|
NM PARATHYROID IMAG
|
Facility
|
OP
|
$2,183.00
|
|
|
Service Code
|
CPT 78070
|
| Hospital Charge Code |
2410024
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$255.16 |
| Max. Negotiated Rate |
$2,073.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$332.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,309.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$332.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$263.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$381.55
|
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cigna Commercial |
$1,855.55
|
| Rate for Payer: First Health Commercial |
$1,964.70
|
| Rate for Payer: First Health Workers Compensation |
$360.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,964.70
|
| Rate for Payer: GEHA Commercial |
$1,746.40
|
| Rate for Payer: GEHA Medicare |
$381.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,964.70
|
| 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 |
$268.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$381.55
|
| Rate for Payer: Multiplan All |
$1,986.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$648.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,528.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,964.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$310.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$268.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$381.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,073.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$763.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,637.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$373.92
|
| Rate for Payer: United Healthcare Commercial |
$1,855.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$268.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,030.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$381.55
|
| Rate for Payer: Zelis Auto |
$873.20
|
| Rate for Payer: Zelis Medicare |
$324.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$457.86
|
| Rate for Payer: Zelis Worker's Compensation |
$255.16
|
|
|
NM PARATHYROID IMAG
|
Facility
|
IP
|
$2,183.00
|
|
|
Service Code
|
CPT 78070
|
| Hospital Charge Code |
2410024
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$255.16 |
| Max. Negotiated Rate |
$2,073.85 |
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cash Price |
$1,309.80
|
| Rate for Payer: Cigna Commercial |
$1,855.55
|
| Rate for Payer: First Health Commercial |
$1,964.70
|
| Rate for Payer: First Health Workers Compensation |
$360.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,964.70
|
| Rate for Payer: GEHA Commercial |
$1,528.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,964.70
|
| Rate for Payer: Multiplan All |
$1,986.53
|
| Rate for Payer: OMNI Networks Commercial |
$1,528.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,964.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,073.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,637.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,030.19
|
| Rate for Payer: Zelis Auto |
$873.20
|
| Rate for Payer: Zelis Worker's Compensation |
$255.16
|
|
|
NM PULM PERF PART
|
Facility
|
OP
|
$2,045.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
2410025
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$203.13 |
| Max. Negotiated Rate |
$1,942.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$309.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,227.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$309.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$245.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$381.55
|
| Rate for Payer: Cash Price |
$1,227.00
|
| Rate for Payer: Cash Price |
$1,227.00
|
| Rate for Payer: Cigna Commercial |
$1,738.25
|
| Rate for Payer: First Health Commercial |
$1,840.50
|
| Rate for Payer: First Health Workers Compensation |
$287.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,840.50
|
| Rate for Payer: GEHA Commercial |
$1,636.00
|
| Rate for Payer: GEHA Medicare |
$381.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,840.50
|
| 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 |
$250.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$381.55
|
| Rate for Payer: Multiplan All |
$1,860.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$648.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,431.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,840.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$289.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$250.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$381.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,942.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$763.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,533.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$373.92
|
| Rate for Payer: United Healthcare Commercial |
$1,738.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$250.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,901.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$381.55
|
| Rate for Payer: Zelis Auto |
$818.00
|
| Rate for Payer: Zelis Medicare |
$324.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$457.86
|
| Rate for Payer: Zelis Worker's Compensation |
$203.13
|
|
|
NM PULM PERF PART
|
Facility
|
IP
|
$2,045.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
2410025
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$203.13 |
| Max. Negotiated Rate |
$1,942.75 |
| Rate for Payer: Cash Price |
$1,227.00
|
| Rate for Payer: Cash Price |
$1,227.00
|
| Rate for Payer: Cigna Commercial |
$1,738.25
|
| Rate for Payer: First Health Commercial |
$1,840.50
|
| Rate for Payer: First Health Workers Compensation |
$287.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,840.50
|
| Rate for Payer: GEHA Commercial |
$1,431.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,840.50
|
| Rate for Payer: Multiplan All |
$1,860.95
|
| Rate for Payer: OMNI Networks Commercial |
$1,431.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,840.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,942.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,533.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,901.85
|
| Rate for Payer: Zelis Auto |
$818.00
|
