|
ST FEES W/LARYNGEAL SENSE TEST
|
Facility
|
OP
|
$852.00
|
|
|
Service Code
|
CPT 92616
|
| Hospital Charge Code |
5992616
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$101.53 |
| Max. Negotiated Rate |
$809.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$128.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$511.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$128.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$101.53
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cigna Commercial |
$724.20
|
| Rate for Payer: First Health Commercial |
$766.80
|
| Rate for Payer: First Health Workers Compensation |
$328.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$766.80
|
| Rate for Payer: GEHA Commercial |
$681.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$766.80
|
| Rate for Payer: Humana ChoiceCare |
$221.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$103.60
|
| Rate for Payer: Multiplan All |
$775.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$511.20
|
| Rate for Payer: OMNI Networks Commercial |
$596.40
|
| Rate for Payer: One Health Plan PPO/POS |
$766.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$119.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$103.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$809.40
|
| Rate for Payer: Three Rivers Provider Network All |
$639.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$749.76
|
| Rate for Payer: United Healthcare Commercial |
$724.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$103.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$792.36
|
| Rate for Payer: Zelis Auto |
$340.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$426.00
|
| Rate for Payer: Zelis Worker's Compensation |
$232.60
|
|
|
ST HEALTH AND BEHAVIOR ASSESSMENT
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT 96150
|
| Hospital Charge Code |
5996150
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$53.23 |
| Max. Negotiated Rate |
$185.25 |
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$165.75
|
| Rate for Payer: First Health Commercial |
$175.50
|
| Rate for Payer: First Health Workers Compensation |
$75.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$175.50
|
| Rate for Payer: GEHA Commercial |
$136.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$175.50
|
| Rate for Payer: Multiplan All |
$177.45
|
| Rate for Payer: OMNI Networks Commercial |
$136.50
|
| Rate for Payer: One Health Plan PPO/POS |
$175.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$185.25
|
| Rate for Payer: Three Rivers Provider Network All |
$146.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$181.35
|
| Rate for Payer: Zelis Auto |
$78.00
|
| Rate for Payer: Zelis Worker's Compensation |
$53.23
|
|
|
ST HEALTH AND BEHAVIOR ASSESSMENT
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
CPT 96150
|
| Hospital Charge Code |
5996150
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$48.75 |
| Max. Negotiated Rate |
$185.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$165.75
|
| Rate for Payer: First Health Commercial |
$175.50
|
| Rate for Payer: First Health Workers Compensation |
$75.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$175.50
|
| Rate for Payer: GEHA Commercial |
$156.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$175.50
|
| Rate for Payer: Humana ChoiceCare |
$50.70
|
| Rate for Payer: Multiplan All |
$177.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$117.00
|
| Rate for Payer: OMNI Networks Commercial |
$136.50
|
| Rate for Payer: One Health Plan PPO/POS |
$175.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$185.25
|
| Rate for Payer: Three Rivers Provider Network All |
$146.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$171.60
|
| Rate for Payer: United Healthcare Commercial |
$165.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$48.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$181.35
|
| Rate for Payer: Zelis Auto |
$78.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$97.50
|
| Rate for Payer: Zelis Worker's Compensation |
$53.23
|
|
|
ST HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSM
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
5996156
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$75.08 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: First Health Workers Compensation |
$106.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$192.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Worker's Compensation |
$75.08
|
|
|
ST HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSM
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
5996156
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$74.66 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$117.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$117.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$93.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.83
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$233.75
|
| Rate for Payer: First Health Commercial |
$247.50
|
| Rate for Payer: First Health Workers Compensation |
$106.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$247.50
|
| Rate for Payer: GEHA Commercial |
$220.00
|
| Rate for Payer: GEHA Medicare |
$87.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$247.50
|
| 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 |
$95.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.83
|
| Rate for Payer: Multiplan All |
$250.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.31
|
| Rate for Payer: OMNI Networks Commercial |
$192.50
|
| Rate for Payer: One Health Plan PPO/POS |
$247.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$109.96
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$95.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$261.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$175.66
|
