|
BOOT TCC-EZ CAST LARGE
|
Facility
|
OP
|
$549.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
7003332
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$149.88 |
| Max. Negotiated Rate |
$521.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$329.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$187.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$252.18
|
| Rate for Payer: Cash Price |
$329.40
|
| Rate for Payer: Cash Price |
$329.40
|
| Rate for Payer: Cigna Commercial |
$466.65
|
| Rate for Payer: First Health Commercial |
$494.10
|
| Rate for Payer: First Health Workers Compensation |
$211.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$494.10
|
| Rate for Payer: GEHA Commercial |
$439.20
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$494.10
|
| Rate for Payer: Humana ChoiceCare |
$277.40
|
| Rate for Payer: Humana Medicare Advantage |
$252.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$423.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$191.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$252.18
|
| Rate for Payer: Multiplan All |
$499.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$384.30
|
| Rate for Payer: One Health Plan PPO/POS |
$494.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$221.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$191.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$252.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$521.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$411.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$247.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$191.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$510.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$219.60
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$149.88
|
|
|
BOOT TCC-EZ CAST LARGE
|
Facility
|
IP
|
$549.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
7003332
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$149.88 |
| Max. Negotiated Rate |
$521.55 |
| Rate for Payer: Cash Price |
$329.40
|
| Rate for Payer: Cigna Commercial |
$466.65
|
| Rate for Payer: First Health Commercial |
$494.10
|
| Rate for Payer: First Health Workers Compensation |
$211.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$494.10
|
| Rate for Payer: GEHA Commercial |
$384.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$494.10
|
| Rate for Payer: Multiplan All |
$499.59
|
| Rate for Payer: OMNI Networks Commercial |
$384.30
|
| Rate for Payer: One Health Plan PPO/POS |
$494.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$521.55
|
| Rate for Payer: Three Rivers Provider Network All |
$411.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$510.57
|
| Rate for Payer: Zelis Auto |
$219.60
|
| Rate for Payer: Zelis Worker's Compensation |
$149.88
|
|
|
BOOT TCC-EZ CAST REGULAR
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
7003331
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$132.41 |
| Max. Negotiated Rate |
$460.75 |
| Rate for Payer: Cash Price |
$291.00
|
| Rate for Payer: Cigna Commercial |
$412.25
|
| Rate for Payer: First Health Commercial |
$436.50
|
| Rate for Payer: First Health Workers Compensation |
$187.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$436.50
|
| Rate for Payer: GEHA Commercial |
$339.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$436.50
|
| Rate for Payer: Multiplan All |
$441.35
|
| Rate for Payer: OMNI Networks Commercial |
$339.50
|
| Rate for Payer: One Health Plan PPO/POS |
$436.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$460.75
|
| Rate for Payer: Three Rivers Provider Network All |
$363.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$451.05
|
| Rate for Payer: Zelis Auto |
$194.00
|
| Rate for Payer: Zelis Worker's Compensation |
$132.41
|
|
|
BOOT TCC-EZ CAST REGULAR
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
7003331
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$132.41 |
| Max. Negotiated Rate |
$504.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$291.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$237.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$187.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$252.18
|
| Rate for Payer: Cash Price |
$291.00
|
| Rate for Payer: Cash Price |
$291.00
|
| Rate for Payer: Cigna Commercial |
$412.25
|
| Rate for Payer: First Health Commercial |
$436.50
|
| Rate for Payer: First Health Workers Compensation |
$187.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$436.50
|
| Rate for Payer: GEHA Commercial |
$388.00
|
| Rate for Payer: GEHA Medicare |
$252.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$436.50
|
| Rate for Payer: Humana ChoiceCare |
$277.40
|
| Rate for Payer: Humana Medicare Advantage |
$252.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$423.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$191.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$252.18
|
| Rate for Payer: Multiplan All |
$441.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$428.71
|
| Rate for Payer: OMNI Networks Commercial |
$339.50
|
| Rate for Payer: One Health Plan PPO/POS |
$436.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$221.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$191.71
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$252.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$460.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$504.36
|
| Rate for Payer: Three Rivers Provider Network All |
$363.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$247.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$191.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$451.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$252.18
|
| Rate for Payer: Zelis Auto |
$194.00
|
| Rate for Payer: Zelis Medicare |
$214.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$302.62
|
| Rate for Payer: Zelis Worker's Compensation |
