|
PERC CRYO ABLATE RENAL TUM
|
Facility
|
OP
|
$1,453.00
|
|
|
Service Code
|
CPT 50593
|
| Hospital Charge Code |
6150593
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$396.67 |
| Max. Negotiated Rate |
$19,771.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,193.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$871.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,193.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,114.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9,885.87
|
| Rate for Payer: Cash Price |
$871.80
|
| Rate for Payer: Cash Price |
$871.80
|
| Rate for Payer: Cigna Commercial |
$1,235.05
|
| Rate for Payer: First Health Commercial |
$1,307.70
|
| Rate for Payer: First Health Workers Compensation |
$561.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,307.70
|
| Rate for Payer: GEHA Commercial |
$1,162.40
|
| Rate for Payer: GEHA Medicare |
$9,885.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,307.70
|
| Rate for Payer: Humana ChoiceCare |
$10,874.46
|
| Rate for Payer: Humana Medicare Advantage |
$9,885.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$16,608.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,197.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9,885.87
|
| Rate for Payer: Multiplan All |
$1,322.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16,805.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,017.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,307.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,846.93
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,197.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9,885.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,380.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$19,771.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,089.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,688.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,197.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,885.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,351.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9,885.87
|
| Rate for Payer: Zelis Auto |
$581.20
|
| Rate for Payer: Zelis Medicare |
$8,402.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11,863.04
|
| Rate for Payer: Zelis Worker's Compensation |
$396.67
|
|
|
PERC CRYO ABLATE RENAL TUM
|
Facility
|
IP
|
$1,453.00
|
|
|
Service Code
|
CPT 50593
|
| Hospital Charge Code |
6150593
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$396.67 |
| Max. Negotiated Rate |
$1,380.35 |
| Rate for Payer: Cash Price |
$871.80
|
| Rate for Payer: Cigna Commercial |
$1,235.05
|
| Rate for Payer: First Health Commercial |
$1,307.70
|
| Rate for Payer: First Health Workers Compensation |
$561.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,307.70
|
| Rate for Payer: GEHA Commercial |
$1,017.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,307.70
|
| Rate for Payer: Multiplan All |
$1,322.23
|
| Rate for Payer: OMNI Networks Commercial |
$1,017.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,307.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,380.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,089.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,351.29
|
| Rate for Payer: Zelis Auto |
$581.20
|
| Rate for Payer: Zelis Worker's Compensation |
$396.67
|
|
|
PERC LAMINO-/LAMINE INDIR IMAG GUIDE LUM
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
CPT 0275T
|
| Hospital Charge Code |
610725
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$573.30 |
| Max. Negotiated Rate |
$1,995.00 |
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cigna Commercial |
$1,785.00
|
| Rate for Payer: First Health Commercial |
$1,890.00
|
| Rate for Payer: First Health Workers Compensation |
$810.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,890.00
|
| Rate for Payer: GEHA Commercial |
$1,470.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,890.00
|
| Rate for Payer: Multiplan All |
$1,911.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,470.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,890.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,995.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,575.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,953.00
|
| Rate for Payer: Zelis Auto |
$840.00
|
| Rate for Payer: Zelis Worker's Compensation |
$573.30
|
|
|
PERC RF ABLATE RENAL TUMOR
|
Facility
|
OP
|
$1,081.00
|
|
|
Service Code
|
CPT 50592
|
| Hospital Charge Code |
6150592
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$295.11 |
| Max. Negotiated Rate |
$11,079.92 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,193.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$648.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,193.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,114.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,539.96
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$918.85
|
| Rate for Payer: First Health Commercial |
$972.90
|
| Rate for Payer: First Health Workers Compensation |
$417.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$972.90
|
| Rate for Payer: GEHA Commercial |
$864.80
|
| Rate for Payer: GEHA Medicare |
$5,539.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$972.90
|
| Rate for Payer: Humana ChoiceCare |
$6,093.96
|
| Rate for Payer: Humana Medicare Advantage |
$5,539.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,307.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,197.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,539.96
|
| Rate for Payer: Multiplan All |
$983.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,417.93
|
| Rate for Payer: OMNI Networks Commercial |
$756.70
|
