|
REMOVL SUTURES UNDER ANESTH SAME SURGEON
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 15850
|
| Hospital Charge Code |
21600307
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$76.95 |
| 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 |
$56.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Worker's Compensation |
$22.11
|
|
|
REMOVL SUTURES UNDER ANESTH SAME SURGEON
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 15850
|
| Hospital Charge Code |
21600307
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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 |
$64.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Humana ChoiceCare |
$21.06
|
| 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: 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 |
$20.25
|
| 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
|
|
|
REMOV/REPLC PENIS PROS COMP
|
Facility
|
OP
|
$2,112.00
|
|
|
Service Code
|
CPT 54411
|
| Hospital Charge Code |
6154411
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$576.58 |
| Max. Negotiated Rate |
$38,225.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$28,829.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,267.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$28,829.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$22,838.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$19,112.87
|
| Rate for Payer: Cash Price |
$1,267.20
|
| Rate for Payer: Cash Price |
$1,267.20
|
| Rate for Payer: Cigna Commercial |
$1,795.20
|
| Rate for Payer: First Health Commercial |
$1,900.80
|
| Rate for Payer: First Health Workers Compensation |
$815.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,900.80
|
| Rate for Payer: GEHA Commercial |
$1,689.60
|
| Rate for Payer: GEHA Medicare |
$19,112.87
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,900.80
|
| Rate for Payer: Humana ChoiceCare |
$21,024.16
|
| Rate for Payer: Humana Medicare Advantage |
$19,112.87
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$32,109.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$23,303.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$19,112.87
|
| Rate for Payer: Multiplan All |
$1,921.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$32,491.88
|
| Rate for Payer: OMNI Networks Commercial |
$1,478.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,900.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$26,907.30
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$23,303.64
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$19,112.87
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,006.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$38,225.74
|
| Rate for Payer: Three Rivers Provider Network All |
$1,584.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18,730.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23,303.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,112.87
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,964.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$19,112.87
|
| Rate for Payer: Zelis Auto |
$844.80
|
| Rate for Payer: Zelis Medicare |
$16,245.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22,935.44
|
| Rate for Payer: Zelis Worker's Compensation |
$576.58
|
|
|
REMOV/REPLC PENIS PROS COMP
|
Facility
|
IP
|
$2,112.00
|
|
|
Service Code
|
CPT 54411
|
| Hospital Charge Code |
6154411
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$576.58 |
| Max. Negotiated Rate |
$2,006.40 |
| Rate for Payer: Cash Price |
$1,267.20
|
| Rate for Payer: Cigna Commercial |
$1,795.20
|
| Rate for Payer: First Health Commercial |
$1,900.80
|
| Rate for Payer: First Health Workers Compensation |
$815.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,900.80
|
| Rate for Payer: GEHA Commercial |
$1,478.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,900.80
|
| Rate for Payer: Multiplan All |
$1,921.92
|
| Rate for Payer: OMNI Networks Commercial |
$1,478.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,900.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,006.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,584.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,964.16
|
| Rate for Payer: Zelis Auto |
$844.80
|
| Rate for Payer: Zelis Worker's Compensation |
$576.58
|
|
|
REMOV/REPLC UR SPHINCTR COMP
|
Facility
|
IP
|
$2,656.00
|
|
|
Service Code
|
CPT 53448
|
| Hospital Charge Code |
6153448
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$725.09 |
| Max. Negotiated Rate |
$2,523.20 |
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Cigna Commercial |
$2,257.60
|
| Rate for Payer: First Health Commercial |
$2,390.40
|
| Rate for Payer: First Health Workers Compensation |
$1,025.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,390.40
|
| Rate for Payer: GEHA Commercial |
$1,859.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,390.40
|
| Rate for Payer: Multiplan All |
$2,416.96
|
| Rate for Payer: OMNI Networks Commercial |
$1,859.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,390.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,523.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,992.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,470.08
|
| Rate for Payer: Zelis Auto |
$1,062.40
|
| Rate for Payer: Zelis Worker's Compensation |
$725.09
|
|
|
REMOV/REPLC UR SPHINCTR COMP
|
Facility
|
OP
|
$2,656.00
|
|
|
Service Code
|
CPT 53448
|
| Hospital Charge Code |
6153448
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$664.00 |
| Max. Negotiated Rate |
$2,523.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,593.60
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Cigna Commercial |
$2,257.60
|
| Rate for Payer: First Health Commercial |
$2,390.40
|
| Rate for Payer: First Health Workers Compensation |
$1,025.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,390.40
|
| Rate for Payer: GEHA Commercial |
$2,124.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,390.40
|
| Rate for Payer: Humana ChoiceCare |
$690.56
|
| Rate for Payer: Multiplan All |
$2,416.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,593.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,859.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,390.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,523.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,992.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,337.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$664.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,470.08
|
| Rate for Payer: Zelis Auto |
$1,062.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,328.00
|
| Rate for Payer: Zelis Worker's Compensation |
$725.09
|
|
|
REM PHYSIOL MNTR 20 MIN MO
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 99457
|
| Hospital Charge Code |
21700039
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.75 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: First Health Workers Compensation |
