|
SKIN SUB T/A/L <=100 CM 1ST 25CM LC
|
Facility
|
IP
|
$1,471.00
|
|
|
Service Code
|
CPT C5271
|
| Hospital Charge Code |
20399216
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$401.58 |
| Max. Negotiated Rate |
$1,397.45 |
| Rate for Payer: Cash Price |
$882.60
|
| Rate for Payer: Cigna Commercial |
$1,250.35
|
| Rate for Payer: First Health Commercial |
$1,323.90
|
| Rate for Payer: First Health Workers Compensation |
$567.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,323.90
|
| Rate for Payer: GEHA Commercial |
$1,029.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,323.90
|
| Rate for Payer: Multiplan All |
$1,338.61
|
| Rate for Payer: OMNI Networks Commercial |
$1,029.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,323.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,397.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,103.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,368.03
|
| Rate for Payer: Zelis Auto |
$588.40
|
| Rate for Payer: Zelis Worker's Compensation |
$401.58
|
|
|
Skin Sub T/A/L >=100CM EA 100CM LC
|
Facility
|
OP
|
$3,834.00
|
|
|
Service Code
|
CPT C5274
|
| Hospital Charge Code |
1905274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$958.50 |
| Max. Negotiated Rate |
$3,642.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,300.40
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cigna Commercial |
$3,258.90
|
| Rate for Payer: First Health Commercial |
$3,450.60
|
| Rate for Payer: First Health Workers Compensation |
$1,480.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,450.60
|
| Rate for Payer: GEHA Commercial |
$3,067.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,450.60
|
| Rate for Payer: Humana ChoiceCare |
$996.84
|
| Rate for Payer: Multiplan All |
$3,488.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,300.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,683.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,450.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,642.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,875.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,373.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$958.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,565.62
|
| Rate for Payer: Zelis Auto |
$1,533.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,917.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,046.68
|
|
|
Skin Sub T/A/L >=100CM EA 100CM LC
|
Facility
|
IP
|
$3,834.00
|
|
|
Service Code
|
CPT C5274
|
| Hospital Charge Code |
1905274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,046.68 |
| Max. Negotiated Rate |
$3,642.30 |
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cigna Commercial |
$3,258.90
|
| Rate for Payer: First Health Commercial |
$3,450.60
|
| Rate for Payer: First Health Workers Compensation |
$1,480.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,450.60
|
| Rate for Payer: GEHA Commercial |
$2,683.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,450.60
|
| Rate for Payer: Multiplan All |
$3,488.94
|
| Rate for Payer: OMNI Networks Commercial |
$2,683.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,450.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,642.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,875.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,565.62
|
| Rate for Payer: Zelis Auto |
$1,533.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,046.68
|
|
|
Skin Sub T/A/L <=100CM EA 25CM LC
|
Facility
|
IP
|
$2,385.00
|
|
|
Service Code
|
CPT C5272
|
| Hospital Charge Code |
1905272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$651.11 |
| Max. Negotiated Rate |
$2,265.75 |
| Rate for Payer: Cash Price |
$1,431.00
|
| Rate for Payer: Cigna Commercial |
$2,027.25
|
| Rate for Payer: First Health Commercial |
$2,146.50
|
| Rate for Payer: First Health Workers Compensation |
$920.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,146.50
|
| Rate for Payer: GEHA Commercial |
$1,669.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,146.50
|
| Rate for Payer: Multiplan All |
$2,170.35
|
| Rate for Payer: OMNI Networks Commercial |
$1,669.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,146.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,265.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,788.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,218.05
|
| Rate for Payer: Zelis Auto |
$954.00
|
| Rate for Payer: Zelis Worker's Compensation |
$651.11
|
|
|
Skin Sub T/A/L <=100CM EA 25CM LC
|
Facility
|
OP
|
$2,385.00
|
|
|
Service Code
|
CPT C5272
|
| Hospital Charge Code |
1905272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$596.25 |
| Max. Negotiated Rate |
$2,265.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,431.00
|
| Rate for Payer: Cash Price |
$1,431.00
|
| Rate for Payer: Cigna Commercial |
$2,027.25
|
| Rate for Payer: First Health Commercial |
$2,146.50
|
| Rate for Payer: First Health Workers Compensation |
$920.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,146.50
|
| Rate for Payer: GEHA Commercial |
$1,908.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,146.50
|
| Rate for Payer: Humana ChoiceCare |
$620.10
|
| Rate for Payer: Multiplan All |
$2,170.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,431.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,669.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,146.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,265.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,788.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,098.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$596.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,218.05
|
| Rate for Payer: Zelis Auto |