| Rate for Payer: One Health Plan PPO/POS |
$972.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,846.93
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,197.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,539.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,026.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,079.92
|
| Rate for Payer: Three Rivers Provider Network All |
$810.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,429.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,197.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,539.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,005.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,539.96
|
| Rate for Payer: Zelis Auto |
$432.40
|
| Rate for Payer: Zelis Medicare |
$4,708.97
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,647.95
|
| Rate for Payer: Zelis Worker's Compensation |
$295.11
|
|
|
PERC RF ABLATE RENAL TUMOR
|
Facility
|
IP
|
$1,081.00
|
|
|
Service Code
|
CPT 50592
|
| Hospital Charge Code |
6150592
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$295.11 |
| Max. Negotiated Rate |
$1,026.95 |
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$918.85
|
| Rate for Payer: First Health Commercial |
$972.90
|
| Rate for Payer: First Health Workers Compensation |
$417.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$972.90
|
| Rate for Payer: GEHA Commercial |
$756.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$972.90
|
| Rate for Payer: Multiplan All |
$983.71
|
| Rate for Payer: OMNI Networks Commercial |
$756.70
|
| Rate for Payer: One Health Plan PPO/POS |
$972.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,026.95
|
| Rate for Payer: Three Rivers Provider Network All |
$810.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,005.33
|
| Rate for Payer: Zelis Auto |
$432.40
|
| Rate for Payer: Zelis Worker's Compensation |
$295.11
|
|
|
PERCUTANEOUS DISKECTOMY
|
Facility
|
IP
|
$1,165.00
|
|
|
Service Code
|
CPT 62287
|
| Hospital Charge Code |
6162287
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$318.05 |
| Max. Negotiated Rate |
$1,106.75 |
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$990.25
|
| Rate for Payer: First Health Commercial |
$1,048.50
|
| Rate for Payer: First Health Workers Compensation |
$449.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,048.50
|
| Rate for Payer: GEHA Commercial |
$815.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,048.50
|
| Rate for Payer: Multiplan All |
$1,060.15
|
| Rate for Payer: OMNI Networks Commercial |
$815.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,048.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,106.75
|
| Rate for Payer: Three Rivers Provider Network All |
$873.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,083.45
|
| Rate for Payer: Zelis Auto |
$466.00
|
| Rate for Payer: Zelis Worker's Compensation |
$318.05
|
|
|
PERCUTANEOUS DISKECTOMY
|
Facility
|
OP
|
$1,165.00
|
|
|
Service Code
|
CPT 62287
|
| Hospital Charge Code |
6162287
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$318.05 |
| Max. Negotiated Rate |
$3,769.41 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,769.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$699.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,769.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,986.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cash Price |
$699.00
|
| Rate for Payer: Cigna Commercial |
$990.25
|
| Rate for Payer: First Health Commercial |
$1,048.50
|
| Rate for Payer: First Health Workers Compensation |
$449.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,048.50
|
| Rate for Payer: GEHA Commercial |
$932.00
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,048.50
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,046.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$1,060.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$815.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,048.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,518.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,046.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,106.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$873.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,046.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,083.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$466.00
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$318.05
|
|
|
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY, EPIDURAL
|
Facility
|
OP
|
$12,463.48
|
|
|
Service Code
|
CPT 63650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,263.23 |
| Max. Negotiated Rate |
$12,463.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,643.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,643.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,263.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,231.74
|
| Rate for Payer: First Health Workers Compensation |
$8,020.25
|
| Rate for Payer: GEHA Medicare |
$6,231.74
|
| Rate for Payer: Humana ChoiceCare |
$6,854.91
|
| Rate for Payer: Humana Medicare Advantage |
$6,231.74
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10,469.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,370.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,231.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,593.96
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,200.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,370.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,231.74
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12,463.48
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,107.11
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,370.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,231.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,231.74