$132.41
|
|
|
BORIC ACID POWDER
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 00395030396
|
| Hospital Charge Code |
3300110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$6.80
|
| Rate for Payer: First Health Commercial |
$7.20
|
| Rate for Payer: First Health Workers Compensation |
$3.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7.20
|
| Rate for Payer: GEHA Commercial |
$5.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7.20
|
| Rate for Payer: Multiplan All |
$7.28
|
| Rate for Payer: OMNI Networks Commercial |
$5.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7.44
|
| Rate for Payer: Zelis Auto |
$3.20
|
| Rate for Payer: Zelis Worker's Compensation |
$2.18
|
|
|
BORIC ACID POWDER
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 00395030396
|
| Hospital Charge Code |
3300110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$6.80
|
| Rate for Payer: First Health Commercial |
$7.20
|
| Rate for Payer: First Health Workers Compensation |
$3.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$7.20
|
| Rate for Payer: GEHA Commercial |
$6.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$7.20
|
| Rate for Payer: Humana ChoiceCare |
$2.08
|
| Rate for Payer: Multiplan All |
$7.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$4.80
|
| Rate for Payer: OMNI Networks Commercial |
$5.60
|
| Rate for Payer: One Health Plan PPO/POS |
$7.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$6.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7.44
|
| Rate for Payer: Zelis Auto |
$3.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.18
|
|
|
BOWEL TO BOWEL FUSION
|
Facility
|
OP
|
$2,764.00
|
|
|
Service Code
|
CPT 44130
|
| Hospital Charge Code |
6144130
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$691.00 |
| Max. Negotiated Rate |
$2,625.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,658.40
|
| Rate for Payer: Cash Price |
$1,658.40
|
| Rate for Payer: Cigna Commercial |
$2,349.40
|
| Rate for Payer: First Health Commercial |
$2,487.60
|
| Rate for Payer: First Health Workers Compensation |
$1,067.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,487.60
|
| Rate for Payer: GEHA Commercial |
$2,211.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,487.60
|
| Rate for Payer: Humana ChoiceCare |
$718.64
|
| Rate for Payer: Multiplan All |
$2,515.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,658.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,934.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,487.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,625.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,073.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,432.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$691.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,570.52
|
| Rate for Payer: Zelis Auto |
$1,105.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,382.00
|
| Rate for Payer: Zelis Worker's Compensation |
$754.57
|
|
|
BOWEL TO BOWEL FUSION
|
Facility
|
IP
|
$2,764.00
|
|
|
Service Code
|
CPT 44130
|
| Hospital Charge Code |
6144130
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$754.57 |
| Max. Negotiated Rate |
$2,625.80 |
| Rate for Payer: Cash Price |
$1,658.40
|
| Rate for Payer: Cigna Commercial |
$2,349.40
|
| Rate for Payer: First Health Commercial |
$2,487.60
|
| Rate for Payer: First Health Workers Compensation |
$1,067.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,487.60
|
| Rate for Payer: GEHA Commercial |
$1,934.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,487.60
|
| Rate for Payer: Multiplan All |
$2,515.24
|
| Rate for Payer: OMNI Networks Commercial |
$1,934.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,487.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,625.80
|
| Rate for Payer: Three Rivers Provider Network All |
$2,073.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,570.52
|
| Rate for Payer: Zelis Auto |
$1,105.60
|
| Rate for Payer: Zelis Worker's Compensation |
$754.57
|
|
|
brca 1/2 comp analysis 485030 REF
|
Facility
|
OP
|
$3,553.00
|
|
|
Service Code
|
CPT 81162
|
| Hospital Charge Code |
2299219
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,421.20 |
| Max. Negotiated Rate |
$3,649.76 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,737.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,131.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,737.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,168.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,824.88
|
| Rate for Payer: Cash Price |
$2,131.80
|
| Rate for Payer: Cash Price |
$2,131.80
|
| Rate for Payer: Cigna Commercial |
$3,020.05
|
| Rate for Payer: First Health Commercial |
$3,197.70
|
| Rate for Payer: First Health Workers Compensation |
$2,396.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,197.70
|
| Rate for Payer: GEHA Commercial |
$2,842.40
|
| Rate for Payer: GEHA Medicare |
$1,824.88
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,197.70
|
| Rate for Payer: Humana ChoiceCare |
$2,007.37
|
| Rate for Payer: Humana Medicare Advantage |
$1,824.88
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,065.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,212.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,824.88
|
| Rate for Payer: Multiplan All |
$3,233.23
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,102.30
|
| Rate for Payer: OMNI Networks Commercial |
$2,487.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,197.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,554.83
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,212.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,824.88
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,375.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,649.76
|
| Rate for Payer: Three Rivers Provider Network All |
$2,664.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,788.38
|