$954.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,192.50
|
| Rate for Payer: Zelis Worker's Compensation |
$651.11
|
|
|
SKIN SUB T/A/L <= 100CM EA 25CM LC
|
Facility
|
OP
|
$1,103.00
|
|
|
Service Code
|
CPT C5272
|
| Hospital Charge Code |
20399217
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$275.75 |
| Max. Negotiated Rate |
$1,047.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$661.80
|
| Rate for Payer: Cash Price |
$661.80
|
| Rate for Payer: Cigna Commercial |
$937.55
|
| Rate for Payer: First Health Commercial |
$992.70
|
| Rate for Payer: First Health Workers Compensation |
$425.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$992.70
|
| Rate for Payer: GEHA Commercial |
$882.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$992.70
|
| Rate for Payer: Humana ChoiceCare |
$286.78
|
| Rate for Payer: Multiplan All |
$1,003.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$661.80
|
| Rate for Payer: OMNI Networks Commercial |
$772.10
|
| Rate for Payer: One Health Plan PPO/POS |
$992.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,047.85
|
| Rate for Payer: Three Rivers Provider Network All |
$827.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$970.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$275.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,025.79
|
| Rate for Payer: Zelis Auto |
$441.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$551.50
|
| Rate for Payer: Zelis Worker's Compensation |
$301.12
|
|
|
SKIN SUB T/A/L <= 100CM EA 25CM LC
|
Facility
|
IP
|
$1,103.00
|
|
|
Service Code
|
CPT C5272
|
| Hospital Charge Code |
20399217
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$301.12 |
| Max. Negotiated Rate |
$1,047.85 |
| Rate for Payer: Cash Price |
$661.80
|
| Rate for Payer: Cigna Commercial |
$937.55
|
| Rate for Payer: First Health Commercial |
$992.70
|
| Rate for Payer: First Health Workers Compensation |
$425.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$992.70
|
| Rate for Payer: GEHA Commercial |
$772.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$992.70
|
| Rate for Payer: Multiplan All |
$1,003.73
|
| Rate for Payer: OMNI Networks Commercial |
$772.10
|
| Rate for Payer: One Health Plan PPO/POS |
$992.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,047.85
|
| Rate for Payer: Three Rivers Provider Network All |
$827.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,025.79
|
| Rate for Payer: Zelis Auto |
$441.20
|
| Rate for Payer: Zelis Worker's Compensation |
$301.12
|
|
|
SKN SPLT A-GRFT F/N/HF/G ADD
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
CPT 15121
|
| Hospital Charge Code |
6115121
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$112.48 |
| Max. Negotiated Rate |
$391.40 |
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cigna Commercial |
$350.20
|
| Rate for Payer: First Health Commercial |
$370.80
|
| Rate for Payer: First Health Workers Compensation |
$159.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$370.80
|
| Rate for Payer: GEHA Commercial |
$288.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$370.80
|
| Rate for Payer: Multiplan All |
$374.92
|
| Rate for Payer: OMNI Networks Commercial |
$288.40
|
| Rate for Payer: One Health Plan PPO/POS |
$370.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$391.40
|
| Rate for Payer: Three Rivers Provider Network All |
$309.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$383.16
|
| Rate for Payer: Zelis Auto |
$164.80
|
| Rate for Payer: Zelis Worker's Compensation |
$112.48
|
|
|
SKN SPLT A-GRFT F/N/HF/G ADD
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
CPT 15121
|
| Hospital Charge Code |
6115121
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$107.12 |
| Max. Negotiated Rate |
$2,419.71 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$247.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cigna Commercial |
$350.20
|
| Rate for Payer: First Health Commercial |
$370.80
|
| Rate for Payer: First Health Workers Compensation |
$159.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$370.80
|
| Rate for Payer: GEHA Commercial |
$329.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$370.80
|
| Rate for Payer: Humana ChoiceCare |
$107.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,955.93
|
| Rate for Payer: Multiplan All |
$374.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$247.20
|
| Rate for Payer: OMNI Networks Commercial |
$288.40
|
| Rate for Payer: One Health Plan PPO/POS |
$370.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$391.40
|
| Rate for Payer: Three Rivers Provider Network All |
$309.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$362.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$383.16
|
| Rate for Payer: Zelis Auto |
$164.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$206.00
|
| Rate for Payer: Zelis Worker's Compensation |
$112.48
|
|
|
SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
21800003
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$110.29 |
| Max. Negotiated Rate |
$383.80 |
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$343.40
|
| Rate for Payer: First Health Commercial |
$363.60
|
| Rate for Payer: First Health Workers Compensation |
$155.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$363.60
|
| Rate for Payer: GEHA Commercial |
$282.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$363.60
|
| Rate for Payer: Multiplan All |
$367.64
|
| Rate for Payer: OMNI Networks Commercial |
$282.80
|
| Rate for Payer: One Health Plan PPO/POS |
$363.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$383.80
|
| Rate for Payer: Three Rivers Provider Network All |
$303.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$375.72
|
| Rate for Payer: Zelis Auto |
$161.60
|