|
| Rate for Payer: Zelis Medicare |
$5,296.98
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,478.09
|
| Rate for Payer: Zelis Worker's Compensation |
$5,670.88
|
|
|
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; PERIPHERAL NERVE (EXCLUDES SACRAL NERVE)
|
Facility
|
OP
|
$12,463.48
|
|
|
Service Code
|
CPT 64555
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,263.23 |
| Max. Negotiated Rate |
$12,463.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6,643.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6,643.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,263.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,231.74
|
| Rate for Payer: First Health Workers Compensation |
$8,020.25
|
| Rate for Payer: GEHA Medicare |
$6,231.74
|
| Rate for Payer: Humana ChoiceCare |
$6,854.91
|
| Rate for Payer: Humana Medicare Advantage |
$6,231.74
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10,469.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,370.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,231.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,593.96
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,200.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,370.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,231.74
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12,463.48
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,107.11
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,370.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,231.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,231.74
|
| Rate for Payer: Zelis Medicare |
$5,296.98
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,478.09
|
| Rate for Payer: Zelis Worker's Compensation |
$5,670.88
|
|
|
PERCUTANEOUS LAMINOTOMY/LAMINECTOMY (INTERLAMINAR APPROACH) FOR DECOMPRESSION OF NEURAL ELEMENTS, (WITH OR WITHOUT LIGAMENTOUS RESECTION, DISCECTOMY, FACETECTOMY AND/OR FORAMINOTOMY), ANY METHOD, UNDER INDIRECT IMAGE GUIDANCE (EG, FLUOROSCOPIC, CT), SINGLE OR MULTIPLE LEVELS, UNILATERAL OR BILATERAL; LUMBAR
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 0275T
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,201.73 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,303.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,303.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,201.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,287.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,950.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,287.30
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,287.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$6,172.77
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF DISTAL RADIAL FRACTURE OR EPIPHYSEAL SEPARATION
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 25606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,070.11 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,070.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,438.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,112.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$2,803.61
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF METACARPAL FRACTURE, EACH BONE
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 26608
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,070.11 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,070.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,438.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,112.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$2,803.61
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF METATARSAL FRACTURE, WITH MANIPULATION, EACH
|
Facility
|
OP
|
$6,161.78
|
|
|
Service Code
|
CPT 28476
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,070.11 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,613.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,070.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: First Health Workers Compensation |
$3,965.11
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,112.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,438.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,112.27
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,112.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$2,803.61
|
|
|
PERCUTANEOUS VERTEBRAL AUGMENTATION
|
Facility
|
OP
|
$15,268.00
|
|
|
Service Code
|
CPT 22514
|
| Hospital Charge Code |
6122514
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$4,168.16 |
| Max. Negotiated Rate |
$14,504.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9,480.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,160.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9,480.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7,510.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$9,160.80
|
| Rate for Payer: Cash Price |
$9,160.80
|
| Rate for Payer: Cigna Commercial |
$12,977.80
|
| Rate for Payer: First Health Commercial |
$13,741.20
|
| Rate for Payer: First Health Workers Compensation |
$5,894.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13,741.20
|
| Rate for Payer: GEHA Commercial |
$12,214.40
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13,741.20
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7,663.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$13,893.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$10,687.60
|
| Rate for Payer: One Health Plan PPO/POS |
$13,741.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8,848.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7,663.39
