|
SYMPATHECTOMY CERVICAL
|
Facility
|
IP
|
$1,365.00
|
|
|
Service Code
|
CPT 64802
|
| Hospital Charge Code |
6164802
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$372.64 |
| Max. Negotiated Rate |
$1,296.75 |
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cigna Commercial |
$1,160.25
|
| Rate for Payer: First Health Commercial |
$1,228.50
|
| Rate for Payer: First Health Workers Compensation |
$527.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,228.50
|
| Rate for Payer: GEHA Commercial |
$955.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,228.50
|
| Rate for Payer: Multiplan All |
$1,242.15
|
| Rate for Payer: OMNI Networks Commercial |
$955.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,228.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,296.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,023.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,269.45
|
| Rate for Payer: Zelis Auto |
$546.00
|
| Rate for Payer: Zelis Worker's Compensation |
$372.64
|
|
|
SYMPATHECTOMY CERVICAL
|
Facility
|
OP
|
$1,365.00
|
|
|
Service Code
|
CPT 64802
|
| Hospital Charge Code |
6164802
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$372.64 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$819.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cigna Commercial |
$1,160.25
|
| Rate for Payer: First Health Commercial |
$1,228.50
|
| Rate for Payer: First Health Workers Compensation |
$527.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,228.50
|
| Rate for Payer: GEHA Commercial |
$1,092.00
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,228.50
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$1,242.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$955.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,228.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,296.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$1,023.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,269.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$546.00
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$372.64
|
|
|
SYMPATHECTOMY DIGITAL ARTERY
|
Facility
|
IP
|
$1,484.00
|
|
|
Service Code
|
CPT 64820
|
| Hospital Charge Code |
6164820
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$405.13 |
| Max. Negotiated Rate |
$1,409.80 |
| Rate for Payer: Cash Price |
$890.40
|
| Rate for Payer: Cigna Commercial |
$1,261.40
|
| Rate for Payer: First Health Commercial |
$1,335.60
|
| Rate for Payer: First Health Workers Compensation |
$572.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,335.60
|
| Rate for Payer: GEHA Commercial |
$1,038.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,335.60
|
| Rate for Payer: Multiplan All |
$1,350.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,038.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,335.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,409.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,113.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,380.12
|
| Rate for Payer: Zelis Auto |
$593.60
|
| Rate for Payer: Zelis Worker's Compensation |
$405.13
|
|
|
SYMPATHECTOMY DIGITAL ARTERY
|
Facility
|
OP
|
$1,484.00
|
|
|
Service Code
|
CPT 64820
|
| Hospital Charge Code |
6164820
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$405.13 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$890.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$890.40
|
| Rate for Payer: Cash Price |
$890.40
|
| Rate for Payer: Cigna Commercial |
$1,261.40
|
| Rate for Payer: First Health Commercial |
$1,335.60
|
| Rate for Payer: First Health Workers Compensation |
$572.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,335.60
|
| Rate for Payer: GEHA Commercial |
$1,187.20
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,335.60
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$1,350.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$1,038.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,335.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,409.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$1,113.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,380.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$593.60
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$405.13
|
|
|
SYMPATHECTOMY SUPFC PALMAR
|
Facility
|
IP
|
$1,599.00
|
|
|
Service Code
|
CPT 64823
|
| Hospital Charge Code |
6164823
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$436.53 |
| Max. Negotiated Rate |
$1,519.05 |
| Rate for Payer: Cash Price |
$959.40
|
| Rate for Payer: Cigna Commercial |
$1,359.15
|
| Rate for Payer: First Health Commercial |
$1,439.10
|
| Rate for Payer: First Health Workers Compensation |
$617.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,439.10
|
| Rate for Payer: GEHA Commercial |
$1,119.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,439.10
|
| Rate for Payer: Multiplan All |
$1,455.09
|
| Rate for Payer: OMNI Networks Commercial |
$1,119.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,439.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,519.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,199.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,487.07