$58.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$120.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Humana ChoiceCare |
$39.26
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$90.60
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$132.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$75.50
|
| Rate for Payer: Zelis Worker's Compensation |
$41.22
|
|
|
REM PHYSIOL MNTR 20 MIN MO
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 99457
|
| Hospital Charge Code |
1999222
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$25.12 |
| Max. Negotiated Rate |
$87.40 |
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: First Health Commercial |
$82.80
|
| Rate for Payer: First Health Workers Compensation |
$35.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$82.80
|
| Rate for Payer: GEHA Commercial |
$64.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$82.80
|
| Rate for Payer: Multiplan All |
$83.72
|
| Rate for Payer: OMNI Networks Commercial |
$64.40
|
| Rate for Payer: One Health Plan PPO/POS |
$82.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$87.40
|
| Rate for Payer: Three Rivers Provider Network All |
$69.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$85.56
|
| Rate for Payer: Zelis Auto |
$36.80
|
| Rate for Payer: Zelis Worker's Compensation |
$25.12
|
|
|
REM PHYSIOL MNTR 20 MIN MO
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 99457
|
| Hospital Charge Code |
7999250
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$37.75 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: First Health Workers Compensation |
$58.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$120.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Humana ChoiceCare |
$39.26
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$90.60
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$132.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$75.50
|
| Rate for Payer: Zelis Worker's Compensation |
$41.22
|
|
|
REM PHYSIOL MNTR 20 MIN MO
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
CPT 99457
|
| Hospital Charge Code |
10099220
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$28.30
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$58.20
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$39.62
|
| Rate for Payer: First Health Workers Compensation |
$84.33
|
| Rate for Payer: GEHA Commercial |
$28.30
|
| Rate for Payer: GEHA Medicare |
$28.30
|
| Rate for Payer: Health Net Federal Services Government |
$28.30
|
| Rate for Payer: HealthSmart Commercial |
$39.62
|
| Rate for Payer: HealthSmart Worker's Compensation |
$80.92
|
| Rate for Payer: Humana ChoiceCare |
$31.13
|
| Rate for Payer: Humana Medicare Advantage |
$28.30
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$39.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$28.30
|
| Rate for Payer: Multiplan All |
$72.75
|
| Rate for Payer: National Preferred Provider Network Commercial |
$92.15
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$85.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29.71
|
| Rate for Payer: OMNI Networks Commercial |
$67.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$37.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$30.48
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$61.41
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.30
|
| Rate for Payer: Zelis Medicare |
$24.05
|
| Rate for Payer: Zelis Worker's Compensation |
$59.63
|
|
|
REM PHYSIOL MNTR 20 MIN MO
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 99457
|
| Hospital Charge Code |
8000009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.22 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: First Health Workers Compensation |
$58.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$105.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
| Rate for Payer: Zelis Worker's Compensation |
$41.22
|
|
|
REM PHYSIOL MNTR 20 MIN MO
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 99457
|
| Hospital Charge Code |
21000006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.22 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: First Health Workers Compensation |
$58.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$105.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
| Rate for Payer: Zelis Worker's Compensation |
$41.22
|
|
|
REM PHYSIOL MNTR 20 MIN MO
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 99457
|
| Hospital Charge Code |
25500019
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.22 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: First Health Workers Compensation |
$58.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$105.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
| Rate for Payer: Zelis Worker's Compensation |
$41.22
|
|
|
REM PHYSIOL MNTR 20 MIN MO
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
CPT 99457
|
| Hospital Charge Code |
11099220
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$28.30
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$58.20
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$39.62
|
| Rate for Payer: First Health Workers Compensation |
$84.33
|
| Rate for Payer: GEHA Commercial |
$28.30
|
| Rate for Payer: GEHA Medicare |
$28.30
|
| Rate for Payer: Health Net Federal Services Government |
$28.30
|
| Rate for Payer: HealthSmart Commercial |
$39.62
|
| Rate for Payer: HealthSmart Worker's Compensation |
$80.92
|
| Rate for Payer: Humana ChoiceCare |
$31.13
|
| Rate for Payer: Humana Medicare Advantage |
$28.30
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$39.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$28.30
|
| Rate for Payer: Multiplan All |
$72.75
|
| Rate for Payer: National Preferred Provider Network Commercial |
$92.15
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$85.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29.71
|
| Rate for Payer: OMNI Networks Commercial |
$67.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$37.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$30.48
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$61.41
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.30
|
| Rate for Payer: Zelis Medicare |
$24.05
|
| Rate for Payer: Zelis Worker's Compensation |
$59.63
|
|
|
REM PHYSIOL MNTR 20 MIN MO
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 99457
|
| Hospital Charge Code |
8300072
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$37.75 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: First Health Workers Compensation |
$58.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$120.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Humana ChoiceCare |
$39.26
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$90.60
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$132.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$75.50
|
| Rate for Payer: Zelis Worker's Compensation |
$41.22
|
|
|
REM PHYSIOL MNTR 20 MIN MO
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 99457
|
| Hospital Charge Code |
