|
protein s antigen REF164517
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
2299185
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.15 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$224.40
|
| Rate for Payer: First Health Commercial |
$237.60
|
| Rate for Payer: First Health Workers Compensation |
$27.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$184.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: OMNI Networks Commercial |
$184.80
|
| Rate for Payer: One Health Plan PPO/POS |
$237.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Worker's Compensation |
$19.15
|
|
|
protein s antigen REF164517
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
2299185
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$27.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$158.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$27.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$15.32
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$224.40
|
| Rate for Payer: First Health Commercial |
$237.60
|
| Rate for Payer: First Health Workers Compensation |
$27.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$211.20
|
| Rate for Payer: GEHA Medicare |
$15.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Humana ChoiceCare |
$16.85
|
| Rate for Payer: Humana Medicare Advantage |
$15.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$22.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$15.32
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$26.04
|
| Rate for Payer: OMNI Networks Commercial |
$184.80
|
| Rate for Payer: One Health Plan PPO/POS |
$237.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$25.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$22.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$15.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$30.64
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$15.01
|
| Rate for Payer: United Healthcare Commercial |
$224.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$22.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$15.32
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Medicare |
$13.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.38
|
| Rate for Payer: Zelis Worker's Compensation |
$19.15
|
|
|
protein total body fluid REF019588
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
22990908
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.00
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$146.20
|
| Rate for Payer: First Health Commercial |
$154.80
|
| Rate for Payer: First Health Workers Compensation |
$7.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$154.80
|
| Rate for Payer: GEHA Commercial |
$137.60
|
| Rate for Payer: GEHA Medicare |
$4.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$154.80
|
| Rate for Payer: Humana ChoiceCare |
$4.40
|
| Rate for Payer: Humana Medicare Advantage |
$4.00
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.00
|
| Rate for Payer: Multiplan All |
$156.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.80
|
| Rate for Payer: OMNI Networks Commercial |
$120.40
|
| Rate for Payer: One Health Plan PPO/POS |
$154.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$163.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$8.00
|
| Rate for Payer: Three Rivers Provider Network All |
$129.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.92
|
| Rate for Payer: United Healthcare Commercial |
$146.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$159.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.00
|
| Rate for Payer: Zelis Auto |
$68.80
|
| Rate for Payer: Zelis Medicare |
$3.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.80
|
| Rate for Payer: Zelis Worker's Compensation |
$5.57
|
|
|
protein total body fluid REF019588
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
22990908
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$146.20
|
| Rate for Payer: First Health Commercial |
$154.80
|
| Rate for Payer: First Health Workers Compensation |
$7.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$154.80
|
| Rate for Payer: GEHA Commercial |
$120.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$154.80
|
| Rate for Payer: Multiplan All |
$156.52
|
| Rate for Payer: OMNI Networks Commercial |
$120.40
|
| Rate for Payer: One Health Plan PPO/POS |
$154.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$163.40
|
| Rate for Payer: Three Rivers Provider Network All |
$129.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$159.96
|
| Rate for Payer: Zelis Auto |
$68.80
|
| Rate for Payer: Zelis Worker's Compensation |
$5.57
|
|
|
PROTEIN TOTAL (Vitros)
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
2232201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3.67
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: First Health Workers Compensation |
$7.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$109.60
|
| Rate for Payer: GEHA Medicare |
$3.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Humana ChoiceCare |
$4.04
|
| Rate for Payer: Humana Medicare Advantage |
$3.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3.67
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.24
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6.16
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7.34
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.60
|
| Rate for Payer: United Healthcare Commercial |
$116.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3.67
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Medicare |
$3.12
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.40
|
| Rate for Payer: Zelis Worker's Compensation |
$5.09
|
|
|
PROTEIN TOTAL (Vitros)
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
2232201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$116.45
|