| Rate for Payer: Zelis Worker's Compensation |
$110.29
|
|
|
SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT
|
Facility
|
IP
|
$1,155.00
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
3000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$315.31 |
| Max. Negotiated Rate |
$1,097.25 |
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cigna Commercial |
$981.75
|
| Rate for Payer: First Health Commercial |
$1,039.50
|
| Rate for Payer: First Health Workers Compensation |
$445.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,039.50
|
| Rate for Payer: GEHA Commercial |
$808.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,039.50
|
| Rate for Payer: Multiplan All |
$1,051.05
|
| Rate for Payer: OMNI Networks Commercial |
$808.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,039.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,097.25
|
| Rate for Payer: Three Rivers Provider Network All |
$866.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,074.15
|
| Rate for Payer: Zelis Auto |
$462.00
|
| Rate for Payer: Zelis Worker's Compensation |
$315.31
|
|
|
SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
21800003
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$110.29 |
| Max. Negotiated Rate |
$383.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$243.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$242.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$243.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$192.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$148.57
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$343.40
|
| Rate for Payer: First Health Commercial |
$363.60
|
| Rate for Payer: First Health Workers Compensation |
$155.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$363.60
|
| Rate for Payer: GEHA Commercial |
$323.20
|
| Rate for Payer: GEHA Medicare |
$148.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$363.60
|
| Rate for Payer: Humana ChoiceCare |
$163.43
|
| Rate for Payer: Humana Medicare Advantage |
$148.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$249.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$196.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$148.57
|
| Rate for Payer: Multiplan All |
$367.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.57
|
| Rate for Payer: OMNI Networks Commercial |
$282.80
|
| Rate for Payer: One Health Plan PPO/POS |
$363.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$226.88
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$196.50
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$148.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$383.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$297.14
|
| Rate for Payer: Three Rivers Provider Network All |
$303.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$196.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$375.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$148.57
|
| Rate for Payer: Zelis Auto |
$161.60
|
| Rate for Payer: Zelis Medicare |
$126.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.28
|
| Rate for Payer: Zelis Worker's Compensation |
$110.29
|
|
|
SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT
|
Facility
|
OP
|
$1,155.00
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
3000004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$126.28 |
| Max. Negotiated Rate |
$1,097.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$243.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$693.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$243.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$192.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$148.57
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cigna Commercial |
$981.75
|
| Rate for Payer: First Health Commercial |
$1,039.50
|
| Rate for Payer: First Health Workers Compensation |
$445.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,039.50
|
| Rate for Payer: GEHA Commercial |
$924.00
|
| Rate for Payer: GEHA Medicare |
$148.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,039.50
|
| Rate for Payer: Humana ChoiceCare |
$163.43
|
| Rate for Payer: Humana Medicare Advantage |
$148.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$249.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$196.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$148.57
|
| Rate for Payer: Multiplan All |
$1,051.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.57
|
| Rate for Payer: OMNI Networks Commercial |
$808.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,039.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$226.88
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$196.50
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$148.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,097.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$297.14
|
| Rate for Payer: Three Rivers Provider Network All |
$866.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$196.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,074.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$148.57
|
| Rate for Payer: Zelis Auto |
$462.00
|
| Rate for Payer: Zelis Medicare |
$126.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.28
|
| Rate for Payer: Zelis Worker's Compensation |
$315.31
|
|
|
SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O
|
Facility
|
OP
|
$2,643.00
|
|
|
Service Code
|
CPT 95807
|
| Hospital Charge Code |
3000005
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$428.26 |
| Max. Negotiated Rate |
$2,510.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,155.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,585.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,155.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$915.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$503.83
