|
NM STRESS TEST W/ EXERCISE MYO/CAR/PERF
|
Facility
|
OP
|
$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: 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 STRESS TEST W/ LEXISCAN MYO/CAR/PERF
|
Facility
|
IP
|
$4,849.00
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
2413353
|
|
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
|
|
|
NM STRESS TEST W/ LEXISCAN MYO/CAR/PERF
|
Facility
|
OP
|
$4,849.00
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
2413353
|
|
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 TAGGM CARDIOLITE
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
CPT A9500
|
| Hospital Charge Code |
2410046
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$182.75 |
| Max. Negotiated Rate |
$694.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$438.60
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$621.35
|
| Rate for Payer: First Health Commercial |
$657.90
|
| Rate for Payer: First Health Workers Compensation |
$282.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$657.90
|
| Rate for Payer: GEHA Commercial |
$584.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$657.90
|
| Rate for Payer: Humana ChoiceCare |
$190.06
|
| Rate for Payer: Multiplan All |
$665.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$438.60
|
| Rate for Payer: OMNI Networks Commercial |
$511.70
|
| Rate for Payer: One Health Plan PPO/POS |
$657.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$694.45
|
| Rate for Payer: Three Rivers Provider Network All |
$548.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$643.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$182.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$679.83
|
| Rate for Payer: Zelis Auto |
$292.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$365.50
|
| Rate for Payer: Zelis Worker's Compensation |
$199.56
|
|
|
NM TAGGM CARDIOLITE
|
Facility
|
IP
|
$731.00
|
|
|
Service Code
|
CPT A9500
|
| Hospital Charge Code |
2410046
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$199.56 |
| Max. Negotiated Rate |
$694.45 |
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$621.35
|
| Rate for Payer: First Health Commercial |
$657.90
|
| Rate for Payer: First Health Workers Compensation |
$282.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$657.90
|
| Rate for Payer: GEHA Commercial |
$511.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$657.90
|
| Rate for Payer: Multiplan All |
$665.21
|
| Rate for Payer: OMNI Networks Commercial |
$511.70
|
| Rate for Payer: One Health Plan PPO/POS |
$657.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$694.45
|
| Rate for Payer: Three Rivers Provider Network All |
$548.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$679.83
|
| Rate for Payer: Zelis Auto |
$292.40
|
| Rate for Payer: Zelis Worker's Compensation |
$199.56
|
|
|
NM TETROFOSMIN STDY DOSE
|
Facility
|
OP
|
$626.00
|
|
|
Service Code
|
CPT A9560
|
| Hospital Charge Code |
4210051
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$156.50 |
| Max. Negotiated Rate |
$594.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$375.60
|
| Rate for Payer: Cash Price |
$375.60
|
| Rate for Payer: Cigna Commercial |
$532.10
|
| Rate for Payer: First Health Commercial |
$563.40
|
| Rate for Payer: First Health Workers Compensation |
$241.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$563.40
|
| Rate for Payer: GEHA Commercial |
$500.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$563.40
|
| Rate for Payer: Humana ChoiceCare |
$162.76
|
| Rate for Payer: Multiplan All |
$569.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$375.60
|
| Rate for Payer: OMNI Networks Commercial |
$438.20
|
| Rate for Payer: One Health Plan PPO/POS |
$563.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$594.70
|
| Rate for Payer: Three Rivers Provider Network All |
$469.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$550.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$156.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$582.18
|
| Rate for Payer: Zelis Auto |
$250.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$313.00
|
| Rate for Payer: Zelis Worker's Compensation |
$170.90
|
|
|
NM TETROFOSMIN STDY DOSE
|
Facility
|
IP
|
$626.00
|
|
|
Service Code
|
CPT A9560
|
| Hospital Charge Code |
4210051
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$170.90 |
| Max. Negotiated Rate |
$594.70 |
| Rate for Payer: Cash Price |
$375.60
|
| Rate for Payer: Cigna Commercial |
$532.10
|
| Rate for Payer: First Health Commercial |
$563.40
|
| Rate for Payer: First Health Workers Compensation |
$241.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$563.40
|
| Rate for Payer: GEHA Commercial |
$438.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$563.40
|
| Rate for Payer: Multiplan All |
$569.66
|
| Rate for Payer: OMNI Networks Commercial |
$438.20
|
| Rate for Payer: One Health Plan PPO/POS |
$563.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$594.70
|
| Rate for Payer: Three Rivers Provider Network All |
$469.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$582.18
|
| Rate for Payer: Zelis Auto |
$250.40
|
| Rate for Payer: Zelis Worker's Compensation |
$170.90
|
|
|
NM THYROID SCAN ONLY
|
Facility
|
IP
|
$1,348.00
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
2410028
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$175.26 |
| Max. Negotiated Rate |
$1,280.60 |
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cigna Commercial |
$1,145.80
|
| Rate for Payer: First Health Commercial |
$1,213.20
|
| Rate for Payer: First Health Workers Compensation |
$247.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,213.20
|
| Rate for Payer: GEHA Commercial |
$943.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,213.20
|
| Rate for Payer: Multiplan All |
$1,226.68
|
| Rate for Payer: OMNI Networks Commercial |