| Rate for Payer: First Health Commercial |
$123.30
|
| Rate for Payer: First Health Workers Compensation |
$7.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$123.30
|
| Rate for Payer: GEHA Commercial |
$95.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$123.30
|
| Rate for Payer: Multiplan All |
$124.67
|
| Rate for Payer: OMNI Networks Commercial |
$95.90
|
| Rate for Payer: One Health Plan PPO/POS |
$123.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$130.15
|
| Rate for Payer: Three Rivers Provider Network All |
$102.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$127.41
|
| Rate for Payer: Zelis Auto |
$54.80
|
| Rate for Payer: Zelis Worker's Compensation |
$5.09
|
|
|
PROTIME
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
2205610
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.29
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$46.75
|
| Rate for Payer: First Health Commercial |
$49.50
|
| Rate for Payer: First Health Workers Compensation |
$6.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$49.50
|
| Rate for Payer: GEHA Commercial |
$44.00
|
| Rate for Payer: GEHA Medicare |
$4.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$49.50
|
| Rate for Payer: Humana ChoiceCare |
$4.72
|
| Rate for Payer: Humana Medicare Advantage |
$4.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7.21
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.29
|
| Rate for Payer: Multiplan All |
$50.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.29
|
| Rate for Payer: OMNI Networks Commercial |
$38.50
|
| Rate for Payer: One Health Plan PPO/POS |
$49.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6.24
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$52.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$8.58
|
| Rate for Payer: Three Rivers Provider Network All |
$41.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.20
|
| Rate for Payer: United Healthcare Commercial |
$46.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$51.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.29
|
| Rate for Payer: Zelis Auto |
$22.00
|
| Rate for Payer: Zelis Medicare |
$3.65
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.15
|
| Rate for Payer: Zelis Worker's Compensation |
$4.77
|
|
|
PROTIME
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
2205610
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$46.75
|
| Rate for Payer: First Health Commercial |
$49.50
|
| Rate for Payer: First Health Workers Compensation |
$6.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$49.50
|
| Rate for Payer: GEHA Commercial |
$38.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$49.50
|
| Rate for Payer: Multiplan All |
$50.05
|
| Rate for Payer: OMNI Networks Commercial |
$38.50
|
| Rate for Payer: One Health Plan PPO/POS |
$49.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$52.25
|
| Rate for Payer: Three Rivers Provider Network All |
$41.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$51.15
|
| Rate for Payer: Zelis Auto |
$22.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.77
|
|
|
protriptyline REF811364
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
2299568
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$27.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$101.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Humana ChoiceCare |
$33.02
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$76.20
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$111.76
|
| Rate for Payer: United Healthcare Commercial |
$107.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$63.50
|
| Rate for Payer: Zelis Worker's Compensation |
$19.29
|
|
|
protriptyline REF811364
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
2299568
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$27.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$88.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Worker's Compensation |
$19.29
|
|
|
PROVAY BLUE 0.5%
|
Facility
|
IP
|
$980.00
|
|
|
Service Code
|
CPT Q9968
|
| Hospital Charge Code |
3305012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$267.54 |
| Max. Negotiated Rate |
$931.00 |
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cigna Commercial |
$833.00
|
| Rate for Payer: First Health Commercial |
$882.00
|
| Rate for Payer: First Health Workers Compensation |
$378.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$882.00
|
| Rate for Payer: GEHA Commercial |
$686.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$882.00
|
| Rate for Payer: Multiplan All |
$891.80
|
| Rate for Payer: OMNI Networks Commercial |
$686.00
|
| Rate for Payer: One Health Plan PPO/POS |
$882.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$931.00
|
| Rate for Payer: Three Rivers Provider Network All |
$735.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$911.40
|
| Rate for Payer: Zelis Auto |
$392.00
|
| Rate for Payer: Zelis Worker's Compensation |
$267.54
|
|
|
PROVAY BLUE 0.5%
|
Facility
|
OP
|
$980.00
|
|
|
Service Code
|
CPT Q9968
|
| Hospital Charge Code |
3305012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$931.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$588.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8.73
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cigna Commercial |
$833.00
|
| Rate for Payer: First Health Commercial |
$882.00
|
| Rate for Payer: First Health Workers Compensation |
$378.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$882.00
|
| Rate for Payer: GEHA Commercial |
$784.00
|
| Rate for Payer: GEHA Medicare |
$8.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$882.00
|
| Rate for Payer: Humana ChoiceCare |
$9.60
|
| Rate for Payer: Humana Medicare Advantage |
$8.73
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$14.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8.73
