|
PORT FLUSH ONLY
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
1996523
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$76.71 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$238.85
|
| Rate for Payer: First Health Commercial |
$252.90
|
| Rate for Payer: First Health Workers Compensation |
$108.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$252.90
|
| Rate for Payer: GEHA Commercial |
$196.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$252.90
|
| Rate for Payer: Multiplan All |
$255.71
|
| Rate for Payer: OMNI Networks Commercial |
$196.70
|
| Rate for Payer: One Health Plan PPO/POS |
$252.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$266.95
|
| Rate for Payer: Three Rivers Provider Network All |
$210.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$261.33
|
| Rate for Payer: Zelis Auto |
$112.40
|
| Rate for Payer: Zelis Worker's Compensation |
$76.71
|
|
|
PORT FLUSH ONLY
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
6180027
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.25 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$203.15
|
| Rate for Payer: First Health Commercial |
$215.10
|
| Rate for Payer: First Health Workers Compensation |
$92.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$215.10
|
| Rate for Payer: GEHA Commercial |
$167.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$215.10
|
| Rate for Payer: Multiplan All |
$217.49
|
| Rate for Payer: OMNI Networks Commercial |
$167.30
|
| Rate for Payer: One Health Plan PPO/POS |
$215.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$227.05
|
| Rate for Payer: Three Rivers Provider Network All |
$179.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$222.27
|
| Rate for Payer: Zelis Auto |
$95.60
|
| Rate for Payer: Zelis Worker's Compensation |
$65.25
|
|
|
PORT FLUSH ONLY
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
24500036
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$61.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$143.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$61.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$49.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$203.15
|
| Rate for Payer: First Health Commercial |
$215.10
|
| Rate for Payer: First Health Workers Compensation |
$92.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$215.10
|
| Rate for Payer: GEHA Commercial |
$191.20
|
| Rate for Payer: GEHA Medicare |
$56.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$215.10
|
| Rate for Payer: Humana ChoiceCare |
$62.04
|
| Rate for Payer: Humana Medicare Advantage |
$56.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$94.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$50.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56.40
|
| Rate for Payer: Multiplan All |
$217.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95.88
|
| Rate for Payer: OMNI Networks Commercial |
$167.30
|
| Rate for Payer: One Health Plan PPO/POS |
$215.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$57.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$50.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$227.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112.80
|
| Rate for Payer: Three Rivers Provider Network All |
$179.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.27
|
| Rate for Payer: United Healthcare Commercial |
$203.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$50.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$222.27
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56.40
|
| Rate for Payer: Zelis Auto |
$95.60
|
| Rate for Payer: Zelis Medicare |
$47.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.68
|
| Rate for Payer: Zelis Worker's Compensation |
$65.25
|
|
|
PORT FLUSH ONLY
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
24500036
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$65.25 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$203.15
|
| Rate for Payer: First Health Commercial |
$215.10
|
| Rate for Payer: First Health Workers Compensation |
$92.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$215.10
|
| Rate for Payer: GEHA Commercial |
$167.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$215.10
|
| Rate for Payer: Multiplan All |
$217.49
|
| Rate for Payer: OMNI Networks Commercial |
$167.30
|
| Rate for Payer: One Health Plan PPO/POS |
$215.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$227.05
|
| Rate for Payer: Three Rivers Provider Network All |
$179.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$222.27
|
| Rate for Payer: Zelis Auto |
$95.60
|
| Rate for Payer: Zelis Worker's Compensation |
$65.25
|
|
|
POS AIRWAY PRESS CHINSTRAP
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT A7036
|
| Hospital Charge Code |
3000028
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: First Health Workers Compensation |
$11.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$21.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.19
|
|
|
POS AIRWAY PRESS CHINSTRAP
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT A7036
|
| Hospital Charge Code |
3000028
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$25.50
|
| Rate for Payer: First Health Commercial |
$27.00
|
| Rate for Payer: First Health Workers Compensation |
$11.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$27.00
