|
ST LARYNGOSCOPIC SENSORY TEST
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
CPT 92614
|
| Hospital Charge Code |
5992614
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$323.00 |
| 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 |
$204.00
|
| 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 |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$289.00
|
| Rate for Payer: First Health Commercial |
$306.00
|
| Rate for Payer: First Health Workers Compensation |
$131.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$306.00
|
| Rate for Payer: GEHA Commercial |
$272.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$306.00
|
| Rate for Payer: Humana ChoiceCare |
$88.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$103.60
|
| Rate for Payer: Multiplan All |
$309.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$204.00
|
| Rate for Payer: OMNI Networks Commercial |
$238.00
|
| Rate for Payer: One Health Plan PPO/POS |
$306.00
|
| 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 |
$323.00
|
| Rate for Payer: Three Rivers Provider Network All |
$255.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$299.20
|
| Rate for Payer: United Healthcare Commercial |
$289.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$103.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$316.20
|
| Rate for Payer: Zelis Auto |
$136.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$170.00
|
| Rate for Payer: Zelis Worker's Compensation |
$92.82
|
|
|
ST LARYNGOSCOPIC SENSORY TEST
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
CPT 92614
|
| Hospital Charge Code |
5992614
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$92.82 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$289.00
|
| Rate for Payer: First Health Commercial |
$306.00
|
| Rate for Payer: First Health Workers Compensation |
$131.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$306.00
|
| Rate for Payer: GEHA Commercial |
$238.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$306.00
|
| Rate for Payer: Multiplan All |
$309.40
|
| Rate for Payer: OMNI Networks Commercial |
$238.00
|
| Rate for Payer: One Health Plan PPO/POS |
$306.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$323.00
|
| Rate for Payer: Three Rivers Provider Network All |
$255.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$316.20
|
| Rate for Payer: Zelis Auto |
$136.00
|
| Rate for Payer: Zelis Worker's Compensation |
$92.82
|
|
|
ST MBS MOTION FLURO SWALLOW
|
Facility
|
OP
|
$624.00
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
5903046
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$101.53 |
| Max. Negotiated Rate |
$592.80 |
| 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 |
$374.40
|
| 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 |
$374.40
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cigna Commercial |
$530.40
|
| Rate for Payer: First Health Commercial |
$561.60
|
| Rate for Payer: First Health Workers Compensation |
$240.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$561.60
|
| Rate for Payer: GEHA Commercial |
$499.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$561.60
|
| Rate for Payer: Humana ChoiceCare |
$162.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$103.60
|
| Rate for Payer: Multiplan All |
$567.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$374.40
|
| Rate for Payer: OMNI Networks Commercial |
$436.80
|
| Rate for Payer: One Health Plan PPO/POS |
$561.60
|
| 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 |
$592.80
|
| Rate for Payer: Three Rivers Provider Network All |
$468.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$549.12
|
| Rate for Payer: United Healthcare Commercial |
$530.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$103.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$580.32
|
| Rate for Payer: Zelis Auto |
$249.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$312.00
|
| Rate for Payer: Zelis Worker's Compensation |
$170.35
|
|
|
ST MBS MOTION FLURO SWALLOW
|
Facility
|
IP
|
$624.00
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
5903046
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$170.35 |
| Max. Negotiated Rate |
$592.80 |
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cigna Commercial |
$530.40
|
| Rate for Payer: First Health Commercial |
$561.60
|
| Rate for Payer: First Health Workers Compensation |
$240.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$561.60
|
| Rate for Payer: GEHA Commercial |
$436.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$561.60
|
| Rate for Payer: Multiplan All |
$567.84
|
| Rate for Payer: OMNI Networks Commercial |
$436.80
|
| Rate for Payer: One Health Plan PPO/POS |
$561.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$592.80
|
| Rate for Payer: Three Rivers Provider Network All |
$468.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$580.32
|
| Rate for Payer: Zelis Auto |
$249.60
|
| Rate for Payer: Zelis Worker's Compensation |
$170.35
|
|
|
stone calculi, with photograph REF910180
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
2299231
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.95 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cigna Commercial |
$166.60
|
| Rate for Payer: First Health Commercial |
$176.40
|
| Rate for Payer: First Health Workers Compensation |
$22.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$176.40
|
| Rate for Payer: GEHA Commercial |
$137.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$176.40
|
| Rate for Payer: Multiplan All |
$178.36
|
| Rate for Payer: OMNI Networks Commercial |
$137.20
|
| Rate for Payer: One Health Plan PPO/POS |
$176.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$186.20
|
| Rate for Payer: Three Rivers Provider Network All |
$147.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$182.28
|
| Rate for Payer: Zelis Auto |
$78.40
|
| Rate for Payer: Zelis Worker's Compensation |
$15.95
|
|
|
stone calculi, with photograph REF910180
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
2299231
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.96 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$23.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.90
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cigna Commercial |
