|
P-MASTECTOMY W/LN REMOVAL
|
Facility
|
OP
|
$1,873.00
|
|
|
Service Code
|
CPT 19302
|
| Hospital Charge Code |
6119302
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$511.33 |
| Max. Negotiated Rate |
$12,638.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,246.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,123.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,246.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,364.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,319.16
|
| Rate for Payer: Cash Price |
$1,123.80
|
| Rate for Payer: Cash Price |
$1,123.80
|
| Rate for Payer: Cigna Commercial |
$1,592.05
|
| Rate for Payer: First Health Commercial |
$1,685.70
|
| Rate for Payer: First Health Workers Compensation |
$723.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,685.70
|
| Rate for Payer: GEHA Commercial |
$1,498.40
|
| Rate for Payer: GEHA Medicare |
$6,319.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,685.70
|
| Rate for Payer: Humana ChoiceCare |
$6,951.08
|
| Rate for Payer: Humana Medicare Advantage |
$6,319.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10,616.19
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,432.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,319.16
|
| Rate for Payer: Multiplan All |
$1,704.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,742.57
|
| Rate for Payer: OMNI Networks Commercial |
$1,311.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,685.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,963.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,432.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,319.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,779.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12,638.32
|
| Rate for Payer: Three Rivers Provider Network All |
$1,404.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,192.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,432.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,319.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,741.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,319.16
|
| Rate for Payer: Zelis Auto |
$749.20
|
| Rate for Payer: Zelis Medicare |
$5,371.29
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,582.99
|
| Rate for Payer: Zelis Worker's Compensation |
$511.33
|
|
|
P-MASTECTOMY W/LN REMOVAL
|
Facility
|
IP
|
$1,873.00
|
|
|
Service Code
|
CPT 19302
|
| Hospital Charge Code |
6119302
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$511.33 |
| Max. Negotiated Rate |
$1,779.35 |
| Rate for Payer: Cash Price |
$1,123.80
|
| Rate for Payer: Cigna Commercial |
$1,592.05
|
| Rate for Payer: First Health Commercial |
$1,685.70
|
| Rate for Payer: First Health Workers Compensation |
$723.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,685.70
|
| Rate for Payer: GEHA Commercial |
$1,311.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,685.70
|
| Rate for Payer: Multiplan All |
$1,704.43
|
| Rate for Payer: OMNI Networks Commercial |
$1,311.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,685.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,779.35
|
| Rate for Payer: Three Rivers Provider Network All |
$1,404.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,741.89
|
| Rate for Payer: Zelis Auto |
$749.20
|
| Rate for Payer: Zelis Worker's Compensation |
$511.33
|
|
|
PM CATARACT SURG W/IOL 1 STAGE
|
Facility
|
IP
|
$1,588.00
|
|
|
Service Code
|
CPT 66984
|
| Hospital Charge Code |
7666984
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$433.52 |
| Max. Negotiated Rate |
$1,508.60 |
| Rate for Payer: Cash Price |
$952.80
|
| Rate for Payer: Cigna Commercial |
$1,349.80
|
| Rate for Payer: First Health Commercial |
$1,429.20
|
| Rate for Payer: First Health Workers Compensation |
$613.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,429.20
|
| Rate for Payer: GEHA Commercial |
$1,111.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,429.20
|
| Rate for Payer: Multiplan All |
$1,445.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,111.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,429.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,508.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,191.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,476.84
|
| Rate for Payer: Zelis Auto |
$635.20
|
| Rate for Payer: Zelis Worker's Compensation |
$433.52
|
|
|
PM CATARACT SURG W/IOL 1 STAGE
|
Facility
|
OP
|
$1,588.00
|
|
|
Service Code
|
CPT 66984
|
| Hospital Charge Code |
7666984
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$433.52 |
| Max. Negotiated Rate |
$4,419.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,455.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$952.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,455.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,945.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,209.98
|
| Rate for Payer: Cash Price |
$952.80
|
| Rate for Payer: Cash Price |
$952.80
|
| Rate for Payer: Cigna Commercial |
$1,349.80
|
| Rate for Payer: First Health Commercial |
$1,429.20
|
| Rate for Payer: First Health Workers Compensation |
$613.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,429.20
|