| Rate for Payer: Zelis Worker's Compensation |
$203.13
|
|
|
NM PULM VENT PART
|
Facility
|
IP
|
$2,008.00
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
4210026
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$174.08 |
| Max. Negotiated Rate |
$1,907.60 |
| Rate for Payer: Cash Price |
$1,204.80
|
| Rate for Payer: Cash Price |
$1,204.80
|
| Rate for Payer: Cigna Commercial |
$1,706.80
|
| Rate for Payer: First Health Commercial |
$1,807.20
|
| Rate for Payer: First Health Workers Compensation |
$246.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,807.20
|
| Rate for Payer: GEHA Commercial |
$1,405.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,807.20
|
| Rate for Payer: Multiplan All |
$1,827.28
|
| Rate for Payer: OMNI Networks Commercial |
$1,405.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,807.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,907.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,506.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,867.44
|
| Rate for Payer: Zelis Auto |
$803.20
|
| Rate for Payer: Zelis Worker's Compensation |
$174.08
|
|
|
NM PULM VENT PART
|
Facility
|
OP
|
$2,008.00
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
4210026
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$174.08 |
| Max. Negotiated Rate |
$1,907.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$292.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,204.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$292.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$231.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$381.55
|
| Rate for Payer: Cash Price |
$1,204.80
|
| Rate for Payer: Cash Price |
$1,204.80
|
| Rate for Payer: Cigna Commercial |
$1,706.80
|
| Rate for Payer: First Health Commercial |
$1,807.20
|
| Rate for Payer: First Health Workers Compensation |
$246.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,807.20
|
| Rate for Payer: GEHA Commercial |
$1,606.40
|
| Rate for Payer: GEHA Medicare |
$381.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,807.20
|
| 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 |
$236.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$381.55
|
| Rate for Payer: Multiplan All |
$1,827.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$648.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,405.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,807.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$272.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$236.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$381.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,907.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$763.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,506.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$373.92
|
| Rate for Payer: United Healthcare Commercial |
$1,706.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$236.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,867.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$381.55
|
| Rate for Payer: Zelis Auto |
$803.20
|
| Rate for Payer: Zelis Medicare |
$324.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$457.86
|
| Rate for Payer: Zelis Worker's Compensation |
$174.08
|
|
|
NM RENAL CORTICAL IMAG
|
Facility
|
OP
|
$2,081.00
|
|
|
Service Code
|
CPT 78701
|
| Hospital Charge Code |
2676818
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$185.84 |
| Max. Negotiated Rate |
$1,976.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$487.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,248.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$487.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$386.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$381.55
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cigna Commercial |
$1,768.85
|
| Rate for Payer: First Health Commercial |
$1,872.90
|
| Rate for Payer: First Health Workers Compensation |
$262.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,872.90
|
| Rate for Payer: GEHA Commercial |
$1,664.80
|
| Rate for Payer: GEHA Medicare |
$381.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,872.90
|
| 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 |
$394.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$381.55
|
| Rate for Payer: Multiplan All |
$1,893.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$648.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,456.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,872.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$455.06
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$394.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$381.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,976.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$763.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,560.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$373.92
|
| Rate for Payer: United Healthcare Commercial |
$1,768.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$394.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,935.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$381.55
|
| Rate for Payer: Zelis Auto |
$832.40
|
| Rate for Payer: Zelis Medicare |
$324.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$457.86
|
| Rate for Payer: Zelis Worker's Compensation |
$185.84
|
|
|
NM RENAL CORTICAL IMAG
|
Facility
|
IP
|
$2,081.00
|
|
|
Service Code
|
CPT 78701
|
| Hospital Charge Code |
2676818
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$185.84 |
| Max. Negotiated Rate |
$1,976.95 |
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cash Price |
$1,248.60
|
| Rate for Payer: Cigna Commercial |
$1,768.85
|
| Rate for Payer: First Health Commercial |
$1,872.90
|
| Rate for Payer: First Health Workers Compensation |
$262.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,872.90
|
| Rate for Payer: GEHA Commercial |
$1,456.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,872.90
|
| Rate for Payer: Multiplan All |
$1,893.71
|
| Rate for Payer: OMNI Networks Commercial |
$1,456.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,872.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,976.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,560.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,935.33
