|
STREPT PNEUMONIAE AB IGG 8 POP REF
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2200126
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.59 |
| 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 |
$26.28
|
| 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 |
$18.59
|
|
|
STREPT PNEUMONIAE AB IGG 8 POP REF
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2300085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$26.98
|
| 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 |
$26.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.99
|
| 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 |
$26.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$96.00
|
| Rate for Payer: GEHA Medicare |
$14.99
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Humana ChoiceCare |
$16.49
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.99
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.48
|
| 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 |
$25.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$29.98
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.69
|
| Rate for Payer: United Healthcare Commercial |
$102.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.99
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Medicare |
$12.74
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.99
|
| Rate for Payer: Zelis Worker's Compensation |
$18.59
|
|
|
STREPT PNEUMONIAE AB IGG 8 POP REF
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2200126
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$26.98
|
| 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 |
$26.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.99
|
| 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 |
$26.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$96.00
|
| Rate for Payer: GEHA Medicare |
$14.99
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Humana ChoiceCare |
$16.49
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.99
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.48
|
| 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 |
$25.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$29.98
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.69
|
| Rate for Payer: United Healthcare Commercial |
$102.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.99
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Medicare |
$12.74
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.99
|
| Rate for Payer: Zelis Worker's Compensation |
$18.59
|
|
|
STREPT PNEUMONIAE AB IGG 8 POP REF
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2300085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.59 |
| 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 |
$26.28
|
| 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 |
$18.59
|
|
|
STREPT PNEUMONIAE AB IGG 9 POP REF
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2300086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$26.98
|
| 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 |
$26.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.99
|
| 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 |
$26.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$96.00
|
| Rate for Payer: GEHA Medicare |
$14.99
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Humana ChoiceCare |
$16.49
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.99
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.48
|
| 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 |
$25.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$29.98
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.69
|
| Rate for Payer: United Healthcare Commercial |
$102.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.99
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Medicare |
$12.74
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.99
|
| Rate for Payer: Zelis Worker's Compensation |
$18.59
|
|
|
STREPT PNEUMONIAE AB IGG 9 POP REF
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2300086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.59 |
| 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 |
$26.28
|
| 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 |
$18.59
|
|
|
STREPT PNEUMONIAE AB IGG 9 POP REF
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2200127
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.59 |
| 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 |
$26.28
|
| 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 |
$18.59
|
|
|
STREPT PNEUMONIAE AB IGG 9 POP REF
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2200127
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$26.98
|
| 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 |
$26.98
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$21.38
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$14.99
|
| 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 |
$26.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$96.00
|
| Rate for Payer: GEHA Medicare |
$14.99
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Humana ChoiceCare |
$16.49
|
| Rate for Payer: Humana Medicare Advantage |
$14.99
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$25.18
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$21.81
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$14.99
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$25.48
|
| 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 |
$25.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$21.81
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$14.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$29.98
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.69
|
| Rate for Payer: United Healthcare Commercial |
$102.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$21.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$14.99
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Medicare |
$12.74
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$17.99
|
| Rate for Payer: Zelis Worker's Compensation |
$18.59
|
|
|
