300.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,733.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$381.55
|
| Rate for Payer: Zelis Auto |
$745.60
|
| Rate for Payer: Zelis Medicare |
$324.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$457.86
|
| Rate for Payer: Zelis Worker's Compensation |
$235.55
|
|
|
NM BONE SCAN MULT AR
|
Facility
|
IP
|
$1,864.00
|
|
|
Service Code
|
CPT 78305
|
| Hospital Charge Code |
2410019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$235.55 |
| Max. Negotiated Rate |
$1,770.80 |
| Rate for Payer: Cash Price |
$1,118.40
|
| Rate for Payer: Cash Price |
$1,118.40
|
| Rate for Payer: Cigna Commercial |
$1,584.40
|
| Rate for Payer: First Health Commercial |
$1,677.60
|
| Rate for Payer: First Health Workers Compensation |
$333.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,677.60
|
| Rate for Payer: GEHA Commercial |
$1,304.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,677.60
|
| Rate for Payer: Multiplan All |
$1,696.24
|
| Rate for Payer: OMNI Networks Commercial |
$1,304.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,677.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,770.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,398.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,733.52
|
| Rate for Payer: Zelis Auto |
$745.60
|
| Rate for Payer: Zelis Worker's Compensation |
$235.55
|
|
|
NM BONE SPECT
|
Facility
|
IP
|
$3,321.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
2500001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$326.41 |
| Max. Negotiated Rate |
$3,154.95 |
| Rate for Payer: Cash Price |
$1,992.60
|
| Rate for Payer: Cash Price |
$1,992.60
|
| Rate for Payer: Cigna Commercial |
$2,822.85
|
| Rate for Payer: First Health Commercial |
$2,988.90
|
| Rate for Payer: First Health Workers Compensation |
$461.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,988.90
|
| Rate for Payer: GEHA Commercial |
$2,324.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,988.90
|
| Rate for Payer: Multiplan All |
$3,022.11
|
| Rate for Payer: OMNI Networks Commercial |
$2,324.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,988.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,154.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,490.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,088.53
|
| Rate for Payer: Zelis Auto |
$1,328.40
|
| Rate for Payer: Zelis Worker's Compensation |
$326.41
|
|
|
NM BONE SPECT
|
Facility
|
OP
|
$3,321.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
2500001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$326.41 |
| Max. Negotiated Rate |
$3,154.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$765.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,992.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$765.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$606.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,239.61
|
| Rate for Payer: Cash Price |
$1,992.60
|
| Rate for Payer: Cash Price |
$1,992.60
|
| Rate for Payer: Cigna Commercial |
$2,822.85
|
| Rate for Payer: First Health Commercial |
$2,988.90
|
| Rate for Payer: First Health Workers Compensation |
$461.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,988.90
|
| Rate for Payer: GEHA Commercial |
$2,656.80
|
| Rate for Payer: GEHA Medicare |
$1,239.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,988.90
|
| Rate for Payer: Humana ChoiceCare |
$1,363.57
|
| Rate for Payer: Humana Medicare Advantage |
$1,239.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,082.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$618.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,239.61
|
| Rate for Payer: Multiplan All |
$3,022.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,107.34
|
| Rate for Payer: OMNI Networks Commercial |
$2,324.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,988.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$714.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$618.87
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,239.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,154.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,479.22
|
| Rate for Payer: Three Rivers Provider Network All |
$2,490.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,214.82
|
| Rate for Payer: United Healthcare Commercial |
$2,822.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$618.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,239.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,088.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,239.61
|
| Rate for Payer: Zelis Auto |
$1,328.40
|
| Rate for Payer: Zelis Medicare |
$1,053.67
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,487.53
|
| Rate for Payer: Zelis Worker's Compensation |
$326.41
|
|
|
NM BONE SPECT
|
Facility
|
OP
|
$1,517.00
|
|
|
Service Code
|
CPT 78320
|
| Hospital Charge Code |
2410020
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$379.25 |
| Max. Negotiated Rate |
$1,441.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$910.20
|
| Rate for Payer: Cash Price |
$910.20
|
| Rate for Payer: Cigna Commercial |
$1,289.45
|
| Rate for Payer: First Health Commercial |
$1,365.30
|
| Rate for Payer: First Health Workers Compensation |
$585.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,365.30
|
| Rate for Payer: GEHA Commercial |
$1,213.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,365.30
|
| Rate for Payer: Humana ChoiceCare |
$394.42
|
| Rate for Payer: Multiplan All |
$1,380.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$910.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,061.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,365.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,441.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,137.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,334.96