|
| Rate for Payer: Cash Price |
$1,585.80
|
| Rate for Payer: Cash Price |
$1,585.80
|
| Rate for Payer: Cigna Commercial |
$2,246.55
|
| Rate for Payer: First Health Commercial |
$2,378.70
|
| Rate for Payer: First Health Workers Compensation |
$1,020.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,378.70
|
| Rate for Payer: GEHA Commercial |
$2,114.40
|
| Rate for Payer: GEHA Medicare |
$503.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,378.70
|
| Rate for Payer: Humana ChoiceCare |
$554.21
|
| Rate for Payer: Humana Medicare Advantage |
$503.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$846.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$934.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$503.83
|
| Rate for Payer: Multiplan All |
$2,405.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$856.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,850.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,378.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,078.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$934.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$503.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,510.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,007.66
|
| Rate for Payer: Three Rivers Provider Network All |
$1,982.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$493.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$934.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$503.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,457.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$503.83
|
| Rate for Payer: Zelis Auto |
$1,057.20
|
| Rate for Payer: Zelis Medicare |
$428.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$604.60
|
| Rate for Payer: Zelis Worker's Compensation |
$721.54
|
|
|
SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O
|
Facility
|
OP
|
$1,243.00
|
|
|
Service Code
|
CPT 95807
|
| Hospital Charge Code |
21800004
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$339.34 |
| Max. Negotiated Rate |
$1,180.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,155.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$745.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,155.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$915.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$503.83
|
| Rate for Payer: Cash Price |
$745.80
|
| Rate for Payer: Cash Price |
$745.80
|
| Rate for Payer: Cigna Commercial |
$1,056.55
|
| Rate for Payer: First Health Commercial |
$1,118.70
|
| Rate for Payer: First Health Workers Compensation |
$479.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,118.70
|
| Rate for Payer: GEHA Commercial |
$994.40
|
| Rate for Payer: GEHA Medicare |
$503.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,118.70
|
| Rate for Payer: Humana ChoiceCare |
$554.21
|
| Rate for Payer: Humana Medicare Advantage |
$503.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$846.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$934.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$503.83
|
| Rate for Payer: Multiplan All |
$1,131.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$856.51
|
| Rate for Payer: OMNI Networks Commercial |
$870.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,118.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,078.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$934.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$503.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,180.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,007.66
|
| Rate for Payer: Three Rivers Provider Network All |
$932.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$493.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$934.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$503.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,155.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$503.83
|
| Rate for Payer: Zelis Auto |
$497.20
|
| Rate for Payer: Zelis Medicare |
$428.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$604.60
|
| Rate for Payer: Zelis Worker's Compensation |
$339.34
|
|
|
SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O
|
Facility
|
IP
|
$2,643.00
|
|
|
Service Code
|
CPT 95807
|
| Hospital Charge Code |
3000005
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$721.54 |
| Max. Negotiated Rate |
$2,510.85 |
| Rate for Payer: Cash Price |
$1,585.80
|
| Rate for Payer: Cigna Commercial |
$2,246.55
|
| Rate for Payer: First Health Commercial |
$2,378.70
|
| Rate for Payer: First Health Workers Compensation |
$1,020.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,378.70
|
| Rate for Payer: GEHA Commercial |
$1,850.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,378.70
|
| Rate for Payer: Multiplan All |
$2,405.13
|
| Rate for Payer: OMNI Networks Commercial |
$1,850.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,378.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,510.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,982.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,457.99
|
| Rate for Payer: Zelis Auto |
$1,057.20
|
| Rate for Payer: Zelis Worker's Compensation |
$721.54
|
|
|
SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O
|
Facility
|
IP
|
$1,243.00
|
|
|
Service Code
|
CPT 95807
|
| Hospital Charge Code |
21800004
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$339.34 |
| Max. Negotiated Rate |
$1,180.85 |
| Rate for Payer: Cash Price |
$745.80
|
| Rate for Payer: Cigna Commercial |
$1,056.55
|
| Rate for Payer: First Health Commercial |
$1,118.70
|
| Rate for Payer: First Health Workers Compensation |
