|
OBSERVATION-ER
|
Facility
|
OP
|
$99.00
|
|
| Hospital Charge Code |
8150000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna Commercial |
$84.15
|
| Rate for Payer: First Health Commercial |
$89.10
|
| Rate for Payer: First Health Workers Compensation |
$38.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$89.10
|
| Rate for Payer: GEHA Commercial |
$79.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$89.10
|
| Rate for Payer: Humana ChoiceCare |
$25.74
|
| Rate for Payer: Multiplan All |
$90.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$59.40
|
| Rate for Payer: OMNI Networks Commercial |
$69.30
|
| Rate for Payer: One Health Plan PPO/POS |
$89.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$94.05
|
| Rate for Payer: Three Rivers Provider Network All |
$74.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$87.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$92.07
|
| Rate for Payer: Zelis Auto |
$39.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$49.50
|
| Rate for Payer: Zelis Worker's Compensation |
$27.03
|
|
|
OBSERVATION-ER
|
Facility
|
IP
|
$99.00
|
|
| Hospital Charge Code |
8150000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.03 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna Commercial |
$84.15
|
| Rate for Payer: First Health Commercial |
$89.10
|
| Rate for Payer: First Health Workers Compensation |
$38.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$89.10
|
| Rate for Payer: GEHA Commercial |
$69.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$89.10
|
| Rate for Payer: Multiplan All |
$90.09
|
| Rate for Payer: OMNI Networks Commercial |
$69.30
|
| Rate for Payer: One Health Plan PPO/POS |
$89.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$94.05
|
| Rate for Payer: Three Rivers Provider Network All |
$74.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$92.07
|
| Rate for Payer: Zelis Auto |
$39.60
|
| Rate for Payer: Zelis Worker's Compensation |
$27.03
|
|
|
OBSERVATION-HIGH
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT 99220
|
| Hospital Charge Code |
9899220
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$146.06 |
| Max. Negotiated Rate |
$508.25 |
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$454.75
|
| Rate for Payer: First Health Commercial |
$481.50
|
| Rate for Payer: First Health Workers Compensation |
$206.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$481.50
|
| Rate for Payer: GEHA Commercial |
$374.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$481.50
|
| Rate for Payer: Multiplan All |
$486.85
|
| Rate for Payer: OMNI Networks Commercial |
$374.50
|
| Rate for Payer: One Health Plan PPO/POS |
$481.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$508.25
|
| Rate for Payer: Three Rivers Provider Network All |
$401.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$497.55
|
| Rate for Payer: Zelis Auto |
$214.00
|
| Rate for Payer: Zelis Worker's Compensation |
$146.06
|
|
|
OBSERVATION IINITIAL HOUR
|
Facility
|
OP
|
$500.00
|
|
| Hospital Charge Code |
31110003
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$425.00
|
| Rate for Payer: First Health Commercial |
$450.00
|
| Rate for Payer: First Health Workers Compensation |
$193.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$450.00
|
| Rate for Payer: GEHA Commercial |
$400.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$450.00
|
| Rate for Payer: Humana ChoiceCare |
$130.00
|
| Rate for Payer: Multiplan All |
$455.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$300.00
|
| Rate for Payer: OMNI Networks Commercial |
$350.00
|
| Rate for Payer: One Health Plan PPO/POS |
$450.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$325.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$475.00
|
| Rate for Payer: Three Rivers Provider Network All |
$375.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$440.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$465.00
|
| Rate for Payer: Zelis Auto |
$200.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$250.00
|
| Rate for Payer: Zelis Worker's Compensation |
$136.50
|
|
|
OBSERVATION IINITIAL HOUR
|
Facility
|
IP
|
$500.00
|
|
| Hospital Charge Code |
31110003
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$425.00
|
| Rate for Payer: First Health Commercial |
$450.00
|
| Rate for Payer: First Health Workers Compensation |
$193.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$450.00
|
| Rate for Payer: GEHA Commercial |
$350.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$450.00
|
| Rate for Payer: Multiplan All |
$455.00
|
| Rate for Payer: OMNI Networks Commercial |
$350.00
|
| Rate for Payer: One Health Plan PPO/POS |
$450.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$325.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$475.00
|
| Rate for Payer: Three Rivers Provider Network All |
$375.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$465.00
|
| Rate for Payer: Zelis Auto |
$200.00
|
| Rate for Payer: Zelis Worker's Compensation |
$136.50
|
|
|
OBSERVATION INITIAL HOUR
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
9400078
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$33.61 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$42.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$42.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$33.61
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$284.75
|
| Rate for Payer: First Health Commercial |
$301.50
|
| Rate for Payer: First Health Workers Compensation |
$129.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$301.50
|
| Rate for Payer: GEHA Commercial |
$268.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$301.50
|
| Rate for Payer: Humana ChoiceCare |
$87.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$34.29
|
| Rate for Payer: Multiplan All |
$304.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$201.00
|
| Rate for Payer: OMNI Networks Commercial |
$234.50
|
| Rate for Payer: One Health Plan PPO/POS |