|
| Rate for Payer: United Healthcare Commercial |
$1,289.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$379.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,410.81
|
| Rate for Payer: Zelis Auto |
$606.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$758.50
|
| Rate for Payer: Zelis Worker's Compensation |
$414.14
|
|
|
NM BONE SPECT
|
Facility
|
IP
|
$1,517.00
|
|
|
Service Code
|
CPT 78320
|
| Hospital Charge Code |
2410020
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$414.14 |
| Max. Negotiated Rate |
$1,441.15 |
| Rate for Payer: Cash Price |
$910.20
|
| Rate for Payer: Cigna Commercial |
$1,289.45
|
| Rate for Payer: First Health Commercial |
$1,365.30
|
| Rate for Payer: First Health Workers Compensation |
$585.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,365.30
|
| Rate for Payer: GEHA Commercial |
$1,061.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,365.30
|
| Rate for Payer: Multiplan All |
$1,380.47
|
| Rate for Payer: OMNI Networks Commercial |
$1,061.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,365.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,441.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,137.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,410.81
|
| Rate for Payer: Zelis Auto |
$606.80
|
| Rate for Payer: Zelis Worker's Compensation |
$414.14
|
|
|
NM BONE WHOLE BODY
|
Facility
|
OP
|
$2,872.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
2410022
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$253.95 |
| Max. Negotiated Rate |
$2,728.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$371.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,723.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$371.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$294.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$381.55
|
| Rate for Payer: Cash Price |
$1,723.20
|
| Rate for Payer: Cash Price |
$1,723.20
|
| Rate for Payer: Cigna Commercial |
$2,441.20
|
| Rate for Payer: First Health Commercial |
$2,584.80
|
| Rate for Payer: First Health Workers Compensation |
$359.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,584.80
|
| Rate for Payer: GEHA Commercial |
$2,297.60
|
| Rate for Payer: GEHA Medicare |
$381.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,584.80
|
| Rate for Payer: Humana ChoiceCare |
$419.70
|
| Rate for Payer: Humana Medicare Advantage |
$381.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$641.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$300.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$381.55
|
| Rate for Payer: Multiplan All |
$2,613.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$648.63
|
| Rate for Payer: OMNI Networks Commercial |
$2,010.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,584.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$346.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$300.01
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$381.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,728.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$763.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,154.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$373.92
|
| Rate for Payer: United Healthcare Commercial |
$2,441.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$300.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,670.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$381.55
|
| Rate for Payer: Zelis Auto |
$1,148.80
|
| Rate for Payer: Zelis Medicare |
$324.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$457.86
|
| Rate for Payer: Zelis Worker's Compensation |
$253.95
|
|
|
NM BONE WHOLE BODY
|
Facility
|
IP
|
$2,872.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
2410022
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$253.95 |
| Max. Negotiated Rate |
$2,728.40 |
| Rate for Payer: Cash Price |
$1,723.20
|
| Rate for Payer: Cash Price |
$1,723.20
|
| Rate for Payer: Cigna Commercial |
$2,441.20
|
| Rate for Payer: First Health Commercial |
$2,584.80
|
| Rate for Payer: First Health Workers Compensation |
$359.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,584.80
|
| Rate for Payer: GEHA Commercial |
$2,010.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,584.80
|
| Rate for Payer: Multiplan All |
$2,613.52
|
| Rate for Payer: OMNI Networks Commercial |
$2,010.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,584.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,728.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,154.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,670.96
|
| Rate for Payer: Zelis Auto |
$1,148.80
|
| Rate for Payer: Zelis Worker's Compensation |
$253.95
|
|
|
NM BRAIN SCAN SPECT
|
Facility
|
OP
|
$2,185.00
|
|
|
Service Code
|
CPT 78607
|
| Hospital Charge Code |
2415003
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$546.25 |
| Max. Negotiated Rate |
$2,075.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,311.00
|
| Rate for Payer: Cash Price |
$1,311.00
|
| Rate for Payer: Cigna Commercial |
$1,857.25
|
| Rate for Payer: First Health Commercial |
$1,966.50
|
| Rate for Payer: First Health Workers Compensation |
$843.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,966.50
|
| Rate for Payer: GEHA Commercial |
$1,748.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,966.50
|
| Rate for Payer: Humana ChoiceCare |
$568.10
|
| Rate for Payer: Multiplan All |