$479.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,118.70
|
| Rate for Payer: GEHA Commercial |
$870.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,118.70
|
| Rate for Payer: Multiplan All |
$1,131.13
|
| Rate for Payer: OMNI Networks Commercial |
$870.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,118.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,180.85
|
| Rate for Payer: Three Rivers Provider Network All |
$932.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,155.99
|
| Rate for Payer: Zelis Auto |
$497.20
|
| Rate for Payer: Zelis Worker's Compensation |
$339.34
|
|
|
SLEEP STUDY <6 YEARS WITH 4 OR MORE PARA
|
Facility
|
OP
|
$2,898.15
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
3095782
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$791.19 |
| Max. Negotiated Rate |
$2,753.24 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,142.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,738.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,142.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$905.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$966.05
|
| Rate for Payer: Cash Price |
$1,738.89
|
| Rate for Payer: Cash Price |
$1,738.89
|
| Rate for Payer: Cigna Commercial |
$2,463.43
|
| Rate for Payer: First Health Commercial |
$2,608.34
|
| Rate for Payer: First Health Workers Compensation |
$1,118.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,608.34
|
| Rate for Payer: GEHA Commercial |
$2,318.52
|
| Rate for Payer: GEHA Medicare |
$966.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,608.34
|
| Rate for Payer: Humana ChoiceCare |
$1,062.65
|
| Rate for Payer: Humana Medicare Advantage |
$966.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,622.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$923.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$966.05
|
| Rate for Payer: Multiplan All |
$2,637.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,642.29
|
| Rate for Payer: OMNI Networks Commercial |
$2,028.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,608.34
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,066.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$923.88
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$966.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,753.24
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,932.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,173.61
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$946.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$923.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$966.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,695.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$966.05
|
| Rate for Payer: Zelis Auto |
$1,159.26
|
| Rate for Payer: Zelis Medicare |
$821.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,159.26
|
| Rate for Payer: Zelis Worker's Compensation |
$791.19
|
|
|
SLEEP STUDY <6 YEARS WITH 4 OR MORE PARA
|
Facility
|
IP
|
$2,898.15
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
3095782
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$791.19 |
| Max. Negotiated Rate |
$2,753.24 |
| Rate for Payer: Cash Price |
$1,738.89
|
| Rate for Payer: Cigna Commercial |
$2,463.43
|
| Rate for Payer: First Health Commercial |
$2,608.34
|
| Rate for Payer: First Health Workers Compensation |
$1,118.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,608.34
|
| Rate for Payer: GEHA Commercial |
$2,028.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,608.34
|
| Rate for Payer: Multiplan All |
$2,637.32
|
| Rate for Payer: OMNI Networks Commercial |
$2,028.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,608.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,753.24
|
| Rate for Payer: Three Rivers Provider Network All |
$2,173.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,695.28
|
| Rate for Payer: Zelis Auto |
$1,159.26
|
| Rate for Payer: Zelis Worker's Compensation |
$791.19
|
|
|
SLEEP STUDY <6 YEARS WITH INITIATION OF
|
Facility
|
IP
|
$2,898.15
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
3095783
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$791.19 |
| Max. Negotiated Rate |
$2,753.24 |
| Rate for Payer: Cash Price |
$1,738.89
|
| Rate for Payer: Cigna Commercial |
$2,463.43
|
| Rate for Payer: First Health Commercial |
$2,608.34
|
| Rate for Payer: First Health Workers Compensation |
$1,118.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,608.34
|
| Rate for Payer: GEHA Commercial |
$2,028.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,608.34
|
| Rate for Payer: Multiplan All |
$2,637.32
|
| Rate for Payer: OMNI Networks Commercial |
$2,028.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,608.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,753.24
|
| Rate for Payer: Three Rivers Provider Network All |
$2,173.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,695.28
|
| Rate for Payer: Zelis Auto |
$1,159.26
|
| Rate for Payer: Zelis Worker's Compensation |
$791.19
|
|
|
SLEEP STUDY <6 YEARS WITH INITIATION OF
|
Facility
|
OP
|
$2,898.15
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
3095783
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$791.19 |
| Max. Negotiated Rate |
$2,753.24 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,142.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,738.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,142.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$905.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$966.05
|
| Rate for Payer: Cash Price |
$1,738.89
|
| Rate for Payer: Cash Price |
$1,738.89
|
| Rate for Payer: Cigna Commercial |
$2,463.43
|
| Rate for Payer: First Health Commercial |