| Rate for Payer: GEHA Commercial |
$1,270.40
|
| Rate for Payer: GEHA Medicare |
$2,209.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,429.20
|
| Rate for Payer: Humana ChoiceCare |
$2,430.98
|
| Rate for Payer: Humana Medicare Advantage |
$2,209.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,712.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,985.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,209.98
|
| Rate for Payer: Multiplan All |
$1,445.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,756.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,111.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,429.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,292.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,985.04
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,209.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,508.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$4,419.96
|
| Rate for Payer: Three Rivers Provider Network All |
$1,191.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,165.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,985.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,209.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,476.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,209.98
|
| Rate for Payer: Zelis Auto |
$635.20
|
| Rate for Payer: Zelis Medicare |
$1,878.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,651.98
|
| Rate for Payer: Zelis Worker's Compensation |
$433.52
|
|
|
PM ONABOTULINUMTOXIN-A 100 UNIT INJ SDV
|
Facility
|
IP
|
$2,460.00
|
|
|
Service Code
|
CPT J0585
|
| Hospital Charge Code |
7600001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$671.58 |
| Max. Negotiated Rate |
$2,337.00 |
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: Cigna Commercial |
$2,091.00
|
| Rate for Payer: First Health Commercial |
$2,214.00
|
| Rate for Payer: First Health Workers Compensation |
$949.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,214.00
|
| Rate for Payer: GEHA Commercial |
$1,722.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,214.00
|
| Rate for Payer: Multiplan All |
$2,238.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,722.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,214.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,337.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,845.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,287.80
|
| Rate for Payer: Zelis Auto |
$984.00
|
| Rate for Payer: Zelis Worker's Compensation |
$671.58
|
|
|
PM ONABOTULINUMTOXIN-A 100 UNIT INJ SDV
|
Facility
|
OP
|
$2,460.00
|
|
|
Service Code
|
CPT J0585
|
| Hospital Charge Code |
7600001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$2,337.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,476.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.50
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: Cigna Commercial |
$2,091.00
|
| Rate for Payer: First Health Commercial |
$2,214.00
|
| Rate for Payer: First Health Workers Compensation |
$949.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,214.00
|
| Rate for Payer: GEHA Commercial |
$7.15
|
| Rate for Payer: GEHA Medicare |
$6.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,214.00
|
| Rate for Payer: Humana ChoiceCare |
$7.15
|
| Rate for Payer: Humana Medicare Advantage |
$6.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.50
|
| Rate for Payer: Multiplan All |
$2,238.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.05
|
| Rate for Payer: OMNI Networks Commercial |
$1,722.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,214.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,337.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,845.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.37
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,287.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.50
|
| Rate for Payer: Zelis Auto |
$984.00
|
| Rate for Payer: Zelis Medicare |
$5.53
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.80
|
| Rate for Payer: Zelis Worker's Compensation |
$671.58
|
|
|
PM ONABOTULINUMTOXIN-A 200 UNIT INJ SDV
|
Facility
|
OP
|
$5,227.00
|
|
|
Service Code
|
CPT J0585
|
| Hospital Charge Code |
7600002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$4,965.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$8.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,136.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$8.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.50
|
| Rate for Payer: Cash Price |
$3,136.20
|
| Rate for Payer: Cash Price |
$3,136.20
|
| Rate for Payer: Cigna Commercial |
$4,442.95
|
| Rate for Payer: First Health Commercial |
$4,704.30
|
| Rate for Payer: First Health Workers Compensation |
$2,018.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,704.30
|
| Rate for Payer: GEHA Commercial |
$7.15
|
| Rate for Payer: GEHA Medicare |
$6.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,704.30
|
| Rate for Payer: Humana ChoiceCare |
$7.15
|
| Rate for Payer: Humana Medicare Advantage |
$6.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.50
|
| Rate for Payer: Multiplan All |
$4,756.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.05
|