| Rate for Payer: Three Rivers Provider Network All |
$206.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.07
|
| Rate for Payer: United Healthcare Commercial |
$233.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$95.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$255.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.83
|
| Rate for Payer: Zelis Auto |
$110.00
|
| Rate for Payer: Zelis Medicare |
$74.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.40
|
| Rate for Payer: Zelis Worker's Compensation |
$75.08
|
|
|
ST HLTH BEHAVIOR IVNTJ IND F2F EA AD 15M
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
5996159
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$61.75 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$55.25
|
| Rate for Payer: First Health Commercial |
$58.50
|
| Rate for Payer: First Health Workers Compensation |
$25.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$58.50
|
| Rate for Payer: GEHA Commercial |
$45.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$58.50
|
| Rate for Payer: Multiplan All |
$59.15
|
| Rate for Payer: OMNI Networks Commercial |
$45.50
|
| Rate for Payer: One Health Plan PPO/POS |
$58.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$61.75
|
| Rate for Payer: Three Rivers Provider Network All |
$48.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$60.45
|
| Rate for Payer: Zelis Auto |
$26.00
|
| Rate for Payer: Zelis Worker's Compensation |
$17.75
|
|
|
ST HLTH BEHAVIOR IVNTJ IND F2F EA AD 15M
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
5996159
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$61.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$55.25
|
| Rate for Payer: First Health Commercial |
$58.50
|
| Rate for Payer: First Health Workers Compensation |
$25.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$58.50
|
| Rate for Payer: GEHA Commercial |
$52.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$58.50
|
| Rate for Payer: Humana ChoiceCare |
$16.90
|
| Rate for Payer: Multiplan All |
$59.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.00
|
| Rate for Payer: OMNI Networks Commercial |
$45.50
|
| Rate for Payer: One Health Plan PPO/POS |
$58.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$61.75
|
| Rate for Payer: Three Rivers Provider Network All |
$48.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$57.20
|
| Rate for Payer: United Healthcare Commercial |
$55.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$60.45
|
| Rate for Payer: Zelis Auto |
$26.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$32.50
|
| Rate for Payer: Zelis Worker's Compensation |
$17.75
|
|
|
ST HLTH BEHAVIOR IVNTJ INDIV F2F 1ST 30M
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
5996158
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$51.05 |
| Max. Negotiated Rate |
$305.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$117.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$117.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$93.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$152.56
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$158.95
|
| Rate for Payer: First Health Commercial |
$168.30
|
| Rate for Payer: First Health Workers Compensation |
$72.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$168.30
|
| Rate for Payer: GEHA Commercial |
$149.60
|
| Rate for Payer: GEHA Medicare |
$152.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$168.30
|
| Rate for Payer: Humana ChoiceCare |
$167.82
|
| Rate for Payer: Humana Medicare Advantage |
$152.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$256.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$95.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$152.56
|
| Rate for Payer: Multiplan All |
$170.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$259.35
|
| Rate for Payer: OMNI Networks Commercial |
$130.90
|
| Rate for Payer: One Health Plan PPO/POS |
$168.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$109.96
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$95.23
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$152.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$177.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$305.12
|
| Rate for Payer: Three Rivers Provider Network All |
$140.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$149.51
|
| Rate for Payer: United Healthcare Commercial |
$158.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$95.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$173.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$152.56
|
| Rate for Payer: Zelis Auto |
$74.80
|
| Rate for Payer: Zelis Medicare |
$129.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$183.07
|
| Rate for Payer: Zelis Worker's Compensation |
$51.05
|
|
|
ST HLTH BEHAVIOR IVNTJ INDIV F2F 1ST 30M
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
5996158
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$51.05 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$158.95
|
| Rate for Payer: First Health Commercial |
$168.30
|
| Rate for Payer: First Health Workers Compensation |
$72.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$168.30
|
| Rate for Payer: GEHA Commercial |
$130.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$168.30
|
| Rate for Payer: Multiplan All |
$170.17
|
| Rate for Payer: OMNI Networks Commercial |
$130.90
|
| Rate for Payer: One Health Plan PPO/POS |
$168.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$177.65
|
| Rate for Payer: Three Rivers Provider Network All |
$140.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$173.91
|
| Rate for Payer: Zelis Auto |
$74.80
|
| Rate for Payer: Zelis Worker's Compensation |
$51.05
|
|
|
ST INDIVIDUAL ST TX
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
5903041
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$301.75
|