$943.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,213.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,280.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,011.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,253.64
|
| Rate for Payer: Zelis Auto |
$539.20
|
| Rate for Payer: Zelis Worker's Compensation |
$175.26
|
|
|
NM THYROID SCAN ONLY
|
Facility
|
OP
|
$1,348.00
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
2410028
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$168.52 |
| Max. Negotiated Rate |
$1,280.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$212.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$808.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$212.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$168.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$381.55
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cigna Commercial |
$1,145.80
|
| Rate for Payer: First Health Commercial |
$1,213.20
|
| Rate for Payer: First Health Workers Compensation |
$247.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,213.20
|
| Rate for Payer: GEHA Commercial |
$1,078.40
|
| Rate for Payer: GEHA Medicare |
$381.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,213.20
|
| 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 |
$171.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$381.55
|
| Rate for Payer: Multiplan All |
$1,226.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$648.63
|
| Rate for Payer: OMNI Networks Commercial |
$943.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,213.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$198.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$171.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$381.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,280.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$763.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,011.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$373.92
|
| Rate for Payer: United Healthcare Commercial |
$1,145.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$171.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,253.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$381.55
|
| Rate for Payer: Zelis Auto |
$539.20
|
| Rate for Payer: Zelis Medicare |
$324.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$457.86
|
| Rate for Payer: Zelis Worker's Compensation |
$175.26
|
|
|
NM THYROID SCAN /UPS
|
Facility
|
IP
|
$1,521.00
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
2410030
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$80.42 |
| Max. Negotiated Rate |
$1,444.95 |
| Rate for Payer: Cash Price |
$912.60
|
| Rate for Payer: Cash Price |
$912.60
|
| Rate for Payer: Cigna Commercial |
$1,292.85
|
| Rate for Payer: First Health Commercial |
$1,368.90
|
| Rate for Payer: First Health Workers Compensation |
$113.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,368.90
|
| Rate for Payer: GEHA Commercial |
$1,064.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,368.90
|
| Rate for Payer: Multiplan All |
$1,384.11
|
| Rate for Payer: OMNI Networks Commercial |
$1,064.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,368.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,444.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,140.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,414.53
|
| Rate for Payer: Zelis Auto |
$608.40
|
| Rate for Payer: Zelis Worker's Compensation |
$80.42
|
|
|
NM THYROID SCAN /UPS
|
Facility
|
OP
|
$1,521.00
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
2410030
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$80.42 |
| Max. Negotiated Rate |
$1,444.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$161.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$912.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$161.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$128.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$381.55
|
| Rate for Payer: Cash Price |
$912.60
|
| Rate for Payer: Cash Price |
$912.60
|
| Rate for Payer: Cigna Commercial |
$1,292.85
|
| Rate for Payer: First Health Commercial |
$1,368.90
|
| Rate for Payer: First Health Workers Compensation |
$113.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,368.90
|
| Rate for Payer: GEHA Commercial |
$1,216.80
|
| Rate for Payer: GEHA Medicare |
$381.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,368.90
|
| 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 |
$130.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$381.55
|
| Rate for Payer: Multiplan All |
$1,384.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$648.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,064.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,368.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$150.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$130.68
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$381.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,444.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$763.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,140.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$373.92
|
| Rate for Payer: United Healthcare Commercial |
$1,292.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$130.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,414.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$381.55
|
| Rate for Payer: Zelis Auto |
$608.40
|
| Rate for Payer: Zelis Medicare |
$324.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$457.86
|
| Rate for Payer: Zelis Worker's Compensation |
$80.42
|
|
|
NM THYROID SCAN W/BLOOD FLOW
|
Facility
|
IP
|
$1,941.00
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
2410029
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$219.28 |
| Max. Negotiated Rate |
$1,843.95 |
| Rate for Payer: Cash Price |
$1,164.60
|
| Rate for Payer: Cash Price |
$1,164.60
|
| Rate for Payer: Cigna Commercial |
$1,649.85
|
| Rate for Payer: First Health Commercial |
$1,746.90
|
| Rate for Payer: First Health Workers Compensation |