$301.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$39.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$325.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$318.25
|
| Rate for Payer: Three Rivers Provider Network All |
$251.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$294.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$311.55
|
| Rate for Payer: Zelis Auto |
$134.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$167.50
|
| Rate for Payer: Zelis Worker's Compensation |
$91.45
|
|
|
OBSERVATION INITIAL HOUR
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
9400078
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$91.45 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$284.75
|
| Rate for Payer: First Health Commercial |
$301.50
|
| Rate for Payer: First Health Workers Compensation |
$129.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$301.50
|
| Rate for Payer: GEHA Commercial |
$234.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$301.50
|
| Rate for Payer: Multiplan All |
$304.85
|
| Rate for Payer: OMNI Networks Commercial |
$234.50
|
| Rate for Payer: One Health Plan PPO/POS |
$301.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$325.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$318.25
|
| Rate for Payer: Three Rivers Provider Network All |
$251.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$311.55
|
| Rate for Payer: Zelis Auto |
$134.00
|
| Rate for Payer: Zelis Worker's Compensation |
$91.45
|
|
|
OBSERVATION-LOW
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 99218
|
| Hospital Charge Code |
9899218
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$78.90 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$245.65
|
| Rate for Payer: First Health Commercial |
$260.10
|
| Rate for Payer: First Health Workers Compensation |
$111.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$260.10
|
| Rate for Payer: GEHA Commercial |
$202.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$260.10
|
| Rate for Payer: Multiplan All |
$262.99
|
| Rate for Payer: OMNI Networks Commercial |
$202.30
|
| Rate for Payer: One Health Plan PPO/POS |
$260.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$274.55
|
| Rate for Payer: Three Rivers Provider Network All |
$216.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$268.77
|
| Rate for Payer: Zelis Auto |
$115.60
|
| Rate for Payer: Zelis Worker's Compensation |
$78.90
|
|
|
OBSERVATION-MODERATE
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT 99219
|
| Hospital Charge Code |
9899219
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$113.57 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna Commercial |
$353.60
|
| Rate for Payer: First Health Commercial |
$374.40
|
| Rate for Payer: First Health Workers Compensation |
$160.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$374.40
|
| Rate for Payer: GEHA Commercial |
$291.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$374.40
|
| Rate for Payer: Multiplan All |
$378.56
|
| Rate for Payer: OMNI Networks Commercial |
$291.20
|
| Rate for Payer: One Health Plan PPO/POS |
$374.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$395.20
|
| Rate for Payer: Three Rivers Provider Network All |
$312.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$386.88
|
| Rate for Payer: Zelis Auto |
$166.40
|
| Rate for Payer: Zelis Worker's Compensation |
$113.57
|
|
|
OBSTETRICAL CARE
|
Facility
|
IP
|
$2,189.00
|
|
|
Service Code
|
CPT 59410
|
| Hospital Charge Code |
6159410
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$597.60 |
| Max. Negotiated Rate |
$2,079.55 |
| Rate for Payer: Cash Price |
$1,313.40
|
| Rate for Payer: Cigna Commercial |
$1,860.65
|
| Rate for Payer: First Health Commercial |
$1,970.10
|
| Rate for Payer: First Health Workers Compensation |
$845.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,970.10
|
| Rate for Payer: GEHA Commercial |
$1,532.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,970.10
|
| Rate for Payer: Multiplan All |
$1,991.99
|
| Rate for Payer: OMNI Networks Commercial |
$1,532.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,970.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,079.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,641.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,035.77
|
| Rate for Payer: Zelis Auto |
$875.60
|
| Rate for Payer: Zelis Worker's Compensation |
$597.60
|
|
|
OBSTETRICAL CARE
|
Facility
|
OP
|
$2,189.00
|
|
|
Service Code
|
CPT 59410
|
| Hospital Charge Code |
6159410
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$547.25 |
| Max. Negotiated Rate |
$2,079.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,313.40
|
| Rate for Payer: Cash Price |
$1,313.40
|
| Rate for Payer: Cigna Commercial |
$1,860.65
|
| Rate for Payer: First Health Commercial |
$1,970.10
|
| Rate for Payer: First Health Workers Compensation |
$845.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,970.10
|
| Rate for Payer: GEHA Commercial |
$1,751.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,970.10
|
| Rate for Payer: Humana ChoiceCare |
$569.14
|
| Rate for Payer: Multiplan All |
$1,991.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,313.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,532.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,970.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,079.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,641.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,926.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$547.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,035.77
|
| Rate for Payer: Zelis Auto |
$875.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,094.50
|
| Rate for Payer: Zelis Worker's Compensation |
$597.60
|
|
|
OBSTETRICAL CARE
|
Facility
|
OP
|
$2,609.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
6159409
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,043.60 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,565.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$1,565.40
|
| Rate for Payer: Cash Price |