| Rate for Payer: First Health Commercial |
$319.50
|
| Rate for Payer: First Health Workers Compensation |
$137.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$319.50
|
| Rate for Payer: GEHA Commercial |
$248.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$319.50
|
| Rate for Payer: Multiplan All |
$323.05
|
| Rate for Payer: OMNI Networks Commercial |
$248.50
|
| Rate for Payer: One Health Plan PPO/POS |
$319.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$337.25
|
| Rate for Payer: Three Rivers Provider Network All |
$266.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$330.15
|
| Rate for Payer: Zelis Auto |
$142.00
|
| Rate for Payer: Zelis Worker's Compensation |
$96.92
|
|
|
ST INDIVIDUAL ST TX
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
5903041
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$69.84 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$213.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$69.84
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$301.75
|
| Rate for Payer: First Health Commercial |
$319.50
|
| Rate for Payer: First Health Workers Compensation |
$137.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$319.50
|
| Rate for Payer: GEHA Commercial |
$284.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$319.50
|
| Rate for Payer: Humana ChoiceCare |
$92.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.26
|
| Rate for Payer: Multiplan All |
$323.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$213.00
|
| Rate for Payer: OMNI Networks Commercial |
$248.50
|
| Rate for Payer: One Health Plan PPO/POS |
$319.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.28
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$337.25
|
| Rate for Payer: Three Rivers Provider Network All |
$266.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$312.40
|
| Rate for Payer: United Healthcare Commercial |
$301.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$330.15
|
| Rate for Payer: Zelis Auto |
$142.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$177.50
|
| Rate for Payer: Zelis Worker's Compensation |
$96.92
|
|
|
ST.JUDE OCTRODE
|
Facility
|
OP
|
$89,130.00
|
|
|
Service Code
|
CPT C1897
|
| Hospital Charge Code |
7008063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,282.50 |
| Max. Negotiated Rate |
$84,673.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$53,478.00
|
| Rate for Payer: Cash Price |
$53,478.00
|
| Rate for Payer: Cash Price |
$53,478.00
|
| Rate for Payer: Cigna Commercial |
$75,760.50
|
| Rate for Payer: First Health Commercial |
$80,217.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$80,217.00
|
| Rate for Payer: GEHA Commercial |
$71,304.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$80,217.00
|
| Rate for Payer: Humana ChoiceCare |
$23,173.80
|
| Rate for Payer: Multiplan All |
$81,108.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$53,478.00
|
| Rate for Payer: OMNI Networks Commercial |
$62,391.00
|
| Rate for Payer: One Health Plan PPO/POS |
$80,217.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$84,673.50
|
| Rate for Payer: Three Rivers Provider Network All |
$66,847.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$78,434.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$22,282.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$82,890.90
|
| Rate for Payer: Zelis Auto |
$35,652.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$44,565.00
|
|
|
ST.JUDE OCTRODE
|
Facility
|
IP
|
$89,130.00
|
|
|
Service Code
|
CPT C1897
|
| Hospital Charge Code |
7008063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35,652.00 |
| Max. Negotiated Rate |
$84,673.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$71,304.00
|
| Rate for Payer: Cash Price |
$53,478.00
|
| Rate for Payer: Cash Price |
$53,478.00
|
| Rate for Payer: Cigna Commercial |
$75,760.50
|
| Rate for Payer: First Health Commercial |
$80,217.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$80,217.00
|
| Rate for Payer: GEHA Commercial |
$62,391.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$80,217.00
|
| Rate for Payer: Multiplan All |
$81,108.30
|
| Rate for Payer: OMNI Networks Commercial |
$62,391.00
|
| Rate for Payer: One Health Plan PPO/POS |
$80,217.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$84,673.50
|
| Rate for Payer: Three Rivers Provider Network All |
$66,847.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$82,890.90
|
| Rate for Payer: Zelis Auto |
$35,652.00
|
|
|
ST.JUDE OCTRODE 60CM LEAD
|
Facility
|
IP
|
$2,284.00
|
|
|
Service Code
|
CPT C1897
|
| Hospital Charge Code |
7008025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.60 |
| Max. Negotiated Rate |
$2,169.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,827.20
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cigna Commercial |
$1,941.40
|
| Rate for Payer: First Health Commercial |
$2,055.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,055.60
|
| Rate for Payer: GEHA Commercial |
$1,598.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,055.60
|
| Rate for Payer: Multiplan All |
$2,078.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,598.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,055.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,169.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,713.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,124.12
|
| Rate for Payer: Zelis Auto |
$913.60
|
|
|
ST.JUDE OCTRODE 60CM LEAD
|
Facility
|
OP
|
$2,284.00
|
|
|
Service Code
|
CPT C1897
|
| Hospital Charge Code |
7008025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$571.00 |
| Max. Negotiated Rate |
$2,169.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,370.40
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cigna Commercial |
$1,941.40
|
| Rate for Payer: First Health Commercial |