$310.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,746.90
|
| Rate for Payer: GEHA Commercial |
$1,358.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,746.90
|
| Rate for Payer: Multiplan All |
$1,766.31
|
| Rate for Payer: OMNI Networks Commercial |
$1,358.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,746.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,843.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,455.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,805.13
|
| Rate for Payer: Zelis Auto |
$776.40
|
| Rate for Payer: Zelis Worker's Compensation |
$219.28
|
|
|
NM THYROID SCAN W/BLOOD FLOW
|
Facility
|
OP
|
$1,941.00
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
2410029
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$219.28 |
| Max. Negotiated Rate |
$1,843.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$330.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,164.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$330.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$261.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$381.55
|
| Rate for Payer: Cash Price |
$1,164.60
|
| Rate for Payer: Cash Price |
$1,164.60
|
| Rate for Payer: Cigna Commercial |
$1,649.85
|
| Rate for Payer: First Health Commercial |
$1,746.90
|
| Rate for Payer: First Health Workers Compensation |
$310.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,746.90
|
| Rate for Payer: GEHA Commercial |
$1,552.80
|
| Rate for Payer: GEHA Medicare |
$381.55
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,746.90
|
| 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 |
$266.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$381.55
|
| Rate for Payer: Multiplan All |
$1,766.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$648.63
|
| Rate for Payer: OMNI Networks Commercial |
$1,358.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,746.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$308.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$266.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$381.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,843.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$763.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,455.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$373.92
|
| Rate for Payer: United Healthcare Commercial |
$1,649.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$266.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,805.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$381.55
|
| Rate for Payer: Zelis Auto |
$776.40
|
| Rate for Payer: Zelis Medicare |
$324.32
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$457.86
|
| Rate for Payer: Zelis Worker's Compensation |
$219.28
|
|
|
NO-HIST DM 10-4-15MG/5ML LIQUID
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 68047018616
|
| Hospital Charge Code |
3300714
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$5.10
|
| Rate for Payer: First Health Commercial |
$5.40
|
| Rate for Payer: First Health Workers Compensation |
$2.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5.40
|
| Rate for Payer: GEHA Commercial |
$4.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5.40
|
| Rate for Payer: Humana ChoiceCare |
$1.56
|
| Rate for Payer: Multiplan All |
$5.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3.60
|
| Rate for Payer: OMNI Networks Commercial |
$4.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5.58
|
| Rate for Payer: Zelis Auto |
$2.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.64
|
|
|
NO-HIST DM 10-4-15MG/5ML LIQUID
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 68047018616
|
| Hospital Charge Code |
3300714
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$5.10
|
| Rate for Payer: First Health Commercial |
$5.40
|
| Rate for Payer: First Health Workers Compensation |
$2.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5.40
|
| Rate for Payer: GEHA Commercial |
$4.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5.40
|
| Rate for Payer: Multiplan All |
$5.46
|
| Rate for Payer: OMNI Networks Commercial |
$4.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5.58
|
| Rate for Payer: Zelis Auto |
$2.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1.64
|
|
|
NON CHARGEABLE DEVICE
|
Facility
|
OP
|
$2,527.00
|
|
| Hospital Charge Code |
90610027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.75 |
| Max. Negotiated Rate |
$2,400.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,516.20
|
| Rate for Payer: Cash Price |
$1,516.20
|
| Rate for Payer: Cash Price |
$1,516.20
|
| Rate for Payer: Cigna Commercial |
$2,147.95
|
| Rate for Payer: First Health Commercial |
$2,274.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,274.30
|
| Rate for Payer: GEHA Commercial |
$2,021.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,274.30
|
| Rate for Payer: Humana ChoiceCare |
$657.02
|
| Rate for Payer: Multiplan All |
$2,299.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,516.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,768.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,274.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,400.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,895.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,223.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$631.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,350.11
|
| Rate for Payer: Zelis Auto |
$1,010.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,263.50
|
|
|
NON CHARGEABLE DEVICE
|
Facility
|
IP
|
$2,527.00
|
|
| Hospital Charge Code |
90610027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,010.80 |
| Max. Negotiated Rate |
$2,400.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,021.60
|
| Rate for Payer: Cash Price |
$1,516.20
|
| Rate for Payer: Cash Price |
$1,516.20
|
| Rate for Payer: Cigna Commercial |
$2,147.95
|
| Rate for Payer: First Health Commercial |
