|
PAVLIK HARNESS
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT L1620
|
| Hospital Charge Code |
8230072
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.74 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$226.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$226.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$179.36
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$64.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$183.01
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.40
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$211.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$183.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$219.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$183.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$124.50
|
|
|
PAVLIK HARNESS
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT L1620
|
| Hospital Charge Code |
8230072
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$99.60 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
|
|
PAVLIK HARNESS
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT L1620
|
| Hospital Charge Code |
8800014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.74 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$226.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$226.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$179.36
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$199.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Humana ChoiceCare |
$64.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$183.01
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.40
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$211.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$183.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$219.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$183.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$124.50
|
|
|
PAVLIK HARNESS
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT L1620
|
| Hospital Charge Code |
8800014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$99.60 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$224.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$224.10
|
| Rate for Payer: GEHA Commercial |
$174.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$224.10
|
| Rate for Payer: Multiplan All |
$226.59
|
| Rate for Payer: OMNI Networks Commercial |
$174.30
|
| Rate for Payer: One Health Plan PPO/POS |
$224.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$236.55
|
| Rate for Payer: Three Rivers Provider Network All |
$186.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$231.57
|
| Rate for Payer: Zelis Auto |
$99.60
|
|
|
PBP2A AGGLUTINATION
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
2300025
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$62.70 |
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$56.10
|
| Rate for Payer: First Health Commercial |
$59.40
|
| Rate for Payer: First Health Workers Compensation |
$13.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$59.40
|
| Rate for Payer: GEHA Commercial |
$46.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$59.40
|
| Rate for Payer: Multiplan All |
$60.06
|
| Rate for Payer: OMNI Networks Commercial |
$46.20
|
| Rate for Payer: One Health Plan PPO/POS |
$59.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$62.70
|
| Rate for Payer: Three Rivers Provider Network All |
$49.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$61.38
|
| Rate for Payer: Zelis Auto |
$26.40
|
| Rate for Payer: Zelis Worker's Compensation |
$9.41
|
|
|
PBP2A AGGLUTINATION
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
2300025
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$62.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$56.10
|
| Rate for Payer: First Health Commercial |
$59.40
|
| Rate for Payer: First Health Workers Compensation |
$13.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$59.40
|
| Rate for Payer: GEHA Commercial |
$52.80
|
| Rate for Payer: GEHA Medicare |
$5.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$59.40
|
| Rate for Payer: Humana ChoiceCare |
$5.70
|
| Rate for Payer: Humana Medicare Advantage |
$5.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.18
|
| Rate for Payer: Multiplan All |
$60.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.81
|
| Rate for Payer: OMNI Networks Commercial |
$46.20
|
| Rate for Payer: One Health Plan PPO/POS |
$59.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.71
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$62.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.36
|
| Rate for Payer: Three Rivers Provider Network All |
$49.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$56.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$61.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.18
|
| Rate for Payer: Zelis Auto |
$26.40
|
| Rate for Payer: Zelis Medicare |
$4.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.22
|
| Rate for Payer: Zelis Worker's Compensation |
$9.41
|
|
|
PBP2A AGGLUTINATION
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
2200076
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$62.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$56.10
|
| Rate for Payer: First Health Commercial |
$59.40
|
| Rate for Payer: First Health Workers Compensation |
$13.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$59.40
|
| Rate for Payer: GEHA Commercial |
$52.80
|
| Rate for Payer: GEHA Medicare |
$5.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$59.40
|
| Rate for Payer: Humana ChoiceCare |
$5.70
|
| Rate for Payer: Humana Medicare Advantage |
$5.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.18
|
| Rate for Payer: Multiplan All |
$60.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.81
|
| Rate for Payer: OMNI Networks Commercial |
$46.20
|
| Rate for Payer: One Health Plan PPO/POS |
$59.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.71
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$62.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.36
|
| Rate for Payer: Three Rivers Provider Network All |
$49.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$56.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$61.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.18
|
| Rate for Payer: Zelis Auto |
$26.40
|
| Rate for Payer: Zelis Medicare |
$4.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.22
|