|
| Rate for Payer: Zelis Auto |
$639.60
|
| Rate for Payer: Zelis Worker's Compensation |
$436.53
|
|
|
SYMPATHECTOMY SUPFC PALMAR
|
Facility
|
OP
|
$1,599.00
|
|
|
Service Code
|
CPT 64823
|
| Hospital Charge Code |
6164823
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$436.53 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$959.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$959.40
|
| Rate for Payer: Cash Price |
$959.40
|
| Rate for Payer: Cigna Commercial |
$1,359.15
|
| Rate for Payer: First Health Commercial |
$1,439.10
|
| Rate for Payer: First Health Workers Compensation |
$617.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,439.10
|
| Rate for Payer: GEHA Commercial |
$1,279.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,439.10
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,455.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,119.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,439.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,519.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,199.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,487.07
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$639.60
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$436.53
|
|
|
SYNCH AUDIO-ONLY EST HIGH 40
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT 98015
|
| Hospital Charge Code |
198015
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$141.96 |
| Max. Negotiated Rate |
$494.00 |
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna Commercial |
$442.00
|
| Rate for Payer: First Health Commercial |
$468.00
|
| Rate for Payer: First Health Workers Compensation |
$200.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$468.00
|
| Rate for Payer: GEHA Commercial |
$364.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$468.00
|
| Rate for Payer: Multiplan All |
$473.20
|
| Rate for Payer: OMNI Networks Commercial |
$364.00
|
| Rate for Payer: One Health Plan PPO/POS |
$468.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$494.00
|
| Rate for Payer: Three Rivers Provider Network All |
$390.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$483.60
|
| Rate for Payer: Zelis Auto |
$208.00
|
| Rate for Payer: Zelis Worker's Compensation |
$141.96
|
|
|
SYNCH AUDIO-ONLY EST HIGH 40
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT 98015
|
| Hospital Charge Code |
198015
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$494.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna Commercial |
$442.00
|
| Rate for Payer: First Health Commercial |
$468.00
|
| Rate for Payer: First Health Workers Compensation |
$200.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$468.00
|
| Rate for Payer: GEHA Commercial |
$416.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$468.00
|
| Rate for Payer: Humana ChoiceCare |
$135.20
|
| Rate for Payer: Multiplan All |
$473.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$312.00
|
| Rate for Payer: OMNI Networks Commercial |
$364.00
|
| Rate for Payer: One Health Plan PPO/POS |
$468.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$494.00
|
| Rate for Payer: Three Rivers Provider Network All |
$390.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$457.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$130.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$483.60
|
| Rate for Payer: Zelis Auto |
$208.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$260.00
|
| Rate for Payer: Zelis Worker's Compensation |
$141.96
|
|
|
SYNCH AUDIO-ONLY EST LOW 20
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 98013
|
| Hospital Charge Code |
198013
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$221.85
|
| Rate for Payer: First Health Commercial |
$234.90
|
| Rate for Payer: First Health Workers Compensation |
$100.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.90
|
| Rate for Payer: GEHA Commercial |
$182.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.90
|
| Rate for Payer: Multiplan All |
$237.51
|
| Rate for Payer: OMNI Networks Commercial |
$182.70
|
| Rate for Payer: One Health Plan PPO/POS |
$234.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$247.95
|
| Rate for Payer: Three Rivers Provider Network All |
$195.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$242.73
|
| Rate for Payer: Zelis Auto |
$104.40
|
| Rate for Payer: Zelis Worker's Compensation |
$71.25
|
|
|
SYNCH AUDIO-ONLY EST LOW 20
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 98013
|
| Hospital Charge Code |
198013
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$65.25 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$156.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$221.85
|
| Rate for Payer: First Health Commercial |
$234.90
|
| Rate for Payer: First Health Workers Compensation |
$100.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.90
|
| Rate for Payer: GEHA Commercial |
$208.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.90
|
| Rate for Payer: Humana ChoiceCare |