| Rate for Payer: OMNI Networks Commercial |
$3,658.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,704.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7.80
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,965.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13.00
|
| Rate for Payer: Three Rivers Provider Network All |
$3,920.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.37
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,861.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.50
|
| Rate for Payer: Zelis Auto |
$2,090.80
|
| Rate for Payer: Zelis Medicare |
$5.53
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,426.97
|
|
|
PM ONABOTULINUMTOXIN-A 200 UNIT INJ SDV
|
Facility
|
IP
|
$5,227.00
|
|
|
Service Code
|
CPT J0585
|
| Hospital Charge Code |
7600002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$4,965.65 |
| Rate for Payer: Cash Price |
$3,136.20
|
| Rate for Payer: Cigna Commercial |
$4,442.95
|
| Rate for Payer: First Health Commercial |
$4,704.30
|
| Rate for Payer: First Health Workers Compensation |
$2,018.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,704.30
|
| Rate for Payer: GEHA Commercial |
$3,658.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,704.30
|
| Rate for Payer: Multiplan All |
$4,756.57
|
| Rate for Payer: OMNI Networks Commercial |
$3,658.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,704.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,965.65
|
| Rate for Payer: Three Rivers Provider Network All |
$3,920.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,861.11
|
| Rate for Payer: Zelis Auto |
$2,090.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,426.97
|
|
|
PM POSTOP FOLLOW UP VISIT RELATED TO ORG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 99024
|
| Hospital Charge Code |
7699024
|
|
Hospital Revenue Code
|
511
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$0.00
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$0.01
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$0.01
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
PM POSTOP FOLLOW UP VISIT RELATED TO ORG
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 99024
|
| Hospital Charge Code |
7699024
|
|
Hospital Revenue Code
|
511
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
PM PVB THORACIC SECOND & ADDL INJ SITE W
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT 64462
|
| Hospital Charge Code |
7664462
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$63.50 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$98.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$203.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Humana ChoiceCare |
$66.04
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$152.40
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$223.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$127.00
|
| Rate for Payer: Zelis Worker's Compensation |
$69.34
|
|
|
PM PVB THORACIC SECOND & ADDL INJ SITE W
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 64462
|
| Hospital Charge Code |
7664462
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$69.34 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$98.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$177.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Worker's Compensation |
$69.34
|
|
|
PM PVB THORACIC SINGLE INJECTION SITE W/
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
CPT 64461
|
| Hospital Charge Code |
7664461
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$124.76 |
| Max. Negotiated Rate |
$434.15 |
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cigna Commercial |
$388.45
|
| Rate for Payer: First Health Commercial |
$411.30
|
| Rate for Payer: First Health Workers Compensation |
$176.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$411.30
|
| Rate for Payer: GEHA Commercial |
$319.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$411.30
|
| Rate for Payer: Multiplan All |
$415.87
|
| Rate for Payer: OMNI Networks Commercial |
$319.90
|
| Rate for Payer: One Health Plan PPO/POS |
$411.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$434.15
|
| Rate for Payer: Three Rivers Provider Network All |
$342.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$425.01
|
| Rate for Payer: Zelis Auto |
$182.80
|
| Rate for Payer: Zelis Worker's Compensation |
$124.76
|
|
|
PM PVB THORACIC SINGLE INJECTION SITE W/
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT 64461
|
| Hospital Charge Code |
7664461
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$124.76 |
| Max. Negotiated Rate |
$1,342.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$877.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$274.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$877.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$695.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$671.04
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cigna Commercial |
$388.45
|
| Rate for Payer: First Health Commercial |
$411.30
|
| Rate for Payer: First Health Workers Compensation |
$176.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$411.30
|
| Rate for Payer: GEHA Commercial |
$365.60
|
| Rate for Payer: GEHA Medicare |