$2,055.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,055.60
|
| Rate for Payer: GEHA Commercial |
$1,827.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,055.60
|
| Rate for Payer: Humana ChoiceCare |
$593.84
|
| Rate for Payer: Multiplan All |
$2,078.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,370.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,598.80
|
| Rate for Payer: One Health Plan PPO/POS |
$2,055.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,169.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,713.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,009.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$571.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,124.12
|
| Rate for Payer: Zelis Auto |
$913.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,142.00
|
|
|
ST.JUDE TRIAL CHARGING SYSTEM
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.75 |
| Max. Negotiated Rate |
$675.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$426.60
|
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Cigna Commercial |
$604.35
|
| Rate for Payer: First Health Commercial |
$639.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$639.90
|
| Rate for Payer: GEHA Commercial |
$568.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$639.90
|
| Rate for Payer: Humana ChoiceCare |
$184.86
|
| Rate for Payer: Multiplan All |
$647.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$426.60
|
| Rate for Payer: OMNI Networks Commercial |
$497.70
|
| Rate for Payer: One Health Plan PPO/POS |
$639.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$675.45
|
| Rate for Payer: Three Rivers Provider Network All |
$533.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$625.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$177.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$661.23
|
| Rate for Payer: Zelis Auto |
$284.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$355.50
|
|
|
ST.JUDE TRIAL CHARGING SYSTEM
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7008027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.40 |
| Max. Negotiated Rate |
$675.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$568.80
|
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Cigna Commercial |
$604.35
|
| Rate for Payer: First Health Commercial |
$639.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$639.90
|
| Rate for Payer: GEHA Commercial |
$497.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$639.90
|
| Rate for Payer: Multiplan All |
$647.01
|
| Rate for Payer: OMNI Networks Commercial |
$497.70
|
| Rate for Payer: One Health Plan PPO/POS |
$639.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$675.45
|
| Rate for Payer: Three Rivers Provider Network All |
$533.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$661.23
|
| Rate for Payer: Zelis Auto |
$284.40
|
|
|
ST.JUDE TRIAL INVISIBLE EPG KIT
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
CPT C1897
|
| Hospital Charge Code |
7008026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$974.40 |
| Max. Negotiated Rate |
$2,314.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,948.80
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cigna Commercial |
$2,070.60
|
| Rate for Payer: First Health Commercial |
$2,192.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,192.40
|
| Rate for Payer: GEHA Commercial |
$1,705.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,192.40
|
| Rate for Payer: Multiplan All |
$2,216.76
|
| Rate for Payer: OMNI Networks Commercial |
$1,705.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,192.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,314.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,827.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,265.48
|
| Rate for Payer: Zelis Auto |
$974.40
|
|
|
ST.JUDE TRIAL INVISIBLE EPG KIT
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
CPT C1897
|
| Hospital Charge Code |
7008026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.00 |
| Max. Negotiated Rate |
$2,314.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cigna Commercial |
$2,070.60
|
| Rate for Payer: First Health Commercial |
$2,192.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,192.40
|
| Rate for Payer: GEHA Commercial |
$1,948.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,192.40
|
| Rate for Payer: Humana ChoiceCare |
$633.36
|
| Rate for Payer: Multiplan All |
$2,216.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,461.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,705.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,192.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,314.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,827.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,143.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$609.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,265.48
|
| Rate for Payer: Zelis Auto |
$974.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,218.00
|
|
|
ST.JUDE TRIAL MULTILEAD TRIAL CABLE
|
Facility
|
OP
|
$1,147.00
|
|
|
Service Code
|
CPT C1897
|
| Hospital Charge Code |
90003871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.75 |
| Max. Negotiated Rate |
$1,089.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$688.20
|
| Rate for Payer: Cash Price |
$688.20
|
| Rate for Payer: Cash Price |
$688.20
|
| Rate for Payer: Cigna Commercial |
$974.95
|
| Rate for Payer: First Health Commercial |
$1,032.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,032.30
|
| Rate for Payer: GEHA Commercial |
$917.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,032.30
|
| Rate for Payer: Humana ChoiceCare |
$298.22
|
| Rate for Payer: Multiplan All |
$1,043.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$688.20
|
| Rate for Payer: OMNI Networks Commercial |