| Rate for Payer: Zelis Worker's Compensation |
$9.41
|
|
|
PBP2A AGGLUTINATION
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
2200076
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$62.70 |
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$56.10
|
| Rate for Payer: First Health Commercial |
$59.40
|
| Rate for Payer: First Health Workers Compensation |
$13.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$59.40
|
| Rate for Payer: GEHA Commercial |
$46.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$59.40
|
| Rate for Payer: Multiplan All |
$60.06
|
| Rate for Payer: OMNI Networks Commercial |
$46.20
|
| Rate for Payer: One Health Plan PPO/POS |
$59.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$62.70
|
| Rate for Payer: Three Rivers Provider Network All |
$49.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$61.38
|
| Rate for Payer: Zelis Auto |
$26.40
|
| Rate for Payer: Zelis Worker's Compensation |
$9.41
|
|
|
pca 3 (prostate cancer gene 3) REF489160
|
Facility
|
IP
|
$793.00
|
|
|
Service Code
|
CPT 81313
|
| Hospital Charge Code |
2200044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$203.92 |
| Max. Negotiated Rate |
$753.35 |
| Rate for Payer: Cash Price |
$475.80
|
| Rate for Payer: Cash Price |
$475.80
|
| Rate for Payer: Cigna Commercial |
$674.05
|
| Rate for Payer: First Health Commercial |
$713.70
|
| Rate for Payer: First Health Workers Compensation |
$288.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$713.70
|
| Rate for Payer: GEHA Commercial |
$555.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$713.70
|
| Rate for Payer: Multiplan All |
$721.63
|
| Rate for Payer: OMNI Networks Commercial |
$555.10
|
| Rate for Payer: One Health Plan PPO/POS |
$713.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$753.35
|
| Rate for Payer: Three Rivers Provider Network All |
$594.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$737.49
|
| Rate for Payer: Zelis Auto |
$317.20
|
| Rate for Payer: Zelis Worker's Compensation |
$203.92
|
|
|
pca 3 (prostate cancer gene 3) REF489160
|
Facility
|
OP
|
$793.00
|
|
|
Service Code
|
CPT 81313
|
| Hospital Charge Code |
2200044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$203.92 |
| Max. Negotiated Rate |
$753.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$382.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$475.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$382.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$303.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$255.05
|
| Rate for Payer: Cash Price |
$475.80
|
| Rate for Payer: Cash Price |
$475.80
|
| Rate for Payer: Cigna Commercial |
$674.05
|
| Rate for Payer: First Health Commercial |
$713.70
|
| Rate for Payer: First Health Workers Compensation |
$288.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$713.70
|
| Rate for Payer: GEHA Commercial |
$634.40
|
| Rate for Payer: GEHA Medicare |
$255.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$713.70
|
| Rate for Payer: Humana ChoiceCare |
$280.56
|
| Rate for Payer: Humana Medicare Advantage |
$255.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$428.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$309.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$255.05
|
| Rate for Payer: Multiplan All |
$721.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$433.58
|
| Rate for Payer: OMNI Networks Commercial |
$555.10
|
| Rate for Payer: One Health Plan PPO/POS |
$713.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$357.07
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$309.25
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$255.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$753.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$510.10
|
| Rate for Payer: Three Rivers Provider Network All |
$594.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$249.95
|
| Rate for Payer: United Healthcare Commercial |
$674.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$309.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$255.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$737.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$255.05
|
| Rate for Payer: Zelis Auto |
$317.20
|
| Rate for Payer: Zelis Medicare |
$216.79
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$306.06
|
| Rate for Payer: Zelis Worker's Compensation |
$203.92
|
|
|
PCA DAILY CHARGE 1 EACH INJ
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
NDC 99999999999
|
| Hospital Charge Code |
3300695
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.23 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$156.40
|
| Rate for Payer: First Health Commercial |
$165.60
|
| Rate for Payer: First Health Workers Compensation |
$71.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$165.60
|
| Rate for Payer: GEHA Commercial |
$128.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$165.60
|
| Rate for Payer: Multiplan All |
$167.44
|
| Rate for Payer: OMNI Networks Commercial |
$128.80
|
| Rate for Payer: One Health Plan PPO/POS |
$165.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$174.80
|
| Rate for Payer: Three Rivers Provider Network All |
$138.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$171.12
|
| Rate for Payer: Zelis Auto |
$73.60
|
| Rate for Payer: Zelis Worker's Compensation |
$50.23
|
|
|
PCA DAILY CHARGE 1 EACH INJ
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
NDC 99999999999
|
| Hospital Charge Code |
3300695
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$156.40
|
| Rate for Payer: First Health Commercial |
$165.60
|
| Rate for Payer: First Health Workers Compensation |
$71.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$165.60
|
| Rate for Payer: GEHA Commercial |
$147.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$165.60
|
| Rate for Payer: Humana ChoiceCare |
$47.84
|
| Rate for Payer: Multiplan All |
$167.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$110.40
|
| Rate for Payer: OMNI Networks Commercial |
$128.80
|
| Rate for Payer: One Health Plan PPO/POS |
$165.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$174.80
|
| Rate for Payer: Three Rivers Provider Network All |
$138.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$161.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$46.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$171.12
|
| Rate for Payer: Zelis Auto |
$73.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$92.00
|
| Rate for Payer: Zelis Worker's Compensation |