| Rate for Payer: United Healthcare Commercial |
$3,020.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,212.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,824.88
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,304.29
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,824.88
|
| Rate for Payer: Zelis Auto |
$1,421.20
|
| Rate for Payer: Zelis Medicare |
$1,551.15
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,189.86
|
| Rate for Payer: Zelis Worker's Compensation |
$1,694.78
|
|
|
brca 1/2 comp analysis 485030 REF
|
Facility
|
IP
|
$3,553.00
|
|
|
Service Code
|
CPT 81162
|
| Hospital Charge Code |
2299219
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,421.20 |
| Max. Negotiated Rate |
$3,375.35 |
| Rate for Payer: Cash Price |
$2,131.80
|
| Rate for Payer: Cash Price |
$2,131.80
|
| Rate for Payer: Cigna Commercial |
$3,020.05
|
| Rate for Payer: First Health Commercial |
$3,197.70
|
| Rate for Payer: First Health Workers Compensation |
$2,396.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,197.70
|
| Rate for Payer: GEHA Commercial |
$2,487.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,197.70
|
| Rate for Payer: Multiplan All |
$3,233.23
|
| Rate for Payer: OMNI Networks Commercial |
$2,487.10
|
| Rate for Payer: One Health Plan PPO/POS |
$3,197.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,375.35
|
| Rate for Payer: Three Rivers Provider Network All |
$2,664.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,304.29
|
| Rate for Payer: Zelis Auto |
$1,421.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,694.78
|
|
|
BREAST RECONSTRUCTION
|
Facility
|
OP
|
$3,674.00
|
|
|
Service Code
|
CPT 19367
|
| Hospital Charge Code |
6119367
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$918.50 |
| Max. Negotiated Rate |
$3,490.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,204.40
|
| Rate for Payer: Cash Price |
$2,204.40
|
| Rate for Payer: Cigna Commercial |
$3,122.90
|
| Rate for Payer: First Health Commercial |
$3,306.60
|
| Rate for Payer: First Health Workers Compensation |
$1,418.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,306.60
|
| Rate for Payer: GEHA Commercial |
$2,939.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,306.60
|
| Rate for Payer: Humana ChoiceCare |
$955.24
|
| Rate for Payer: Multiplan All |
$3,343.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,204.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,571.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,306.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,490.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,755.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,233.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$918.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,416.82
|
| Rate for Payer: Zelis Auto |
$1,469.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,837.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1,003.00
|
|
|
BREAST RECONSTRUCTION
|
Facility
|
IP
|
$3,674.00
|
|
|
Service Code
|
CPT 19367
|
| Hospital Charge Code |
6119367
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,003.00 |
| Max. Negotiated Rate |
$3,490.30 |
| Rate for Payer: Cash Price |
$2,204.40
|
| Rate for Payer: Cigna Commercial |
$3,122.90
|
| Rate for Payer: First Health Commercial |
$3,306.60
|
| Rate for Payer: First Health Workers Compensation |
$1,418.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,306.60
|
| Rate for Payer: GEHA Commercial |
$2,571.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,306.60
|
| Rate for Payer: Multiplan All |
$3,343.34
|
| Rate for Payer: OMNI Networks Commercial |
$2,571.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3,306.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,490.30
|
| Rate for Payer: Three Rivers Provider Network All |
$2,755.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,416.82
|
| Rate for Payer: Zelis Auto |
$1,469.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,003.00
|
|
|
BREATHING (CO2 REPONSE CURVE)
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 94400
|
| Hospital Charge Code |
4094400
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
BREATHING (CO2 REPONSE CURVE)
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 94400
|
| Hospital Charge Code |
4094400
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$43.25 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Humana ChoiceCare |
$44.98
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$103.80
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$152.24
|
| Rate for Payer: United Healthcare Commercial |
$147.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$43.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$86.50
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
BREATHING (HYOIXUA RESPONSE CURVE)
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 94450
|
| Hospital Charge Code |
4094450
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$297.14 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$241.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$103.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$241.83
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$191.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$148.57
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$138.40
|
| Rate for Payer: GEHA Medicare |
$148.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| 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 |
$195.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$148.57
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.57
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$225.71
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$195.48
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$148.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$297.14
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.60
|
