|
NM I-123 WHOLE BODY
|
Facility
|
OP
|
$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: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$435.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,859.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$435.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$344.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$511.11
|
| 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 |
$2,479.20
|
| Rate for Payer: GEHA Medicare |
$511.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,789.10
|
| 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 |
$351.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$511.11
|
| Rate for Payer: Multiplan All |
$2,820.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$868.89
|
| Rate for Payer: OMNI Networks Commercial |
$2,169.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,789.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$406.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$351.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$511.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,944.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,022.22
|
| Rate for Payer: Three Rivers Provider Network All |
$2,324.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$500.89
|
| Rate for Payer: United Healthcare Commercial |
$2,634.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$351.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$511.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,882.07
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$511.11
|
| Rate for Payer: Zelis Auto |
$1,239.60
|
| Rate for Payer: Zelis Medicare |
$434.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$613.33
|
| Rate for Payer: Zelis Worker's Compensation |
$266.20
|
|
|
NM I-131 30 mCi CAPSULE
|
Facility
|
IP
|
$3,172.00
|
|
|
Service Code
|
CPT A9530
|
| Hospital Charge Code |
2509530
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$865.96 |
| Max. Negotiated Rate |
$3,013.40 |
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$2,696.20
|
| Rate for Payer: First Health Commercial |
$2,854.80
|
| Rate for Payer: First Health Workers Compensation |
$1,224.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,854.80
|
| Rate for Payer: GEHA Commercial |
$2,220.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,854.80
|
| Rate for Payer: Multiplan All |
$2,886.52
|
| Rate for Payer: OMNI Networks Commercial |
$2,220.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,854.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,013.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,379.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,949.96
|
| Rate for Payer: Zelis Auto |
$1,268.80
|
| Rate for Payer: Zelis Worker's Compensation |
$865.96
|
|
|
NM I-131 30 mCi CAPSULE
|
Facility
|
OP
|
$3,172.00
|
|
|
Service Code
|
CPT A9530
|
| Hospital Charge Code |
2509530
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$3,013.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$19.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,903.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$19.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$15.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20.88
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cash Price |
$1,903.20
|
| Rate for Payer: Cigna Commercial |
$2,696.20
|
| Rate for Payer: First Health Commercial |
$2,854.80
|
| Rate for Payer: First Health Workers Compensation |
$1,224.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,854.80
|
| Rate for Payer: GEHA Commercial |
$2,537.60
|
| Rate for Payer: GEHA Medicare |
$20.88
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,854.80
|
| Rate for Payer: Humana ChoiceCare |
$22.97
|
| Rate for Payer: Humana Medicare Advantage |
$20.88
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$35.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20.88
|
| Rate for Payer: Multiplan All |
$2,886.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.50
|
| Rate for Payer: OMNI Networks Commercial |
$2,220.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,854.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$18.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20.88
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,013.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$41.76
|
| Rate for Payer: Three Rivers Provider Network All |
$2,379.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$20.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.88
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,949.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$20.88
|
| Rate for Payer: Zelis Auto |
$1,268.80
|
| Rate for Payer: Zelis Medicare |
$17.75
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$25.06
|
| Rate for Payer: Zelis Worker's Compensation |
$865.96
|
|
|
NM I-131 THYROID THERAPY
|
Facility
|
OP
|
$2,545.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2579005
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$131.17 |
| Max. Negotiated Rate |
$2,417.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$327.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,527.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$327.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$259.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$212.82
|
| Rate for Payer: Cash Price |
$1,527.00
|
| Rate for Payer: Cash Price |
$1,527.00
|
| Rate for Payer: Cigna Commercial |
$2,163.25
|
| Rate for Payer: First Health Commercial |
$2,290.50
|
| Rate for Payer: First Health Workers Compensation |
$185.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,290.50
|
| Rate for Payer: GEHA Commercial |
$2,036.00
|
| Rate for Payer: GEHA Medicare |
$212.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,290.50
|
| Rate for Payer: Humana ChoiceCare |
$234.10
|
| Rate for Payer: Humana Medicare Advantage |