$671.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$411.30
|
| Rate for Payer: Humana ChoiceCare |
$738.14
|
| Rate for Payer: Humana Medicare Advantage |
$671.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,127.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$709.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$671.04
|
| Rate for Payer: Multiplan All |
$415.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,140.77
|
| Rate for Payer: OMNI Networks Commercial |
$319.90
|
| Rate for Payer: One Health Plan PPO/POS |
$411.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$819.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$709.52
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$671.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$434.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,342.08
|
| Rate for Payer: Three Rivers Provider Network All |
$342.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$657.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$709.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$671.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$425.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$671.04
|
| Rate for Payer: Zelis Auto |
$182.80
|
| Rate for Payer: Zelis Medicare |
$570.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$805.25
|
| Rate for Payer: Zelis Worker's Compensation |
$124.76
|
|
|
PM THER/PROPH/DIAG INJ SC/IM
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
7696372
|
|
Hospital Revenue Code
|
511
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$116.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$68.96
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$164.90
|
| Rate for Payer: First Health Commercial |
$174.60
|
| Rate for Payer: First Health Workers Compensation |
$74.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$174.60
|
| Rate for Payer: GEHA Commercial |
$155.20
|
| Rate for Payer: GEHA Medicare |
$68.96
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$174.60
|
| Rate for Payer: Humana ChoiceCare |
$75.86
|
| Rate for Payer: Humana Medicare Advantage |
$68.96
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$115.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$68.96
|
| Rate for Payer: Multiplan All |
$176.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$117.23
|
| Rate for Payer: OMNI Networks Commercial |
$135.80
|
| Rate for Payer: One Health Plan PPO/POS |
$174.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$68.96
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$184.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$137.92
|
| Rate for Payer: Three Rivers Provider Network All |
$145.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$67.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.96
|
| Rate for Payer: United Payors & United Providers UP&UP |
$180.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$68.96
|
| Rate for Payer: Zelis Auto |
$77.60
|
| Rate for Payer: Zelis Medicare |
$58.62
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$82.75
|
| Rate for Payer: Zelis Worker's Compensation |
$52.96
|
|
|
PM THER/PROPH/DIAG INJ SC/IM
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
7696372
|
|
Hospital Revenue Code
|
511
|
| Min. Negotiated Rate |
$52.96 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$164.90
|
| Rate for Payer: First Health Commercial |
$174.60
|
| Rate for Payer: First Health Workers Compensation |
$74.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$174.60
|
| Rate for Payer: GEHA Commercial |
$135.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$174.60
|
| Rate for Payer: Multiplan All |
$176.54
|
| Rate for Payer: OMNI Networks Commercial |
$135.80
|
| Rate for Payer: One Health Plan PPO/POS |
$174.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$184.30
|
| Rate for Payer: Three Rivers Provider Network All |
$145.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$180.42
|
| Rate for Payer: Zelis Auto |
$77.60
|
| Rate for Payer: Zelis Worker's Compensation |
$52.96
|
|
|
PM TREAT SPINAL CANAL LESION
|
Facility
|
OP
|
$868.00
|
|
|
Service Code
|
CPT 62282
|
| Hospital Charge Code |
7662282
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$236.96 |
| Max. Negotiated Rate |
$1,725.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$520.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$576.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$862.67
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cigna Commercial |
$737.80
|
| Rate for Payer: First Health Commercial |
$781.20
|
| Rate for Payer: First Health Workers Compensation |
$335.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$781.20
|
| Rate for Payer: GEHA Commercial |
$694.40
|
| Rate for Payer: GEHA Medicare |
$862.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$781.20
|
| Rate for Payer: Humana ChoiceCare |
$948.94
|
| Rate for Payer: Humana Medicare Advantage |
$862.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,449.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$862.67
|
| Rate for Payer: Multiplan All |
$789.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,466.54
|
| Rate for Payer: OMNI Networks Commercial |
$607.60
|