$1,988.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,311.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,529.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,966.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,075.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,638.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,922.80
|
| Rate for Payer: United Healthcare Commercial |
$1,857.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$546.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,032.05
|
| Rate for Payer: Zelis Auto |
$874.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,092.50
|
| Rate for Payer: Zelis Worker's Compensation |
$596.50
|
|
|
NM BRAIN SCAN SPECT
|
Facility
|
IP
|
$2,185.00
|
|
|
Service Code
|
CPT 78607
|
| Hospital Charge Code |
2415003
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$596.50 |
| Max. Negotiated Rate |
$2,075.75 |
| Rate for Payer: Cash Price |
$1,311.00
|
| Rate for Payer: Cigna Commercial |
$1,857.25
|
| Rate for Payer: First Health Commercial |
$1,966.50
|
| Rate for Payer: First Health Workers Compensation |
$843.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,966.50
|
| Rate for Payer: GEHA Commercial |
$1,529.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,966.50
|
| Rate for Payer: Multiplan All |
$1,988.35
|
| Rate for Payer: OMNI Networks Commercial |
$1,529.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,966.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,075.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,638.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,032.05
|
| Rate for Payer: Zelis Auto |
$874.00
|
| Rate for Payer: Zelis Worker's Compensation |
$596.50
|
|
|
NM BRAIN SCAN SPECT
|
Facility
|
OP
|
$3,321.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
2500002
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$326.41 |
| Max. Negotiated Rate |
$3,154.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$765.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,992.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$765.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$606.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,239.61
|
| Rate for Payer: Cash Price |
$1,992.60
|
| Rate for Payer: Cash Price |
$1,992.60
|
| Rate for Payer: Cigna Commercial |
$2,822.85
|
| Rate for Payer: First Health Commercial |
$2,988.90
|
| Rate for Payer: First Health Workers Compensation |
$461.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,988.90
|
| Rate for Payer: GEHA Commercial |
$2,656.80
|
| Rate for Payer: GEHA Medicare |
$1,239.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,988.90
|
| Rate for Payer: Humana ChoiceCare |
$1,363.57
|
| Rate for Payer: Humana Medicare Advantage |
$1,239.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,082.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$618.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,239.61
|
| Rate for Payer: Multiplan All |
$3,022.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,107.34
|
| Rate for Payer: OMNI Networks Commercial |
$2,324.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,988.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$714.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$618.87
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,239.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,154.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,479.22
|
| Rate for Payer: Three Rivers Provider Network All |
$2,490.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,214.82
|
| Rate for Payer: United Healthcare Commercial |
$2,822.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$618.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,239.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,088.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,239.61
|
| Rate for Payer: Zelis Auto |
$1,328.40
|
| Rate for Payer: Zelis Medicare |
$1,053.67
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,487.53
|
| Rate for Payer: Zelis Worker's Compensation |
$326.41
|
|
|
NM BRAIN SCAN SPECT
|
Facility
|
IP
|
$3,321.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
2500002
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$326.41 |
| Max. Negotiated Rate |
$3,154.95 |
| Rate for Payer: Cash Price |
$1,992.60
|
| Rate for Payer: Cash Price |
$1,992.60
|
| Rate for Payer: Cigna Commercial |
$2,822.85
|
| Rate for Payer: First Health Commercial |
$2,988.90
|
| Rate for Payer: First Health Workers Compensation |
$461.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,988.90
|
| Rate for Payer: GEHA Commercial |
$2,324.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,988.90
|
| Rate for Payer: Multiplan All |
$3,022.11
|
| Rate for Payer: OMNI Networks Commercial |
$2,324.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,988.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,154.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,490.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,088.53
|
| Rate for Payer: Zelis Auto |
$1,328.40
|
| Rate for Payer: Zelis Worker's Compensation |
$326.41
|
|
|
NM CARDIAC AMYLOIDOSIS
|
Facility
|
IP
|
$3,321.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
2578803
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$326.41 |
| Max. Negotiated Rate |
$3,154.95 |
| Rate for Payer: Cash Price |
$1,992.60
|
| Rate for Payer: Cash Price |
$1,992.60
|
| Rate for Payer: Cigna Commercial |
$2,822.85
|
| Rate for Payer: First Health Commercial |
$2,988.90
|
| Rate for Payer: First Health Workers Compensation |
$461.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,988.90
|
| Rate for Payer: GEHA Commercial |
$2,324.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,988.90
|
| Rate for Payer: Multiplan All |
$3,022.11
|
| Rate for Payer: OMNI Networks Commercial |