$2,608.34
|
| Rate for Payer: First Health Workers Compensation |
$1,118.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,608.34
|
| Rate for Payer: GEHA Commercial |
$2,318.52
|
| Rate for Payer: GEHA Medicare |
$966.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,608.34
|
| Rate for Payer: Humana ChoiceCare |
$1,062.65
|
| Rate for Payer: Humana Medicare Advantage |
$966.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,622.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$923.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$966.05
|
| Rate for Payer: Multiplan All |
$2,637.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,642.29
|
| Rate for Payer: OMNI Networks Commercial |
$2,028.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,608.34
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,066.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$923.88
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$966.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,753.24
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,932.10
|
| Rate for Payer: Three Rivers Provider Network All |
$2,173.61
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$946.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$923.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$966.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,695.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$966.05
|
| Rate for Payer: Zelis Auto |
$1,159.26
|
| Rate for Payer: Zelis Medicare |
$821.14
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,159.26
|
| Rate for Payer: Zelis Worker's Compensation |
$791.19
|
|
|
SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)
|
Facility
|
OP
|
$9,374.72
|
|
|
Service Code
|
CPT 57288
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,603.59 |
| Max. Negotiated Rate |
$9,374.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,548.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,548.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,603.59
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,687.36
|
| Rate for Payer: First Health Workers Compensation |
$6,032.63
|
| Rate for Payer: GEHA Medicare |
$4,687.36
|
| Rate for Payer: Humana ChoiceCare |
$5,156.10
|
| Rate for Payer: Humana Medicare Advantage |
$4,687.36
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7,874.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,676.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,687.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7,968.51
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,245.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,676.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,687.36
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,374.72
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,593.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,676.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,687.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,687.36
|
| Rate for Payer: Zelis Medicare |
$3,984.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,624.83
|
| Rate for Payer: Zelis Worker's Compensation |
$4,265.50
|
|
|
SLINGS
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
8504565
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$13.60
|
| Rate for Payer: First Health Commercial |
$14.40
|
| Rate for Payer: First Health Workers Compensation |
$6.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14.40
|
| Rate for Payer: GEHA Commercial |
$11.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14.40
|
| Rate for Payer: Multiplan All |
$14.56
|
| Rate for Payer: OMNI Networks Commercial |
$11.20
|
| Rate for Payer: One Health Plan PPO/POS |
$14.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15.20
|
| Rate for Payer: Three Rivers Provider Network All |
$12.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14.88
|
| Rate for Payer: Zelis Auto |
$6.40
|
| Rate for Payer: Zelis Worker's Compensation |
$4.37
|
|
|
SLINGS
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
8504565
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$13.60
|
| Rate for Payer: First Health Commercial |
$14.40
|
| Rate for Payer: First Health Workers Compensation |
$6.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14.40
|
| Rate for Payer: GEHA Commercial |
$12.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14.40
|
| Rate for Payer: Humana ChoiceCare |
$4.16
|
| Rate for Payer: Multiplan All |
$14.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.60
|
| Rate for Payer: OMNI Networks Commercial |
$11.20
|
| Rate for Payer: One Health Plan PPO/POS |
$14.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15.20
|
| Rate for Payer: Three Rivers Provider Network All |
$12.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14.88
|
| Rate for Payer: Zelis Auto |
$6.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.37
|
|
|
SLINGS
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
7204565
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$13.60
|
| Rate for Payer: First Health Commercial |
$14.40
|
| Rate for Payer: First Health Workers Compensation |
$6.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14.40
|
| Rate for Payer: GEHA Commercial |
$11.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14.40
|
| Rate for Payer: Multiplan All |
$14.56
|
| Rate for Payer: OMNI Networks Commercial |
$11.20
|
| Rate for Payer: One Health Plan PPO/POS |
$14.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15.20
|
| Rate for Payer: Three Rivers Provider Network All |
$12.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14.88
|
| Rate for Payer: Zelis Auto |
$6.40
|
| Rate for Payer: Zelis Worker's Compensation |
$4.37
|
|
