|
SBSQ NURSNG FACILITY CARE MOD MDM 25 MIN
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
CPT 99309
|
| Hospital Charge Code |
9699309
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.75 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$237.15
|
| Rate for Payer: First Health Commercial |
$251.10
|
| Rate for Payer: First Health Workers Compensation |
$107.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$251.10
|
| Rate for Payer: GEHA Commercial |
$223.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$251.10
|
| Rate for Payer: Humana ChoiceCare |
$72.54
|
| Rate for Payer: Multiplan All |
$253.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$167.40
|
| Rate for Payer: OMNI Networks Commercial |
$195.30
|
| Rate for Payer: One Health Plan PPO/POS |
$251.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$265.05
|
| Rate for Payer: Three Rivers Provider Network All |
$209.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$245.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$69.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$259.47
|
| Rate for Payer: Zelis Auto |
$111.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$139.50
|
| Rate for Payer: Zelis Worker's Compensation |
$76.17
|
|
|
SBSQ NURSNG FACILITY CARE MOD MDM 25 MIN
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 99309
|
| Hospital Charge Code |
8599309
|
|
Hospital Revenue Code
|
524
|
| Min. Negotiated Rate |
$69.50 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$236.30
|
| Rate for Payer: First Health Commercial |
$250.20
|
| Rate for Payer: First Health Workers Compensation |
$107.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$250.20
|
| Rate for Payer: GEHA Commercial |
$222.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$250.20
|
| Rate for Payer: Humana ChoiceCare |
$72.28
|
| Rate for Payer: Multiplan All |
$252.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$166.80
|
| Rate for Payer: OMNI Networks Commercial |
$194.60
|
| Rate for Payer: One Health Plan PPO/POS |
$250.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$264.10
|
| Rate for Payer: Three Rivers Provider Network All |
$208.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$244.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$69.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$258.54
|
| Rate for Payer: Zelis Auto |
$111.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$139.00
|
| Rate for Payer: Zelis Worker's Compensation |
$75.89
|
|
|
SBSQ NURSNG FACILITY CARE MOD MDM 25 MIN
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 99309
|
| Hospital Charge Code |
8599309
|
|
Hospital Revenue Code
|
524
|
| Min. Negotiated Rate |
$75.89 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$236.30
|
| Rate for Payer: First Health Commercial |
$250.20
|
| Rate for Payer: First Health Workers Compensation |
$107.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$250.20
|
| Rate for Payer: GEHA Commercial |
$194.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$250.20
|
| Rate for Payer: Multiplan All |
$252.98
|
| Rate for Payer: OMNI Networks Commercial |
$194.60
|
| Rate for Payer: One Health Plan PPO/POS |
$250.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$264.10
|
| Rate for Payer: Three Rivers Provider Network All |
$208.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$258.54
|
| Rate for Payer: Zelis Auto |
$111.20
|
| Rate for Payer: Zelis Worker's Compensation |
$75.89
|
|
|
SBSQ NURSNG FACILITY CARE MOD MDM 25 MIN
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 99309
|
| Hospital Charge Code |
8799309
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.17 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$237.15
|
| Rate for Payer: First Health Commercial |
$251.10
|
| Rate for Payer: First Health Workers Compensation |
$107.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$251.10
|
| Rate for Payer: GEHA Commercial |
$195.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$251.10
|
| Rate for Payer: Multiplan All |
$253.89
|
| Rate for Payer: OMNI Networks Commercial |
$195.30
|
| Rate for Payer: One Health Plan PPO/POS |
$251.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$265.05
|
| Rate for Payer: Three Rivers Provider Network All |
$209.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$259.47
|
| Rate for Payer: Zelis Auto |
$111.60
|
| Rate for Payer: Zelis Worker's Compensation |
$76.17
|
|
|
SBSQ OBSERVATION CARE/DAY 15 MINUTES
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 99224
|
| Hospital Charge Code |
21799478
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$76.50
|
| Rate for Payer: First Health Commercial |
$81.00
|
| Rate for Payer: First Health Workers Compensation |
$34.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.00
|
| Rate for Payer: GEHA Commercial |
$72.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.00
|
| Rate for Payer: Humana ChoiceCare |
$23.40
|
| Rate for Payer: Multiplan All |
$81.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$54.00
|
| Rate for Payer: OMNI Networks Commercial |