$166.60
|
| Rate for Payer: First Health Commercial |
$176.40
|
| Rate for Payer: First Health Workers Compensation |
$22.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$176.40
|
| Rate for Payer: GEHA Commercial |
$156.80
|
| Rate for Payer: GEHA Medicare |
$12.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$176.40
|
| Rate for Payer: Humana ChoiceCare |
$14.19
|
| Rate for Payer: Humana Medicare Advantage |
$12.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$21.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.90
|
| Rate for Payer: Multiplan All |
$178.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.93
|
| Rate for Payer: OMNI Networks Commercial |
$137.20
|
| Rate for Payer: One Health Plan PPO/POS |
$176.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$21.67
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$186.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$25.80
|
| Rate for Payer: Three Rivers Provider Network All |
$147.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.64
|
| Rate for Payer: United Healthcare Commercial |
$166.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$182.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.90
|
| Rate for Payer: Zelis Auto |
$78.40
|
| Rate for Payer: Zelis Medicare |
$10.96
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.48
|
| Rate for Payer: Zelis Worker's Compensation |
$15.95
|
|
|
STOOL AERO ADDITIONAL PATH POP REF
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
CPT 87045
|
| Hospital Charge Code |
2239389
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$17.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$112.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$17.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$9.44
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$159.80
|
| Rate for Payer: First Health Commercial |
$169.20
|
| Rate for Payer: First Health Workers Compensation |
$16.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$169.20
|
| Rate for Payer: GEHA Commercial |
$150.40
|
| Rate for Payer: GEHA Medicare |
$9.44
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$169.20
|
| Rate for Payer: Humana ChoiceCare |
$10.38
|
| Rate for Payer: Humana Medicare Advantage |
$9.44
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$9.44
|
| Rate for Payer: Multiplan All |
$171.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$16.05
|
| Rate for Payer: OMNI Networks Commercial |
$131.60
|
| Rate for Payer: One Health Plan PPO/POS |
$169.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$15.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13.74
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$9.44
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$178.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$18.88
|
| Rate for Payer: Three Rivers Provider Network All |
$141.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9.25
|
| Rate for Payer: United Healthcare Commercial |
$159.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.44
|
| Rate for Payer: United Payors & United Providers UP&UP |
$174.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$9.44
|
| Rate for Payer: Zelis Auto |
$75.20
|
| Rate for Payer: Zelis Medicare |
$8.02
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11.33
|
| Rate for Payer: Zelis Worker's Compensation |
$11.75
|
|
|
STOOL AERO ADDITIONAL PATH POP REF
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
CPT 87045
|
| Hospital Charge Code |
2239389
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$159.80
|
| Rate for Payer: First Health Commercial |
$169.20
|
| Rate for Payer: First Health Workers Compensation |
$16.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$169.20
|
| Rate for Payer: GEHA Commercial |
$131.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$169.20
|
| Rate for Payer: Multiplan All |
$171.08
|
| Rate for Payer: OMNI Networks Commercial |
$131.60
|
| Rate for Payer: One Health Plan PPO/POS |
$169.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$178.60
|
| Rate for Payer: Three Rivers Provider Network All |
$141.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$174.84
|
| Rate for Payer: Zelis Auto |
$75.20
|
| Rate for Payer: Zelis Worker's Compensation |
$11.75
|
|
|
stool pH REF010991
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
2200053
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$62.90
|
| Rate for Payer: First Health Commercial |
$66.60
|
| Rate for Payer: First Health Workers Compensation |
$6.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$66.60
|
| Rate for Payer: GEHA Commercial |
$51.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$66.60
|
| Rate for Payer: Multiplan All |
$67.34
|
| Rate for Payer: OMNI Networks Commercial |
$51.80
|
| Rate for Payer: One Health Plan PPO/POS |
$66.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$70.30
|
| Rate for Payer: Three Rivers Provider Network All |
$55.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$68.82
|
| Rate for Payer: Zelis Auto |
$29.60
|
| Rate for Payer: Zelis Worker's Compensation |
$4.35
|
|
|
stool pH REF010991
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
2200053
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$44.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3.58
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$62.90
|
| Rate for Payer: First Health Commercial |
$66.60
|
| Rate for Payer: First Health Workers Compensation |
$6.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$66.60
|
| Rate for Payer: GEHA Commercial |
$59.20
|
| Rate for Payer: GEHA Medicare |
$3.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$66.60
|
| Rate for Payer: Humana ChoiceCare |
$3.94
|
| Rate for Payer: Humana Medicare Advantage |
$3.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.21
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3.58
|
| Rate for Payer: Multiplan All |
$67.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.09
|
| Rate for Payer: OMNI Networks Commercial |
$51.80
|
| Rate for Payer: One Health Plan PPO/POS |
$66.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6.02
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.21