|
| Rate for Payer: Zelis Auto |
$832.40
|
| Rate for Payer: Zelis Worker's Compensation |
$185.84
|
|
|
NM RENAL SCAN NO LASIX
|
Facility
|
IP
|
$2,644.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
2410023
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$197.62 |
| Max. Negotiated Rate |
$2,511.80 |
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cigna Commercial |
$2,247.40
|
| Rate for Payer: First Health Commercial |
$2,379.60
|
| Rate for Payer: First Health Workers Compensation |
$279.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,379.60
|
| Rate for Payer: GEHA Commercial |
$1,850.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,379.60
|
| Rate for Payer: Multiplan All |
$2,406.04
|
| Rate for Payer: OMNI Networks Commercial |
$1,850.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,379.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,511.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,983.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,458.92
|
| Rate for Payer: Zelis Auto |
$1,057.60
|
| Rate for Payer: Zelis Worker's Compensation |
$197.62
|
|
|
NM RENAL SCAN NO LASIX
|
Facility
|
OP
|
$2,644.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
2410051
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$197.62 |
| Max. Negotiated Rate |
$2,511.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$487.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,586.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$487.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$386.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$511.11
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cigna Commercial |
$2,247.40
|
| Rate for Payer: First Health Commercial |
$2,379.60
|
| Rate for Payer: First Health Workers Compensation |
$279.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,379.60
|
| Rate for Payer: GEHA Commercial |
$2,115.20
|
| Rate for Payer: GEHA Medicare |
$511.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,379.60
|
| 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 |
$394.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$511.11
|
| Rate for Payer: Multiplan All |
$2,406.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$868.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,850.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,379.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$455.06
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$394.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$511.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,511.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,022.22
|
| Rate for Payer: Three Rivers Provider Network All |
$1,983.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$500.89
|
| Rate for Payer: United Healthcare Commercial |
$2,247.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$394.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$511.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,458.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$511.11
|
| Rate for Payer: Zelis Auto |
$1,057.60
|
| Rate for Payer: Zelis Medicare |
$434.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$613.33
|
| Rate for Payer: Zelis Worker's Compensation |
$197.62
|
|
|
NM RENAL SCAN NO LASIX
|
Facility
|
OP
|
$2,644.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
2410023
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$197.62 |
| Max. Negotiated Rate |
$2,511.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$487.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,586.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$487.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$386.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$511.11
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cigna Commercial |
$2,247.40
|
| Rate for Payer: First Health Commercial |
$2,379.60
|
| Rate for Payer: First Health Workers Compensation |
$279.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,379.60
|
| Rate for Payer: GEHA Commercial |
$2,115.20
|
| Rate for Payer: GEHA Medicare |
$511.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,379.60
|
| 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 |
$394.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$511.11
|
| Rate for Payer: Multiplan All |
$2,406.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$868.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,850.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,379.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$455.06
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$394.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$511.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,511.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,022.22
|
| Rate for Payer: Three Rivers Provider Network All |
$1,983.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$500.89
|
| Rate for Payer: United Healthcare Commercial |
$2,247.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$394.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$511.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,458.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$511.11
|
| Rate for Payer: Zelis Auto |
$1,057.60
|
| Rate for Payer: Zelis Medicare |
$434.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$613.33
|
| Rate for Payer: Zelis Worker's Compensation |
$197.62
|
|
|
NM RENAL SCAN NO LASIX
|
Facility
|
IP
|
$2,644.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
2410051
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$197.62 |
| Max. Negotiated Rate |
$2,511.80 |
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cigna Commercial |
$2,247.40
|
| Rate for Payer: First Health Commercial |
$2,379.60
|
| Rate for Payer: First Health Workers Compensation |
$279.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,379.60
|
| Rate for Payer: GEHA Commercial |
$1,850.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,379.60
|
| Rate for Payer: Multiplan All |
$2,406.04
|
| Rate for Payer: OMNI Networks Commercial |
$1,850.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,379.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,511.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,983.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,458.92