|
| Rate for Payer: Multiplan All |
$891.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$14.84
|
| Rate for Payer: OMNI Networks Commercial |
$686.00
|
| Rate for Payer: One Health Plan PPO/POS |
$882.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2.15
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$931.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17.46
|
| Rate for Payer: Three Rivers Provider Network All |
$735.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$911.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8.73
|
| Rate for Payer: Zelis Auto |
$392.00
|
| Rate for Payer: Zelis Medicare |
$7.42
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.48
|
| Rate for Payer: Zelis Worker's Compensation |
$267.54
|
|
|
PRP I/HERN INIT BLOCK >5 YR
|
Facility
|
OP
|
$1,871.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
6149507
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$510.78 |
| Max. Negotiated Rate |
$6,701.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,122.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,560.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,350.98
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cigna Commercial |
$1,590.35
|
| Rate for Payer: First Health Commercial |
$1,683.90
|
| Rate for Payer: First Health Workers Compensation |
$722.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,683.90
|
| Rate for Payer: GEHA Commercial |
$1,496.80
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,683.90
|
| Rate for Payer: Humana ChoiceCare |
$3,686.08
|
| Rate for Payer: Humana Medicare Advantage |
$3,350.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,629.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,612.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,350.98
|
| Rate for Payer: Multiplan All |
$1,702.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,309.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,683.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,016.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,612.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,350.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,777.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: Three Rivers Provider Network All |
$1,403.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,283.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,612.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,740.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Auto |
$748.40
|
| Rate for Payer: Zelis Medicare |
$2,848.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,021.18
|
| Rate for Payer: Zelis Worker's Compensation |
$510.78
|
|
|
PRP I/HERN INIT BLOCK >5 YR
|
Facility
|
IP
|
$1,871.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
6149507
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$510.78 |
| Max. Negotiated Rate |
$1,777.45 |
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cigna Commercial |
$1,590.35
|
| Rate for Payer: First Health Commercial |
$1,683.90
|
| Rate for Payer: First Health Workers Compensation |
$722.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,683.90
|
| Rate for Payer: GEHA Commercial |
$1,309.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,683.90
|
| Rate for Payer: Multiplan All |
$1,702.61
|
| Rate for Payer: OMNI Networks Commercial |
$1,309.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,683.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,777.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,403.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,740.03
|
| Rate for Payer: Zelis Auto |
$748.40
|
| Rate for Payer: Zelis Worker's Compensation |
$510.78
|
|
|
PRP I/HERN INIT REDUC >5 YR
|
Facility
|
OP
|
$1,087.00
|
|
|
Service Code
|
CPT 49505
|
| Hospital Charge Code |
6149505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$296.75 |
| Max. Negotiated Rate |
$6,701.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$652.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,232.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,560.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,350.98
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Cigna Commercial |
$923.95
|
| Rate for Payer: First Health Commercial |
$978.30
|
| Rate for Payer: First Health Workers Compensation |
$419.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$978.30
|
| Rate for Payer: GEHA Commercial |
$869.60
|
| Rate for Payer: GEHA Medicare |
$3,350.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$978.30
|
| Rate for Payer: Humana ChoiceCare |
$3,686.08
|
| Rate for Payer: Humana Medicare Advantage |
$3,350.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,629.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,612.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,350.98
|
| Rate for Payer: Multiplan All |
$989.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,696.67
|
| Rate for Payer: OMNI Networks Commercial |
$760.90
|
| Rate for Payer: One Health Plan PPO/POS |
$978.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,016.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,612.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,350.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,032.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,701.96
|
| Rate for Payer: Three Rivers Provider Network All |
$815.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,283.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,612.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,010.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,350.98
|
| Rate for Payer: Zelis Auto |
$434.80
|
| Rate for Payer: Zelis Medicare |
$2,848.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,021.18
|