$2,324.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,988.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,154.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,490.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,088.53
|
| Rate for Payer: Zelis Auto |
$1,328.40
|
| Rate for Payer: Zelis Worker's Compensation |
$326.41
|
|
|
NM CARDIAC AMYLOIDOSIS
|
Facility
|
OP
|
$3,321.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
2578803
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$326.41 |
| Max. Negotiated Rate |
$3,154.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$765.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,992.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$765.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$606.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,239.61
|
| Rate for Payer: Cash Price |
$1,992.60
|
| Rate for Payer: Cash Price |
$1,992.60
|
| Rate for Payer: Cigna Commercial |
$2,822.85
|
| Rate for Payer: First Health Commercial |
$2,988.90
|
| Rate for Payer: First Health Workers Compensation |
$461.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,988.90
|
| Rate for Payer: GEHA Commercial |
$2,656.80
|
| Rate for Payer: GEHA Medicare |
$1,239.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,988.90
|
| Rate for Payer: Humana ChoiceCare |
$1,363.57
|
| Rate for Payer: Humana Medicare Advantage |
$1,239.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,082.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$618.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,239.61
|
| Rate for Payer: Multiplan All |
$3,022.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,107.34
|
| Rate for Payer: OMNI Networks Commercial |
$2,324.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,988.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$714.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$618.87
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,239.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,154.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,479.22
|
| Rate for Payer: Three Rivers Provider Network All |
$2,490.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,214.82
|
| Rate for Payer: United Healthcare Commercial |
$2,822.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$618.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,239.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,088.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,239.61
|
| Rate for Payer: Zelis Auto |
$1,328.40
|
| Rate for Payer: Zelis Medicare |
$1,053.67
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,487.53
|
| Rate for Payer: Zelis Worker's Compensation |
$326.41
|
|
|
NM GASTRIC EMPTYING
|
Facility
|
IP
|
$2,670.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
2410007
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$283.54 |
| Max. Negotiated Rate |
$2,536.50 |
| Rate for Payer: Cash Price |
$1,602.00
|
| Rate for Payer: Cash Price |
$1,602.00
|
| Rate for Payer: Cigna Commercial |
$2,269.50
|
| Rate for Payer: First Health Commercial |
$2,403.00
|
| Rate for Payer: First Health Workers Compensation |
$401.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,403.00
|
| Rate for Payer: GEHA Commercial |
$1,869.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,403.00
|
| Rate for Payer: Multiplan All |
$2,429.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,869.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,403.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,536.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,002.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,483.10
|
| Rate for Payer: Zelis Auto |
$1,068.00
|
| Rate for Payer: Zelis Worker's Compensation |
$283.54
|
|
|
NM GASTRIC EMPTYING
|
Facility
|
OP
|
$2,670.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
2410007
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$283.54 |
| Max. Negotiated Rate |
$2,536.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$371.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,602.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$371.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$293.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$381.55
|
| Rate for Payer: Cash Price |
$1,602.00
|
| Rate for Payer: Cash Price |
$1,602.00
|
| Rate for Payer: Cigna Commercial |
$2,269.50
|
| Rate for Payer: First Health Commercial |
$2,403.00
|
| Rate for Payer: First Health Workers Compensation |
$401.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,403.00
|
| Rate for Payer: GEHA Commercial |
$2,136.00
|
| Rate for Payer: GEHA Medicare |
$381.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,403.00
|
| Rate for Payer: Humana ChoiceCare |
$419.70
|
| Rate for Payer: Humana Medicare Advantage |
$381.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$641.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$299.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$381.55
|
| Rate for Payer: Multiplan All |
$2,429.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$648.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,869.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,403.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$346.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$299.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$381.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,536.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$763.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,002.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$373.92
|
| Rate for Payer: United Healthcare Commercial |