$212.82
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$357.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$264.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$212.82
|
| Rate for Payer: Multiplan All |
$2,315.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$361.79
|
| Rate for Payer: OMNI Networks Commercial |
$1,781.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,290.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$305.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$264.45
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$212.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,417.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$425.64
|
| Rate for Payer: Three Rivers Provider Network All |
$1,908.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$208.56
|
| Rate for Payer: United Healthcare Commercial |
$2,163.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$264.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,366.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$212.82
|
| Rate for Payer: Zelis Auto |
$1,018.00
|
| Rate for Payer: Zelis Medicare |
$180.90
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$255.38
|
| Rate for Payer: Zelis Worker's Compensation |
$131.17
|
|
|
NM I-131 THYROID THERAPY
|
Facility
|
IP
|
$2,545.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2579005
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$131.17 |
| Max. Negotiated Rate |
$2,417.75 |
| Rate for Payer: Cash Price |
$1,527.00
|
| Rate for Payer: Cash Price |
$1,527.00
|
| Rate for Payer: Cigna Commercial |
$2,163.25
|
| Rate for Payer: First Health Commercial |
$2,290.50
|
| Rate for Payer: First Health Workers Compensation |
$185.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,290.50
|
| Rate for Payer: GEHA Commercial |
$1,781.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,290.50
|
| Rate for Payer: Multiplan All |
$2,315.95
|
| Rate for Payer: OMNI Networks Commercial |
$1,781.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,290.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,417.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,908.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,366.85
|
| Rate for Payer: Zelis Auto |
$1,018.00
|
| Rate for Payer: Zelis Worker's Compensation |
$131.17
|
|
|
NM LIVER SPECT
|
Facility
|
IP
|
$1,209.00
|
|
|
Service Code
|
CPT 78205
|
| Hospital Charge Code |
2410012
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$330.06 |
| Max. Negotiated Rate |
$1,148.55 |
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cigna Commercial |
$1,027.65
|
| Rate for Payer: First Health Commercial |
$1,088.10
|
| Rate for Payer: First Health Workers Compensation |
$466.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,088.10
|
| Rate for Payer: GEHA Commercial |
$846.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,088.10
|
| Rate for Payer: Multiplan All |
$1,100.19
|
| Rate for Payer: OMNI Networks Commercial |
$846.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,088.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,148.55
|
| Rate for Payer: Three Rivers Provider Network All |
$906.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,124.37
|
| Rate for Payer: Zelis Auto |
$483.60
|
| Rate for Payer: Zelis Worker's Compensation |
$330.06
|
|
|
NM LIVER SPECT
|
Facility
|
OP
|
$3,321.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
2500000
|
|
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 LIVER SPECT
|
Facility
|
IP
|
$3,321.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
2500000
|
|
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 LIVER SPECT
|
Facility
|
OP
|
$1,209.00
|
|
|
Service Code
|
CPT 78205
|
| Hospital Charge Code |
2410012
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$302.25 |
| Max. Negotiated Rate |
$1,148.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$725.40
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cigna Commercial |
$1,027.65
|
| Rate for Payer: First Health Commercial |
$1,088.10
|
| Rate for Payer: First Health Workers Compensation |
$466.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,088.10
|
| Rate for Payer: GEHA Commercial |
$967.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,088.10
|
| Rate for Payer: Humana ChoiceCare |
$314.34
|
| Rate for Payer: Multiplan All |
$1,100.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$725.40
|
| Rate for Payer: OMNI Networks Commercial |
$846.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,088.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,148.55
|
| Rate for Payer: Three Rivers Provider Network All |
$906.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,063.92
|
| Rate for Payer: United Healthcare Commercial |
$1,027.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$302.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,124.37
|
| Rate for Payer: Zelis Auto |
$483.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$604.50
|
| Rate for Payer: Zelis Worker's Compensation |
$330.06
|
|
|
NM LIVER/SPLEEN W/FL
|
Facility
|
OP
|
$2,231.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
2410047
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$117.45 |
| Max. Negotiated Rate |
$2,119.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$436.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,338.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$436.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$345.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$381.55
|
| Rate for Payer: Cash Price |
$1,338.60
|
| Rate for Payer: Cash Price |
$1,338.60
|
| Rate for Payer: Cigna Commercial |
$1,896.35
|
| Rate for Payer: First Health Commercial |
$2,007.90
|
| Rate for Payer: First Health Workers Compensation |
$166.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,007.90
|
| Rate for Payer: GEHA Commercial |
$1,784.80
|