$50.23
|
|
|
PEAK FLOW
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
4000026
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$88.72 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$241.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$195.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$241.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$191.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$148.57
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$276.25
|
| Rate for Payer: First Health Commercial |
$292.50
|
| Rate for Payer: First Health Workers Compensation |
$125.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$292.50
|
| Rate for Payer: GEHA Commercial |
$260.00
|
| Rate for Payer: GEHA Medicare |
$148.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$292.50
|
| 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 |
$195.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$148.57
|
| Rate for Payer: Multiplan All |
$295.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.57
|
| Rate for Payer: OMNI Networks Commercial |
$227.50
|
| Rate for Payer: One Health Plan PPO/POS |
$292.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$225.71
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$195.48
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$148.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$308.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$297.14
|
| Rate for Payer: Three Rivers Provider Network All |
$243.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.60
|
| Rate for Payer: United Healthcare Commercial |
$276.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$195.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$302.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$148.57
|
| Rate for Payer: Zelis Auto |
$130.00
|
| Rate for Payer: Zelis Medicare |
$126.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.28
|
| Rate for Payer: Zelis Worker's Compensation |
$88.72
|
|
|
PEAK FLOW
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
4000026
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$88.72 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$276.25
|
| Rate for Payer: First Health Commercial |
$292.50
|
| Rate for Payer: First Health Workers Compensation |
$125.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$292.50
|
| Rate for Payer: GEHA Commercial |
$227.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$292.50
|
| Rate for Payer: Multiplan All |
$295.75
|
| Rate for Payer: OMNI Networks Commercial |
$227.50
|
| Rate for Payer: One Health Plan PPO/POS |
$292.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$308.75
|
| Rate for Payer: Three Rivers Provider Network All |
$243.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$302.25
|
| Rate for Payer: Zelis Auto |
$130.00
|
| Rate for Payer: Zelis Worker's Compensation |
$88.72
|
|
|
peanut IgE REF602451
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299198
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
peanut IgE REF602451
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299198
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
PEDCLE FH/CH/CH/M/N/AX/G/H/F
|
Facility
|
IP
|
$1,567.00
|
|
|
Service Code
|
CPT 15574
|
| Hospital Charge Code |
6115574
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$427.79 |
| Max. Negotiated Rate |
$1,488.65 |
| Rate for Payer: Cash Price |
$940.20
|
| Rate for Payer: Cigna Commercial |
$1,331.95
|
| Rate for Payer: First Health Commercial |
$1,410.30
|
| Rate for Payer: First Health Workers Compensation |
$605.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,410.30
|
| Rate for Payer: GEHA Commercial |
$1,096.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,410.30
|
| Rate for Payer: Multiplan All |
$1,425.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,096.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,410.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,488.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,175.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,457.31
|
| Rate for Payer: Zelis Auto |
$626.80
|
| Rate for Payer: Zelis Worker's Compensation |
$427.79
|
|
|
PEDCLE FH/CH/CH/M/N/AX/G/H/F
|
Facility
|
OP
|
$1,567.00
|
|
|
Service Code
|
CPT 15574
|
| Hospital Charge Code |
6115574
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$427.79 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$940.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$940.20
|
| Rate for Payer: Cash Price |
$940.20
|
| Rate for Payer: Cigna Commercial |
$1,331.95
|
| Rate for Payer: First Health Commercial |
$1,410.30
|
| Rate for Payer: First Health Workers Compensation |
$605.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,410.30
|
| Rate for Payer: GEHA Commercial |
$1,253.60
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,410.30
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$1,425.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,096.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,410.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,488.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,175.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,457.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$626.80
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$427.79
|
|
|
PEDICLE E/N/E/L/NTRORAL
|
Facility
|
IP
|
$1,368.00
|
|
|
Service Code
|
CPT 15576
|
| Hospital Charge Code |
6115576
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$373.46 |
| Max. Negotiated Rate |
$1,299.60 |
| Rate for Payer: Cash Price |
$820.80
|
| Rate for Payer: Cigna Commercial |
$1,162.80
|
| Rate for Payer: First Health Commercial |
$1,231.20
|
| Rate for Payer: First Health Workers Compensation |
$528.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,231.20
|
| Rate for Payer: GEHA Commercial |
$957.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,231.20
|
| Rate for Payer: Multiplan All |
$1,244.88
|
| Rate for Payer: OMNI Networks Commercial |
$957.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,231.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,299.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,026.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,272.24
|
| Rate for Payer: Zelis Auto |
$547.20
|
| Rate for Payer: Zelis Worker's Compensation |
$373.46
|
|
|
PEDICLE E/N/E/L/NTRORAL
|
Facility
|
OP
|
$1,368.00
|
|
|
Service Code
|
CPT 15576
|
| Hospital Charge Code |
