|
TIS TRNFR F/C/C/M/N/A/G/H/F
|
Facility
|
OP
|
$1,288.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
6114040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$351.62 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$772.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,285.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$772.80
|
| Rate for Payer: Cash Price |
$772.80
|
| Rate for Payer: Cigna Commercial |
$1,094.80
|
| Rate for Payer: First Health Commercial |
$1,159.20
|
| Rate for Payer: First Health Workers Compensation |
$497.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,159.20
|
| Rate for Payer: GEHA Commercial |
$1,030.40
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,159.20
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,312.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$1,172.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$901.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,159.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,515.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,312.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,223.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$966.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,312.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,197.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$515.20
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$351.62
|
|
|
TIS TRNFR F/C/C/M/N/A/G/H/F
|
Facility
|
IP
|
$1,588.00
|
|
|
Service Code
|
CPT 14041
|
| Hospital Charge Code |
6114041
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$433.52 |
| Max. Negotiated Rate |
$1,508.60 |
| Rate for Payer: Cash Price |
$952.80
|
| Rate for Payer: Cigna Commercial |
$1,349.80
|
| Rate for Payer: First Health Commercial |
$1,429.20
|
| Rate for Payer: First Health Workers Compensation |
$613.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,429.20
|
| Rate for Payer: GEHA Commercial |
$1,111.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,429.20
|
| Rate for Payer: Multiplan All |
$1,445.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,111.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,429.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,508.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,191.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,476.84
|
| Rate for Payer: Zelis Auto |
$635.20
|
| Rate for Payer: Zelis Worker's Compensation |
$433.52
|
|
|
TIS TRNFR F/C/C/M/N/A/G/H/F
|
Facility
|
OP
|
$1,588.00
|
|
|
Service Code
|
CPT 14041
|
| Hospital Charge Code |
6114041
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$433.52 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$952.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,285.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$952.80
|
| Rate for Payer: Cash Price |
$952.80
|
| Rate for Payer: Cigna Commercial |
$1,349.80
|
| Rate for Payer: First Health Commercial |
$1,429.20
|
| Rate for Payer: First Health Workers Compensation |
$613.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,429.20
|
| Rate for Payer: GEHA Commercial |
$1,270.40
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,429.20
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,312.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$1,445.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,111.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,429.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,515.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,312.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,508.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,191.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,312.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,476.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$635.20
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$433.52
|
|
|
TIS TRNFR S/A/L 10.1-30 SQCM
|
Facility
|
OP
|
$1,465.00
|
|
|
Service Code
|
CPT 14021
|
| Hospital Charge Code |
6114021
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$399.94 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$879.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,285.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$879.00
|
| Rate for Payer: Cash Price |
$879.00
|
| Rate for Payer: Cigna Commercial |
$1,245.25
|
| Rate for Payer: First Health Commercial |
$1,318.50
|
| Rate for Payer: First Health Workers Compensation |
$565.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,318.50
|
| Rate for Payer: GEHA Commercial |
$1,172.00
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,318.50
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,312.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$1,333.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,025.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,318.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,515.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,312.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,391.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,098.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,312.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,362.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$586.00
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$399.94
|
|
|
TIS TRNFR S/A/L 10.1-30 SQCM
|
Facility
|
IP
|
$1,465.00
|
|
|
Service Code
|
CPT 14021
|
| Hospital Charge Code |
6114021
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$399.94 |
| Max. Negotiated Rate |
$1,391.75 |
| Rate for Payer: Cash Price |
$879.00
|
| Rate for Payer: Cigna Commercial |
$1,245.25
|
| Rate for Payer: First Health Commercial |
$1,318.50
|
| Rate for Payer: First Health Workers Compensation |
$565.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,318.50
|
| Rate for Payer: GEHA Commercial |
$1,025.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,318.50
|
| Rate for Payer: Multiplan All |
$1,333.15
|
| Rate for Payer: OMNI Networks Commercial |