| Rate for Payer: GEHA Medicare |
$381.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,007.90
|
| 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 |
$352.57
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$381.55
|
| Rate for Payer: Multiplan All |
$2,030.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$648.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,561.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,007.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$407.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$352.57
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$381.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,119.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$763.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,673.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$373.92
|
| Rate for Payer: United Healthcare Commercial |
$1,896.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$352.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,074.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$381.55
|
| Rate for Payer: Zelis Auto |
$892.40
|
| Rate for Payer: Zelis Medicare |
$324.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$457.86
|
| Rate for Payer: Zelis Worker's Compensation |
$117.45
|
|
|
NM LIVER/SPLEEN W/FL
|
Facility
|
IP
|
$2,231.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
2410047
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$117.45 |
| Max. Negotiated Rate |
$2,119.45 |
| Rate for Payer: Cash Price |
$1,338.60
|
| Rate for Payer: Cash Price |
$1,338.60
|
| Rate for Payer: Cigna Commercial |
$1,896.35
|
| Rate for Payer: First Health Commercial |
$2,007.90
|
| Rate for Payer: First Health Workers Compensation |
$166.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,007.90
|
| Rate for Payer: GEHA Commercial |
$1,561.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,007.90
|
| Rate for Payer: Multiplan All |
$2,030.21
|
| Rate for Payer: OMNI Networks Commercial |
$1,561.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,007.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,119.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,673.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,074.83
|
| Rate for Payer: Zelis Auto |
$892.40
|
| Rate for Payer: Zelis Worker's Compensation |
$117.45
|
|
|
NM LUNG PERFUSION IMAGING
|
Facility
|
IP
|
$2,996.00
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
2410081
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$303.78 |
| Max. Negotiated Rate |
$2,846.20 |
| Rate for Payer: Cash Price |
$1,797.60
|
| Rate for Payer: Cash Price |
$1,797.60
|
| Rate for Payer: Cigna Commercial |
$2,546.60
|
| Rate for Payer: First Health Commercial |
$2,696.40
|
| Rate for Payer: First Health Workers Compensation |
$429.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,696.40
|
| Rate for Payer: GEHA Commercial |
$2,097.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,696.40
|
| Rate for Payer: Multiplan All |
$2,726.36
|
| Rate for Payer: OMNI Networks Commercial |
$2,097.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,696.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,846.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,247.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,786.28
|
| Rate for Payer: Zelis Auto |
$1,198.40
|
| Rate for Payer: Zelis Worker's Compensation |
$303.78
|
|
|
NM LUNG PERFUSION IMAGING
|
Facility
|
OP
|
$2,996.00
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
2410081
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$303.78 |
| Max. Negotiated Rate |
$2,846.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$456.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,797.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$456.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$361.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$511.11
|
| Rate for Payer: Cash Price |
$1,797.60
|
| Rate for Payer: Cash Price |
$1,797.60
|
| Rate for Payer: Cigna Commercial |
$2,546.60
|
| Rate for Payer: First Health Commercial |
$2,696.40
|
| Rate for Payer: First Health Workers Compensation |
$429.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,696.40
|
| Rate for Payer: GEHA Commercial |
$2,396.80
|
| Rate for Payer: GEHA Medicare |
$511.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,696.40
|
| 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 |
$369.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$511.11
|
| Rate for Payer: Multiplan All |
$2,726.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$868.89
|
| Rate for Payer: OMNI Networks Commercial |
$2,097.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,696.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$426.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$369.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$511.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,846.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,022.22
|
| Rate for Payer: Three Rivers Provider Network All |
$2,247.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$500.89
|
| Rate for Payer: United Healthcare Commercial |
$2,546.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$369.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$511.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,786.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$511.11
|
| Rate for Payer: Zelis Auto |
$1,198.40
|
| Rate for Payer: Zelis Medicare |
$434.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$613.33
|
| Rate for Payer: Zelis Worker's Compensation |
$303.78
|
|
|
NM LUNG SCAN VEN
|
Facility
|
OP
|
$1,743.00
|
|
| Hospital Charge Code |
2495000
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$435.75 |
| Max. Negotiated Rate |
$1,655.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,045.80
|
| Rate for Payer: Cash Price |
$1,045.80
|
| Rate for Payer: Cigna Commercial |