$63.00
|
| Rate for Payer: One Health Plan PPO/POS |
$81.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$85.50
|
| Rate for Payer: Three Rivers Provider Network All |
$67.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$79.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$22.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$83.70
|
| Rate for Payer: Zelis Auto |
$36.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$45.00
|
| Rate for Payer: Zelis Worker's Compensation |
$24.57
|
|
|
SBSQ OBSERVATION CARE/DAY 15 MINUTES
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 99224
|
| Hospital Charge Code |
21999409
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$76.50
|
| Rate for Payer: First Health Commercial |
$81.00
|
| Rate for Payer: First Health Workers Compensation |
$34.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.00
|
| Rate for Payer: GEHA Commercial |
$72.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.00
|
| Rate for Payer: Humana ChoiceCare |
$23.40
|
| Rate for Payer: Multiplan All |
$81.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$54.00
|
| Rate for Payer: OMNI Networks Commercial |
$63.00
|
| Rate for Payer: One Health Plan PPO/POS |
$81.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$85.50
|
| Rate for Payer: Three Rivers Provider Network All |
$67.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$79.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$22.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$83.70
|
| Rate for Payer: Zelis Auto |
$36.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$45.00
|
| Rate for Payer: Zelis Worker's Compensation |
$24.57
|
|
|
SBSQ OBSERVATION CARE/DAY 15 MINUTES
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 99224
|
| Hospital Charge Code |
21799478
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$76.50
|
| Rate for Payer: First Health Commercial |
$81.00
|
| Rate for Payer: First Health Workers Compensation |
$34.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.00
|
| Rate for Payer: GEHA Commercial |
$63.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.00
|
| Rate for Payer: Multiplan All |
$81.90
|
| Rate for Payer: OMNI Networks Commercial |
$63.00
|
| Rate for Payer: One Health Plan PPO/POS |
$81.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$85.50
|
| Rate for Payer: Three Rivers Provider Network All |
$67.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$83.70
|
| Rate for Payer: Zelis Auto |
$36.00
|
| Rate for Payer: Zelis Worker's Compensation |
$24.57
|
|
|
SBSQ OBSERVATION CARE/DAY 15 MINUTES
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 99224
|
| Hospital Charge Code |
8299224
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$76.50
|
| Rate for Payer: First Health Commercial |
$81.00
|
| Rate for Payer: First Health Workers Compensation |
$34.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.00
|
| Rate for Payer: GEHA Commercial |
$63.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.00
|
| Rate for Payer: Multiplan All |
$81.90
|
| Rate for Payer: OMNI Networks Commercial |
$63.00
|
| Rate for Payer: One Health Plan PPO/POS |
$81.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$85.50
|
| Rate for Payer: Three Rivers Provider Network All |
$67.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$83.70
|
| Rate for Payer: Zelis Auto |
$36.00
|
| Rate for Payer: Zelis Worker's Compensation |
$24.57
|
|
|
SBSQ OBSERVATION CARE/DAY 15 MINUTES
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 99224
|
| Hospital Charge Code |
8299224
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$76.50
|
| Rate for Payer: First Health Commercial |
$81.00
|
| Rate for Payer: First Health Workers Compensation |
$34.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.00
|
| Rate for Payer: GEHA Commercial |
$72.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.00
|
| Rate for Payer: Humana ChoiceCare |
$23.40
|
| Rate for Payer: Multiplan All |
$81.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$54.00
|
| Rate for Payer: OMNI Networks Commercial |
$63.00
|
| Rate for Payer: One Health Plan PPO/POS |
$81.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$85.50
|
| Rate for Payer: Three Rivers Provider Network All |
$67.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$79.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$22.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$83.70
|
| Rate for Payer: Zelis Auto |
$36.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$45.00
|
| Rate for Payer: Zelis Worker's Compensation |
$24.57
|
|
|
SBSQ OBSERVATION CARE/DAY 15 MINUTES
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 99224
|
| Hospital Charge Code |
21999409
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$76.50
|
| Rate for Payer: First Health Commercial |
$81.00
|
| Rate for Payer: First Health Workers Compensation |
$34.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.00
|
| Rate for Payer: GEHA Commercial |
$63.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.00
|
| Rate for Payer: Multiplan All |