$67.86
|
| Rate for Payer: Multiplan All |
$237.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$156.60
|
| Rate for Payer: OMNI Networks Commercial |
$182.70
|
| Rate for Payer: One Health Plan PPO/POS |
$234.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$247.95
|
| Rate for Payer: Three Rivers Provider Network All |
$195.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$229.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$242.73
|
| Rate for Payer: Zelis Auto |
$104.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$130.50
|
| Rate for Payer: Zelis Worker's Compensation |
$71.25
|
|
|
SYNCH AUDIO-ONLY EST MOD 30
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 98014
|
| Hospital Charge Code |
198014
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$101.01 |
| Max. Negotiated Rate |
$351.50 |
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$314.50
|
| Rate for Payer: First Health Commercial |
$333.00
|
| Rate for Payer: First Health Workers Compensation |
$142.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.00
|
| Rate for Payer: GEHA Commercial |
$259.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.00
|
| Rate for Payer: Multiplan All |
$336.70
|
| Rate for Payer: OMNI Networks Commercial |
$259.00
|
| Rate for Payer: One Health Plan PPO/POS |
$333.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$351.50
|
| Rate for Payer: Three Rivers Provider Network All |
$277.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$344.10
|
| Rate for Payer: Zelis Auto |
$148.00
|
| Rate for Payer: Zelis Worker's Compensation |
$101.01
|
|
|
SYNCH AUDIO-ONLY EST MOD 30
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT 98014
|
| Hospital Charge Code |
198014
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$92.50 |
| Max. Negotiated Rate |
$351.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$314.50
|
| Rate for Payer: First Health Commercial |
$333.00
|
| Rate for Payer: First Health Workers Compensation |
$142.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$333.00
|
| Rate for Payer: GEHA Commercial |
$296.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$333.00
|
| Rate for Payer: Humana ChoiceCare |
$96.20
|
| Rate for Payer: Multiplan All |
$336.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$222.00
|
| Rate for Payer: OMNI Networks Commercial |
$259.00
|
| Rate for Payer: One Health Plan PPO/POS |
$333.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$351.50
|
| Rate for Payer: Three Rivers Provider Network All |
$277.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$325.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$92.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$344.10
|
| Rate for Payer: Zelis Auto |
$148.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$185.00
|
| Rate for Payer: Zelis Worker's Compensation |
$101.01
|
|
|
SYNCH AUDIO-ONLY EST SF 10
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 98012
|
| Hospital Charge Code |
198012
|
|
Hospital Revenue Code
|
780
|
| 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
|
|
|
SYNCH AUDIO-ONLY EST SF 10
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 98012
|
| Hospital Charge Code |
198012
|
|
Hospital Revenue Code
|
780
|
| 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 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
|
|
|
SYNCH AUDIO-ONLY NEW HIGH 60
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 98011
|
| Hospital Charge Code |
198011
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$160.25 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$384.60
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$544.85
|
| Rate for Payer: First Health Commercial |
$576.90
|
| Rate for Payer: First Health Workers Compensation |
$247.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.90
|
| Rate for Payer: GEHA Commercial |
$512.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| Rate for Payer: Humana ChoiceCare |
$166.66
|
| Rate for Payer: Multiplan All |
$583.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$384.60
|
| Rate for Payer: OMNI Networks Commercial |
$448.70
|
| Rate for Payer: One Health Plan PPO/POS |
$576.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.95
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$564.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$160.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$596.13
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$320.50
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
SYNCH AUDIO-ONLY NEW HIGH 60
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 98011
|
| Hospital Charge Code |
198011
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$174.99 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$544.85
|
| Rate for Payer: First Health Commercial |
$576.90
|
| Rate for Payer: First Health Workers Compensation |
$247.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$576.90
|
| Rate for Payer: GEHA Commercial |
$448.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$576.90
|
| Rate for Payer: Multiplan All |
$583.31
|