|
| Rate for Payer: Zelis Auto |
$1,057.60
|
| Rate for Payer: Zelis Worker's Compensation |
$197.62
|
|
|
NM RENAL SCAN W CAP
|
Facility
|
IP
|
$2,644.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
2410060
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$197.62 |
| Max. Negotiated Rate |
$2,511.80 |
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cigna Commercial |
$2,247.40
|
| Rate for Payer: First Health Commercial |
$2,379.60
|
| Rate for Payer: First Health Workers Compensation |
$279.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,379.60
|
| Rate for Payer: GEHA Commercial |
$1,850.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,379.60
|
| Rate for Payer: Multiplan All |
$2,406.04
|
| Rate for Payer: OMNI Networks Commercial |
$1,850.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,379.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,511.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,983.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,458.92
|
| Rate for Payer: Zelis Auto |
$1,057.60
|
| Rate for Payer: Zelis Worker's Compensation |
$197.62
|
|
|
NM RENAL SCAN W CAP
|
Facility
|
IP
|
$2,644.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
241060
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$197.62 |
| Max. Negotiated Rate |
$2,511.80 |
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cigna Commercial |
$2,247.40
|
| Rate for Payer: First Health Commercial |
$2,379.60
|
| Rate for Payer: First Health Workers Compensation |
$279.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,379.60
|
| Rate for Payer: GEHA Commercial |
$1,850.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,379.60
|
| Rate for Payer: Multiplan All |
$2,406.04
|
| Rate for Payer: OMNI Networks Commercial |
$1,850.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,379.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,511.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,983.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,458.92
|
| Rate for Payer: Zelis Auto |
$1,057.60
|
| Rate for Payer: Zelis Worker's Compensation |
$197.62
|
|
|
NM RENAL SCAN W CAP
|
Facility
|
OP
|
$2,644.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
241060
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$197.62 |
| Max. Negotiated Rate |
$2,511.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$487.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,586.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$487.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$386.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$511.11
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cigna Commercial |
$2,247.40
|
| Rate for Payer: First Health Commercial |
$2,379.60
|
| Rate for Payer: First Health Workers Compensation |
$279.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,379.60
|
| Rate for Payer: GEHA Commercial |
$2,115.20
|
| Rate for Payer: GEHA Medicare |
$511.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,379.60
|
| 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 |
$394.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$511.11
|
| Rate for Payer: Multiplan All |
$2,406.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$868.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,850.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,379.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$455.06
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$394.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$511.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,511.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,022.22
|
| Rate for Payer: Three Rivers Provider Network All |
$1,983.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$500.89
|
| Rate for Payer: United Healthcare Commercial |
$2,247.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$394.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$511.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,458.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$511.11
|
| Rate for Payer: Zelis Auto |
$1,057.60
|
| Rate for Payer: Zelis Medicare |
$434.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$613.33
|
| Rate for Payer: Zelis Worker's Compensation |
$197.62
|
|
|
NM RENAL SCAN W CAP
|
Facility
|
OP
|
$2,644.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
2410060
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$197.62 |
| Max. Negotiated Rate |
$2,511.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$487.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,586.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$487.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$386.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$511.11
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cigna Commercial |
$2,247.40
|
| Rate for Payer: First Health Commercial |
$2,379.60
|
| Rate for Payer: First Health Workers Compensation |
$279.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,379.60
|
| Rate for Payer: GEHA Commercial |
$2,115.20
|
| Rate for Payer: GEHA Medicare |
$511.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,379.60
|
| 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 |
$394.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$511.11
|
| Rate for Payer: Multiplan All |
$2,406.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$868.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,850.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,379.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$455.06
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$394.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$511.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,511.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,022.22
|
| Rate for Payer: Three Rivers Provider Network All |
$1,983.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$500.89
|
| Rate for Payer: United Healthcare Commercial |
$2,247.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$394.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$511.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,458.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$511.11