STRESS TEST TRACING ONLY
|
Facility
|
IP
|
$608.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
9100009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$165.98 |
| Max. Negotiated Rate |
$577.60 |
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$516.80
|
| Rate for Payer: First Health Commercial |
$547.20
|
| Rate for Payer: First Health Workers Compensation |
$234.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$547.20
|
| Rate for Payer: GEHA Commercial |
$425.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$547.20
|
| Rate for Payer: Multiplan All |
$553.28
|
| Rate for Payer: OMNI Networks Commercial |
$425.60
|
| Rate for Payer: One Health Plan PPO/POS |
$547.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$577.60
|
| Rate for Payer: Three Rivers Provider Network All |
$456.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$565.44
|
| Rate for Payer: Zelis Auto |
$243.20
|
| Rate for Payer: Zelis Worker's Compensation |
$165.98
|
|
|
STRESS TEST TRACING ONLY
|
Facility
|
OP
|
$608.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
9100009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$165.98 |
| Max. Negotiated Rate |
$591.38 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$356.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$364.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$356.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$282.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$516.80
|
| Rate for Payer: First Health Commercial |
$547.20
|
| Rate for Payer: First Health Workers Compensation |
$234.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$547.20
|
| Rate for Payer: GEHA Commercial |
$486.40
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$547.20
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$288.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$553.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$425.60
|
| Rate for Payer: One Health Plan PPO/POS |
$547.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$333.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$288.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$577.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$456.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$288.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$565.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$243.20
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$165.98
|
|
|
STRIATED MUSCLE AB SCRN REF
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2300012
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.21 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$35.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Worker's Compensation |
$25.21
|
|
|
STRIATED MUSCLE AB SCRN REF
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2300012
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$35.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$153.60
|
| Rate for Payer: GEHA Medicare |
$12.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Humana ChoiceCare |
$13.26
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.05
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.48
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.10
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.81
|
| Rate for Payer: United Healthcare Commercial |
$163.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.05
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Medicare |
$10.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.46
|
| Rate for Payer: Zelis Worker's Compensation |
$25.21
|
|
|
striated muscle abs REF160184
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2200063
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.21 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$35.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Worker's Compensation |
$25.21
|
|
|
striated muscle abs REF160184
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2200063
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$163.20
|
| Rate for Payer: First Health Commercial |
$172.80
|
| Rate for Payer: First Health Workers Compensation |
$35.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$172.80
|
| Rate for Payer: GEHA Commercial |
$153.60
|
| Rate for Payer: GEHA Medicare |
$12.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$172.80
|
| Rate for Payer: Humana ChoiceCare |
$13.26
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.05
|
| Rate for Payer: Multiplan All |
$174.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.48
|
| Rate for Payer: OMNI Networks Commercial |
$134.40
|
| Rate for Payer: One Health Plan PPO/POS |
$172.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$182.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.10
|
| Rate for Payer: Three Rivers Provider Network All |
$144.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.81
|
| Rate for Payer: United Healthcare Commercial |
$163.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$178.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.05
|
| Rate for Payer: Zelis Auto |
$76.80
|
| Rate for Payer: Zelis Medicare |
$10.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.46
|
| Rate for Payer: Zelis Worker's Compensation |
$25.21
|
|
|
striational muscle ab REF160184
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2299522
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.21 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$35.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$177.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Worker's Compensation |
$25.21
|
|
|
striational muscle ab REF160184
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2299522
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$152.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$215.90
|
| Rate for Payer: First Health Commercial |
$228.60
|
| Rate for Payer: First Health Workers Compensation |
$35.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$228.60
|
| Rate for Payer: GEHA Commercial |
$203.20
|
| Rate for Payer: GEHA Medicare |