$2,269.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$299.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,483.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$381.55
|
| Rate for Payer: Zelis Auto |
$1,068.00
|
| Rate for Payer: Zelis Medicare |
$324.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$457.86
|
| Rate for Payer: Zelis Worker's Compensation |
$283.54
|
|
|
NM GI BLEED
|
Facility
|
OP
|
$2,404.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
2410008
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$293.97 |
| Max. Negotiated Rate |
$2,283.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$371.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,442.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$371.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$293.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$381.55
|
| Rate for Payer: Cash Price |
$1,442.40
|
| Rate for Payer: Cash Price |
$1,442.40
|
| Rate for Payer: Cigna Commercial |
$2,043.40
|
| Rate for Payer: First Health Commercial |
$2,163.60
|
| Rate for Payer: First Health Workers Compensation |
$418.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,163.60
|
| Rate for Payer: GEHA Commercial |
$1,923.20
|
| Rate for Payer: GEHA Medicare |
$381.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,163.60
|
| Rate for Payer: Humana ChoiceCare |
$419.70
|
| Rate for Payer: Humana Medicare Advantage |
$381.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$641.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$299.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$381.55
|
| Rate for Payer: Multiplan All |
$2,187.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$648.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,682.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,163.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$346.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$299.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$381.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,283.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$763.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,803.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$373.92
|
| Rate for Payer: United Healthcare Commercial |
$2,043.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$299.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,235.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$381.55
|
| Rate for Payer: Zelis Auto |
$961.60
|
| Rate for Payer: Zelis Medicare |
$324.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$457.86
|
| Rate for Payer: Zelis Worker's Compensation |
$296.13
|
|
|
NM GI BLEED
|
Facility
|
IP
|
$2,404.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
2410008
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$296.13 |
| Max. Negotiated Rate |
$2,283.80 |
| Rate for Payer: Cash Price |
$1,442.40
|
| Rate for Payer: Cash Price |
$1,442.40
|
| Rate for Payer: Cigna Commercial |
$2,043.40
|
| Rate for Payer: First Health Commercial |
$2,163.60
|
| Rate for Payer: First Health Workers Compensation |
$418.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,163.60
|
| Rate for Payer: GEHA Commercial |
$1,682.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,163.60
|
| Rate for Payer: Multiplan All |
$2,187.64
|
| Rate for Payer: OMNI Networks Commercial |
$1,682.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,163.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,283.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,803.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,235.72
|
| Rate for Payer: Zelis Auto |
$961.60
|
| Rate for Payer: Zelis Worker's Compensation |
$296.13
|
|
|
NM HIDA SCAN INCL PHARM
|
Facility
|
IP
|
$3,046.20
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
2410009
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$388.93 |
| Max. Negotiated Rate |
$2,893.89 |
| Rate for Payer: Cash Price |
$1,827.72
|
| Rate for Payer: Cash Price |
$1,827.72
|
| Rate for Payer: Cigna Commercial |
$2,589.27
|
| Rate for Payer: First Health Commercial |
$2,741.58
|
| Rate for Payer: First Health Workers Compensation |
$550.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,741.58
|
| Rate for Payer: GEHA Commercial |
$2,132.34
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,741.58
|
| Rate for Payer: Multiplan All |
$2,772.04
|
| Rate for Payer: OMNI Networks Commercial |
$2,132.34
|
| Rate for Payer: One Health Plan PPO/POS |
$2,741.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,893.89
|
| Rate for Payer: Three Rivers Provider Network All |
$2,284.65
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,832.97
|
| Rate for Payer: Zelis Auto |
$1,218.48
|
| Rate for Payer: Zelis Worker's Compensation |
$388.93
|
|
|
NM HIDA SCAN INCL PHARM
|
Facility
|
OP
|
$3,046.20
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
2410009
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$335.60 |
| Max. Negotiated Rate |
$2,893.89 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$423.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,827.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$423.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$335.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$511.11
|
| Rate for Payer: Cash Price |
$1,827.72
|
| Rate for Payer: Cash Price |
$1,827.72
|
| Rate for Payer: Cigna Commercial |
$2,589.27
|
| Rate for Payer: First Health Commercial |
$2,741.58
|
| Rate for Payer: First Health Workers Compensation |
$550.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,741.58
|
| Rate for Payer: GEHA Commercial |
$2,436.96
|
| Rate for Payer: GEHA Medicare |
$511.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,741.58
|