| Rate for Payer: Zelis Worker's Compensation |
$296.75
|
|
|
PRP I/HERN INIT REDUC >5 YR
|
Facility
|
IP
|
$1,087.00
|
|
|
Service Code
|
CPT 49505
|
| Hospital Charge Code |
6149505
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$296.75 |
| Max. Negotiated Rate |
$1,032.65 |
| Rate for Payer: Cash Price |
$652.20
|
| Rate for Payer: Cigna Commercial |
$923.95
|
| Rate for Payer: First Health Commercial |
$978.30
|
| Rate for Payer: First Health Workers Compensation |
$419.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$978.30
|
| Rate for Payer: GEHA Commercial |
$760.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$978.30
|
| Rate for Payer: Multiplan All |
$989.17
|
| Rate for Payer: OMNI Networks Commercial |
$760.90
|
| Rate for Payer: One Health Plan PPO/POS |
$978.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,032.65
|
| Rate for Payer: Three Rivers Provider Network All |
$815.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,010.91
|
| Rate for Payer: Zelis Auto |
$434.80
|
| Rate for Payer: Zelis Worker's Compensation |
$296.75
|
|
|
PRP INJ W/IMG HARVEST/PREPARATION
|
Facility
|
IP
|
$1,694.00
|
|
|
Service Code
|
CPT 99199
|
| Hospital Charge Code |
8299199
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$462.46 |
| Max. Negotiated Rate |
$1,609.30 |
| Rate for Payer: Cash Price |
$1,016.40
|
| Rate for Payer: Cigna Commercial |
$1,439.90
|
| Rate for Payer: First Health Commercial |
$1,524.60
|
| Rate for Payer: First Health Workers Compensation |
$654.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,524.60
|
| Rate for Payer: GEHA Commercial |
$1,185.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,524.60
|
| Rate for Payer: Multiplan All |
$1,541.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,185.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,524.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,609.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,270.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,575.42
|
| Rate for Payer: Zelis Auto |
$677.60
|
| Rate for Payer: Zelis Worker's Compensation |
$462.46
|
|
|
PRP INJ W/IMG HARVEST/PREPARATION
|
Facility
|
OP
|
$1,694.00
|
|
|
Service Code
|
CPT 99199
|
| Hospital Charge Code |
8299199
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$423.50 |
| Max. Negotiated Rate |
$1,609.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,016.40
|
| Rate for Payer: Cash Price |
$1,016.40
|
| Rate for Payer: Cigna Commercial |
$1,439.90
|
| Rate for Payer: First Health Commercial |
$1,524.60
|
| Rate for Payer: First Health Workers Compensation |
$654.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,524.60
|
| Rate for Payer: GEHA Commercial |
$1,355.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,524.60
|
| Rate for Payer: Humana ChoiceCare |
$440.44
|
| Rate for Payer: Multiplan All |
$1,541.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,016.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,185.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,524.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,609.30
|
| Rate for Payer: Three Rivers Provider Network All |
$1,270.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,490.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$423.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,575.42
|
| Rate for Payer: Zelis Auto |
$677.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$847.00
|
| Rate for Payer: Zelis Worker's Compensation |
$462.46
|
|
|
PRP KIT
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 99070
|
| Hospital Charge Code |
8299070
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.73 |
| Max. Negotiated Rate |
$340.10 |
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$304.30
|
| Rate for Payer: First Health Commercial |
$322.20
|
| Rate for Payer: First Health Workers Compensation |
$138.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$322.20
|
| Rate for Payer: GEHA Commercial |
$250.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$322.20
|
| Rate for Payer: Multiplan All |
$325.78
|
| Rate for Payer: OMNI Networks Commercial |
$250.60
|
| Rate for Payer: One Health Plan PPO/POS |
$322.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$340.10
|
| Rate for Payer: Three Rivers Provider Network All |
$268.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$332.94
|
| Rate for Payer: Zelis Auto |
$143.20
|
| Rate for Payer: Zelis Worker's Compensation |
$97.73
|
|
|
PRP KIT
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 99070
|
| Hospital Charge Code |
8299070
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.50 |
| Max. Negotiated Rate |
$340.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$214.80
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$304.30
|
| Rate for Payer: First Health Commercial |
$322.20
|
| Rate for Payer: First Health Workers Compensation |
$138.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$322.20
|
| Rate for Payer: GEHA Commercial |
$286.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$322.20
|
| Rate for Payer: Humana ChoiceCare |
$93.08
|
| Rate for Payer: Multiplan All |
$325.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$214.80
|
| Rate for Payer: OMNI Networks Commercial |
$250.60
|
| Rate for Payer: One Health Plan PPO/POS |
$322.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$340.10
|
| Rate for Payer: Three Rivers Provider Network All |
$268.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$315.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$89.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$332.94
|
| Rate for Payer: Zelis Auto |
$143.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.00
|
| Rate for Payer: Zelis Worker's Compensation |
$97.73
|
|
|
PRQ IMPLTJ NEUROSTIM ELTRD SAC NRVE W/IM