6115576
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$373.46 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$820.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$820.80
|
| Rate for Payer: Cash Price |
$820.80
|
| Rate for Payer: Cigna Commercial |
$1,162.80
|
| Rate for Payer: First Health Commercial |
$1,231.20
|
| Rate for Payer: First Health Workers Compensation |
$528.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,231.20
|
| Rate for Payer: GEHA Commercial |
$1,094.40
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,231.20
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$1,244.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$957.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,231.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,299.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,026.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,272.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$547.20
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$373.46
|
|
|
PELVIC EXAMINATION
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
6157410
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$90.09 |
| Max. Negotiated Rate |
$313.50 |
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cigna Commercial |
$280.50
|
| Rate for Payer: First Health Commercial |
$297.00
|
| Rate for Payer: First Health Workers Compensation |
$127.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$297.00
|
| Rate for Payer: GEHA Commercial |
$231.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$297.00
|
| Rate for Payer: Multiplan All |
$300.30
|
| Rate for Payer: OMNI Networks Commercial |
$231.00
|
| Rate for Payer: One Health Plan PPO/POS |
$297.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$313.50
|
| Rate for Payer: Three Rivers Provider Network All |
$247.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$306.90
|
| Rate for Payer: Zelis Auto |
$132.00
|
| Rate for Payer: Zelis Worker's Compensation |
$90.09
|
|
|
PELVIC EXAMINATION
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
6157410
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$90.09 |
| 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 |
$198.00
|
| 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 |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cigna Commercial |
$280.50
|
| Rate for Payer: First Health Commercial |
$297.00
|
| Rate for Payer: First Health Workers Compensation |
$127.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$297.00
|
| Rate for Payer: GEHA Commercial |
$264.00
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$297.00
|
| 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 |
$300.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$231.00
|
| Rate for Payer: One Health Plan PPO/POS |
$297.00
|
| 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 |
$313.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$247.50
|
| 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 |
$306.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$132.00
|
| 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 |
$90.09
|
|
|
PELVIC EXAM, LIST SEP TO PRIMARY CODE
|
Facility
|
OP
|
$60.66
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
8500241
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$15.16 |
| Max. Negotiated Rate |
$57.63 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$36.40
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: Cigna Commercial |
$51.56
|
| Rate for Payer: First Health Commercial |
$54.59
|
| Rate for Payer: First Health Workers Compensation |
$23.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$54.59
|
| Rate for Payer: GEHA Commercial |
$48.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$54.59
|
| Rate for Payer: Humana ChoiceCare |
$15.77
|
| Rate for Payer: Multiplan All |
$55.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$36.40
|
| Rate for Payer: OMNI Networks Commercial |
$42.46
|
| Rate for Payer: One Health Plan PPO/POS |
$54.59
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$57.63
|
| Rate for Payer: Three Rivers Provider Network All |
$45.49
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$53.38
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$56.41
|
| Rate for Payer: Zelis Auto |
$24.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$30.33
|
| Rate for Payer: Zelis Worker's Compensation |
$16.56
|
|
|
PELVIC EXAM, LIST SEP TO PRIMARY CODE
|
Facility
|
IP
|
$60.66
|
|
|
Service Code
|
CPT 99459
|
| Hospital Charge Code |
8500241
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$16.56 |
| Max. Negotiated Rate |
$57.63 |
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: Cigna Commercial |
$51.56
|
| Rate for Payer: First Health Commercial |
$54.59
|
| Rate for Payer: First Health Workers Compensation |
$23.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$54.59
|
| Rate for Payer: GEHA Commercial |
$42.46
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$54.59
|
| Rate for Payer: Multiplan All |
$55.20
|
| Rate for Payer: OMNI Networks Commercial |
$42.46
|
| Rate for Payer: One Health Plan PPO/POS |
$54.59
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$57.63
|
| Rate for Payer: Three Rivers Provider Network All |
$45.49
|
| Rate for Payer: United Payors & United Providers UP&UP |
$56.41
|
| Rate for Payer: Zelis Auto |
$24.26
|
| Rate for Payer: Zelis Worker's Compensation |
$16.56
|
|
|
PELVIC EXENTERATION
|
Facility
|
IP
|
$5,856.00
|
|
|
Service Code
|
CPT 45126
|
| Hospital Charge Code |
6145126
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,598.69 |
| Max. Negotiated Rate |
$5,563.20 |
| Rate for Payer: Cash Price |
$3,513.60
|
| Rate for Payer: Cigna Commercial |
$4,977.60
|
| Rate for Payer: First Health Commercial |
$5,270.40
|
| Rate for Payer: First Health Workers Compensation |
$2,261.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,270.40
|
| Rate for Payer: GEHA Commercial |
$4,099.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,270.40
|
| Rate for Payer: Multiplan All |
$5,328.96
|
| Rate for Payer: OMNI Networks Commercial |
$4,099.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5,270.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,563.20
|
| Rate for Payer: Three Rivers Provider Network All |
$4,392.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,446.08
|
| Rate for Payer: Zelis Auto |
$2,342.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,598.69
|
|