$81.90
|
| Rate for Payer: OMNI Networks Commercial |
$63.00
|
| Rate for Payer: One Health Plan PPO/POS |
$81.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$85.50
|
| Rate for Payer: Three Rivers Provider Network All |
$67.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$83.70
|
| Rate for Payer: Zelis Auto |
$36.00
|
| Rate for Payer: Zelis Worker's Compensation |
$24.57
|
|
|
SBSQ OBSERVATION CARE/DAY 25 MINUTES
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 99225
|
| Hospital Charge Code |
21999410
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$69.50 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$236.30
|
| Rate for Payer: First Health Commercial |
$250.20
|
| Rate for Payer: First Health Workers Compensation |
$107.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$250.20
|
| Rate for Payer: GEHA Commercial |
$222.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$250.20
|
| Rate for Payer: Humana ChoiceCare |
$72.28
|
| Rate for Payer: Multiplan All |
$252.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$166.80
|
| Rate for Payer: OMNI Networks Commercial |
$194.60
|
| Rate for Payer: One Health Plan PPO/POS |
$250.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$264.10
|
| Rate for Payer: Three Rivers Provider Network All |
$208.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$244.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$69.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$258.54
|
| Rate for Payer: Zelis Auto |
$111.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$139.00
|
| Rate for Payer: Zelis Worker's Compensation |
$75.89
|
|
|
SBSQ OBSERVATION CARE/DAY 25 MINUTES
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 99225
|
| Hospital Charge Code |
21999410
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$75.89 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$236.30
|
| Rate for Payer: First Health Commercial |
$250.20
|
| Rate for Payer: First Health Workers Compensation |
$107.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$250.20
|
| Rate for Payer: GEHA Commercial |
$194.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$250.20
|
| Rate for Payer: Multiplan All |
$252.98
|
| Rate for Payer: OMNI Networks Commercial |
$194.60
|
| Rate for Payer: One Health Plan PPO/POS |
$250.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$264.10
|
| Rate for Payer: Three Rivers Provider Network All |
$208.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$258.54
|
| Rate for Payer: Zelis Auto |
$111.20
|
| Rate for Payer: Zelis Worker's Compensation |
$75.89
|
|
|
SBSQ OBSERVATION CARE/DAY 25 MINUTES
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 99225
|
| Hospital Charge Code |
21799479
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$75.89 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$236.30
|
| Rate for Payer: First Health Commercial |
$250.20
|
| Rate for Payer: First Health Workers Compensation |
$107.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$250.20
|
| Rate for Payer: GEHA Commercial |
$194.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$250.20
|
| Rate for Payer: Multiplan All |
$252.98
|
| Rate for Payer: OMNI Networks Commercial |
$194.60
|
| Rate for Payer: One Health Plan PPO/POS |
$250.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$264.10
|
| Rate for Payer: Three Rivers Provider Network All |
$208.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$258.54
|
| Rate for Payer: Zelis Auto |
$111.20
|
| Rate for Payer: Zelis Worker's Compensation |
$75.89
|
|
|
SBSQ OBSERVATION CARE/DAY 25 MINUTES
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 99225
|
| Hospital Charge Code |
21799479
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$69.50 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$236.30
|
| Rate for Payer: First Health Commercial |
$250.20
|
| Rate for Payer: First Health Workers Compensation |
$107.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$250.20
|
| Rate for Payer: GEHA Commercial |
$222.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$250.20
|
| Rate for Payer: Humana ChoiceCare |
$72.28
|
| Rate for Payer: Multiplan All |
$252.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$166.80
|
| Rate for Payer: OMNI Networks Commercial |
$194.60
|
| Rate for Payer: One Health Plan PPO/POS |
$250.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$264.10
|
| Rate for Payer: Three Rivers Provider Network All |
$208.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$244.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$69.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$258.54
|
| Rate for Payer: Zelis Auto |
$111.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$139.00
|
| Rate for Payer: Zelis Worker's Compensation |
$75.89
|
|
|
SBSQ OBSERVATION CARE/DAY 25 MINUTES
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 99225
|
| Hospital Charge Code |
8299225
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$69.50 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$236.30
|
| Rate for Payer: First Health Commercial |