$1,481.55
|
| Rate for Payer: First Health Commercial |
$1,568.70
|
| Rate for Payer: First Health Workers Compensation |
$672.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,568.70
|
| Rate for Payer: GEHA Commercial |
$1,394.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,568.70
|
| Rate for Payer: Humana ChoiceCare |
$453.18
|
| Rate for Payer: Multiplan All |
$1,586.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,045.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,220.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,568.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,655.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,307.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,533.84
|
| Rate for Payer: United Healthcare Commercial |
$1,481.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$435.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,620.99
|
| Rate for Payer: Zelis Auto |
$697.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$871.50
|
| Rate for Payer: Zelis Worker's Compensation |
$475.84
|
|
|
NM LUNG SCAN VEN
|
Facility
|
IP
|
$1,743.00
|
|
| Hospital Charge Code |
2495000
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$475.84 |
| Max. Negotiated Rate |
$1,655.85 |
| Rate for Payer: Cash Price |
$1,045.80
|
| Rate for Payer: Cigna Commercial |
$1,481.55
|
| Rate for Payer: First Health Commercial |
$1,568.70
|
| Rate for Payer: First Health Workers Compensation |
$672.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,568.70
|
| Rate for Payer: GEHA Commercial |
$1,220.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,568.70
|
| Rate for Payer: Multiplan All |
$1,586.13
|
| Rate for Payer: OMNI Networks Commercial |
$1,220.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,568.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,655.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,307.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,620.99
|
| Rate for Payer: Zelis Auto |
$697.20
|
| Rate for Payer: Zelis Worker's Compensation |
$475.84
|
|
|
NM LUNG VQ SCAN
|
Facility
|
IP
|
$2,786.00
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
7778598
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$288.97 |
| Max. Negotiated Rate |
$2,646.70 |
| Rate for Payer: Cash Price |
$1,671.60
|
| Rate for Payer: Cash Price |
$1,671.60
|
| Rate for Payer: Cigna Commercial |
$2,368.10
|
| Rate for Payer: First Health Commercial |
$2,507.40
|
| Rate for Payer: First Health Workers Compensation |
$408.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,507.40
|
| Rate for Payer: GEHA Commercial |
$1,950.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,507.40
|
| Rate for Payer: Multiplan All |
$2,535.26
|
| Rate for Payer: OMNI Networks Commercial |
$1,950.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,507.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,646.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,089.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,590.98
|
| Rate for Payer: Zelis Auto |
$1,114.40
|
| Rate for Payer: Zelis Worker's Compensation |
$288.97
|
|
|
NM LUNG VQ SCAN
|
Facility
|
OP
|
$2,786.00
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
7778598
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$288.97 |
| Max. Negotiated Rate |
$2,646.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$456.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,671.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$456.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$361.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$511.11
|
| Rate for Payer: Cash Price |
$1,671.60
|
| Rate for Payer: Cash Price |
$1,671.60
|
| Rate for Payer: Cigna Commercial |
$2,368.10
|
| Rate for Payer: First Health Commercial |
$2,507.40
|
| Rate for Payer: First Health Workers Compensation |
$408.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,507.40
|
| Rate for Payer: GEHA Commercial |
$2,228.80
|
| Rate for Payer: GEHA Medicare |
$511.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,507.40
|
| 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 |
$369.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$511.11
|
| Rate for Payer: Multiplan All |
$2,535.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$868.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,950.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,507.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$426.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$369.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$511.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,646.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,022.22
|
| Rate for Payer: Three Rivers Provider Network All |
$2,089.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$500.89
|
| Rate for Payer: United Healthcare Commercial |
$2,368.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$369.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$511.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,590.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$511.11
|
| Rate for Payer: Zelis Auto |
$1,114.40
|
| Rate for Payer: Zelis Medicare |
$434.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$613.33
|
| Rate for Payer: Zelis Worker's Compensation |
$288.97
|
|
|
NM LYMPHOSCINTIGRAPHY
|
Facility
|
OP
|
$2,657.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
2410014
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$298.85 |
| Max. Negotiated Rate |
$2,524.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$387.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,594.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$387.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$307.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$511.11
|
| Rate for Payer: Cash Price |
$1,594.20
|
| Rate for Payer: Cash Price |
$1,594.20
|