|
| Rate for Payer: Zelis Auto |
$1,057.60
|
| Rate for Payer: Zelis Medicare |
$434.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$613.33
|
| Rate for Payer: Zelis Worker's Compensation |
$197.62
|
|
|
NM RENAL SCAN W DTPA
|
Facility
|
OP
|
$2,644.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
2410160
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$197.62 |
| Max. Negotiated Rate |
$2,511.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$487.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,586.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$487.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$386.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$511.11
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cigna Commercial |
$2,247.40
|
| Rate for Payer: First Health Commercial |
$2,379.60
|
| Rate for Payer: First Health Workers Compensation |
$279.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,379.60
|
| Rate for Payer: GEHA Commercial |
$2,115.20
|
| Rate for Payer: GEHA Medicare |
$511.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,379.60
|
| 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 |
$394.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$511.11
|
| Rate for Payer: Multiplan All |
$2,406.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$868.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,850.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,379.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$455.06
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$394.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$511.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,511.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,022.22
|
| Rate for Payer: Three Rivers Provider Network All |
$1,983.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$500.89
|
| Rate for Payer: United Healthcare Commercial |
$2,247.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$394.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$511.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,458.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$511.11
|
| Rate for Payer: Zelis Auto |
$1,057.60
|
| Rate for Payer: Zelis Medicare |
$434.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$613.33
|
| Rate for Payer: Zelis Worker's Compensation |
$197.62
|
|
|
NM RENAL SCAN W DTPA
|
Facility
|
IP
|
$2,644.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
2410160
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$197.62 |
| Max. Negotiated Rate |
$2,511.80 |
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cigna Commercial |
$2,247.40
|
| Rate for Payer: First Health Commercial |
$2,379.60
|
| Rate for Payer: First Health Workers Compensation |
$279.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,379.60
|
| Rate for Payer: GEHA Commercial |
$1,850.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,379.60
|
| Rate for Payer: Multiplan All |
$2,406.04
|
| Rate for Payer: OMNI Networks Commercial |
$1,850.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,379.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,511.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,983.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,458.92
|
| Rate for Payer: Zelis Auto |
$1,057.60
|
| Rate for Payer: Zelis Worker's Compensation |
$197.62
|
|
|
NM RENAL SCAN W MAG 3
|
Facility
|
IP
|
$2,644.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
2410161
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$197.62 |
| Max. Negotiated Rate |
$2,511.80 |
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cigna Commercial |
$2,247.40
|
| Rate for Payer: First Health Commercial |
$2,379.60
|
| Rate for Payer: First Health Workers Compensation |
$279.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,379.60
|
| Rate for Payer: GEHA Commercial |
$1,850.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,379.60
|
| Rate for Payer: Multiplan All |
$2,406.04
|
| Rate for Payer: OMNI Networks Commercial |
$1,850.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,379.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,511.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,983.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,458.92
|
| Rate for Payer: Zelis Auto |
$1,057.60
|
| Rate for Payer: Zelis Worker's Compensation |
$197.62
|
|
|
NM RENAL SCAN W MAG 3
|
Facility
|
OP
|
$2,644.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
2410161
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$197.62 |
| Max. Negotiated Rate |
$2,511.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$487.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,586.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$487.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$386.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$511.11
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cigna Commercial |
$2,247.40
|
| Rate for Payer: First Health Commercial |
$2,379.60
|
| Rate for Payer: First Health Workers Compensation |
$279.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,379.60
|
| Rate for Payer: GEHA Commercial |
$2,115.20
|
| Rate for Payer: GEHA Medicare |
$511.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,379.60
|
| 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 |
$394.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$511.11
|
| Rate for Payer: Multiplan All |
$2,406.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$868.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,850.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,379.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$455.06
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$394.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$511.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,511.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,022.22
|
| Rate for Payer: Three Rivers Provider Network All |
$1,983.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$500.89
|
| Rate for Payer: United Healthcare Commercial |
$2,247.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$394.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$511.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,458.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$511.11