$12.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$228.60
|
| Rate for Payer: Humana ChoiceCare |
$13.26
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.05
|
| Rate for Payer: Multiplan All |
$231.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20.48
|
| Rate for Payer: OMNI Networks Commercial |
$177.80
|
| Rate for Payer: One Health Plan PPO/POS |
$228.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$241.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24.10
|
| Rate for Payer: Three Rivers Provider Network All |
$190.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11.81
|
| Rate for Payer: United Healthcare Commercial |
$215.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$236.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.05
|
| Rate for Payer: Zelis Auto |
$101.60
|
| Rate for Payer: Zelis Medicare |
$10.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.46
|
| Rate for Payer: Zelis Worker's Compensation |
$25.21
|
|
|
STRP SHOULDER APPLC (eg. VELPEAU)
|
Facility
|
IP
|
$206.00
|
|
| Hospital Charge Code |
8150057
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$56.24 |
| Max. Negotiated Rate |
$195.70 |
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$175.10
|
| Rate for Payer: First Health Commercial |
$185.40
|
| Rate for Payer: First Health Workers Compensation |
$79.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$185.40
|
| Rate for Payer: GEHA Commercial |
$144.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$185.40
|
| Rate for Payer: Multiplan All |
$187.46
|
| Rate for Payer: OMNI Networks Commercial |
$144.20
|
| Rate for Payer: One Health Plan PPO/POS |
$185.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$195.70
|
| Rate for Payer: Three Rivers Provider Network All |
$154.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$191.58
|
| Rate for Payer: Zelis Auto |
$82.40
|
| Rate for Payer: Zelis Worker's Compensation |
$56.24
|
|
|
STRP SHOULDER APPLC (eg. VELPEAU)
|
Facility
|
OP
|
$206.00
|
|
| Hospital Charge Code |
8150057
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$51.50 |
| Max. Negotiated Rate |
$195.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$175.10
|
| Rate for Payer: First Health Commercial |
$185.40
|
| Rate for Payer: First Health Workers Compensation |
$79.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$185.40
|
| Rate for Payer: GEHA Commercial |
$164.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$185.40
|
| Rate for Payer: Humana ChoiceCare |
$53.56
|
| Rate for Payer: Multiplan All |
$187.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$123.60
|
| Rate for Payer: OMNI Networks Commercial |
$144.20
|
| Rate for Payer: One Health Plan PPO/POS |
$185.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$195.70
|
| Rate for Payer: Three Rivers Provider Network All |
$154.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$181.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$51.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$191.58
|
| Rate for Payer: Zelis Auto |
$82.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$103.00
|
| Rate for Payer: Zelis Worker's Compensation |
$56.24
|
|
|
ST SPEECH PROD EVAL
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
CPT 92522
|
| Hospital Charge Code |
5903045
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$124.76 |
| Max. Negotiated Rate |
$434.15 |
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cigna Commercial |
$388.45
|
| Rate for Payer: First Health Commercial |
$411.30
|
| Rate for Payer: First Health Workers Compensation |
$176.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$411.30
|
| Rate for Payer: GEHA Commercial |
$319.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$411.30
|
| Rate for Payer: Multiplan All |
$415.87
|
| Rate for Payer: OMNI Networks Commercial |
$319.90
|
| Rate for Payer: One Health Plan PPO/POS |
$411.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$434.15
|
| Rate for Payer: Three Rivers Provider Network All |
$342.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$425.01
|
| Rate for Payer: Zelis Auto |
$182.80
|
| Rate for Payer: Zelis Worker's Compensation |
$124.76
|
|
|
ST SPEECH PROD EVAL
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT 92522
|
| Hospital Charge Code |
5903045
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$118.82 |
| Max. Negotiated Rate |
$434.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$176.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$274.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$176.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$140.10
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Cigna Commercial |
$388.45
|
| Rate for Payer: First Health Commercial |
$411.30
|
| Rate for Payer: First Health Workers Compensation |
$176.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$411.30
|
| Rate for Payer: GEHA Commercial |
$365.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$411.30
|
| Rate for Payer: Humana ChoiceCare |
$118.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$142.95
|
| Rate for Payer: Multiplan All |
$415.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$274.20
|
| Rate for Payer: OMNI Networks Commercial |
$319.90
|
| Rate for Payer: One Health Plan PPO/POS |
$411.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$165.06
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$142.95
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$434.15
|
| Rate for Payer: Three Rivers Provider Network All |
$342.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$402.16
|
| Rate for Payer: United Healthcare Commercial |
$388.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$142.95
|
| Rate for Payer: United Payors & United Providers UP&UP |
$425.01
|
| Rate for Payer: Zelis Auto |
$182.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$228.50
|
| Rate for Payer: Zelis Worker's Compensation |
$124.76
|
|
|
ST STANDARD COG EVAL
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 96125
|
| Hospital Charge Code |