| Rate for Payer: One Health Plan PPO/POS |
$781.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$679.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$588.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$862.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$824.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,725.34
|
| Rate for Payer: Three Rivers Provider Network All |
$651.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$845.42
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$862.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$807.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$862.67
|
| Rate for Payer: Zelis Auto |
$347.20
|
| Rate for Payer: Zelis Medicare |
$733.27
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,035.20
|
| Rate for Payer: Zelis Worker's Compensation |
$236.96
|
|
|
PM TREAT SPINAL CANAL LESION
|
Facility
|
IP
|
$868.00
|
|
|
Service Code
|
CPT 62282
|
| Hospital Charge Code |
7662282
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$236.96 |
| Max. Negotiated Rate |
$824.60 |
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cigna Commercial |
$737.80
|
| Rate for Payer: First Health Commercial |
$781.20
|
| Rate for Payer: First Health Workers Compensation |
$335.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$781.20
|
| Rate for Payer: GEHA Commercial |
$607.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$781.20
|
| Rate for Payer: Multiplan All |
$789.88
|
| Rate for Payer: OMNI Networks Commercial |
$607.60
|
| Rate for Payer: One Health Plan PPO/POS |
$781.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$824.60
|
| Rate for Payer: Three Rivers Provider Network All |
$651.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$807.24
|
| Rate for Payer: Zelis Auto |
$347.20
|
| Rate for Payer: Zelis Worker's Compensation |
$236.96
|
|
|
PNEUMOCOCCAL 15- VALENT CONJUGATE
|
Facility
|
IP
|
$1,075.00
|
|
|
Service Code
|
CPT 90671
|
| Hospital Charge Code |
3303161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$293.48 |
| Max. Negotiated Rate |
$1,021.25 |
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cigna Commercial |
$913.75
|
| Rate for Payer: First Health Commercial |
$967.50
|
| Rate for Payer: First Health Workers Compensation |
$415.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$967.50
|
| Rate for Payer: GEHA Commercial |
$752.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$967.50
|
| Rate for Payer: Multiplan All |
$978.25
|
| Rate for Payer: OMNI Networks Commercial |
$752.50
|
| Rate for Payer: One Health Plan PPO/POS |
$967.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,021.25
|
| Rate for Payer: Three Rivers Provider Network All |
$806.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$999.75
|
| Rate for Payer: Zelis Auto |
$430.00
|
| Rate for Payer: Zelis Worker's Compensation |
$293.48
|
|
|
PNEUMOCOCCAL 15- VALENT CONJUGATE
|
Facility
|
OP
|
$1,075.00
|
|
|
Service Code
|
CPT 90671
|
| Hospital Charge Code |
3303161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$268.75 |
| Max. Negotiated Rate |
$1,021.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$645.00
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cigna Commercial |
$913.75
|
| Rate for Payer: First Health Commercial |
$967.50
|
| Rate for Payer: First Health Workers Compensation |
$415.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$967.50
|
| Rate for Payer: GEHA Commercial |
$287.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$967.50
|
| Rate for Payer: Humana ChoiceCare |
$279.50
|
| Rate for Payer: Multiplan All |
$978.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$645.00
|
| Rate for Payer: OMNI Networks Commercial |
$752.50
|
| Rate for Payer: One Health Plan PPO/POS |
$967.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,021.25
|
| Rate for Payer: Three Rivers Provider Network All |
$806.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$946.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$268.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$999.75
|
| Rate for Payer: Zelis Auto |
$430.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$537.50
|
| Rate for Payer: Zelis Worker's Compensation |
$293.48
|
|
|
PNEUMOCOCCAL 20- VALENT CONJUGATE
|
Facility
|
IP
|
$1,129.00
|
|
|
Service Code
|
CPT 90677
|
| Hospital Charge Code |
3303162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$308.22 |
| Max. Negotiated Rate |
$1,072.55 |
| Rate for Payer: Cash Price |
$677.40
|
| Rate for Payer: Cigna Commercial |
$959.65
|
| Rate for Payer: First Health Commercial |
$1,016.10
|
| Rate for Payer: First Health Workers Compensation |
$435.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,016.10
|
| Rate for Payer: GEHA Commercial |
$790.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,016.10
|
| Rate for Payer: Multiplan All |
$1,027.39
|
| Rate for Payer: OMNI Networks Commercial |
$790.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,016.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,072.55
|
| Rate for Payer: Three Rivers Provider Network All |
$846.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,049.97
|
| Rate for Payer: Zelis Auto |
$451.60
|
| Rate for Payer: Zelis Worker's Compensation |