| Rate for Payer: United Healthcare Commercial |
$147.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$195.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$148.57
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Medicare |
$126.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.28
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
BREATHING (HYOIXUA RESPONSE CURVE)
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 94450
|
| Hospital Charge Code |
4094450
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$147.05
|
| Rate for Payer: First Health Commercial |
$155.70
|
| Rate for Payer: First Health Workers Compensation |
$66.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$155.70
|
| Rate for Payer: GEHA Commercial |
$121.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$155.70
|
| Rate for Payer: Multiplan All |
$157.43
|
| Rate for Payer: OMNI Networks Commercial |
$121.10
|
| Rate for Payer: One Health Plan PPO/POS |
$155.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$164.35
|
| Rate for Payer: Three Rivers Provider Network All |
$129.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$160.89
|
| Rate for Payer: Zelis Auto |
$69.20
|
| Rate for Payer: Zelis Worker's Compensation |
$47.23
|
|
|
BRIEF ALCOHOL MISUSE COUNSEL
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT G0443
|
| Hospital Charge Code |
9199538
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.78 |
| Max. Negotiated Rate |
$187.15 |
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cigna Commercial |
$167.45
|
| Rate for Payer: First Health Commercial |
$177.30
|
| Rate for Payer: First Health Workers Compensation |
$76.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$177.30
|
| Rate for Payer: GEHA Commercial |
$137.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$177.30
|
| Rate for Payer: Multiplan All |
$179.27
|
| Rate for Payer: OMNI Networks Commercial |
$137.90
|
| Rate for Payer: One Health Plan PPO/POS |
$177.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$187.15
|
| Rate for Payer: Three Rivers Provider Network All |
$147.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$183.21
|
| Rate for Payer: Zelis Auto |
$78.80
|
| Rate for Payer: Zelis Worker's Compensation |
$53.78
|
|
|
BRIEF ALCOHOL MISUSE COUNSEL
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT G0443
|
| Hospital Charge Code |
9199538
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.38 |
| Max. Negotiated Rate |
$187.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$63.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$118.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$63.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$50.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.83
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cigna Commercial |
$167.45
|
| Rate for Payer: First Health Commercial |
$177.30
|
| Rate for Payer: First Health Workers Compensation |
$76.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$177.30
|
| Rate for Payer: GEHA Commercial |
$157.60
|
| Rate for Payer: GEHA Medicare |
$87.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$177.30
|
| Rate for Payer: Humana ChoiceCare |
$96.61
|
| Rate for Payer: Humana Medicare Advantage |
$87.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$147.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$51.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.83
|
| Rate for Payer: Multiplan All |
$179.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.31
|
| Rate for Payer: OMNI Networks Commercial |
$137.90
|
| Rate for Payer: One Health Plan PPO/POS |
$177.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$59.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$51.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$187.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$175.66
|
| Rate for Payer: Three Rivers Provider Network All |
$147.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.07
|
| Rate for Payer: United Healthcare Managed Medicaid |
$51.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$183.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.83
|
| Rate for Payer: Zelis Auto |
$78.80
|
| Rate for Payer: Zelis Medicare |
$74.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.40
|
| Rate for Payer: Zelis Worker's Compensation |
$53.78
|
|
|
BRIEF CHECK IN BY MD/QHP
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT G2012
|
| Hospital Charge Code |
21500021
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$38.25
|
| Rate for Payer: First Health Commercial |
$40.50
|
| Rate for Payer: First Health Workers Compensation |
$17.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$40.50
|
| Rate for Payer: GEHA Commercial |
$31.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$40.50
|
| Rate for Payer: Multiplan All |
$40.95
|
| Rate for Payer: OMNI Networks Commercial |
$31.50
|
| Rate for Payer: One Health Plan PPO/POS |
$40.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$42.75
|
| Rate for Payer: Three Rivers Provider Network All |
$33.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$41.85
|
| Rate for Payer: Zelis Auto |
$18.00
|
| Rate for Payer: Zelis Worker's Compensation |
$12.29
|
|
|
BRIEF CHECK IN BY MD/QHP
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
CPT G2012
|
| Hospital Charge Code |
12099222
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$38.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13.03
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$8.31
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$24.60
|
| Rate for Payer: Health Net Federal Services Government |
$34.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.31
|
| Rate for Payer: Multiplan All |
$30.75
|
| Rate for Payer: National Preferred Provider Network Commercial |
$38.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$24.60
|
| Rate for Payer: OMNI Networks Commercial |