$2,274.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,274.30
|
| Rate for Payer: GEHA Commercial |
$1,768.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,274.30
|
| Rate for Payer: Multiplan All |
$2,299.57
|
| Rate for Payer: OMNI Networks Commercial |
$1,768.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,274.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,400.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,895.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,350.11
|
| Rate for Payer: Zelis Auto |
$1,010.80
|
|
|
NON CHARGEABLE SUPPLIES
|
Facility
|
OP
|
$6,836.00
|
|
| Hospital Charge Code |
90009324
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,709.00 |
| Max. Negotiated Rate |
$6,494.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,101.60
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cigna Commercial |
$5,810.60
|
| Rate for Payer: First Health Commercial |
$6,152.40
|
| Rate for Payer: First Health Workers Compensation |
$2,639.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,152.40
|
| Rate for Payer: GEHA Commercial |
$5,468.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,152.40
|
| Rate for Payer: Humana ChoiceCare |
$1,777.36
|
| Rate for Payer: Multiplan All |
$6,220.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4,101.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,785.20
|
| Rate for Payer: One Health Plan PPO/POS |
$6,152.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,494.20
|
| Rate for Payer: Three Rivers Provider Network All |
$5,127.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,015.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,709.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,357.48
|
| Rate for Payer: Zelis Auto |
$2,734.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,418.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,866.23
|
|
|
NON CHARGEABLE SUPPLIES
|
Facility
|
IP
|
$6,836.00
|
|
| Hospital Charge Code |
90009324
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,866.23 |
| Max. Negotiated Rate |
$6,494.20 |
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cigna Commercial |
$5,810.60
|
| Rate for Payer: First Health Commercial |
$6,152.40
|
| Rate for Payer: First Health Workers Compensation |
$2,639.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,152.40
|
| Rate for Payer: GEHA Commercial |
$4,785.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,152.40
|
| Rate for Payer: Multiplan All |
$6,220.76
|
| Rate for Payer: OMNI Networks Commercial |
$4,785.20
|
| Rate for Payer: One Health Plan PPO/POS |
$6,152.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,494.20
|
| Rate for Payer: Three Rivers Provider Network All |
$5,127.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,357.48
|
| Rate for Payer: Zelis Auto |
$2,734.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,866.23
|
|
|
NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
21600120
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$297.14 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$97.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$43.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$97.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$77.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$148.57
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$61.20
|
| Rate for Payer: First Health Commercial |
$64.80
|
| Rate for Payer: First Health Workers Compensation |
$27.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$64.80
|
| Rate for Payer: GEHA Commercial |
$57.60
|
| Rate for Payer: GEHA Medicare |
$148.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$64.80
|
| Rate for Payer: Humana ChoiceCare |
$163.43
|
| Rate for Payer: Humana Medicare Advantage |
$148.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$249.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$78.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$148.57
|
| Rate for Payer: Multiplan All |
$65.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.57
|
| Rate for Payer: OMNI Networks Commercial |
$50.40
|
| Rate for Payer: One Health Plan PPO/POS |
$64.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$90.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$78.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$148.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$68.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$297.14
|
| Rate for Payer: Three Rivers Provider Network All |
$54.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$78.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$66.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$148.57
|
| Rate for Payer: Zelis Auto |
$28.80
|
| Rate for Payer: Zelis Medicare |
$126.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.28
|
| Rate for Payer: Zelis Worker's Compensation |
$19.66
|
|
|
NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
21600120
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$61.20
|
| Rate for Payer: First Health Commercial |
$64.80
|
| Rate for Payer: First Health Workers Compensation |
$27.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$64.80
|
| Rate for Payer: GEHA Commercial |
$50.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$64.80
|
| Rate for Payer: Multiplan All |
$65.52
|
| Rate for Payer: OMNI Networks Commercial |
$50.40
|
| Rate for Payer: One Health Plan PPO/POS |
$64.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$68.40
|
| Rate for Payer: Three Rivers Provider Network All |
$54.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$66.96
|
| Rate for Payer: Zelis Auto |
$28.80
|
| Rate for Payer: Zelis Worker's Compensation |
$19.66
|
|
|
NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY
|
Facility
|
OP
|
$389.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
20300042
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$106.20 |
| Max. Negotiated Rate |