$1,025.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,318.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,391.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,098.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,362.45
|
| Rate for Payer: Zelis Auto |
$586.00
|
| Rate for Payer: Zelis Worker's Compensation |
$399.94
|
|
|
TIS TRNFR S/A/L 10 SQ CM/<
|
Facility
|
IP
|
$1,154.00
|
|
|
Service Code
|
CPT 14020
|
| Hospital Charge Code |
6114020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$315.04 |
| Max. Negotiated Rate |
$1,096.30 |
| Rate for Payer: Cash Price |
$692.40
|
| Rate for Payer: Cigna Commercial |
$980.90
|
| Rate for Payer: First Health Commercial |
$1,038.60
|
| Rate for Payer: First Health Workers Compensation |
$445.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,038.60
|
| Rate for Payer: GEHA Commercial |
$807.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,038.60
|
| Rate for Payer: Multiplan All |
$1,050.14
|
| Rate for Payer: OMNI Networks Commercial |
$807.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,038.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,096.30
|
| Rate for Payer: Three Rivers Provider Network All |
$865.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,073.22
|
| Rate for Payer: Zelis Auto |
$461.60
|
| Rate for Payer: Zelis Worker's Compensation |
$315.04
|
|
|
TIS TRNFR S/A/L 10 SQ CM/<
|
Facility
|
OP
|
$1,154.00
|
|
|
Service Code
|
CPT 14020
|
| Hospital Charge Code |
6114020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$315.04 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$692.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,285.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$692.40
|
| Rate for Payer: Cash Price |
$692.40
|
| Rate for Payer: Cigna Commercial |
$980.90
|
| Rate for Payer: First Health Commercial |
$1,038.60
|
| Rate for Payer: First Health Workers Compensation |
$445.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,038.60
|
| Rate for Payer: GEHA Commercial |
$923.20
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,038.60
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,312.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$1,050.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$807.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,038.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,515.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,312.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,096.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$865.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,312.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,073.22
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$461.60
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$315.04
|
|
|
TIS TRNFR TRUNK 10.1-30SQCM
|
Facility
|
OP
|
$1,336.00
|
|
|
Service Code
|
CPT 14001
|
| Hospital Charge Code |
6114001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$364.73 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$801.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,285.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$801.60
|
| Rate for Payer: Cash Price |
$801.60
|
| Rate for Payer: Cigna Commercial |
$1,135.60
|
| Rate for Payer: First Health Commercial |
$1,202.40
|
| Rate for Payer: First Health Workers Compensation |
$515.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,202.40
|
| Rate for Payer: GEHA Commercial |
$1,068.80
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,202.40
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,312.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$1,215.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$935.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,202.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,515.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,312.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,269.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,002.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,312.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,242.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$534.40
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$364.73
|
|
|
TIS TRNFR TRUNK 10.1-30SQCM
|
Facility
|
IP
|
$1,336.00
|
|
|
Service Code
|
CPT 14001
|
| Hospital Charge Code |
6114001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$364.73 |
| Max. Negotiated Rate |
$1,269.20 |
| Rate for Payer: Cash Price |
$801.60
|
| Rate for Payer: Cigna Commercial |
$1,135.60
|
| Rate for Payer: First Health Commercial |
$1,202.40
|
| Rate for Payer: First Health Workers Compensation |
$515.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,202.40
|
| Rate for Payer: GEHA Commercial |
$935.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,202.40
|
| Rate for Payer: Multiplan All |
$1,215.76
|
| Rate for Payer: OMNI Networks Commercial |
$935.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,202.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,269.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,002.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,242.48
|
| Rate for Payer: Zelis Auto |
$534.40
|
| Rate for Payer: Zelis Worker's Compensation |
$364.73
|
|
|
TIS TRNFR TRUNK 10 SQ CM/<
|
Facility
|
IP
|
$1,021.00
|
|
|
Service Code
|
CPT 14000
|
| Hospital Charge Code |
6114000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$278.73 |
| Max. Negotiated Rate |
$969.95 |
| Rate for Payer: Cash Price |
$612.60
|
| Rate for Payer: Cigna Commercial |
$867.85
|
| Rate for Payer: First Health Commercial |
$918.90
|
| Rate for Payer: First Health Workers Compensation |
$394.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$918.90
|
| Rate for Payer: GEHA Commercial |
$714.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$918.90
|
| Rate for Payer: Multiplan All |
$929.11
|
| Rate for Payer: OMNI Networks Commercial |
$714.70
|
| Rate for Payer: One Health Plan PPO/POS |
$918.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$969.95
|
| Rate for Payer: Three Rivers Provider Network All |
$765.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$949.53