$28.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.56
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$36.08
|
|
|
BRIEF CHECK IN BY MD/QHP
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT G2012
|
| Hospital Charge Code |
7599222
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$38.25
|
| Rate for Payer: First Health Commercial |
$40.50
|
| Rate for Payer: First Health Workers Compensation |
$17.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$40.50
|
| Rate for Payer: GEHA Commercial |
$31.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$40.50
|
| Rate for Payer: Multiplan All |
$40.95
|
| Rate for Payer: OMNI Networks Commercial |
$31.50
|
| Rate for Payer: One Health Plan PPO/POS |
$40.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$42.75
|
| Rate for Payer: Three Rivers Provider Network All |
$33.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$41.85
|
| Rate for Payer: Zelis Auto |
$18.00
|
| Rate for Payer: Zelis Worker's Compensation |
$12.29
|
|
|
BRIEF CHECK IN BY MD/QHP
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT G2012
|
| Hospital Charge Code |
21700041
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.46
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$38.25
|
| Rate for Payer: First Health Commercial |
$40.50
|
| Rate for Payer: First Health Workers Compensation |
$17.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$40.50
|
| Rate for Payer: GEHA Commercial |
$36.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$40.50
|
| Rate for Payer: Humana ChoiceCare |
$11.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.79
|
| Rate for Payer: Multiplan All |
$40.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.00
|
| Rate for Payer: OMNI Networks Commercial |
$31.50
|
| Rate for Payer: One Health Plan PPO/POS |
$40.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$42.75
|
| Rate for Payer: Three Rivers Provider Network All |
$33.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$39.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$41.85
|
| Rate for Payer: Zelis Auto |
$18.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.50
|
| Rate for Payer: Zelis Worker's Compensation |
$12.29
|
|
|
BRIEF CHECK IN BY MD/QHP
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT G2012
|
| Hospital Charge Code |
20399225
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.46
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$38.25
|
| Rate for Payer: First Health Commercial |
$40.50
|
| Rate for Payer: First Health Workers Compensation |
$17.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$40.50
|
| Rate for Payer: GEHA Commercial |
$36.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$40.50
|
| Rate for Payer: Humana ChoiceCare |
$11.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.79
|
| Rate for Payer: Multiplan All |
$40.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.00
|
| Rate for Payer: OMNI Networks Commercial |
$31.50
|
| Rate for Payer: One Health Plan PPO/POS |
$40.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$42.75
|
| Rate for Payer: Three Rivers Provider Network All |
$33.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$39.60
|
| Rate for Payer: United Healthcare Commercial |
$38.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$41.85
|
| Rate for Payer: Zelis Auto |
$18.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.50
|
| Rate for Payer: Zelis Worker's Compensation |
$12.29
|
|
|
BRIEF CHECK IN BY MD/QHP
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT G2012
|
| Hospital Charge Code |
8700011
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.46
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$38.25
|
| Rate for Payer: First Health Commercial |
$40.50
|
| Rate for Payer: First Health Workers Compensation |
$17.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$40.50
|
| Rate for Payer: GEHA Commercial |
$36.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$40.50
|
| Rate for Payer: Humana ChoiceCare |
$11.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.79
|
| Rate for Payer: Multiplan All |
$40.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.00
|
| Rate for Payer: OMNI Networks Commercial |
$31.50
|
| Rate for Payer: One Health Plan PPO/POS |
$40.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$42.75
|
| Rate for Payer: Three Rivers Provider Network All |
$33.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$39.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$41.85
|
| Rate for Payer: Zelis Auto |
$18.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.50
|
| Rate for Payer: Zelis Worker's Compensation |
$12.29
|
|
|
BRIEF CHECK IN BY MD/QHP
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT G2012
|
| Hospital Charge Code |
9400100
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.46
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$38.25
|
| Rate for Payer: First Health Commercial |
$40.50
|
| Rate for Payer: First Health Workers Compensation |
$17.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$40.50
|
| Rate for Payer: GEHA Commercial |
$36.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$40.50
|
| Rate for Payer: Humana ChoiceCare |
$11.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.79
|
| Rate for Payer: Multiplan All |
$40.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.00
|
| Rate for Payer: OMNI Networks Commercial |
$31.50
|
| Rate for Payer: One Health Plan PPO/POS |
$40.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.39
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$42.75
|
| Rate for Payer: Three Rivers Provider Network All |
$33.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$39.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$41.85
|
| Rate for Payer: Zelis Auto |
$18.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.50
|
| Rate for Payer: Zelis Worker's Compensation |
$12.29
|
|