$1,565.40
|
| Rate for Payer: Cigna Commercial |
$2,217.65
|
| Rate for Payer: First Health Commercial |
$2,348.10
|
| Rate for Payer: First Health Workers Compensation |
$3,885.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,348.10
|
| Rate for Payer: GEHA Commercial |
$2,087.20
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,348.10
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$2,374.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$1,826.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,348.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,478.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$1,956.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,426.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$1,043.60
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$2,747.37
|
|
|
OBSTETRICAL CARE
|
Facility
|
IP
|
$2,609.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
6159409
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$712.26 |
| Max. Negotiated Rate |
$2,478.55 |
| Rate for Payer: Cash Price |
$1,565.40
|
| Rate for Payer: Cigna Commercial |
$2,217.65
|
| Rate for Payer: First Health Commercial |
$2,348.10
|
| Rate for Payer: First Health Workers Compensation |
$1,007.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,348.10
|
| Rate for Payer: GEHA Commercial |
$1,826.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,348.10
|
| Rate for Payer: Multiplan All |
$2,374.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,826.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,348.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,478.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,956.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,426.37
|
| Rate for Payer: Zelis Auto |
$1,043.60
|
| Rate for Payer: Zelis Worker's Compensation |
$712.26
|
|
|
OBTAINING SCREEN PAP SMEAR
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT Q0091
|
| Hospital Charge Code |
23500023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$43.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$43.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$23.25
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: First Health Workers Compensation |
$52.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$109.60
|
| Rate for Payer: GEHA Medicare |
$23.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Humana ChoiceCare |
$25.57
|
| Rate for Payer: Humana Medicare Advantage |
$23.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$39.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$35.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$23.25
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.52
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$40.92
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$35.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$23.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$46.50
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$22.79
|
| Rate for Payer: United Healthcare Managed Medicaid |
$35.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$23.25
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Medicare |
$19.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$27.90
|
| Rate for Payer: Zelis Worker's Compensation |
$37.40
|
|
|
OBTAINING SCREEN PAP SMEAR
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT Q0091
|
| Hospital Charge Code |
23500023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: First Health Workers Compensation |
$52.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$95.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Worker's Compensation |
$37.40
|
|
|
OCCULT BLD 1 SAMPLE DIAGNOSTIC
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT 82272
|
| Hospital Charge Code |
2300035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$8.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.23
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$6.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$4.00
|
| Rate for Payer: GEHA Medicare |
$4.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Humana ChoiceCare |
$4.65
|
| Rate for Payer: Humana Medicare Advantage |
$4.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.23
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.19
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$8.46
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.15
|
| Rate for Payer: United Healthcare Commercial |
$4.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.23
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Medicare |
$3.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.08
|
| Rate for Payer: Zelis Worker's Compensation |
$4.91
|
|
|
OCCULT BLD 1 SAMPLE DIAGNOSTIC
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT 82272
|
| Hospital Charge Code |
2300035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$6.95 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$6.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$3.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.91
|
|
|
OCCULT BLOOD 1 SCREEN
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
2300034
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$8.76 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.38
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$5.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$4.00
|
| Rate for Payer: GEHA Medicare |
$4.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Humana ChoiceCare |
$4.82
|
| Rate for Payer: Humana Medicare Advantage |
$4.38
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.38
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.45
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$8.76
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.29
|
| Rate for Payer: United Healthcare Commercial |
$4.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.38
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Medicare |
$3.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.26
|
| Rate for Payer: Zelis Worker's Compensation |