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$70.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7.16
|
| Rate for Payer: Three Rivers Provider Network All |
$55.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.51
|
| Rate for Payer: United Healthcare Commercial |
$62.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$68.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3.58
|
| Rate for Payer: Zelis Auto |
$29.60
|
| Rate for Payer: Zelis Medicare |
$3.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.30
|
| Rate for Payer: Zelis Worker's Compensation |
$4.35
|
|
|
stool reducing substances REF830811
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 84376
|
| Hospital Charge Code |
2200052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.50
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$9.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$96.00
|
| Rate for Payer: GEHA Medicare |
$5.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Humana ChoiceCare |
$6.05
|
| Rate for Payer: Humana Medicare Advantage |
$5.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$8.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.50
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.35
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$9.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$8.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11.00
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.39
|
| Rate for Payer: United Healthcare Commercial |
$102.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$8.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.50
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Medicare |
$4.67
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.60
|
| Rate for Payer: Zelis Worker's Compensation |
$6.48
|
|
|
stool reducing substances REF830811
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 84376
|
| Hospital Charge Code |
2200052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$9.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$84.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Worker's Compensation |
$6.48
|
|
|
stool wbc stain REF008656
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
22990090
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$48.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$68.85
|
| Rate for Payer: First Health Commercial |
$72.90
|
| Rate for Payer: First Health Workers Compensation |
$7.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$64.80
|
| Rate for Payer: GEHA Medicare |
$4.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Humana ChoiceCare |
$4.70
|
| Rate for Payer: Humana Medicare Advantage |
$4.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6.21
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.27
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.26
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6.21
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$8.54
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.18
|
| Rate for Payer: United Healthcare Commercial |
$68.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.27
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Medicare |
$3.63
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.12
|
| Rate for Payer: Zelis Worker's Compensation |
$5.50
|
|
|
stool wbc stain REF008656
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
22990090
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$68.85
|
| Rate for Payer: First Health Commercial |
$72.90
|
| Rate for Payer: First Health Workers Compensation |
$7.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$72.90
|
| Rate for Payer: GEHA Commercial |
$56.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$72.90
|
| Rate for Payer: Multiplan All |
$73.71
|
| Rate for Payer: OMNI Networks Commercial |
$56.70
|
| Rate for Payer: One Health Plan PPO/POS |
$72.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$76.95
|
| Rate for Payer: Three Rivers Provider Network All |
$60.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$75.33
|
| Rate for Payer: Zelis Auto |
$32.40
|
| Rate for Payer: Zelis Worker's Compensation |
$5.50
|
|
|
ST ORAL SPEECH DEVICE EVAL
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
CPT 92597
|
| Hospital Charge Code |
5992597
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$37.65 |
| Max. Negotiated Rate |
$587.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$47.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$370.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$47.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$37.65
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cigna Commercial |
$525.30
|
| Rate for Payer: First Health Commercial |
$556.20
|
| Rate for Payer: First Health Workers Compensation |
$238.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$556.20
|
| Rate for Payer: GEHA Commercial |
$494.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$556.20
|
| Rate for Payer: Humana ChoiceCare |
$160.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$38.41
|
| Rate for Payer: Multiplan All |
$562.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$370.80
|
| Rate for Payer: OMNI Networks Commercial |
$432.60
|
| Rate for Payer: One Health Plan PPO/POS |
$556.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$44.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$38.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$587.10
|
| Rate for Payer: Three Rivers Provider Network All |
$463.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$543.84
|
| Rate for Payer: United Healthcare Commercial |
$525.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$38.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$574.74
|
| Rate for Payer: Zelis Auto |
$247.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$309.00
|
| Rate for Payer: Zelis Worker's Compensation |
$168.71
|
|
|
ST ORAL SPEECH DEVICE EVAL
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
CPT 92597
|
| Hospital Charge Code |
5992597
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$168.71 |
| Max. Negotiated Rate |
$587.10 |
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cigna Commercial |
$525.30
|
| Rate for Payer: First Health Commercial |
$556.20
|
| Rate for Payer: First Health Workers Compensation |