8000009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.75 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: First Health Workers Compensation |
$58.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$120.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Humana ChoiceCare |
$39.26
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$90.60
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$132.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$75.50
|
| Rate for Payer: Zelis Worker's Compensation |
$41.22
|
|
|
REM PHYSIOL MNTR 20 MIN MO
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
CPT 99457
|
| Hospital Charge Code |
14099220
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.35
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$28.30
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$58.20
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$39.62
|
| Rate for Payer: First Health Workers Compensation |
$84.33
|
| Rate for Payer: GEHA Commercial |
$28.30
|
| Rate for Payer: GEHA Medicare |
$28.30
|
| Rate for Payer: Health Net Federal Services Government |
$28.30
|
| Rate for Payer: HealthSmart Commercial |
$39.62
|
| Rate for Payer: HealthSmart Worker's Compensation |
$80.92
|
| Rate for Payer: Humana ChoiceCare |
$31.13
|
| Rate for Payer: Humana Medicare Advantage |
$28.30
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$39.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$28.30
|
| Rate for Payer: Multiplan All |
$72.75
|
| Rate for Payer: National Preferred Provider Network Commercial |
$92.15
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$85.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29.71
|
| Rate for Payer: OMNI Networks Commercial |
$67.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$37.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$30.48
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$61.41
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.30
|
| Rate for Payer: Zelis Medicare |
$24.05
|
| Rate for Payer: Zelis Worker's Compensation |
$59.63
|
|
|
REM PHYSIOL MNTR 20 MIN MO
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 99457
|
| Hospital Charge Code |
8900031
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.22 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: First Health Workers Compensation |
$58.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$105.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
| Rate for Payer: Zelis Worker's Compensation |
$41.22
|
|
|
REM PHYSIOL MNTR 20 MIN MO
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 99457
|
| Hospital Charge Code |
9000030
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$41.22 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: First Health Workers Compensation |
$58.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$105.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
| Rate for Payer: Zelis Worker's Compensation |
$41.22
|
|
|
REM PHYSIOL MNTR 20 MIN MO
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 99457
|
| Hospital Charge Code |
21000006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.75 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: First Health Workers Compensation |
$58.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$120.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Humana ChoiceCare |
$39.26
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$90.60
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$132.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$75.50
|
| Rate for Payer: Zelis Worker's Compensation |
$41.22
|
|
|
REM PHYSIOL MNTR 20 MIN MO
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 99457
|
| Hospital Charge Code |
20399223
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$41.22 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: First Health Workers Compensation |
$58.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$105.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
| Rate for Payer: Zelis Worker's Compensation |
$41.22
|
|
|
REM PHYSIOL MNTR 20 MIN MO
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 99457
|
| Hospital Charge Code |
21600019
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$41.22 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: First Health Workers Compensation |
$58.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$105.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
| Rate for Payer: Zelis Worker's Compensation |
$41.22
|
|
|
REM PHYSIOL MNTR 20 MIN MO
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 99457
|
| Hospital Charge Code |
21700039
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.22 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: First Health Workers Compensation |
$58.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$105.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
| Rate for Payer: Zelis Worker's Compensation |
$41.22
|
|
|
REM PHYSIOL MNTR 20 MIN MO
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 99457
|
| Hospital Charge Code |
1999222
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$87.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: First Health Commercial |
$82.80
|
| Rate for Payer: First Health Workers Compensation |
$35.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$82.80
|
| Rate for Payer: GEHA Commercial |
$73.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$82.80
|
| Rate for Payer: Humana ChoiceCare |
$23.92
|
| Rate for Payer: Multiplan All |
$83.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$55.20
|
| Rate for Payer: OMNI Networks Commercial |
$64.40
|
| Rate for Payer: One Health Plan PPO/POS |
$82.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$87.40
|
| Rate for Payer: Three Rivers Provider Network All |
$69.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$80.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$85.56
|
| Rate for Payer: Zelis Auto |
$36.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$46.00
|
| Rate for Payer: Zelis Worker's Compensation |
$25.12
|
|
|
REM PHYSIOL MNTR 20 MIN MO
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 99457
|
| Hospital Charge Code |
7999250
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$41.22 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$128.35
|
| Rate for Payer: First Health Commercial |
$135.90
|
| Rate for Payer: First Health Workers Compensation |
$58.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$135.90
|
| Rate for Payer: GEHA Commercial |
$105.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$135.90
|
| Rate for Payer: Multiplan All |
$137.41
|
| Rate for Payer: OMNI Networks Commercial |
$105.70
|
| Rate for Payer: One Health Plan PPO/POS |
$135.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$143.45
|
| Rate for Payer: Three Rivers Provider Network All |
$113.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$140.43
|
| Rate for Payer: Zelis Auto |
$60.40
|
| Rate for Payer: Zelis Worker's Compensation |
$41.22
|
|
