|
ST SW TREATMENT
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
4303032
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$117.66 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: First Health Workers Compensation |
$166.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$301.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Worker's Compensation |
$117.66
|
|
|
ST SW TREATMENT
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT 92526
|
| Hospital Charge Code |
5903032
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$92.77 |
| Max. Negotiated Rate |
$365.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$117.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$231.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$117.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$92.77
|
| Rate for Payer: Cash Price |
$231.00
|
| 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 |
$308.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$346.50
|
| Rate for Payer: Humana ChoiceCare |
$100.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$94.66
|
| Rate for Payer: Multiplan All |
$350.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$231.00
|
| Rate for Payer: OMNI Networks Commercial |
$269.50
|
| Rate for Payer: One Health Plan PPO/POS |
$346.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$109.30
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$94.66
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$365.75
|
| Rate for Payer: Three Rivers Provider Network All |
$288.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$338.80
|
| Rate for Payer: United Healthcare Commercial |
$327.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$94.66
|
| Rate for Payer: United Payors & United Providers UP&UP |
$358.05
|
| Rate for Payer: Zelis Auto |
$154.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$192.50
|
| Rate for Payer: Zelis Worker's Compensation |
$105.11
|
|
|
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
|
|
|
ST THERAP GROUP 2 OR MO
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
5900601
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$30.33 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$124.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.28
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.33
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna Commercial |
$176.80
|
| Rate for Payer: First Health Commercial |
$187.20
|
| Rate for Payer: First Health Workers Compensation |
$80.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$187.20
|
| Rate for Payer: GEHA Commercial |
$166.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$187.20
|
| Rate for Payer: Humana ChoiceCare |
$54.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.94
|
| Rate for Payer: Multiplan All |
$189.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$124.80
|
| Rate for Payer: OMNI Networks Commercial |
$145.60
|
| Rate for Payer: One Health Plan PPO/POS |
$187.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$30.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$197.60
|
| Rate for Payer: Three Rivers Provider Network All |
$156.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$183.04
|
| Rate for Payer: United Healthcare Commercial |
$176.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$193.44
|
| Rate for Payer: Zelis Auto |
$83.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$104.00
|
| Rate for Payer: Zelis Worker's Compensation |
$56.78
|
|
|
ST THERAP GROUP 2 OR MO
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
5900601
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$56.78 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna Commercial |
$176.80
|
| Rate for Payer: First Health Commercial |
$187.20
|
| Rate for Payer: First Health Workers Compensation |
$80.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$187.20
|
| Rate for Payer: GEHA Commercial |
$145.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$187.20
|
| Rate for Payer: Multiplan All |
$189.28
|
| Rate for Payer: OMNI Networks Commercial |
$145.60
|
| Rate for Payer: One Health Plan PPO/POS |
$187.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$197.60
|
| Rate for Payer: Three Rivers Provider Network All |
$156.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$193.44
|
| Rate for Payer: Zelis Auto |
$83.20
|
| Rate for Payer: Zelis Worker's Compensation |
$56.78
|
|
|
ST THER INVNTJ W/FOCUS COG FUNCJ
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
5900045
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$114.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
ST THER INVNTJ W/FOCUS COG FUNCJ
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 97127
|
| Hospital Charge Code |
5900045
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$40.75 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$130.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Humana ChoiceCare |
$42.38
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.80
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$143.44
|
| Rate for Payer: United Healthcare Commercial |
$138.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$40.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.50
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
ST THER IVNTJ COG FUNCJ CNTCT 1ST 15 MIN
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
5997129
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$61.20
|
| Rate for Payer: First Health Commercial |
$64.80
|
| Rate for Payer: First Health Workers Compensation |
$27.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$64.80
|
| Rate for Payer: GEHA Commercial |
$50.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$64.80
|
| Rate for Payer: Multiplan All |
$65.52
|
| Rate for Payer: OMNI Networks Commercial |
$50.40
|
| Rate for Payer: One Health Plan PPO/POS |
$64.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$68.40
|
| Rate for Payer: Three Rivers Provider Network All |
$54.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$66.96
|
| Rate for Payer: Zelis Auto |
$28.80
|
| Rate for Payer: Zelis Worker's Compensation |
$19.66
|
|
|
ST THER IVNTJ COG FUNCJ CNTCT 1ST 15 MIN
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
5997129
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$48.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$43.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$48.41
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$38.35
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$61.20
|
| Rate for Payer: First Health Commercial |