| Rate for Payer: Cigna Commercial |
$2,258.45
|
| Rate for Payer: First Health Commercial |
$2,391.30
|
| Rate for Payer: First Health Workers Compensation |
$422.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,391.30
|
| Rate for Payer: GEHA Commercial |
$2,125.60
|
| Rate for Payer: GEHA Medicare |
$511.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,391.30
|
| 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 |
$313.37
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$511.11
|
| Rate for Payer: Multiplan All |
$2,417.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$868.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,859.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,391.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$361.83
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$313.37
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$511.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,524.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,022.22
|
| Rate for Payer: Three Rivers Provider Network All |
$1,992.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$500.89
|
| Rate for Payer: United Healthcare Commercial |
$2,258.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$313.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$511.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,471.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$511.11
|
| Rate for Payer: Zelis Auto |
$1,062.80
|
| Rate for Payer: Zelis Medicare |
$434.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$613.33
|
| Rate for Payer: Zelis Worker's Compensation |
$298.85
|
|
|
NM LYMPHOSCINTIGRAPHY
|
Facility
|
IP
|
$2,657.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
2410014
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$298.85 |
| Max. Negotiated Rate |
$2,524.15 |
| Rate for Payer: Cash Price |
$1,594.20
|
| Rate for Payer: Cash Price |
$1,594.20
|
| Rate for Payer: Cigna Commercial |
$2,258.45
|
| Rate for Payer: First Health Commercial |
$2,391.30
|
| Rate for Payer: First Health Workers Compensation |
$422.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,391.30
|
| Rate for Payer: GEHA Commercial |
$1,859.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,391.30
|
| Rate for Payer: Multiplan All |
$2,417.87
|
| Rate for Payer: OMNI Networks Commercial |
$1,859.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,391.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,524.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,992.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,471.01
|
| Rate for Payer: Zelis Auto |
$1,062.80
|
| Rate for Payer: Zelis Worker's Compensation |
$298.85
|
|
|
NM MECKELS GAST MUC
|
Facility
|
IP
|
$1,729.00
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
2410015
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$260.44 |
| Max. Negotiated Rate |
$1,642.55 |
| Rate for Payer: Cash Price |
$1,037.40
|
| Rate for Payer: Cash Price |
$1,037.40
|
| Rate for Payer: Cigna Commercial |
$1,469.65
|
| Rate for Payer: First Health Commercial |
$1,556.10
|
| Rate for Payer: First Health Workers Compensation |
$368.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,556.10
|
| Rate for Payer: GEHA Commercial |
$1,210.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,556.10
|
| Rate for Payer: Multiplan All |
$1,573.39
|
| Rate for Payer: OMNI Networks Commercial |
$1,210.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,556.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,642.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,296.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,607.97
|
| Rate for Payer: Zelis Auto |
$691.60
|
| Rate for Payer: Zelis Worker's Compensation |
$260.44
|
|
|
NM MECKELS GAST MUC
|
Facility
|
OP
|
$1,729.00
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
2410015
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$260.44 |
| Max. Negotiated Rate |
$1,642.55 |
| 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 |
$1,037.40
|
| 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 |
$1,037.40
|
| Rate for Payer: Cash Price |
$1,037.40
|
| Rate for Payer: Cigna Commercial |
$1,469.65
|
| Rate for Payer: First Health Commercial |
$1,556.10
|
| Rate for Payer: First Health Workers Compensation |
$368.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,556.10
|
| Rate for Payer: GEHA Commercial |
$1,383.20
|
| Rate for Payer: GEHA Medicare |
$381.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,556.10
|
| 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 |
$299.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$381.55
|
| Rate for Payer: Multiplan All |
$1,573.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$648.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,210.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,556.10
|
| 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 |
$1,642.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$763.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,296.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$373.92
|
| Rate for Payer: United Healthcare Commercial |
$1,469.65
|
| 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 |
$1,607.97
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$381.55
|
| Rate for Payer: Zelis Auto |
$691.60
|
| Rate for Payer: Zelis Medicare |
$324.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$457.86
|
| Rate for Payer: Zelis Worker's Compensation |
$260.44
|
|
|
NM MUGA
|
Facility
|
OP
|
$2,689.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
2410048
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$194.12 |
| Max. Negotiated Rate |
$2,554.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$458.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,613.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$458.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$363.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$381.55