| Rate for Payer: OMNI Networks Commercial |
$448.70
|
| Rate for Payer: One Health Plan PPO/POS |
$576.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$608.95
|
| Rate for Payer: Three Rivers Provider Network All |
$480.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$596.13
|
| Rate for Payer: Zelis Auto |
$256.40
|
| Rate for Payer: Zelis Worker's Compensation |
$174.99
|
|
|
SYNCH AUDIO-ONLY NEW LOW 30
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 98009
|
| Hospital Charge Code |
198009
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$81.50 |
| Max. Negotiated Rate |
$309.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$195.60
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$277.10
|
| Rate for Payer: First Health Commercial |
$293.40
|
| Rate for Payer: First Health Workers Compensation |
$125.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$293.40
|
| Rate for Payer: GEHA Commercial |
$260.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$293.40
|
| Rate for Payer: Humana ChoiceCare |
$84.76
|
| Rate for Payer: Multiplan All |
$296.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$195.60
|
| Rate for Payer: OMNI Networks Commercial |
$228.20
|
| Rate for Payer: One Health Plan PPO/POS |
$293.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$309.70
|
| Rate for Payer: Three Rivers Provider Network All |
$244.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$286.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$81.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$303.18
|
| Rate for Payer: Zelis Auto |
$130.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$163.00
|
| Rate for Payer: Zelis Worker's Compensation |
$89.00
|
|
|
SYNCH AUDIO-ONLY NEW LOW 30
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 98009
|
| Hospital Charge Code |
198009
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$309.70 |
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$277.10
|
| Rate for Payer: First Health Commercial |
$293.40
|
| Rate for Payer: First Health Workers Compensation |
$125.87
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$293.40
|
| Rate for Payer: GEHA Commercial |
$228.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$293.40
|
| Rate for Payer: Multiplan All |
$296.66
|
| Rate for Payer: OMNI Networks Commercial |
$228.20
|
| Rate for Payer: One Health Plan PPO/POS |
$293.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$309.70
|
| Rate for Payer: Three Rivers Provider Network All |
$244.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$303.18
|
| Rate for Payer: Zelis Auto |
$130.40
|
| Rate for Payer: Zelis Worker's Compensation |
$89.00
|
|
|
SYNCH AUDIO-ONLY NEW MOD 45
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
CPT 98010
|
| Hospital Charge Code |
198010
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$121.25 |
| Max. Negotiated Rate |
$460.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$291.00
|
| Rate for Payer: Cash Price |
$291.00
|
| Rate for Payer: Cigna Commercial |
$412.25
|
| Rate for Payer: First Health Commercial |
$436.50
|
| Rate for Payer: First Health Workers Compensation |
$187.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$436.50
|
| Rate for Payer: GEHA Commercial |
$388.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$436.50
|
| Rate for Payer: Humana ChoiceCare |
$126.10
|
| Rate for Payer: Multiplan All |
$441.35
|
| Rate for Payer: New Mexico Health Connections Medicare |
$291.00
|
| Rate for Payer: OMNI Networks Commercial |
$339.50
|
| Rate for Payer: One Health Plan PPO/POS |
$436.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$460.75
|
| Rate for Payer: Three Rivers Provider Network All |
$363.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$426.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$121.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$451.05
|
| Rate for Payer: Zelis Auto |
$194.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$242.50
|
| Rate for Payer: Zelis Worker's Compensation |
$132.41
|
|
|
SYNCH AUDIO-ONLY NEW MOD 45
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
CPT 98010
|
| Hospital Charge Code |
198010
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$132.41 |
| Max. Negotiated Rate |
$460.75 |
| Rate for Payer: Cash Price |
$291.00
|
| Rate for Payer: Cigna Commercial |
$412.25
|
| Rate for Payer: First Health Commercial |
$436.50
|
| Rate for Payer: First Health Workers Compensation |
$187.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$436.50
|
| Rate for Payer: GEHA Commercial |
$339.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$436.50
|
| Rate for Payer: Multiplan All |
$441.35
|
| Rate for Payer: OMNI Networks Commercial |
$339.50
|
| Rate for Payer: One Health Plan PPO/POS |
$436.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$460.75
|
| Rate for Payer: Three Rivers Provider Network All |
$363.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$451.05
|
| Rate for Payer: Zelis Auto |
$194.00
|
| Rate for Payer: Zelis Worker's Compensation |
$132.41
|
|
|
SYNCH AUDIO-ONLY NEW SF 15
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 98008