$369.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$162.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$233.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$162.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$128.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$148.57
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cigna Commercial |
$330.65
|
| Rate for Payer: First Health Commercial |
$350.10
|
| Rate for Payer: First Health Workers Compensation |
$150.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$350.10
|
| Rate for Payer: GEHA Commercial |
$311.20
|
| Rate for Payer: GEHA Medicare |
$148.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$350.10
|
| Rate for Payer: Humana ChoiceCare |
$163.43
|
| Rate for Payer: Humana Medicare Advantage |
$148.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$249.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$131.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$148.57
|
| Rate for Payer: Multiplan All |
$353.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.57
|
| Rate for Payer: OMNI Networks Commercial |
$272.30
|
| Rate for Payer: One Health Plan PPO/POS |
$350.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$151.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$131.39
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$148.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$369.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$297.14
|
| Rate for Payer: Three Rivers Provider Network All |
$291.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$131.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$361.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$148.57
|
| Rate for Payer: Zelis Auto |
$155.60
|
| Rate for Payer: Zelis Medicare |
$126.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.28
|
| Rate for Payer: Zelis Worker's Compensation |
$106.20
|
|
|
NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY
|
Facility
|
OP
|
$1,338.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
1900042
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$126.28 |
| Max. Negotiated Rate |
$1,271.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$162.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$802.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$162.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$128.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$148.57
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$1,137.30
|
| Rate for Payer: First Health Commercial |
$1,204.20
|
| Rate for Payer: First Health Workers Compensation |
$516.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,204.20
|
| Rate for Payer: GEHA Commercial |
$1,070.40
|
| Rate for Payer: GEHA Medicare |
$148.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,204.20
|
| Rate for Payer: Humana ChoiceCare |
$163.43
|
| Rate for Payer: Humana Medicare Advantage |
$148.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$249.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$131.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$148.57
|
| Rate for Payer: Multiplan All |
$1,217.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.57
|
| Rate for Payer: OMNI Networks Commercial |
$936.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,204.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$151.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$131.39
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$148.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,271.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$297.14
|
| Rate for Payer: Three Rivers Provider Network All |
$1,003.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$131.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,244.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$148.57
|
| Rate for Payer: Zelis Auto |
$535.20
|
| Rate for Payer: Zelis Medicare |
$126.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.28
|
| Rate for Payer: Zelis Worker's Compensation |
$365.27
|
|
|
NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY
|
Facility
|
IP
|
$1,338.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
1900042
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$365.27 |
| Max. Negotiated Rate |
$1,271.10 |
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cigna Commercial |
$1,137.30
|
| Rate for Payer: First Health Commercial |
$1,204.20
|
| Rate for Payer: First Health Workers Compensation |
$516.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,204.20
|
| Rate for Payer: GEHA Commercial |
$936.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,204.20
|
| Rate for Payer: Multiplan All |
$1,217.58
|
| Rate for Payer: OMNI Networks Commercial |
$936.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,204.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,271.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,003.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,244.34
|
| Rate for Payer: Zelis Auto |
$535.20
|
| Rate for Payer: Zelis Worker's Compensation |
$365.27
|
|
|
NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
20300042
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$106.20 |
| Max. Negotiated Rate |
$369.55 |
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cigna Commercial |
$330.65
|
| Rate for Payer: First Health Commercial |
$350.10
|
| Rate for Payer: First Health Workers Compensation |
$150.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$350.10
|
| Rate for Payer: GEHA Commercial |
$272.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$350.10
|
| Rate for Payer: Multiplan All |
$353.99
|
| Rate for Payer: OMNI Networks Commercial |
$272.30
|
| Rate for Payer: One Health Plan PPO/POS |
$350.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$369.55
|
| Rate for Payer: Three Rivers Provider Network All |
$291.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$361.77
|
| Rate for Payer: Zelis Auto |
$155.60
|
| Rate for Payer: Zelis Worker's Compensation |
$106.20
|
|