$3.90
|
|
|
OCCULT BLOOD 1 SCREEN
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
2300034
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$5.51 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$5.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$3.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3.90
|
|
|
OCCULT BLOOD 2ND SCREEN
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
2300032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$8.76 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.38
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$5.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$4.00
|
| Rate for Payer: GEHA Medicare |
$4.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Humana ChoiceCare |
$4.82
|
| Rate for Payer: Humana Medicare Advantage |
$4.38
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.38
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.45
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$8.76
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.29
|
| Rate for Payer: United Healthcare Commercial |
$4.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.38
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Medicare |
$3.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.26
|
| Rate for Payer: Zelis Worker's Compensation |
$3.90
|
|
|
OCCULT BLOOD 2ND SCREEN
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
2300032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$5.51 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$5.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$3.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3.90
|
|
|
OCCULT BLOOD 3RD SCREEN
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
2300033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$5.51 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$5.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$3.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$3.90
|
|
|
OCCULT BLOOD 3RD SCREEN
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
2300033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$8.76 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.38
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$5.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$4.00
|
| Rate for Payer: GEHA Medicare |
$4.38
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Humana ChoiceCare |
$4.82
|
| Rate for Payer: Humana Medicare Advantage |
$4.38
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.38
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.45
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.38
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$8.76
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.29
|
| Rate for Payer: United Healthcare Commercial |
$4.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.38
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.38
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Medicare |
$3.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.26
|
| Rate for Payer: Zelis Worker's Compensation |
$3.90
|
|
|
OCCULT BLOOD FECAL DIAGNOSTIC IMMUNO
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
2247436
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$71.40
|
| Rate for Payer: First Health Commercial |
$75.60
|
| Rate for Payer: First Health Workers Compensation |
$20.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$75.60
|
| Rate for Payer: GEHA Commercial |
$58.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$75.60
|
| Rate for Payer: Multiplan All |
$76.44
|
| Rate for Payer: OMNI Networks Commercial |
$58.80
|
| Rate for Payer: One Health Plan PPO/POS |
$75.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$79.80
|
| Rate for Payer: Three Rivers Provider Network All |
$63.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$78.12
|
| Rate for Payer: Zelis Auto |
$33.60
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
|
OCCULT BLOOD FECAL DIAGNOSTIC IMMUNO
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
2247436
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$28.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$50.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$28.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$22.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$15.92
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$71.40
|
| Rate for Payer: First Health Commercial |
$75.60
|
| Rate for Payer: First Health Workers Compensation |
$20.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$75.60
|
| Rate for Payer: GEHA Commercial |
$67.20
|
| Rate for Payer: GEHA Medicare |
$15.92
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$75.60
|
| Rate for Payer: Humana ChoiceCare |
$17.51
|
| Rate for Payer: Humana Medicare Advantage |
$15.92
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$26.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$23.16
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$15.92
|
| Rate for Payer: Multiplan All |
$76.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.06
|
| Rate for Payer: OMNI Networks Commercial |
$58.80
|
| Rate for Payer: One Health Plan PPO/POS |
$75.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$26.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$23.16
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$15.92
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$79.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$31.84
|
| Rate for Payer: Three Rivers Provider Network All |
$63.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.60
|
| Rate for Payer: United Healthcare Commercial |
$71.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.92
|
| Rate for Payer: United Payors & United Providers UP&UP |
$78.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$15.92
|
| Rate for Payer: Zelis Auto |
$33.60
|
| Rate for Payer: Zelis Medicare |
$13.53
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.10
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