$308.22
|
|
|
PNEUMOCOCCAL 20- VALENT CONJUGATE
|
Facility
|
OP
|
$1,129.00
|
|
|
Service Code
|
CPT 90677
|
| Hospital Charge Code |
3303162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$282.25 |
| Max. Negotiated Rate |
$1,072.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$677.40
|
| Rate for Payer: Cash Price |
$677.40
|
| Rate for Payer: Cash Price |
$677.40
|
| Rate for Payer: Cigna Commercial |
$959.65
|
| Rate for Payer: First Health Commercial |
$1,016.10
|
| Rate for Payer: First Health Workers Compensation |
$435.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,016.10
|
| Rate for Payer: GEHA Commercial |
$344.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,016.10
|
| Rate for Payer: Humana ChoiceCare |
$293.54
|
| Rate for Payer: Multiplan All |
$1,027.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$677.40
|
| Rate for Payer: OMNI Networks Commercial |
$790.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,016.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,072.55
|
| Rate for Payer: Three Rivers Provider Network All |
$846.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$993.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$282.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,049.97
|
| Rate for Payer: Zelis Auto |
$451.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$564.50
|
| Rate for Payer: Zelis Worker's Compensation |
$308.22
|
|
|
PNEUMOCOCCAL VACC, 13 VAL IM
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
8590670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.36 |
| Max. Negotiated Rate |
$293.55 |
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cigna Commercial |
$262.65
|
| Rate for Payer: First Health Commercial |
$278.10
|
| Rate for Payer: First Health Workers Compensation |
$119.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$278.10
|
| Rate for Payer: GEHA Commercial |
$216.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$278.10
|
| Rate for Payer: Multiplan All |
$281.19
|
| Rate for Payer: OMNI Networks Commercial |
$216.30
|
| Rate for Payer: One Health Plan PPO/POS |
$278.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$293.55
|
| Rate for Payer: Three Rivers Provider Network All |
$231.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$287.37
|
| Rate for Payer: Zelis Auto |
$123.60
|
| Rate for Payer: Zelis Worker's Compensation |
$84.36
|
|
|
PNEUMOCOCCAL VACC, 13 VAL IM
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
8590670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.34 |
| Max. Negotiated Rate |
$293.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$288.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$185.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$288.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$228.91
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cigna Commercial |
$262.65
|
| Rate for Payer: First Health Commercial |
$278.10
|
| Rate for Payer: First Health Workers Compensation |
$119.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$278.10
|
| Rate for Payer: GEHA Commercial |
$283.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$278.10
|
| Rate for Payer: Humana ChoiceCare |
$80.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$233.58
|
| Rate for Payer: Multiplan All |
$281.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$185.40
|
| Rate for Payer: OMNI Networks Commercial |
$216.30
|
| Rate for Payer: One Health Plan PPO/POS |
$278.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$269.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$233.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$293.55
|
| Rate for Payer: Three Rivers Provider Network All |
$231.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$271.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$233.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$287.37
|
| Rate for Payer: Zelis Auto |
$123.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$154.50
|
| Rate for Payer: Zelis Worker's Compensation |
$84.36
|
|
|
PNEUMOCOCCAL VACCINE
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
9100004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.06 |
| Max. Negotiated Rate |
$148.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$148.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$48.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$148.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.46
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$68.85
|
| Rate for Payer: First Health Commercial |
$72.90
|
| Rate for Payer: First Health Workers Compensation |
$31.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$146.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Humana ChoiceCare |
$21.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.86
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.60
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$138.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.86
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$71.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.86
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$40.50
|
| Rate for Payer: Zelis Worker's Compensation |
$22.11
|
|