|
| Hospital Charge Code |
198008
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$57.06 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: First Health Workers Compensation |
$80.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$188.10
|
| Rate for Payer: GEHA Commercial |
$146.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$188.10
|
| Rate for Payer: Multiplan All |
$190.19
|
| Rate for Payer: OMNI Networks Commercial |
$146.30
|
| Rate for Payer: One Health Plan PPO/POS |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$198.55
|
| Rate for Payer: Three Rivers Provider Network All |
$156.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$194.37
|
| Rate for Payer: Zelis Auto |
$83.60
|
| Rate for Payer: Zelis Worker's Compensation |
$57.06
|
|
|
SYNCH AUDIO-ONLY NEW SF 15
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT 98008
|
| Hospital Charge Code |
198008
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$52.25 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: First Health Workers Compensation |
$80.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$188.10
|
| Rate for Payer: GEHA Commercial |
$167.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$188.10
|
| Rate for Payer: Humana ChoiceCare |
$54.34
|
| Rate for Payer: Multiplan All |
$190.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$125.40
|
| Rate for Payer: OMNI Networks Commercial |
$146.30
|
| Rate for Payer: One Health Plan PPO/POS |
$188.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$198.55
|
| Rate for Payer: Three Rivers Provider Network All |
$156.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$183.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$52.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$194.37
|
| Rate for Payer: Zelis Auto |
$83.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$104.50
|
| Rate for Payer: Zelis Worker's Compensation |
$57.06
|
|
|
SYNCH AUDIO-VIDEO EST HI 40
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT 98007
|
| Hospital Charge Code |
198007
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$141.96 |
| Max. Negotiated Rate |
$494.00 |
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna Commercial |
$442.00
|
| Rate for Payer: First Health Commercial |
$468.00
|
| Rate for Payer: First Health Workers Compensation |
$200.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$468.00
|
| Rate for Payer: GEHA Commercial |
$364.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$468.00
|
| Rate for Payer: Multiplan All |
$473.20
|
| Rate for Payer: OMNI Networks Commercial |
$364.00
|
| Rate for Payer: One Health Plan PPO/POS |
$468.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$494.00
|
| Rate for Payer: Three Rivers Provider Network All |
$390.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$483.60
|
| Rate for Payer: Zelis Auto |
$208.00
|
| Rate for Payer: Zelis Worker's Compensation |
$141.96
|
|
|
SYNCH AUDIO-VIDEO EST HI 40
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT 98007
|
| Hospital Charge Code |
198007
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$494.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna Commercial |
$442.00
|
| Rate for Payer: First Health Commercial |
$468.00
|
| Rate for Payer: First Health Workers Compensation |
$200.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$468.00
|
| Rate for Payer: GEHA Commercial |
$416.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$468.00
|
| Rate for Payer: Humana ChoiceCare |
$135.20
|
| Rate for Payer: Multiplan All |
$473.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$312.00
|
| Rate for Payer: OMNI Networks Commercial |
$364.00
|
| Rate for Payer: One Health Plan PPO/POS |
$468.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$494.00
|
| Rate for Payer: Three Rivers Provider Network All |
$390.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$457.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$130.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$483.60
|
| Rate for Payer: Zelis Auto |
$208.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$260.00
|
| Rate for Payer: Zelis Worker's Compensation |
$141.96
|
|
|
SYNCH AUDIO-VIDEO EST LOW 20
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 98005
|
| Hospital Charge Code |
198005
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$221.85
|
| Rate for Payer: First Health Commercial |
$234.90
|
| Rate for Payer: First Health Workers Compensation |
$100.77
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.90
|
| Rate for Payer: GEHA Commercial |
$182.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.90
|
| Rate for Payer: Multiplan All |
$237.51
|
| Rate for Payer: OMNI Networks Commercial |
$182.70
|
| Rate for Payer: One Health Plan PPO/POS |
$234.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$247.95
|
| Rate for Payer: Three Rivers Provider Network All |
$195.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$242.73
|
| Rate for Payer: Zelis Auto |
$104.40
|
| Rate for Payer: Zelis Worker's Compensation |
$71.25
|
|