$250.20
|
| Rate for Payer: First Health Workers Compensation |
$107.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$250.20
|
| Rate for Payer: GEHA Commercial |
$222.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$250.20
|
| Rate for Payer: Humana ChoiceCare |
$72.28
|
| Rate for Payer: Multiplan All |
$252.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$166.80
|
| Rate for Payer: OMNI Networks Commercial |
$194.60
|
| Rate for Payer: One Health Plan PPO/POS |
$250.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$264.10
|
| Rate for Payer: Three Rivers Provider Network All |
$208.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$244.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$69.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$258.54
|
| Rate for Payer: Zelis Auto |
$111.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$139.00
|
| Rate for Payer: Zelis Worker's Compensation |
$75.89
|
|
|
SBSQ OBSERVATION CARE/DAY 25 MINUTES
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 99225
|
| Hospital Charge Code |
8299225
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$75.89 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$236.30
|
| Rate for Payer: First Health Commercial |
$250.20
|
| Rate for Payer: First Health Workers Compensation |
$107.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$250.20
|
| Rate for Payer: GEHA Commercial |
$194.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$250.20
|
| Rate for Payer: Multiplan All |
$252.98
|
| Rate for Payer: OMNI Networks Commercial |
$194.60
|
| Rate for Payer: One Health Plan PPO/POS |
$250.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$264.10
|
| Rate for Payer: Three Rivers Provider Network All |
$208.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$258.54
|
| Rate for Payer: Zelis Auto |
$111.20
|
| Rate for Payer: Zelis Worker's Compensation |
$75.89
|
|
|
SBSQ OBSERVATION CARE/DAY 35 MINUTES
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 99226
|
| Hospital Charge Code |
21999411
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$63.25 |
| Max. Negotiated Rate |
$240.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$215.05
|
| Rate for Payer: First Health Commercial |
$227.70
|
| Rate for Payer: First Health Workers Compensation |
$97.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$227.70
|
| Rate for Payer: GEHA Commercial |
$202.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$227.70
|
| Rate for Payer: Humana ChoiceCare |
$65.78
|
| Rate for Payer: Multiplan All |
$230.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$151.80
|
| Rate for Payer: OMNI Networks Commercial |
$177.10
|
| Rate for Payer: One Health Plan PPO/POS |
$227.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$240.35
|
| Rate for Payer: Three Rivers Provider Network All |
$189.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$222.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$235.29
|
| Rate for Payer: Zelis Auto |
$101.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$126.50
|
| Rate for Payer: Zelis Worker's Compensation |
$69.07
|
|
|
SBSQ OBSERVATION CARE/DAY 35 MINUTES
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT 99226
|
| Hospital Charge Code |
21799480
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$69.07 |
| Max. Negotiated Rate |
$240.35 |
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$215.05
|
| Rate for Payer: First Health Commercial |
$227.70
|
| Rate for Payer: First Health Workers Compensation |
$97.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$227.70
|
| Rate for Payer: GEHA Commercial |
$177.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$227.70
|
| Rate for Payer: Multiplan All |
$230.23
|
| Rate for Payer: OMNI Networks Commercial |
$177.10
|
| Rate for Payer: One Health Plan PPO/POS |
$227.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$240.35
|
| Rate for Payer: Three Rivers Provider Network All |
$189.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$235.29
|
| Rate for Payer: Zelis Auto |
$101.20
|
| Rate for Payer: Zelis Worker's Compensation |
$69.07
|
|
|
SBSQ OBSERVATION CARE/DAY 35 MINUTES
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT 99226
|
| Hospital Charge Code |
8299226
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$69.07 |
| Max. Negotiated Rate |
$240.35 |
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$215.05
|
| Rate for Payer: First Health Commercial |
$227.70
|
| Rate for Payer: First Health Workers Compensation |
$97.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$227.70
|
| Rate for Payer: GEHA Commercial |
$177.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$227.70
|
| Rate for Payer: Multiplan All |
$230.23
|
| Rate for Payer: OMNI Networks Commercial |
$177.10
|
| Rate for Payer: One Health Plan PPO/POS |
$227.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$240.35
|
| Rate for Payer: Three Rivers Provider Network All |
$189.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$235.29
|
| Rate for Payer: Zelis Auto |
$101.20
|