|
| Rate for Payer: Zelis Auto |
$408.40
|
| Rate for Payer: Zelis Worker's Compensation |
$278.73
|
|
|
TIS TRNFR TRUNK 10 SQ CM/<
|
Facility
|
OP
|
$1,021.00
|
|
|
Service Code
|
CPT 14000
|
| Hospital Charge Code |
6114000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$278.73 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$612.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,623.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,285.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$612.60
|
| Rate for Payer: Cash Price |
$612.60
|
| Rate for Payer: Cigna Commercial |
$867.85
|
| Rate for Payer: First Health Commercial |
$918.90
|
| Rate for Payer: First Health Workers Compensation |
$394.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$918.90
|
| Rate for Payer: GEHA Commercial |
$816.80
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$918.90
|
| Rate for Payer: Humana ChoiceCare |
$1,910.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,736.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,918.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,312.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$929.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$714.70
|
| Rate for Payer: One Health Plan PPO/POS |
$918.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,515.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,312.11
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$969.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$765.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,312.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$949.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$408.40
|
| Rate for Payer: Zelis Medicare |
$1,476.39
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,084.32
|
| Rate for Payer: Zelis Worker's Compensation |
$278.73
|
|
|
tiZANidine HCL TAB 2MG
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 50268075915
|
| Hospital Charge Code |
3300896
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: First Health Commercial |
$8.10
|
| Rate for Payer: First Health Workers Compensation |
$3.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8.10
|
| Rate for Payer: GEHA Commercial |
$7.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8.10
|
| Rate for Payer: Humana ChoiceCare |
$2.34
|
| Rate for Payer: Multiplan All |
$8.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5.40
|
| Rate for Payer: OMNI Networks Commercial |
$6.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$7.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8.37
|
| Rate for Payer: Zelis Auto |
$3.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.50
|
| Rate for Payer: Zelis Worker's Compensation |
$2.46
|
|
|
tiZANidine HCL TAB 2MG
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 50268075915
|
| Hospital Charge Code |
3300896
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: First Health Commercial |
$8.10
|
| Rate for Payer: First Health Workers Compensation |
$3.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8.10
|
| Rate for Payer: GEHA Commercial |
$6.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8.10
|
| Rate for Payer: Multiplan All |
$8.19
|
| Rate for Payer: OMNI Networks Commercial |
$6.30
|
| Rate for Payer: One Health Plan PPO/POS |
$8.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8.55
|
| Rate for Payer: Three Rivers Provider Network All |
$6.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8.37
|
| Rate for Payer: Zelis Auto |
$3.60
|
| Rate for Payer: Zelis Worker's Compensation |
$2.46
|
|
|
tiZANidine HCL TAB 4MG
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
NDC 51079099820
|
| Hospital Charge Code |
3300897
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: First Health Commercial |
$18.90
|
| Rate for Payer: First Health Workers Compensation |
$8.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.90
|
| Rate for Payer: GEHA Commercial |
$16.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.90
|
| Rate for Payer: Humana ChoiceCare |
$5.46
|
| Rate for Payer: Multiplan All |
$19.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12.60
|
| Rate for Payer: OMNI Networks Commercial |
$14.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.95
|
| Rate for Payer: Three Rivers Provider Network All |
$15.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$18.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.53
|
| Rate for Payer: Zelis Auto |
$8.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.50
|
| Rate for Payer: Zelis Worker's Compensation |
$5.73
|
|
|
tiZANidine HCL TAB 4MG
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
NDC 51079099820
|
| Hospital Charge Code |
3300897
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$17.85
|
| Rate for Payer: First Health Commercial |
$18.90
|
| Rate for Payer: First Health Workers Compensation |
$8.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.90
|
| Rate for Payer: GEHA Commercial |
$14.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.90
|
| Rate for Payer: Multiplan All |
$19.11
|
| Rate for Payer: OMNI Networks Commercial |
$14.70
|
| Rate for Payer: One Health Plan PPO/POS |
$18.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.95
|
| Rate for Payer: Three Rivers Provider Network All |
$15.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$19.53
|
| Rate for Payer: Zelis Auto |
$8.40
|
| Rate for Payer: Zelis Worker's Compensation |
$5.73
|
|
|
TM DM OP SLF-MGMT TRN SRVC IND-30 MIN
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT G0108
|
| Hospital Charge Code |
20500100
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$44.23 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$137.70
|
| Rate for Payer: First Health Commercial |
$145.80
|
| Rate for Payer: First Health Workers Compensation |
$62.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.80
|
| Rate for Payer: GEHA Commercial |
$113.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.80
|
| Rate for Payer: Multiplan All |
$147.42
|
| Rate for Payer: OMNI Networks Commercial |