5903039
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$131.59 |
| Max. Negotiated Rate |
$457.90 |
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$409.70
|
| Rate for Payer: First Health Commercial |
$433.80
|
| Rate for Payer: First Health Workers Compensation |
$186.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$433.80
|
| Rate for Payer: GEHA Commercial |
$337.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$433.80
|
| Rate for Payer: Multiplan All |
$438.62
|
| Rate for Payer: OMNI Networks Commercial |
$337.40
|
| Rate for Payer: One Health Plan PPO/POS |
$433.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$457.90
|
| Rate for Payer: Three Rivers Provider Network All |
$361.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$448.26
|
| Rate for Payer: Zelis Auto |
$192.80
|
| Rate for Payer: Zelis Worker's Compensation |
$131.59
|
|
|
ST STANDARD COG EVAL
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 96125
|
| Hospital Charge Code |
5903039
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$73.07 |
| Max. Negotiated Rate |
$457.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$92.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$289.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$92.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$73.07
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$409.70
|
| Rate for Payer: First Health Commercial |
$433.80
|
| Rate for Payer: First Health Workers Compensation |
$186.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$433.80
|
| Rate for Payer: GEHA Commercial |
$385.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$433.80
|
| Rate for Payer: Humana ChoiceCare |
$125.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$74.56
|
| Rate for Payer: Multiplan All |
$438.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$289.20
|
| Rate for Payer: OMNI Networks Commercial |
$337.40
|
| Rate for Payer: One Health Plan PPO/POS |
$433.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$86.09
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$74.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$457.90
|
| Rate for Payer: Three Rivers Provider Network All |
$361.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$424.16
|
| Rate for Payer: United Healthcare Commercial |
$409.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$74.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$448.26
|
| Rate for Payer: Zelis Auto |
$192.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$241.00
|
| Rate for Payer: Zelis Worker's Compensation |
$131.59
|
|
|
ST SW EVAL
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
5903033
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$101.53 |
| Max. Negotiated Rate |
$538.65 |
| 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 |
$340.20
|
| 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 |
$340.20
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cigna Commercial |
$481.95
|
| Rate for Payer: First Health Commercial |
$510.30
|
| Rate for Payer: First Health Workers Compensation |
$218.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$510.30
|
| Rate for Payer: GEHA Commercial |
$453.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$510.30
|
| Rate for Payer: Humana ChoiceCare |
$147.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$103.60
|
| Rate for Payer: Multiplan All |
$515.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$340.20
|
| Rate for Payer: OMNI Networks Commercial |
$396.90
|
| Rate for Payer: One Health Plan PPO/POS |
$510.30
|
| 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 |
$538.65
|
| Rate for Payer: Three Rivers Provider Network All |
$425.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$498.96
|
| Rate for Payer: United Healthcare Commercial |
$481.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$103.60
|
| Rate for Payer: United Payors & United Providers UP&UP |
$527.31
|
| Rate for Payer: Zelis Auto |
$226.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$283.50
|
| Rate for Payer: Zelis Worker's Compensation |
$154.79
|
|
|
ST SW EVAL
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
CPT 92610
|
| Hospital Charge Code |
5903033
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$154.79 |
| Max. Negotiated Rate |
$538.65 |
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cigna Commercial |
$481.95
|
| Rate for Payer: First Health Commercial |
$510.30
|
| Rate for Payer: First Health Workers Compensation |
$218.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$510.30
|
| Rate for Payer: GEHA Commercial |
$396.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$510.30
|
| Rate for Payer: Multiplan All |
$515.97
|
| Rate for Payer: OMNI Networks Commercial |
$396.90
|
| Rate for Payer: One Health Plan PPO/POS |
$510.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$538.65
|
| Rate for Payer: Three Rivers Provider Network All |
$425.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$527.31
|
| Rate for Payer: Zelis Auto |
$226.80
|
| Rate for Payer: Zelis Worker's Compensation |
$154.79
|
|
|
ST SW TREATMENT
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
5903032
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$105.11 |
| Max. Negotiated Rate |
$365.75 |
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$327.25
|
| Rate for Payer: First Health Commercial |
$346.50
|
| Rate for Payer: First Health Workers Compensation |
$148.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$346.50
|
| Rate for Payer: GEHA Commercial |
$269.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$346.50
|
| Rate for Payer: Multiplan All |
$350.35
|
| Rate for Payer: OMNI Networks Commercial |
$269.50
|
| Rate for Payer: One Health Plan PPO/POS |
$346.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$365.75
|
| Rate for Payer: Three Rivers Provider Network All |
$288.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$358.05
|
| Rate for Payer: Zelis Auto |
$154.00
|
| Rate for Payer: Zelis Worker's Compensation |
$105.11
|
|