|
| Rate for Payer: GEHA Commercial |
$24.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$27.00
|
| Rate for Payer: Humana ChoiceCare |
$7.80
|
| Rate for Payer: Multiplan All |
$27.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18.00
|
| Rate for Payer: OMNI Networks Commercial |
$21.00
|
| Rate for Payer: One Health Plan PPO/POS |
$27.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$28.50
|
| Rate for Payer: Three Rivers Provider Network All |
$22.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$26.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$27.90
|
| Rate for Payer: Zelis Auto |
$12.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.19
|
|
|
POS AIRWAY PRESS HEADGEAR
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT A7035
|
| Hospital Charge Code |
3000027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.74 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$45.90
|
| Rate for Payer: First Health Commercial |
$48.60
|
| Rate for Payer: First Health Workers Compensation |
$20.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$48.60
|
| Rate for Payer: GEHA Commercial |
$37.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$48.60
|
| Rate for Payer: Multiplan All |
$49.14
|
| Rate for Payer: OMNI Networks Commercial |
$37.80
|
| Rate for Payer: One Health Plan PPO/POS |
$48.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$51.30
|
| Rate for Payer: Three Rivers Provider Network All |
$40.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$50.22
|
| Rate for Payer: Zelis Auto |
$21.60
|
| Rate for Payer: Zelis Worker's Compensation |
$14.74
|
|
|
POS AIRWAY PRESS HEADGEAR
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT A7035
|
| Hospital Charge Code |
3000027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$45.90
|
| Rate for Payer: First Health Commercial |
$48.60
|
| Rate for Payer: First Health Workers Compensation |
$20.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$48.60
|
| Rate for Payer: GEHA Commercial |
$43.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$48.60
|
| Rate for Payer: Humana ChoiceCare |
$14.04
|
| Rate for Payer: Multiplan All |
$49.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$32.40
|
| Rate for Payer: OMNI Networks Commercial |
$37.80
|
| Rate for Payer: One Health Plan PPO/POS |
$48.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$51.30
|
| Rate for Payer: Three Rivers Provider Network All |
$40.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$47.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$50.22
|
| Rate for Payer: Zelis Auto |
$21.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$27.00
|
| Rate for Payer: Zelis Worker's Compensation |
$14.74
|
|
|
POS AIRWAY PRESSURE FILTER
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
CPT A7038
|
| Hospital Charge Code |
3000025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$5.10
|
| Rate for Payer: First Health Commercial |
$5.40
|
| Rate for Payer: First Health Workers Compensation |
$2.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5.40
|
| Rate for Payer: GEHA Commercial |
$4.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5.40
|
| Rate for Payer: Humana ChoiceCare |
$1.56
|
| Rate for Payer: Multiplan All |
$5.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3.60
|
| Rate for Payer: OMNI Networks Commercial |
$4.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5.58
|
| Rate for Payer: Zelis Auto |
$2.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.64
|
|
|
POS AIRWAY PRESSURE FILTER
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
CPT A7038
|
| Hospital Charge Code |
3000025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$5.10
|
| Rate for Payer: First Health Commercial |
$5.40
|
| Rate for Payer: First Health Workers Compensation |
$2.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5.40
|
| Rate for Payer: GEHA Commercial |
$4.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5.40
|
| Rate for Payer: Multiplan All |
$5.46
|
| Rate for Payer: OMNI Networks Commercial |
$4.20
|
| Rate for Payer: One Health Plan PPO/POS |
$5.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5.58
|
| Rate for Payer: Zelis Auto |
$2.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1.64
|
|
|
POS AIRWAY PRESSURE TUBING
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT A7037
|
| Hospital Charge Code |
3000023
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: First Health Commercial |
$32.40
|
| Rate for Payer: First Health Workers Compensation |
$13.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$28.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Humana ChoiceCare |
$9.36
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.60
|
| Rate for Payer: OMNI Networks Commercial |
$25.20
|
| Rate for Payer: One Health Plan PPO/POS |
$32.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$31.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.00
|
| Rate for Payer: Zelis Worker's Compensation |
$9.83
|
|
|
POS AIRWAY PRESSURE TUBING
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT A7037
|
| Hospital Charge Code |
3000023
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: First Health Commercial |
$32.40
|
| Rate for Payer: First Health Workers Compensation |