| Rate for Payer: Humana ChoiceCare |
$562.22
|
| Rate for Payer: Humana Medicare Advantage |
$511.11
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$858.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$342.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$511.11
|
| Rate for Payer: Multiplan All |
$2,772.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$868.89
|
| Rate for Payer: OMNI Networks Commercial |
$2,132.34
|
| Rate for Payer: One Health Plan PPO/POS |
$2,741.58
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$395.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$342.43
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$511.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,893.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,022.22
|
| Rate for Payer: Three Rivers Provider Network All |
$2,284.65
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$500.89
|
| Rate for Payer: United Healthcare Commercial |
$2,589.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$342.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$511.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,832.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$511.11
|
| Rate for Payer: Zelis Auto |
$1,218.48
|
| Rate for Payer: Zelis Medicare |
$434.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$613.33
|
| Rate for Payer: Zelis Worker's Compensation |
$388.93
|
|
|
NM HIDA SCAN W/O PHARMA
|
Facility
|
OP
|
$2,712.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
2410080
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$285.99 |
| Max. Negotiated Rate |
$2,576.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$423.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,627.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$423.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$335.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$381.55
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cigna Commercial |
$2,305.20
|
| Rate for Payer: First Health Commercial |
$2,440.80
|
| Rate for Payer: First Health Workers Compensation |
$404.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,440.80
|
| Rate for Payer: GEHA Commercial |
$2,169.60
|
| Rate for Payer: GEHA Medicare |
$381.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,440.80
|
| Rate for Payer: Humana ChoiceCare |
$419.70
|
| Rate for Payer: Humana Medicare Advantage |
$381.55
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$641.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$342.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$381.55
|
| Rate for Payer: Multiplan All |
$2,467.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$648.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,898.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,440.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$395.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$342.43
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$381.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,576.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$763.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,034.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$373.92
|
| Rate for Payer: United Healthcare Commercial |
$2,305.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$342.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,522.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$381.55
|
| Rate for Payer: Zelis Auto |
$1,084.80
|
| Rate for Payer: Zelis Medicare |
$324.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$457.86
|
| Rate for Payer: Zelis Worker's Compensation |
$285.99
|
|
|
NM HIDA SCAN W/O PHARMA
|
Facility
|
IP
|
$2,712.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
2410080
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$285.99 |
| Max. Negotiated Rate |
$2,576.40 |
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cigna Commercial |
$2,305.20
|
| Rate for Payer: First Health Commercial |
$2,440.80
|
| Rate for Payer: First Health Workers Compensation |
$404.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,440.80
|
| Rate for Payer: GEHA Commercial |
$1,898.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,440.80
|
| Rate for Payer: Multiplan All |
$2,467.92
|
| Rate for Payer: OMNI Networks Commercial |
$1,898.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,440.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,576.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,034.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,522.16
|
| Rate for Payer: Zelis Auto |
$1,084.80
|
| Rate for Payer: Zelis Worker's Compensation |
$285.99
|
|
|
NM I-123 WHOLE BODY
|
Facility
|
IP
|
$3,099.00
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
2495100
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$266.20 |
| Max. Negotiated Rate |
$2,944.05 |
| Rate for Payer: Cash Price |
$1,859.40
|
| Rate for Payer: Cash Price |
$1,859.40
|
| Rate for Payer: Cigna Commercial |
$2,634.15
|
| Rate for Payer: First Health Commercial |
$2,789.10
|
| Rate for Payer: First Health Workers Compensation |
$376.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,789.10
|
| Rate for Payer: GEHA Commercial |
$2,169.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,789.10
|
| Rate for Payer: Multiplan All |
$2,820.09
|
| Rate for Payer: OMNI Networks Commercial |
$2,169.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,789.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,944.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,324.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,882.07
|
| Rate for Payer: Zelis Auto |
$1,239.60
|
| Rate for Payer: Zelis Worker's Compensation |
$266.20
|
|