$113.40
|
| Rate for Payer: One Health Plan PPO/POS |
$145.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$153.90
|
| Rate for Payer: Three Rivers Provider Network All |
$121.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$150.66
|
| Rate for Payer: Zelis Auto |
$64.80
|
| Rate for Payer: Zelis Worker's Compensation |
$44.23
|
|
|
TM DM OP SLF-MGMT TRN SRVC IND-30 MIN
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT G0108
|
| Hospital Charge Code |
20500100
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$42.12 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$77.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$77.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$61.68
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$137.70
|
| Rate for Payer: First Health Commercial |
$145.80
|
| Rate for Payer: First Health Workers Compensation |
$62.55
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$145.80
|
| Rate for Payer: GEHA Commercial |
$129.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$145.80
|
| Rate for Payer: Humana ChoiceCare |
$42.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$62.94
|
| Rate for Payer: Multiplan All |
$147.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$97.20
|
| Rate for Payer: OMNI Networks Commercial |
$113.40
|
| Rate for Payer: One Health Plan PPO/POS |
$145.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$72.67
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$62.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$153.90
|
| Rate for Payer: Three Rivers Provider Network All |
$121.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$142.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$62.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$150.66
|
| Rate for Payer: Zelis Auto |
$64.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.00
|
| Rate for Payer: Zelis Worker's Compensation |
$44.23
|
|
|
TM DM SLF-MGMT TRN SRVC GRP-30 MIN
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT G0109
|
| Hospital Charge Code |
20500101
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$38.25
|
| Rate for Payer: First Health Commercial |
$40.50
|
| Rate for Payer: First Health Workers Compensation |
$17.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$40.50
|
| Rate for Payer: GEHA Commercial |
$31.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$40.50
|
| Rate for Payer: Multiplan All |
$40.95
|
| Rate for Payer: OMNI Networks Commercial |
$31.50
|
| Rate for Payer: One Health Plan PPO/POS |
$40.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$42.75
|
| Rate for Payer: Three Rivers Provider Network All |
$33.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$41.85
|
| Rate for Payer: Zelis Auto |
$18.00
|
| Rate for Payer: Zelis Worker's Compensation |
$12.29
|
|
|
TM DM SLF-MGMT TRN SRVC GRP-30 MIN
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT G0109
|
| Hospital Charge Code |
20500101
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16.58
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$38.25
|
| Rate for Payer: First Health Commercial |
$40.50
|
| Rate for Payer: First Health Workers Compensation |
$17.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$40.50
|
| Rate for Payer: GEHA Commercial |
$36.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$40.50
|
| Rate for Payer: Humana ChoiceCare |
$11.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16.91
|
| Rate for Payer: Multiplan All |
$40.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$27.00
|
| Rate for Payer: OMNI Networks Commercial |
$31.50
|
| Rate for Payer: One Health Plan PPO/POS |
$40.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16.91
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$42.75
|
| Rate for Payer: Three Rivers Provider Network All |
$33.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$39.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$41.85
|
| Rate for Payer: Zelis Auto |
$18.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$22.50
|
| Rate for Payer: Zelis Worker's Compensation |
$12.29
|
|
|
TOBACCO USE CESSATION INTENSIVE >10 MINU
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
21600205
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$31.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$51.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$31.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$28.29
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$73.10
|
| Rate for Payer: First Health Commercial |
$77.40
|
| Rate for Payer: First Health Workers Compensation |
$33.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$77.40
|
| Rate for Payer: GEHA Commercial |
$68.80
|
| Rate for Payer: GEHA Medicare |
$28.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$77.40
|
| Rate for Payer: Humana ChoiceCare |
$31.12
|
| Rate for Payer: Humana Medicare Advantage |
$28.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$47.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$28.29
|
| Rate for Payer: Multiplan All |
$78.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.09
|
| Rate for Payer: OMNI Networks Commercial |
$60.20
|
| Rate for Payer: One Health Plan PPO/POS |
$77.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$29.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$28.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$81.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$56.58
|
| Rate for Payer: Three Rivers Provider Network All |
$64.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$79.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$28.29
|
| Rate for Payer: Zelis Auto |
$34.40
|
| Rate for Payer: Zelis Medicare |
$24.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.95
|
| Rate for Payer: Zelis Worker's Compensation |
$23.48
|
|
|
TOBACCO USE CESSATION INTENSIVE >10 MINU
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
20300036
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$73.10
|
| Rate for Payer: First Health Commercial |
$77.40
|