$13.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$25.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: OMNI Networks Commercial |
$25.20
|
| Rate for Payer: One Health Plan PPO/POS |
$32.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Worker's Compensation |
$9.83
|
|
|
POSITIONAL CHANGE OF FINGER
|
Facility
|
IP
|
$2,702.00
|
|
|
Service Code
|
CPT 26555
|
| Hospital Charge Code |
6126555
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$737.65 |
| Max. Negotiated Rate |
$2,566.90 |
| Rate for Payer: Cash Price |
$1,621.20
|
| Rate for Payer: Cigna Commercial |
$2,296.70
|
| Rate for Payer: First Health Commercial |
$2,431.80
|
| Rate for Payer: First Health Workers Compensation |
$1,043.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,431.80
|
| Rate for Payer: GEHA Commercial |
$1,891.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,431.80
|
| Rate for Payer: Multiplan All |
$2,458.82
|
| Rate for Payer: OMNI Networks Commercial |
$1,891.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,431.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,566.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,026.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,512.86
|
| Rate for Payer: Zelis Auto |
$1,080.80
|
| Rate for Payer: Zelis Worker's Compensation |
$737.65
|
|
|
POSITIONAL CHANGE OF FINGER
|
Facility
|
OP
|
$2,702.00
|
|
|
Service Code
|
CPT 26555
|
| Hospital Charge Code |
6126555
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$737.65 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,621.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,621.20
|
| Rate for Payer: Cash Price |
$1,621.20
|
| Rate for Payer: Cigna Commercial |
$2,296.70
|
| Rate for Payer: First Health Commercial |
$2,431.80
|
| Rate for Payer: First Health Workers Compensation |
$1,043.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,431.80
|
| Rate for Payer: GEHA Commercial |
$2,161.60
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,431.80
|
| 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 |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$2,458.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,891.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,431.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,566.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$2,026.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,512.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$1,080.80
|
| 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 |
$737.65
|
|
|
POSITIONAL NYSTAGMUS TEST
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 92532
|
| Hospital Charge Code |
8392532
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$144.50
|
| Rate for Payer: First Health Commercial |
$153.00
|
| Rate for Payer: First Health Workers Compensation |
$65.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.00
|
| Rate for Payer: GEHA Commercial |
$119.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.00
|
| Rate for Payer: Multiplan All |
$154.70
|
| Rate for Payer: OMNI Networks Commercial |
$119.00
|
| Rate for Payer: One Health Plan PPO/POS |
$153.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$161.50
|
| Rate for Payer: Three Rivers Provider Network All |
$127.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$158.10
|
| Rate for Payer: Zelis Auto |
$68.00
|
| Rate for Payer: Zelis Worker's Compensation |
$46.41
|
|
|
POSITIONAL NYSTAGMUS TEST
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 92532
|
| Hospital Charge Code |
8392532
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$42.50 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$144.50
|
| Rate for Payer: First Health Commercial |
$153.00
|
| Rate for Payer: First Health Workers Compensation |
$65.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.00
|
| Rate for Payer: GEHA Commercial |
$136.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.00
|
| Rate for Payer: Humana ChoiceCare |
$44.20
|
| Rate for Payer: Multiplan All |
$154.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$102.00
|
| Rate for Payer: OMNI Networks Commercial |
$119.00
|
| Rate for Payer: One Health Plan PPO/POS |
$153.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$161.50
|
| Rate for Payer: Three Rivers Provider Network All |
$127.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$149.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$42.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$158.10
|
| Rate for Payer: Zelis Auto |
$68.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$85.00
|
| Rate for Payer: Zelis Worker's Compensation |
$46.41
|
|
|
POSITIONAL NYSTAGMUS TEST
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 92532
|
| Hospital Charge Code |
7992532
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$144.50
|
| Rate for Payer: First Health Commercial |
$153.00
|
| Rate for Payer: First Health Workers Compensation |
$65.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.00
|
| Rate for Payer: GEHA Commercial |
$119.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.00
|
| Rate for Payer: Multiplan All |
$154.70
|
| Rate for Payer: OMNI Networks Commercial |
$119.00
|
| Rate for Payer: One Health Plan PPO/POS |
$153.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$161.50
|
| Rate for Payer: Three Rivers Provider Network All |