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14,504.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$11,451.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7,663.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14,199.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$6,107.20
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$4,168.16
|
|
|
PERCUTANEOUS VERTEBRAL AUGMENTATION
|
Facility
|
IP
|
$15,268.00
|
|
|
Service Code
|
CPT 22514
|
| Hospital Charge Code |
6122514
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$4,168.16 |
| Max. Negotiated Rate |
$14,504.60 |
| Rate for Payer: Cash Price |
$9,160.80
|
| Rate for Payer: Cigna Commercial |
$12,977.80
|
| Rate for Payer: First Health Commercial |
$13,741.20
|
| Rate for Payer: First Health Workers Compensation |
$5,894.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13,741.20
|
| Rate for Payer: GEHA Commercial |
$10,687.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13,741.20
|
| Rate for Payer: Multiplan All |
$13,893.88
|
| Rate for Payer: OMNI Networks Commercial |
$10,687.60
|
| Rate for Payer: One Health Plan PPO/POS |
$13,741.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14,504.60
|
| Rate for Payer: Three Rivers Provider Network All |
$11,451.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14,199.24
|
| Rate for Payer: Zelis Auto |
$6,107.20
|
| Rate for Payer: Zelis Worker's Compensation |
$4,168.16
|
|
|
PERC VACUUM/ROT BX
|
Facility
|
IP
|
$2,440.00
|
|
| Hospital Charge Code |
2766907
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$666.12 |
| Max. Negotiated Rate |
$2,318.00 |
| Rate for Payer: Cash Price |
$1,464.00
|
| Rate for Payer: Cigna Commercial |
$2,074.00
|
| Rate for Payer: First Health Commercial |
$2,196.00
|
| Rate for Payer: First Health Workers Compensation |
$942.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,196.00
|
| Rate for Payer: GEHA Commercial |
$1,708.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,196.00
|
| Rate for Payer: Multiplan All |
$2,220.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,708.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,196.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,318.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,830.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,269.20
|
| Rate for Payer: Zelis Auto |
$976.00
|
| Rate for Payer: Zelis Worker's Compensation |
$666.12
|
|
|
PERC VACUUM/ROT BX
|
Facility
|
OP
|
$2,440.00
|
|
| Hospital Charge Code |
2766907
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$610.00 |
| Max. Negotiated Rate |
$2,318.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,464.00
|
| Rate for Payer: Cash Price |
$1,464.00
|
| Rate for Payer: Cigna Commercial |
$2,074.00
|
| Rate for Payer: First Health Commercial |
$2,196.00
|
| Rate for Payer: First Health Workers Compensation |
$942.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,196.00
|
| Rate for Payer: GEHA Commercial |
$1,952.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,196.00
|
| Rate for Payer: Humana ChoiceCare |
$634.40
|
| Rate for Payer: Multiplan All |
$2,220.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,464.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,708.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,196.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,318.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,830.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,147.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$610.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,269.20
|
| Rate for Payer: Zelis Auto |
$976.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,220.00
|
| Rate for Payer: Zelis Worker's Compensation |
$666.12
|
|
|
PERICARDIOCENTESIS;INIT
|
Facility
|
OP
|
$1,852.00
|
|
| Hospital Charge Code |
8133010
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$463.00 |
| Max. Negotiated Rate |
$1,759.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,111.20
|
| Rate for Payer: Cash Price |
$1,111.20
|
| Rate for Payer: Cigna Commercial |
$1,574.20
|
| Rate for Payer: First Health Commercial |
$1,666.80
|
| Rate for Payer: First Health Workers Compensation |
$715.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,666.80
|
| Rate for Payer: GEHA Commercial |
$1,481.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,666.80
|
| Rate for Payer: Humana ChoiceCare |
$481.52
|
| Rate for Payer: Multiplan All |
$1,685.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,111.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,296.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,666.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,759.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,389.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,629.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$463.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,722.36
|
| Rate for Payer: Zelis Auto |
$740.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$926.00
|
| Rate for Payer: Zelis Worker's Compensation |
$505.60
|
|
|
PERICARDIOCENTESIS;INIT
|
Facility
|
IP
|
$1,852.00
|
|
| Hospital Charge Code |
8133010
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$505.60 |
| Max. Negotiated Rate |
$1,759.40 |
| Rate for Payer: Cash Price |
$1,111.20
|
| Rate for Payer: Cigna Commercial |
$1,574.20
|
| Rate for Payer: First Health Commercial |
$1,666.80
|
| Rate for Payer: First Health Workers Compensation |
$715.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,666.80
|
| Rate for Payer: GEHA Commercial |
$1,296.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,666.80
|
| Rate for Payer: Multiplan All |
$1,685.32
|
| Rate for Payer: OMNI Networks Commercial |