|
| Rate for Payer: Zelis Auto |
$1,057.60
|
| Rate for Payer: Zelis Medicare |
$434.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$613.33
|
| Rate for Payer: Zelis Worker's Compensation |
$197.62
|
|
|
NM RENAL WITH LASIX
|
Facility
|
IP
|
$2,690.00
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
2410049
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$2,555.50 |
| Rate for Payer: Cash Price |
$1,614.00
|
| Rate for Payer: Cash Price |
$1,614.00
|
| Rate for Payer: Cigna Commercial |
$2,286.50
|
| Rate for Payer: First Health Commercial |
$2,421.00
|
| Rate for Payer: First Health Workers Compensation |
$221.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,421.00
|
| Rate for Payer: GEHA Commercial |
$1,883.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,421.00
|
| Rate for Payer: Multiplan All |
$2,447.90
|
| Rate for Payer: OMNI Networks Commercial |
$1,883.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,421.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,555.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,017.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,501.70
|
| Rate for Payer: Zelis Auto |
$1,076.00
|
| Rate for Payer: Zelis Worker's Compensation |
$156.80
|
|
|
NM RENAL WITH LASIX
|
Facility
|
OP
|
$2,690.00
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
2410049
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$2,555.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$487.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,614.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$487.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$386.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$511.11
|
| Rate for Payer: Cash Price |
$1,614.00
|
| Rate for Payer: Cash Price |
$1,614.00
|
| Rate for Payer: Cigna Commercial |
$2,286.50
|
| Rate for Payer: First Health Commercial |
$2,421.00
|
| Rate for Payer: First Health Workers Compensation |
$221.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,421.00
|
| Rate for Payer: GEHA Commercial |
$2,152.00
|
| Rate for Payer: GEHA Medicare |
$511.11
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,421.00
|
| 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 |
$394.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$511.11
|
| Rate for Payer: Multiplan All |
$2,447.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$868.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,883.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,421.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$455.06
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$394.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$511.11
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,555.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,022.22
|
| Rate for Payer: Three Rivers Provider Network All |
$2,017.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$500.89
|
| Rate for Payer: United Healthcare Commercial |
$2,286.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$394.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$511.11
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,501.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$511.11
|
| Rate for Payer: Zelis Auto |
$1,076.00
|
| Rate for Payer: Zelis Medicare |
$434.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$613.33
|
| Rate for Payer: Zelis Worker's Compensation |
$156.80
|
|
|
NM STRESS TEST
|
Facility
|
IP
|
$6,520.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
2410043
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$443.80 |
| Max. Negotiated Rate |
$6,194.00 |
| Rate for Payer: Cash Price |
$3,912.00
|
| Rate for Payer: Cash Price |
$3,912.00
|
| Rate for Payer: Cigna Commercial |
$5,542.00
|
| Rate for Payer: First Health Commercial |
$5,868.00
|
| Rate for Payer: First Health Workers Compensation |
$627.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,868.00
|
| Rate for Payer: GEHA Commercial |
$4,564.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,868.00
|
| Rate for Payer: Multiplan All |
$5,933.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,564.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,868.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,194.00
|
| Rate for Payer: Three Rivers Provider Network All |
$4,890.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,063.60
|
| Rate for Payer: Zelis Auto |
$2,608.00
|
| Rate for Payer: Zelis Worker's Compensation |
$443.80
|
|
|
NM STRESS TEST
|
Facility
|
OP
|
$6,520.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
2410043
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$443.80 |
| Max. Negotiated Rate |
$6,194.00 |
| 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 |
$3,912.00
|
| 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 |
$3,912.00
|
| Rate for Payer: Cash Price |
$3,912.00
|
| Rate for Payer: Cigna Commercial |
$5,542.00
|
| Rate for Payer: First Health Commercial |
$5,868.00
|
| Rate for Payer: First Health Workers Compensation |
$627.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,868.00
|
| Rate for Payer: GEHA Commercial |
$5,216.00
|
| Rate for Payer: GEHA Medicare |
$1,239.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,868.00
|
| 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 |
$5,933.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,107.34
|
| Rate for Payer: OMNI Networks Commercial |
$4,564.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,868.00
|
| 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 |
$6,194.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,479.22
|
| Rate for Payer: Three Rivers Provider Network All |
$4,890.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,214.82
|
| Rate for Payer: United Healthcare Commercial |
$5,542.00
|
| 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 |
$6,063.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,239.61
|
| Rate for Payer: Zelis Auto |
$2,608.00
|
| 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 |
$443.80
|
|
|
NM STRESS TEST W/ EXERCISE MYO/CAR/PERF
|
Facility
|
IP
|
$4,849.00
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
2413354
|
|
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
|
|