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
6164561
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$212.94 |
| 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 Community HMO |
$468.00
|
| 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: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna Commercial |
$663.00
|
| Rate for Payer: First Health Commercial |
$702.00
|
| Rate for Payer: First Health Workers Compensation |
$301.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$702.00
|
| Rate for Payer: GEHA Commercial |
$624.00
|
| Rate for Payer: GEHA Medicare |
$6,231.74
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$702.00
|
| 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: Multiplan All |
$709.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,593.96
|
| Rate for Payer: OMNI Networks Commercial |
$546.00
|
| Rate for Payer: One Health Plan PPO/POS |
$702.00
|
| 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 Commercial |
$741.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12,463.48
|
| Rate for Payer: Three Rivers Provider Network All |
$585.00
|
| 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: United Payors & United Providers UP&UP |
$725.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,231.74
|
| Rate for Payer: Zelis Auto |
$312.00
|
| 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 |
$212.94
|
|
|
PRQ IMPLTJ NEUROSTIM ELTRD SAC NRVE W/IM
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
23500058
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$212.94 |
| 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 Community HMO |
$468.00
|
| 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: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna Commercial |
$663.00
|
| Rate for Payer: First Health Commercial |
$702.00
|
| Rate for Payer: First Health Workers Compensation |
$301.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$702.00
|
| Rate for Payer: GEHA Commercial |
$624.00
|
| Rate for Payer: GEHA Medicare |
$6,231.74
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$702.00
|
| 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: Multiplan All |
$709.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,593.96
|
| Rate for Payer: OMNI Networks Commercial |
$546.00
|
| Rate for Payer: One Health Plan PPO/POS |
$702.00
|
| 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 Commercial |
$741.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12,463.48
|
| Rate for Payer: Three Rivers Provider Network All |
$585.00
|
| 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: United Payors & United Providers UP&UP |
$725.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,231.74
|
| Rate for Payer: Zelis Auto |
$312.00
|
| 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 |
$212.94
|
|
|
PRQ IMPLTJ NEUROSTIM ELTRD SAC NRVE W/IM
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
23500058
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$212.94 |
| Max. Negotiated Rate |
$741.00 |
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna Commercial |
$663.00
|
| Rate for Payer: First Health Commercial |
$702.00
|
| Rate for Payer: First Health Workers Compensation |
$301.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$702.00
|
| Rate for Payer: GEHA Commercial |
$546.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$702.00
|
| Rate for Payer: Multiplan All |
$709.80
|
| Rate for Payer: OMNI Networks Commercial |
$546.00
|
| Rate for Payer: One Health Plan PPO/POS |
$702.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$741.00
|
| Rate for Payer: Three Rivers Provider Network All |
$585.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$725.40
|
| Rate for Payer: Zelis Auto |
$312.00
|
| Rate for Payer: Zelis Worker's Compensation |
$212.94
|
|
|
PRQ IMPLTJ NEUROSTIM ELTRD SAC NRVE W/IM
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
6164561
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$212.94 |
| Max. Negotiated Rate |
$741.00 |
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna Commercial |
$663.00
|
| Rate for Payer: First Health Commercial |
$702.00
|
| Rate for Payer: First Health Workers Compensation |
$301.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$702.00
|
| Rate for Payer: GEHA Commercial |
$546.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$702.00
|
| Rate for Payer: Multiplan All |
$709.80
|
| Rate for Payer: OMNI Networks Commercial |
$546.00
|
| Rate for Payer: One Health Plan PPO/POS |
$702.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$741.00
|
| Rate for Payer: Three Rivers Provider Network All |
$585.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$725.40
|
| Rate for Payer: Zelis Auto |
$312.00
|
| Rate for Payer: Zelis Worker's Compensation |
$212.94
|
|
|
PRQ SKELETAL FIXATION TIBIAL SHAFT FRACT
|
Facility
|
IP
|
$1,167.00
|
|
|
Service Code
|
CPT 27756
|
| Hospital Charge Code |
6127756
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$318.59 |
| Max. Negotiated Rate |
$1,108.65 |
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Cigna Commercial |
$991.95
|
| Rate for Payer: First Health Commercial |
$1,050.30
|
| Rate for Payer: First Health Workers Compensation |
$450.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,050.30
|
| Rate for Payer: GEHA Commercial |
$816.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,050.30
|
| Rate for Payer: Multiplan All |
$1,061.97
|
| Rate for Payer: OMNI Networks Commercial |
$816.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,050.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,108.65
|
| Rate for Payer: Three Rivers Provider Network All |
$875.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,085.31
|
| Rate for Payer: Zelis Auto |
$466.80
|
| Rate for Payer: Zelis Worker's Compensation |
$318.59
|
|