$1,296.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,666.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,759.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,389.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,722.36
|
| Rate for Payer: Zelis Auto |
$740.80
|
| Rate for Payer: Zelis Worker's Compensation |
$505.60
|
|
|
PERIODIC PREVENTIVE MED ESTAB PAT <1YR
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 99391
|
| Hospital Charge Code |
23099391
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$170.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$130.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Humana ChoiceCare |
$42.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.80
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$143.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.50
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
PERIODIC PREVENTIVE MED ESTAB PAT <1YR
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 99391
|
| Hospital Charge Code |
23099391
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$114.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
PERIODIC PREVENTIVE MED EST PAT 12-17YR
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 99394
|
| Hospital Charge Code |
23099394
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$122.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cigna Commercial |
$173.40
|
| Rate for Payer: First Health Commercial |
$183.60
|
| Rate for Payer: First Health Workers Compensation |
$78.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$183.60
|
| Rate for Payer: GEHA Commercial |
$163.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$183.60
|
| Rate for Payer: Humana ChoiceCare |
$53.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$185.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$122.40
|
| Rate for Payer: OMNI Networks Commercial |
$142.80
|
| Rate for Payer: One Health Plan PPO/POS |
$183.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$193.80
|
| Rate for Payer: Three Rivers Provider Network All |
$153.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$179.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$189.72
|
| Rate for Payer: Zelis Auto |
$81.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$102.00
|
| Rate for Payer: Zelis Worker's Compensation |
$55.69
|
|
|
PERIODIC PREVENTIVE MED EST PAT 12-17YR
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 99394
|
| Hospital Charge Code |
23099394
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.69 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cigna Commercial |
$173.40
|
| Rate for Payer: First Health Commercial |
$183.60
|
| Rate for Payer: First Health Workers Compensation |
$78.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$183.60
|
| Rate for Payer: GEHA Commercial |
$142.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$183.60
|
| Rate for Payer: Multiplan All |
$185.64
|
| Rate for Payer: OMNI Networks Commercial |
$142.80
|
| Rate for Payer: One Health Plan PPO/POS |
$183.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$193.80
|
| Rate for Payer: Three Rivers Provider Network All |
$153.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$189.72
|
| Rate for Payer: Zelis Auto |
$81.60
|
| Rate for Payer: Zelis Worker's Compensation |
$55.69
|
|
|
PERIODIC PREVENTIVE MED EST PAT 18-39YR
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT 99395
|
| Hospital Charge Code |
23099395
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.35 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$234.60
|
| Rate for Payer: First Health Commercial |
$248.40
|
| Rate for Payer: First Health Workers Compensation |
$106.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$248.40
|
| Rate for Payer: GEHA Commercial |
$193.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$248.40
|
| Rate for Payer: Multiplan All |
$251.16
|
| Rate for Payer: OMNI Networks Commercial |
$193.20
|
| Rate for Payer: One Health Plan PPO/POS |
$248.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$262.20
|
| Rate for Payer: Three Rivers Provider Network All |
$207.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$256.68
|
| Rate for Payer: Zelis Auto |
$110.40
|
| Rate for Payer: Zelis Worker's Compensation |
$75.35
|
|
|
PERIODIC PREVENTIVE MED EST PAT 18-39YR
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT 99395
|
| Hospital Charge Code |
23099395
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.76 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$170.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$134.80
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$234.60
|
| Rate for Payer: First Health Commercial |
$248.40
|
| Rate for Payer: First Health Workers Compensation |
$106.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$248.40
|
| Rate for Payer: GEHA Commercial |
$220.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$248.40
|
| Rate for Payer: Humana ChoiceCare |
$71.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$137.55
|
| Rate for Payer: Multiplan All |
$251.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$165.60
|
| Rate for Payer: OMNI Networks Commercial |
$193.20
|
| Rate for Payer: One Health Plan PPO/POS |
$248.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$158.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$137.55
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$262.20
|
| Rate for Payer: Three Rivers Provider Network All |
$207.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$242.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.55
|
| Rate for Payer: United Payors & United Providers UP&UP |
$256.68
|
| Rate for Payer: Zelis Auto |
$110.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$138.00
|
| Rate for Payer: Zelis Worker's Compensation |
$75.35
|
|