$64.80
|
| Rate for Payer: First Health Workers Compensation |
$27.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$64.80
|
| Rate for Payer: GEHA Commercial |
$57.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$64.80
|
| Rate for Payer: Humana ChoiceCare |
$18.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$39.13
|
| Rate for Payer: Multiplan All |
$65.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$43.20
|
| Rate for Payer: OMNI Networks Commercial |
$50.40
|
| Rate for Payer: One Health Plan PPO/POS |
$64.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$45.18
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$39.13
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$68.40
|
| Rate for Payer: Three Rivers Provider Network All |
$54.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$63.36
|
| Rate for Payer: United Healthcare Commercial |
$61.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$39.13
|
| Rate for Payer: United Payors & United Providers UP&UP |
$66.96
|
| Rate for Payer: Zelis Auto |
$28.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$36.00
|
| Rate for Payer: Zelis Worker's Compensation |
$19.66
|
|
|
ST THER IVNTJ COG FUNCJ CNTCT EA ADD 15M
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
5997130
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$19.11 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$59.50
|
| Rate for Payer: First Health Commercial |
$63.00
|
| Rate for Payer: First Health Workers Compensation |
$27.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$63.00
|
| Rate for Payer: GEHA Commercial |
$49.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$63.00
|
| Rate for Payer: Multiplan All |
$63.70
|
| Rate for Payer: OMNI Networks Commercial |
$49.00
|
| Rate for Payer: One Health Plan PPO/POS |
$63.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$66.50
|
| Rate for Payer: Three Rivers Provider Network All |
$52.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$65.10
|
| Rate for Payer: Zelis Auto |
$28.00
|
| Rate for Payer: Zelis Worker's Compensation |
$19.11
|
|
|
ST THER IVNTJ COG FUNCJ CNTCT EA ADD 15M
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
5997130
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$46.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$42.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$46.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$36.65
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$59.50
|
| Rate for Payer: First Health Commercial |
$63.00
|
| Rate for Payer: First Health Workers Compensation |
$27.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$63.00
|
| Rate for Payer: GEHA Commercial |
$56.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$63.00
|
| Rate for Payer: Humana ChoiceCare |
$18.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$37.39
|
| Rate for Payer: Multiplan All |
$63.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$42.00
|
| Rate for Payer: OMNI Networks Commercial |
$49.00
|
| Rate for Payer: One Health Plan PPO/POS |
$63.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$43.18
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$37.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$66.50
|
| Rate for Payer: Three Rivers Provider Network All |
$52.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$61.60
|
| Rate for Payer: United Healthcare Commercial |
$59.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$65.10
|
| Rate for Payer: Zelis Auto |
$28.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$35.00
|
| Rate for Payer: Zelis Worker's Compensation |
$19.11
|
|
|
ST TRTMNT OF SPEECH, LANGUAGE, VOICE, CO
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 92508
|
| Hospital Charge Code |
5992508
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$88.18 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$274.55
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: First Health Workers Compensation |
$124.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$290.70
|
| Rate for Payer: GEHA Commercial |
$226.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$290.70
|
| Rate for Payer: Multiplan All |
$293.93
|
| Rate for Payer: OMNI Networks Commercial |
$226.10
|
| Rate for Payer: One Health Plan PPO/POS |
$290.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$306.85
|
| Rate for Payer: Three Rivers Provider Network All |
$242.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$300.39
|
| Rate for Payer: Zelis Auto |
$129.20
|
| Rate for Payer: Zelis Worker's Compensation |
$88.18
|
|
|
ST TRTMNT OF SPEECH, LANGUAGE, VOICE, CO
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 92508
|
| Hospital Charge Code |
5992508
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$40.62 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$51.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$193.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$51.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$40.62
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$274.55
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: First Health Workers Compensation |
$124.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$290.70
|
| Rate for Payer: GEHA Commercial |
$258.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$290.70
|
| Rate for Payer: Humana ChoiceCare |
$83.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$41.44
|
| Rate for Payer: Multiplan All |
$293.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$193.80
|
| Rate for Payer: OMNI Networks Commercial |
$226.10
|
| Rate for Payer: One Health Plan PPO/POS |
$290.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$47.85
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$41.44
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$306.85
|
| Rate for Payer: Three Rivers Provider Network All |
$242.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$284.24
|
| Rate for Payer: United Healthcare Commercial |
$274.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$41.44
|
| Rate for Payer: United Payors & United Providers UP&UP |
$300.39
|
| Rate for Payer: Zelis Auto |
$129.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$161.50
|
| Rate for Payer: Zelis Worker's Compensation |
$88.18
|
|
|
ST USE OF SPEECH DEVICE SERVICE
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
5992609
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$117.39 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$365.50
|
| Rate for Payer: First Health Commercial |
$387.00
|