$238.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$556.20
|
| Rate for Payer: GEHA Commercial |
$432.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$556.20
|
| Rate for Payer: Multiplan All |
$562.38
|
| Rate for Payer: OMNI Networks Commercial |
$432.60
|
| Rate for Payer: One Health Plan PPO/POS |
$556.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$587.10
|
| Rate for Payer: Three Rivers Provider Network All |
$463.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$574.74
|
| Rate for Payer: Zelis Auto |
$247.20
|
| Rate for Payer: Zelis Worker's Compensation |
$168.71
|
|
|
STRAIGHT PLATE 7HOLE
|
Facility
|
IP
|
$2,027.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70090018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$810.80 |
| Max. Negotiated Rate |
$1,925.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,621.60
|
| Rate for Payer: Cash Price |
$1,216.20
|
| Rate for Payer: Cash Price |
$1,216.20
|
| Rate for Payer: Cigna Commercial |
$1,722.95
|
| Rate for Payer: First Health Commercial |
$1,824.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,824.30
|
| Rate for Payer: GEHA Commercial |
$1,418.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,824.30
|
| Rate for Payer: Multiplan All |
$1,844.57
|
| Rate for Payer: OMNI Networks Commercial |
$1,418.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,824.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,925.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,520.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,885.11
|
| Rate for Payer: Zelis Auto |
$810.80
|
|
|
STRAIGHT PLATE 7HOLE
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
70090018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.75 |
| Max. Negotiated Rate |
$1,925.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,216.20
|
| Rate for Payer: Cash Price |
$1,216.20
|
| Rate for Payer: Cash Price |
$1,216.20
|
| Rate for Payer: Cigna Commercial |
$1,722.95
|
| Rate for Payer: First Health Commercial |
$1,824.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,824.30
|
| Rate for Payer: GEHA Commercial |
$1,621.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,824.30
|
| Rate for Payer: Humana ChoiceCare |
$527.02
|
| Rate for Payer: Multiplan All |
$1,844.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,216.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,418.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,824.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,925.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,520.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,783.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$506.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,885.11
|
| Rate for Payer: Zelis Auto |
$810.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,013.50
|
|
|
STRAPPING ANKLE &/FOOT
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
21600156
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$23.75 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$73.95
|
| Rate for Payer: First Health Commercial |
$78.30
|
| Rate for Payer: First Health Workers Compensation |
$33.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$78.30
|
| Rate for Payer: GEHA Commercial |
$60.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$78.30
|
| Rate for Payer: Multiplan All |
$79.17
|
| Rate for Payer: OMNI Networks Commercial |
$60.90
|
| Rate for Payer: One Health Plan PPO/POS |
$78.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$82.65
|
| Rate for Payer: Three Rivers Provider Network All |
$65.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$80.91
|
| Rate for Payer: Zelis Auto |
$34.80
|
| Rate for Payer: Zelis Worker's Compensation |
$23.75
|
|
|
STRAPPING ANKLE &/FOOT
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
8229540
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$23.75 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$73.95
|
| Rate for Payer: First Health Commercial |
$78.30
|
| Rate for Payer: First Health Workers Compensation |
$33.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$78.30
|
| Rate for Payer: GEHA Commercial |
$60.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$78.30
|
| Rate for Payer: Multiplan All |
$79.17
|
| Rate for Payer: OMNI Networks Commercial |
$60.90
|
| Rate for Payer: One Health Plan PPO/POS |
$78.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$82.65
|
| Rate for Payer: Three Rivers Provider Network All |
$65.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$80.91
|
| Rate for Payer: Zelis Auto |
$34.80
|
| Rate for Payer: Zelis Worker's Compensation |
$23.75
|
|
|
STRAPPING ANKLE &/FOOT
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
21600156
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$23.75 |
| Max. Negotiated Rate |
$299.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$84.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$149.83
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$73.95
|
| Rate for Payer: First Health Commercial |
$78.30
|
| Rate for Payer: First Health Workers Compensation |
$33.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$78.30
|
| Rate for Payer: GEHA Commercial |
$69.60
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$78.30
|
| Rate for Payer: Humana ChoiceCare |
$164.81
|
| Rate for Payer: Humana Medicare Advantage |
$149.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$251.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$86.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$149.83
|
| Rate for Payer: Multiplan All |
$79.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$60.90
|
| Rate for Payer: One Health Plan PPO/POS |
$78.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$99.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$86.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$149.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$82.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$65.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$146.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$80.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$34.80
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$23.75
|
|
|
STRAPPING ANKLE &/FOOT
