|
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 |
7599220
|
|
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 |
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 |
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
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 99457
|
| Hospital Charge Code |
8900031
|
|
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 |
8499222
|
|
Hospital Revenue Code
|
513
|
| 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 |
9400098
|
|
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 SKN TAGS MLT FIBRQ TAGS UPW/15
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
23500066
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$72.07 |
| Max. Negotiated Rate |
$385.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| 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 |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| 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 |
$101.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$211.20
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| 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 |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$72.07
|
|
|
REM SKN TAGS MLT FIBRQ TAGS UPW/15
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
23500066
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$72.07 |
| Max. Negotiated Rate |
$250.80 |
| 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 |
$101.93
|
| 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 |
$72.07
|
|
|
REM SKN TAGS MLT FIBRQ TAGS UPW/15
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
20300050
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.07 |
| Max. Negotiated Rate |
$250.80 |
| 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 |
$101.93
|
| 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 |
$72.07
|
|
|
REM SKN TAGS MLT FIBRQ TAGS UPW/15
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
21600023
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$72.07 |
| Max. Negotiated Rate |
$385.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| 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 |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| 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 |
$101.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$211.20
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| 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 |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$72.07
|
|
|
REM SKN TAGS MLT FIBRQ TAGS UPW/15
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
6111200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$60.88 |
| Max. Negotiated Rate |
$385.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$133.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cigna Commercial |
$189.55
|
| Rate for Payer: First Health Commercial |
$200.70
|
| Rate for Payer: First Health Workers Compensation |
$86.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$200.70
|
| Rate for Payer: GEHA Commercial |
$178.40
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$200.70
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$202.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| Rate for Payer: OMNI Networks Commercial |
$156.10
|
| Rate for Payer: One Health Plan PPO/POS |
$200.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$211.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$167.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$207.39
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$89.20
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$60.88
|
|
|
REM SKN TAGS MLT FIBRQ TAGS UPW/15
|
Facility
|
OP
|
$255.21
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
7211200
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$69.67 |
| Max. Negotiated Rate |
$385.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$153.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| Rate for Payer: Cash Price |
$153.13
|
| Rate for Payer: Cash Price |
$153.13
|
| Rate for Payer: Cigna Commercial |
$216.93
|
| Rate for Payer: First Health Commercial |
$229.69
|
| Rate for Payer: First Health Workers Compensation |
$98.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$229.69
|
| Rate for Payer: GEHA Commercial |
$204.17
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$229.69
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$232.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| Rate for Payer: OMNI Networks Commercial |
$178.65
|
| Rate for Payer: One Health Plan PPO/POS |
$229.69
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$242.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$191.41
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$237.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$102.08
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$69.67
|
|
|
REM SKN TAGS MLT FIBRQ TAGS UPW/15
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
6111200
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$60.88 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cigna Commercial |
$189.55
|
| Rate for Payer: First Health Commercial |
$200.70
|
| Rate for Payer: First Health Workers Compensation |
$86.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$200.70
|
| Rate for Payer: GEHA Commercial |
$156.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$200.70
|
| Rate for Payer: Multiplan All |
$202.93
|
| Rate for Payer: OMNI Networks Commercial |
$156.10
|
| Rate for Payer: One Health Plan PPO/POS |
$200.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$211.85
|
| Rate for Payer: Three Rivers Provider Network All |
$167.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$207.39
|
| Rate for Payer: Zelis Auto |
$89.20
|
| Rate for Payer: Zelis Worker's Compensation |
$60.88
|
|
|
REM SKN TAGS MLT FIBRQ TAGS UPW/15
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
8300065
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$72.07 |
| Max. Negotiated Rate |
$250.80 |
| 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 |
$101.93
|
| 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 |
$72.07
|
|
|
REM SKN TAGS MLT FIBRQ TAGS UPW/15
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
25500023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.07 |
| Max. Negotiated Rate |
$385.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| 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 |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| 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 |
$101.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$211.20
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| 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 |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$72.07
|
|
|
REM SKN TAGS MLT FIBRQ TAGS UPW/15
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
8300065
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$72.07 |
| Max. Negotiated Rate |
$385.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| 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 |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| 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 |
$101.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$211.20
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| 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 |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$72.07
|
|
|
REM SKN TAGS MLT FIBRQ TAGS UPW/15
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
25500023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.07 |
| Max. Negotiated Rate |
$250.80 |
| 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 |
$101.93
|
| 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 |
$72.07
|
|
|
REM SKN TAGS MLT FIBRQ TAGS UPW/15
|
Facility
|
OP
|
$255.21
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
8511200
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$69.67 |
| Max. Negotiated Rate |
$385.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$153.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| Rate for Payer: Cash Price |
$153.13
|
| Rate for Payer: Cash Price |
$153.13
|
| Rate for Payer: Cigna Commercial |
$216.93
|
| Rate for Payer: First Health Commercial |
$229.69
|
| Rate for Payer: First Health Workers Compensation |
$98.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$229.69
|
| Rate for Payer: GEHA Commercial |
$204.17
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$229.69
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$232.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| Rate for Payer: OMNI Networks Commercial |
$178.65
|
| Rate for Payer: One Health Plan PPO/POS |
$229.69
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$242.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$191.41
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$237.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$102.08
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$69.67
|
|
|
REM SKN TAGS MLT FIBRQ TAGS UPW/15
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
20300050
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.07 |
| Max. Negotiated Rate |
$385.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| 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 |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| 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 |
$101.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$237.60
|
| Rate for Payer: GEHA Commercial |
$211.20
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$237.60
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$240.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| 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 |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$250.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$198.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$245.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$105.60
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$72.07
|
|
|
REM SKN TAGS MLT FIBRQ TAGS UPW/15
|
Facility
|
IP
|
$255.21
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
7211200
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$69.67 |
| Max. Negotiated Rate |
$242.45 |
| Rate for Payer: OMNI Networks Commercial |
$178.65
|
| Rate for Payer: One Health Plan PPO/POS |
$229.69
|
| Rate for Payer: Cash Price |
$153.13
|
| Rate for Payer: Cigna Commercial |
$216.93
|
| Rate for Payer: First Health Commercial |
$229.69
|
| Rate for Payer: First Health Workers Compensation |
$98.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$229.69
|
| Rate for Payer: GEHA Commercial |
$178.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$229.69
|
| Rate for Payer: Multiplan All |
$232.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$242.45
|
| Rate for Payer: Three Rivers Provider Network All |
$191.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$237.35
|
| Rate for Payer: Zelis Auto |
$102.08
|
| Rate for Payer: Zelis Worker's Compensation |
$69.67
|
|
|
REM SKN TAGS MLT FIBRQ TAGS UPW/15
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
21600023
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$72.07 |
| Max. Negotiated Rate |
$250.80 |
| 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 |
$101.93
|
| 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 |
$72.07
|
|