|
| Rate for Payer: Cash Price |
$1,613.40
|
| Rate for Payer: Cash Price |
$1,613.40
|
| Rate for Payer: Cigna Commercial |
$2,285.65
|
| Rate for Payer: First Health Commercial |
$2,420.10
|
| Rate for Payer: First Health Workers Compensation |
$274.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,420.10
|
| Rate for Payer: GEHA Commercial |
$2,151.20
|
| Rate for Payer: GEHA Medicare |
$381.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,420.10
|
| 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 |
$370.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$381.55
|
| Rate for Payer: Multiplan All |
$2,446.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$648.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,882.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,420.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$428.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$370.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$381.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,554.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$763.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,016.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$373.92
|
| Rate for Payer: United Healthcare Commercial |
$2,285.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$370.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,500.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$381.55
|
| Rate for Payer: Zelis Auto |
$1,075.60
|
| Rate for Payer: Zelis Medicare |
$324.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$457.86
|
| Rate for Payer: Zelis Worker's Compensation |
$194.12
|
|
|
NM MUGA
|
Facility
|
IP
|
$2,689.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
2410048
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$194.12 |
| Max. Negotiated Rate |
$2,554.55 |
| Rate for Payer: Cash Price |
$1,613.40
|
| Rate for Payer: Cash Price |
$1,613.40
|
| Rate for Payer: Cigna Commercial |
$2,285.65
|
| Rate for Payer: First Health Commercial |
$2,420.10
|
| Rate for Payer: First Health Workers Compensation |
$274.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,420.10
|
| Rate for Payer: GEHA Commercial |
$1,882.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,420.10
|
| Rate for Payer: Multiplan All |
$2,446.99
|
| Rate for Payer: OMNI Networks Commercial |
$1,882.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,420.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,554.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,016.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,500.77
|
| Rate for Payer: Zelis Auto |
$1,075.60
|
| Rate for Payer: Zelis Worker's Compensation |
$194.12
|
|
|
NM MYOCARDIAL VIABILITY
|
Facility
|
OP
|
$4,849.00
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
2410045
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$295.41 |
| Max. Negotiated Rate |
$4,606.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,162.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,909.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,162.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$921.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,239.61
|
| Rate for Payer: Cash Price |
$2,909.40
|
| Rate for Payer: Cash Price |
$2,909.40
|
| Rate for Payer: Cigna Commercial |
$4,121.65
|
| Rate for Payer: First Health Commercial |
$4,364.10
|
| Rate for Payer: First Health Workers Compensation |
$417.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,364.10
|
| Rate for Payer: GEHA Commercial |
$3,879.20
|
| Rate for Payer: GEHA Medicare |
$1,239.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,364.10
|
| 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 |
$939.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,239.61
|
| Rate for Payer: Multiplan All |
$4,412.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,107.34
|
| Rate for Payer: OMNI Networks Commercial |
$3,394.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,364.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,085.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$939.80
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,239.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,606.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,479.22
|
| Rate for Payer: Three Rivers Provider Network All |
$3,636.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,214.82
|
| Rate for Payer: United Healthcare Commercial |
$4,121.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$939.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,239.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,509.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,239.61
|
| Rate for Payer: Zelis Auto |
$1,939.60
|
| 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 |
$295.41
|
|
|
NM MYOCARDIAL VIABILITY
|
Facility
|
IP
|
$4,849.00
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
2410045
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$295.41 |
| Max. Negotiated Rate |
$4,606.55 |
| Rate for Payer: Cash Price |
$2,909.40
|
| Rate for Payer: Cash Price |
$2,909.40
|
| Rate for Payer: Cigna Commercial |
$4,121.65
|
| Rate for Payer: First Health Commercial |
$4,364.10
|
| Rate for Payer: First Health Workers Compensation |
$417.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,364.10
|
| Rate for Payer: GEHA Commercial |
$3,394.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,364.10
|
| Rate for Payer: Multiplan All |
$4,412.59
|
| Rate for Payer: OMNI Networks Commercial |
$3,394.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,364.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,606.55
|
| Rate for Payer: Three Rivers Provider Network All |
$3,636.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,509.57
|
| Rate for Payer: Zelis Auto |
$1,939.60
|
| Rate for Payer: Zelis Worker's Compensation |
$295.41
|
|