| Rate for Payer: First Health Workers Compensation |
$166.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.00
|
| Rate for Payer: GEHA Commercial |
$301.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.00
|
| Rate for Payer: Multiplan All |
$391.30
|
| Rate for Payer: OMNI Networks Commercial |
$301.00
|
| Rate for Payer: One Health Plan PPO/POS |
$387.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$408.50
|
| Rate for Payer: Three Rivers Provider Network All |
$322.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$399.90
|
| Rate for Payer: Zelis Auto |
$172.00
|
| Rate for Payer: Zelis Worker's Compensation |
$117.39
|
|
|
ST USE OF SPEECH DEVICE SERVICE
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
5992609
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$37.65 |
| Max. Negotiated Rate |
$408.50 |
| 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 |
$258.00
|
| 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 |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$365.50
|
| Rate for Payer: First Health Commercial |
$387.00
|
| Rate for Payer: First Health Workers Compensation |
$166.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.00
|
| Rate for Payer: GEHA Commercial |
$344.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.00
|
| Rate for Payer: Humana ChoiceCare |
$111.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$38.41
|
| Rate for Payer: Multiplan All |
$391.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$258.00
|
| Rate for Payer: OMNI Networks Commercial |
$301.00
|
| Rate for Payer: One Health Plan PPO/POS |
$387.00
|
| 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 |
$408.50
|
| Rate for Payer: Three Rivers Provider Network All |
$322.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$378.40
|
| Rate for Payer: United Healthcare Commercial |
$365.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$38.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$399.90
|
| Rate for Payer: Zelis Auto |
$172.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$215.00
|
| Rate for Payer: Zelis Worker's Compensation |
$117.39
|
|
|
SUBCUTANEOUS INJECT FILLING MATERL 1CC/<
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 11950
|
| Hospital Charge Code |
7211950
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$63.06 |
| Max. Negotiated Rate |
$219.45 |
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna Commercial |
$196.35
|
| Rate for Payer: First Health Commercial |
$207.90
|
| Rate for Payer: First Health Workers Compensation |
$89.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.90
|
| Rate for Payer: GEHA Commercial |
$161.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.90
|
| Rate for Payer: Multiplan All |
$210.21
|
| Rate for Payer: OMNI Networks Commercial |
$161.70
|
| Rate for Payer: One Health Plan PPO/POS |
$207.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$219.45
|
| Rate for Payer: Three Rivers Provider Network All |
$173.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$214.83
|
| Rate for Payer: Zelis Auto |
$92.40
|
| Rate for Payer: Zelis Worker's Compensation |
$63.06
|
|
|
SUBCUTANEOUS INJECT FILLING MATERL 1CC/<
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 11950
|
| Hospital Charge Code |
8511113
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$63.06 |
| Max. Negotiated Rate |
$219.45 |
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna Commercial |
$196.35
|
| Rate for Payer: First Health Commercial |
$207.90
|
| Rate for Payer: First Health Workers Compensation |
$89.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.90
|
| Rate for Payer: GEHA Commercial |
$161.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.90
|
| Rate for Payer: Multiplan All |
$210.21
|
| Rate for Payer: OMNI Networks Commercial |
$161.70
|
| Rate for Payer: One Health Plan PPO/POS |
$207.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$219.45
|
| Rate for Payer: Three Rivers Provider Network All |
$173.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$214.83
|
| Rate for Payer: Zelis Auto |
$92.40
|
| Rate for Payer: Zelis Worker's Compensation |
$63.06
|
|
|
SUBCUTANEOUS INJECT FILLING MATERL 1CC/<
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 11950
|
| Hospital Charge Code |
6111950
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$42.59 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$93.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$132.60
|
| Rate for Payer: First Health Commercial |
$140.40
|
| Rate for Payer: First Health Workers Compensation |
$60.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$140.40
|
| Rate for Payer: GEHA Commercial |
$124.80
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$140.40
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$110.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$141.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$109.20
|
| Rate for Payer: One Health Plan PPO/POS |
$140.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$127.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$110.68
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$148.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$117.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$145.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$62.40
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$42.59
|
|
|
SUBCUTANEOUS INJECT FILLING MATERL 1CC/<
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 11950
|
| Hospital Charge Code |
6111950
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$42.59 |
| Max. Negotiated Rate |
$148.20 |
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$132.60
|
| Rate for Payer: First Health Commercial |
$140.40
|
| Rate for Payer: First Health Workers Compensation |
$60.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$140.40
|
| Rate for Payer: GEHA Commercial |
$109.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$140.40
|
| Rate for Payer: Multiplan All |
$141.96
|
| Rate for Payer: OMNI Networks Commercial |
$109.20
|
| Rate for Payer: One Health Plan PPO/POS |
$140.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$148.20
|
| Rate for Payer: Three Rivers Provider Network All |
$117.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$145.08
|
| Rate for Payer: Zelis Auto |
$62.40
|
| Rate for Payer: Zelis Worker's Compensation |
$42.59
|
|
|
SUBCUTANEOUS INJECT FILLING MATERL 1CC/<
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 11950
|
| Hospital Charge Code |
7211950