$802.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,032.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,089.65
|
| Rate for Payer: Three Rivers Provider Network All |
$860.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,009.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$286.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,066.71
|
| Rate for Payer: Zelis Auto |
$458.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$573.50
|
|
|
ST.JUDE TRIAL MULTILEAD TRIAL CABLE
|
Facility
|
IP
|
$1,147.00
|
|
|
Service Code
|
CPT C1897
|
| Hospital Charge Code |
90003871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$458.80 |
| Max. Negotiated Rate |
$1,089.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$917.60
|
| Rate for Payer: Cash Price |
$688.20
|
| Rate for Payer: Cash Price |
$688.20
|
| Rate for Payer: Cigna Commercial |
$974.95
|
| Rate for Payer: First Health Commercial |
$1,032.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,032.30
|
| Rate for Payer: GEHA Commercial |
$802.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,032.30
|
| Rate for Payer: Multiplan All |
$1,043.77
|
| Rate for Payer: OMNI Networks Commercial |
$802.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,032.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,089.65
|
| Rate for Payer: Three Rivers Provider Network All |
$860.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,066.71
|
| Rate for Payer: Zelis Auto |
$458.80
|
|
|
ST LARYNGEAL FUNCTION STUDIES
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
CPT 92520
|
| Hospital Charge Code |
5992520
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$534.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$337.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$337.80
|
| Rate for Payer: Cash Price |
$337.80
|
| Rate for Payer: Cigna Commercial |
$478.55
|
| Rate for Payer: First Health Commercial |
$506.70
|
| Rate for Payer: First Health Workers Compensation |
$217.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$506.70
|
| Rate for Payer: GEHA Commercial |
$450.40
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$506.70
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$512.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$394.10
|
| Rate for Payer: One Health Plan PPO/POS |
$506.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$534.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$422.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Commercial |
$478.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$523.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$225.20
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$153.70
|
|
|
ST LARYNGEAL FUNCTION STUDIES
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
CPT 92520
|
| Hospital Charge Code |
5992520
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$153.70 |
| Max. Negotiated Rate |
$534.85 |
| Rate for Payer: Cash Price |
$337.80
|
| Rate for Payer: Cigna Commercial |
$478.55
|
| Rate for Payer: First Health Commercial |
$506.70
|
| Rate for Payer: First Health Workers Compensation |
$217.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$506.70
|
| Rate for Payer: GEHA Commercial |
$394.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$506.70
|
| Rate for Payer: Multiplan All |
$512.33
|
| Rate for Payer: OMNI Networks Commercial |
$394.10
|
| Rate for Payer: One Health Plan PPO/POS |
$506.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$534.85
|
| Rate for Payer: Three Rivers Provider Network All |
$422.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$523.59
|
| Rate for Payer: Zelis Auto |
$225.20
|
| Rate for Payer: Zelis Worker's Compensation |
$153.70
|
|
|
ST LARYNGO REPORT
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 92615
|
| Hospital Charge Code |
5903043
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$26.75 |
| Max. Negotiated Rate |
$101.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$90.95
|
| Rate for Payer: First Health Commercial |
$96.30
|
| Rate for Payer: First Health Workers Compensation |
$41.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$96.30
|
| Rate for Payer: GEHA Commercial |
$85.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$96.30
|
| Rate for Payer: Humana ChoiceCare |
$27.82
|
| Rate for Payer: Multiplan All |
$97.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$64.20
|
| Rate for Payer: OMNI Networks Commercial |
$74.90
|
| Rate for Payer: One Health Plan PPO/POS |
$96.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$101.65
|
| Rate for Payer: Three Rivers Provider Network All |
$80.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$94.16
|
| Rate for Payer: United Healthcare Commercial |
$90.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$99.51
|
| Rate for Payer: Zelis Auto |
$42.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$53.50
|
| Rate for Payer: Zelis Worker's Compensation |
$29.21
|
|
|
ST LARYNGO REPORT
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 92615
|
| Hospital Charge Code |
5903043
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$29.21 |
| Max. Negotiated Rate |
$101.65 |
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$90.95
|
| Rate for Payer: First Health Commercial |
$96.30
|
| Rate for Payer: First Health Workers Compensation |
$41.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$96.30
|
| Rate for Payer: GEHA Commercial |
$74.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$96.30
|
| Rate for Payer: Multiplan All |
$97.37
|
| Rate for Payer: OMNI Networks Commercial |
$74.90
|
| Rate for Payer: One Health Plan PPO/POS |
$96.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$101.65
|
| Rate for Payer: Three Rivers Provider Network All |
$80.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$99.51
|
| Rate for Payer: Zelis Auto |
$42.80
|
| Rate for Payer: Zelis Worker's Compensation |
$29.21
|
|