$127.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$158.10
|
| Rate for Payer: Zelis Auto |
$68.00
|
| Rate for Payer: Zelis Worker's Compensation |
$46.41
|
|
|
POSITIONAL NYSTAGMUS TEST
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 92532
|
| Hospital Charge Code |
7992532
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$42.50 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$144.50
|
| Rate for Payer: First Health Commercial |
$153.00
|
| Rate for Payer: First Health Workers Compensation |
$65.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.00
|
| Rate for Payer: GEHA Commercial |
$136.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.00
|
| Rate for Payer: Humana ChoiceCare |
$44.20
|
| Rate for Payer: Multiplan All |
$154.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$102.00
|
| Rate for Payer: OMNI Networks Commercial |
$119.00
|
| Rate for Payer: One Health Plan PPO/POS |
$153.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$161.50
|
| Rate for Payer: Three Rivers Provider Network All |
$127.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$149.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$42.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$158.10
|
| Rate for Payer: Zelis Auto |
$68.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$85.00
|
| Rate for Payer: Zelis Worker's Compensation |
$46.41
|
|
|
POSITIONAL NYSTAGMUS TEST
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 92532
|
| Hospital Charge Code |
8592532
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$144.50
|
| Rate for Payer: First Health Commercial |
$153.00
|
| Rate for Payer: First Health Workers Compensation |
$65.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.00
|
| Rate for Payer: GEHA Commercial |
$119.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.00
|
| Rate for Payer: Multiplan All |
$154.70
|
| Rate for Payer: OMNI Networks Commercial |
$119.00
|
| Rate for Payer: One Health Plan PPO/POS |
$153.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$161.50
|
| Rate for Payer: Three Rivers Provider Network All |
$127.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$158.10
|
| Rate for Payer: Zelis Auto |
$68.00
|
| Rate for Payer: Zelis Worker's Compensation |
$46.41
|
|
|
POSITIONAL NYSTAGMUS TEST
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 92532
|
| Hospital Charge Code |
8592532
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$42.50 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$144.50
|
| Rate for Payer: First Health Commercial |
$153.00
|
| Rate for Payer: First Health Workers Compensation |
$65.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$153.00
|
| Rate for Payer: GEHA Commercial |
$136.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$153.00
|
| Rate for Payer: Humana ChoiceCare |
$44.20
|
| Rate for Payer: Multiplan All |
$154.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$102.00
|
| Rate for Payer: OMNI Networks Commercial |
$119.00
|
| Rate for Payer: One Health Plan PPO/POS |
$153.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$161.50
|
| Rate for Payer: Three Rivers Provider Network All |
$127.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$149.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$42.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$158.10
|
| Rate for Payer: Zelis Auto |
$68.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$85.00
|
| Rate for Payer: Zelis Worker's Compensation |
$46.41
|
|
|
POSTERIOR COLPORRHAPHY, REPAIR OF RECTOCELE WITH OR WITHOUT PERINEORRHAPHY
|
Facility
|
OP
|
$9,374.72
|
|
|
Service Code
|
CPT 57250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,824.80 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,565.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,824.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: First Health Workers Compensation |
$6,032.63
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Humana ChoiceCare |
$5,156.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,687.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,874.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,882.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,328.05
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,882.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,882.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| Rate for Payer: Zelis Worker's Compensation |
$4,265.50
|
|
|
POSTOP FOLLOW UP VISIT RELATED ORIG PX
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 99024
|
| Hospital Charge Code |
9699024
|
|
Hospital Revenue Code
|
510
|
| 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
|
|
|
POSTOP FOLLOW UP VISIT RELATED ORIG PX
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 99024
|
| Hospital Charge Code |
9699024
|
|
Hospital Revenue Code
|
510
|
| 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
|
|
|
POSTOP FOLLOW UP VISIT RELATED TO ORG PX
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 99024
|
| Hospital Charge Code |
8399024
|
|
Hospital Revenue Code
|
519
|
| 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
|
|
|
POSTOP FOLLOW UP VISIT RELATED TO ORG PX
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 99024
|
| Hospital Charge Code |
7999024
|
|
Hospital Revenue Code
|
519
|
| 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
|
|