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
8229540
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$23.75 |
| Max. Negotiated Rate |
$299.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$84.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$149.83
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$73.95
|
| Rate for Payer: First Health Commercial |
$78.30
|
| Rate for Payer: First Health Workers Compensation |
$33.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$78.30
|
| Rate for Payer: GEHA Commercial |
$69.60
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$78.30
|
| Rate for Payer: Humana ChoiceCare |
$164.81
|
| Rate for Payer: Humana Medicare Advantage |
$149.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$251.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$86.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$149.83
|
| Rate for Payer: Multiplan All |
$79.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$60.90
|
| Rate for Payer: One Health Plan PPO/POS |
$78.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$99.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$86.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$149.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$82.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$65.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$146.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$80.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$34.80
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$23.75
|
|
|
STRAPPING ANKLE &/FOOT
|
Facility
|
OP
|
$538.32
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
9629540
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$511.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$322.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$84.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$149.83
|
| Rate for Payer: Cash Price |
$322.99
|
| Rate for Payer: Cash Price |
$322.99
|
| Rate for Payer: Cigna Commercial |
$457.57
|
| Rate for Payer: First Health Commercial |
$484.49
|
| Rate for Payer: First Health Workers Compensation |
$207.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$484.49
|
| Rate for Payer: GEHA Commercial |
$430.66
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$484.49
|
| Rate for Payer: Humana ChoiceCare |
$164.81
|
| Rate for Payer: Humana Medicare Advantage |
$149.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$251.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$86.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$149.83
|
| Rate for Payer: Multiplan All |
$489.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$376.82
|
| Rate for Payer: One Health Plan PPO/POS |
$484.49
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$99.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$86.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$149.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$511.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$403.74
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$146.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$500.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$215.33
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$146.96
|
|
|
STRAPPING ANKLE &/FOOT
|
Facility
|
IP
|
$538.32
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
9629540
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.96 |
| Max. Negotiated Rate |
$511.40 |
| Rate for Payer: Cash Price |
$322.99
|
| Rate for Payer: Cigna Commercial |
$457.57
|
| Rate for Payer: First Health Commercial |
$484.49
|
| Rate for Payer: First Health Workers Compensation |
$207.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$484.49
|
| Rate for Payer: GEHA Commercial |
$376.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$484.49
|
| Rate for Payer: Multiplan All |
$489.87
|
| Rate for Payer: OMNI Networks Commercial |
$376.82
|
| Rate for Payer: One Health Plan PPO/POS |
$484.49
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$511.40
|
| Rate for Payer: Three Rivers Provider Network All |
$403.74
|
| Rate for Payer: United Payors & United Providers UP&UP |
$500.64
|
| Rate for Payer: Zelis Auto |
$215.33
|
| Rate for Payer: Zelis Worker's Compensation |
$146.96
|
|
|
STRAPPING ANKLE &/FOOT
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
8729540
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.75 |
| Max. Negotiated Rate |
$299.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$106.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$84.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$149.83
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$73.95
|
| Rate for Payer: First Health Commercial |
$78.30
|
| Rate for Payer: First Health Workers Compensation |
$33.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$78.30
|
| Rate for Payer: GEHA Commercial |
$69.60
|
| Rate for Payer: GEHA Medicare |
$149.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$78.30
|
| Rate for Payer: Humana ChoiceCare |
$164.81
|
| Rate for Payer: Humana Medicare Advantage |
$149.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$251.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$86.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$149.83
|
| Rate for Payer: Multiplan All |
$79.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$254.71
|
| Rate for Payer: OMNI Networks Commercial |
$60.90
|
| Rate for Payer: One Health Plan PPO/POS |
$78.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$99.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$86.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$149.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$82.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$299.66
|
| Rate for Payer: Three Rivers Provider Network All |
$65.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$146.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$86.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$80.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$149.83
|
| Rate for Payer: Zelis Auto |
$34.80
|
| Rate for Payer: Zelis Medicare |
$127.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$179.80
|
| Rate for Payer: Zelis Worker's Compensation |
$23.75
|
|