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$63.06 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$138.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna Commercial |
$196.35
|
| Rate for Payer: First Health Commercial |
$207.90
|
| Rate for Payer: First Health Workers Compensation |
$89.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.90
|
| Rate for Payer: GEHA Commercial |
$184.80
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.90
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$110.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$210.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$161.70
|
| Rate for Payer: One Health Plan PPO/POS |
$207.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$127.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$110.68
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$219.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$173.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$214.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$92.40
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$63.06
|
|
|
SUBCUTANEOUS INJECT FILLING MATERL 1CC/<
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 11950
|
| Hospital Charge Code |
21600293
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$42.59 |
| Max. Negotiated Rate |
$148.20 |
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$132.60
|
| Rate for Payer: First Health Commercial |
$140.40
|
| Rate for Payer: First Health Workers Compensation |
$60.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$140.40
|
| Rate for Payer: GEHA Commercial |
$109.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$140.40
|
| Rate for Payer: Multiplan All |
$141.96
|
| Rate for Payer: OMNI Networks Commercial |
$109.20
|
| Rate for Payer: One Health Plan PPO/POS |
$140.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$148.20
|
| Rate for Payer: Three Rivers Provider Network All |
$117.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$145.08
|
| Rate for Payer: Zelis Auto |
$62.40
|
| Rate for Payer: Zelis Worker's Compensation |
$42.59
|
|
|
SUBCUTANEOUS INJECT FILLING MATERL 1CC/<
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 11950
|
| Hospital Charge Code |
8511113
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$63.06 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$138.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna Commercial |
$196.35
|
| Rate for Payer: First Health Commercial |
$207.90
|
| Rate for Payer: First Health Workers Compensation |
$89.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$207.90
|
| Rate for Payer: GEHA Commercial |
$184.80
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$207.90
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$110.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$210.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$161.70
|
| Rate for Payer: One Health Plan PPO/POS |
$207.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$127.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$110.68
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$219.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$173.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$214.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$92.40
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$63.06
|
|
|
SUBCUTANEOUS INJECT FILLING MATERL 1CC/<
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 11950
|
| Hospital Charge Code |
21600293
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$42.59 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$93.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$132.60
|
| Rate for Payer: First Health Commercial |
$140.40
|
| Rate for Payer: First Health Workers Compensation |
$60.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$140.40
|
| Rate for Payer: GEHA Commercial |
$124.80
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$140.40
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$110.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$141.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$109.20
|
| Rate for Payer: One Health Plan PPO/POS |
$140.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$127.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$110.68
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$148.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$117.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$145.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$62.40
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$42.59
|
|
|
SUB GRFT FSNHFGMD >/= 100SCM 1ST 100SQCM
|
Facility
|
IP
|
$4,879.00
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
1905290
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,331.97 |
| Max. Negotiated Rate |
$4,635.05 |
| Rate for Payer: Cash Price |
$2,927.40
|
| Rate for Payer: Cigna Commercial |
$4,147.15
|
| Rate for Payer: First Health Commercial |
$4,391.10
|
| Rate for Payer: First Health Workers Compensation |
$1,883.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,391.10
|
| Rate for Payer: GEHA Commercial |
$3,415.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,391.10
|
| Rate for Payer: Multiplan All |
$4,439.89
|
| Rate for Payer: OMNI Networks Commercial |
$3,415.30
|
| Rate for Payer: One Health Plan PPO/POS |
$4,391.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,635.05
|
| Rate for Payer: Three Rivers Provider Network All |
$3,659.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,537.47
|
| Rate for Payer: Zelis Auto |
$1,951.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,331.97
|
|
|
SUB GRFT FSNHFGMD >/= 100SCM 1ST 100SQCM
|
Facility
|
IP
|
$727.00
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
6115277
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$198.47 |
| Max. Negotiated Rate |
$690.65 |
| Rate for Payer: Cash Price |
$436.20
|
| Rate for Payer: Cigna Commercial |
$617.95
|
| Rate for Payer: First Health Commercial |
$654.30
|
| Rate for Payer: First Health Workers Compensation |
$280.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$654.30
|
| Rate for Payer: GEHA Commercial |
$508.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$654.30
|
| Rate for Payer: Multiplan All |
$661.57
|
| Rate for Payer: OMNI Networks Commercial |
$508.90
|
| Rate for Payer: One Health Plan PPO/POS |
$654.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$690.65
|
| Rate for Payer: Three Rivers Provider Network All |
$545.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$676.11
|
| Rate for Payer: Zelis Auto |
$290.80
|
| Rate for Payer: Zelis Worker's Compensation |
$198.47
|
|