| Rate for Payer: Zelis Worker's Compensation |
$69.07
|
|
|
SBSQ OBSERVATION CARE/DAY 35 MINUTES
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 99226
|
| Hospital Charge Code |
8299226
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$63.25 |
| Max. Negotiated Rate |
$240.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$215.05
|
| Rate for Payer: First Health Commercial |
$227.70
|
| Rate for Payer: First Health Workers Compensation |
$97.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$227.70
|
| Rate for Payer: GEHA Commercial |
$202.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$227.70
|
| Rate for Payer: Humana ChoiceCare |
$65.78
|
| Rate for Payer: Multiplan All |
$230.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$151.80
|
| Rate for Payer: OMNI Networks Commercial |
$177.10
|
| Rate for Payer: One Health Plan PPO/POS |
$227.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$240.35
|
| Rate for Payer: Three Rivers Provider Network All |
$189.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$222.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$235.29
|
| Rate for Payer: Zelis Auto |
$101.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$126.50
|
| Rate for Payer: Zelis Worker's Compensation |
$69.07
|
|
|
SBSQ OBSERVATION CARE/DAY 35 MINUTES
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT 99226
|
| Hospital Charge Code |
21999411
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$69.07 |
| Max. Negotiated Rate |
$240.35 |
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$215.05
|
| Rate for Payer: First Health Commercial |
$227.70
|
| Rate for Payer: First Health Workers Compensation |
$97.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$227.70
|
| Rate for Payer: GEHA Commercial |
$177.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$227.70
|
| Rate for Payer: Multiplan All |
$230.23
|
| Rate for Payer: OMNI Networks Commercial |
$177.10
|
| Rate for Payer: One Health Plan PPO/POS |
$227.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$240.35
|
| Rate for Payer: Three Rivers Provider Network All |
$189.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$235.29
|
| Rate for Payer: Zelis Auto |
$101.20
|
| Rate for Payer: Zelis Worker's Compensation |
$69.07
|
|
|
SBSQ OBSERVATION CARE/DAY 35 MINUTES
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 99226
|
| Hospital Charge Code |
21799480
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$63.25 |
| Max. Negotiated Rate |
$240.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$215.05
|
| Rate for Payer: First Health Commercial |
$227.70
|
| Rate for Payer: First Health Workers Compensation |
$97.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$227.70
|
| Rate for Payer: GEHA Commercial |
$202.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$227.70
|
| Rate for Payer: Humana ChoiceCare |
$65.78
|
| Rate for Payer: Multiplan All |
$230.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$151.80
|
| Rate for Payer: OMNI Networks Commercial |
$177.10
|
| Rate for Payer: One Health Plan PPO/POS |
$227.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$240.35
|
| Rate for Payer: Three Rivers Provider Network All |
$189.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$222.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$235.29
|
| Rate for Payer: Zelis Auto |
$101.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$126.50
|
| Rate for Payer: Zelis Worker's Compensation |
$69.07
|
|
|
scallop IgE REF602478
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299636
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
scallop IgE REF602478
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299636
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
SCAN PROC CRANIAL EXTRA
|
Facility
|
OP
|
$553.00
|
|
|
Service Code
|
CPT 61782
|
| Hospital Charge Code |
6161782
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$138.25 |
| Max. Negotiated Rate |
$525.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$331.80
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cigna Commercial |
$470.05
|
| Rate for Payer: First Health Commercial |
$497.70
|
| Rate for Payer: First Health Workers Compensation |
$213.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$497.70
|
| Rate for Payer: GEHA Commercial |
$442.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$497.70
|
| Rate for Payer: Humana ChoiceCare |
$143.78
|
| Rate for Payer: Multiplan All |
$503.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$331.80
|
| Rate for Payer: OMNI Networks Commercial |
$387.10
|
| Rate for Payer: One Health Plan PPO/POS |
$497.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$525.35
|
| Rate for Payer: Three Rivers Provider Network All |
$414.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$486.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$138.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$514.29
|
| Rate for Payer: Zelis Auto |
$221.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$276.50
|
| Rate for Payer: Zelis Worker's Compensation |
$150.97
|
|