| Rate for Payer: First Health Workers Compensation |
$33.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$77.40
|
| Rate for Payer: GEHA Commercial |
$60.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$77.40
|
| Rate for Payer: Multiplan All |
$78.26
|
| Rate for Payer: OMNI Networks Commercial |
$60.20
|
| Rate for Payer: One Health Plan PPO/POS |
$77.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$81.70
|
| Rate for Payer: Three Rivers Provider Network All |
$64.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$79.98
|
| Rate for Payer: Zelis Auto |
$34.40
|
| Rate for Payer: Zelis Worker's Compensation |
$23.48
|
|
|
TOBACCO USE CESSATION INTENSIVE >10 MINU
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
1900036
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$28.94 |
| Max. Negotiated Rate |
$100.70 |
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$90.10
|
| Rate for Payer: First Health Commercial |
$95.40
|
| Rate for Payer: First Health Workers Compensation |
$40.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$95.40
|
| Rate for Payer: GEHA Commercial |
$74.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$95.40
|
| Rate for Payer: Multiplan All |
$96.46
|
| Rate for Payer: OMNI Networks Commercial |
$74.20
|
| Rate for Payer: One Health Plan PPO/POS |
$95.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$100.70
|
| Rate for Payer: Three Rivers Provider Network All |
$79.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$98.58
|
| Rate for Payer: Zelis Auto |
$42.40
|
| Rate for Payer: Zelis Worker's Compensation |
$28.94
|
|
|
TOBACCO USE CESSATION INTENSIVE >10 MINU
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
1900036
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$100.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$31.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$63.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$31.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$28.29
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$90.10
|
| Rate for Payer: First Health Commercial |
$95.40
|
| Rate for Payer: First Health Workers Compensation |
$40.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$95.40
|
| Rate for Payer: GEHA Commercial |
$84.80
|
| Rate for Payer: GEHA Medicare |
$28.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$95.40
|
| Rate for Payer: Humana ChoiceCare |
$31.12
|
| Rate for Payer: Humana Medicare Advantage |
$28.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$47.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$28.29
|
| Rate for Payer: Multiplan All |
$96.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.09
|
| Rate for Payer: OMNI Networks Commercial |
$74.20
|
| Rate for Payer: One Health Plan PPO/POS |
$95.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$29.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$28.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$100.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$56.58
|
| Rate for Payer: Three Rivers Provider Network All |
$79.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$98.58
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$28.29
|
| Rate for Payer: Zelis Auto |
$42.40
|
| Rate for Payer: Zelis Medicare |
$24.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.95
|
| Rate for Payer: Zelis Worker's Compensation |
$28.94
|
|
|
TOBACCO USE CESSATION INTENSIVE >10 MINU
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
21600205
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$73.10
|
| Rate for Payer: First Health Commercial |
$77.40
|
| Rate for Payer: First Health Workers Compensation |
$33.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$77.40
|
| Rate for Payer: GEHA Commercial |
$60.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$77.40
|
| Rate for Payer: Multiplan All |
$78.26
|
| Rate for Payer: OMNI Networks Commercial |
$60.20
|
| Rate for Payer: One Health Plan PPO/POS |
$77.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$81.70
|
| Rate for Payer: Three Rivers Provider Network All |
$64.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$79.98
|
| Rate for Payer: Zelis Auto |
$34.40
|
| Rate for Payer: Zelis Worker's Compensation |
$23.48
|
|
|
TOBACCO USE CESSATION INTENSIVE >10 MINU
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
20300036
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$31.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$51.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$31.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$28.29
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$73.10
|
| Rate for Payer: First Health Commercial |
$77.40
|
| Rate for Payer: First Health Workers Compensation |
$33.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$77.40
|
| Rate for Payer: GEHA Commercial |
$68.80
|
| Rate for Payer: GEHA Medicare |
$28.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$77.40
|
| Rate for Payer: Humana ChoiceCare |
$31.12
|
| Rate for Payer: Humana Medicare Advantage |
$28.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$47.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$25.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$28.29
|
| Rate for Payer: Multiplan All |
$78.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.09
|
| Rate for Payer: OMNI Networks Commercial |
$60.20
|
| Rate for Payer: One Health Plan PPO/POS |
$77.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$29.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$25.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$28.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$81.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$56.58
|
| Rate for Payer: Three Rivers Provider Network All |
$64.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$79.98
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$28.29
|
| Rate for Payer: Zelis Auto |
$34.40
|
| Rate for Payer: Zelis Medicare |
$24.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.95
|
| Rate for Payer: Zelis Worker's Compensation |
$23.48
|
|
