|
CHANGE OF WINDPIPE AIRWAY
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
6131502
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$93.50
|
| Rate for Payer: First Health Commercial |
$99.00
|
| Rate for Payer: First Health Workers Compensation |
$42.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.00
|
| Rate for Payer: GEHA Commercial |
$77.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.00
|
| Rate for Payer: Multiplan All |
$100.10
|
| Rate for Payer: OMNI Networks Commercial |
$77.00
|
| Rate for Payer: One Health Plan PPO/POS |
$99.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$104.50
|
| Rate for Payer: Three Rivers Provider Network All |
$82.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$102.30
|
| Rate for Payer: Zelis Auto |
$44.00
|
| Rate for Payer: Zelis Worker's Compensation |
$30.03
|
|
|
CHARCOAL ACTIVATED LIQ - ADULT
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
NDC 00574052076
|
| Hospital Charge Code |
3300169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.04 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$112.20
|
| Rate for Payer: First Health Commercial |
$118.80
|
| Rate for Payer: First Health Workers Compensation |
$50.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$118.80
|
| Rate for Payer: GEHA Commercial |
$92.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$118.80
|
| Rate for Payer: Multiplan All |
$120.12
|
| Rate for Payer: OMNI Networks Commercial |
$92.40
|
| Rate for Payer: One Health Plan PPO/POS |
$118.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$125.40
|
| Rate for Payer: Three Rivers Provider Network All |
$99.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$122.76
|
| Rate for Payer: Zelis Auto |
$52.80
|
| Rate for Payer: Zelis Worker's Compensation |
$36.04
|
|
|
CHARCOAL ACTIVATED LIQ - ADULT
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
NDC 00574052076
|
| Hospital Charge Code |
3300169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$112.20
|
| Rate for Payer: First Health Commercial |
$118.80
|
| Rate for Payer: First Health Workers Compensation |
$50.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$118.80
|
| Rate for Payer: GEHA Commercial |
$105.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$118.80
|
| Rate for Payer: Humana ChoiceCare |
$34.32
|
| Rate for Payer: Multiplan All |
$120.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$79.20
|
| Rate for Payer: OMNI Networks Commercial |
$92.40
|
| Rate for Payer: One Health Plan PPO/POS |
$118.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$125.40
|
| Rate for Payer: Three Rivers Provider Network All |
$99.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$116.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$33.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$122.76
|
| Rate for Payer: Zelis Auto |
$52.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$66.00
|
| Rate for Payer: Zelis Worker's Compensation |
$36.04
|
|
|
CHARCOAL ACTIVATED LIQ - PEDI
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
NDC 66689020204
|
| Hospital Charge Code |
3300168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$88.40
|
| Rate for Payer: First Health Commercial |
$93.60
|
| Rate for Payer: First Health Workers Compensation |
$40.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$93.60
|
| Rate for Payer: GEHA Commercial |
$83.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$93.60
|
| Rate for Payer: Humana ChoiceCare |
$27.04
|
| Rate for Payer: Multiplan All |
$94.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$62.40
|
| Rate for Payer: OMNI Networks Commercial |
$72.80
|
| Rate for Payer: One Health Plan PPO/POS |
$93.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$98.80
|
| Rate for Payer: Three Rivers Provider Network All |
$78.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$91.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$96.72
|
| Rate for Payer: Zelis Auto |
$41.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$52.00
|
| Rate for Payer: Zelis Worker's Compensation |
$28.39
|
|
|
CHARCOAL ACTIVATED LIQ - PEDI
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
NDC 66689020204
|
| Hospital Charge Code |
3300168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.39 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$88.40
|
| Rate for Payer: First Health Commercial |
$93.60
|
| Rate for Payer: First Health Workers Compensation |
$40.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$93.60
|
| Rate for Payer: GEHA Commercial |
$72.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$93.60
|
| Rate for Payer: Multiplan All |
$94.64
|
| Rate for Payer: OMNI Networks Commercial |
$72.80
|
| Rate for Payer: One Health Plan PPO/POS |
$93.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$98.80
|
| Rate for Payer: Three Rivers Provider Network All |
$78.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$96.72
|
| Rate for Payer: Zelis Auto |
$41.60
|
| Rate for Payer: Zelis Worker's Compensation |
$28.39
|
|
|
CHARGE ABG BASIC
|
Facility
|
IP
|
$429.61
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
4000004
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.38 |
| Max. Negotiated Rate |
$408.13 |
| Rate for Payer: Cash Price |
$257.77
|
| Rate for Payer: Cash Price |
$257.77
|
| Rate for Payer: Cigna Commercial |
$365.17
|
| Rate for Payer: First Health Commercial |
$386.65
|
| Rate for Payer: First Health Workers Compensation |
$38.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$386.65
|
| Rate for Payer: GEHA Commercial |
$300.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$386.65
|
| Rate for Payer: Multiplan All |
$390.95
|
| Rate for Payer: OMNI Networks Commercial |
$300.73
|
| Rate for Payer: One Health Plan PPO/POS |
$386.65
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$408.13
|
| Rate for Payer: Three Rivers Provider Network All |
$322.21
|
| Rate for Payer: United Payors & United Providers UP&UP |
$399.54
|
| Rate for Payer: Zelis Auto |
$171.84
|
| Rate for Payer: Zelis Worker's Compensation |
$27.38
|
|
|
CHARGE ABG BASIC
|
Facility
|
OP
|
$429.61
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
4000004
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.16 |
| Max. Negotiated Rate |
$408.13 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$46.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$257.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$46.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$37.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$26.07
|
| Rate for Payer: Cash Price |
$257.77
|
| Rate for Payer: Cash Price |
$257.77
|
| Rate for Payer: Cigna Commercial |
$365.17
|
| Rate for Payer: First Health Commercial |
$386.65
|
| Rate for Payer: First Health Workers Compensation |
$38.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$386.65
|
| Rate for Payer: GEHA Commercial |
$343.69
|
| Rate for Payer: GEHA Medicare |
$26.07
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$386.65
|
| Rate for Payer: Humana ChoiceCare |
$28.68
|
| Rate for Payer: Humana Medicare Advantage |
$26.07
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$43.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$37.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$26.07
|
| Rate for Payer: Multiplan All |
$390.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$44.32
|
| Rate for Payer: OMNI Networks Commercial |
$300.73
|
| Rate for Payer: One Health Plan PPO/POS |
$386.65
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$43.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$37.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$26.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$408.13
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$52.14
|
| Rate for Payer: Three Rivers Provider Network All |
$322.21
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$25.55
|
| Rate for Payer: United Healthcare Commercial |
$365.17
|
| Rate for Payer: United Healthcare Managed Medicaid |
$37.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.07
|
| Rate for Payer: United Payors & United Providers UP&UP |
$399.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$26.07
|
| Rate for Payer: Zelis Auto |
$171.84
|
| Rate for Payer: Zelis Medicare |
$22.16
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$31.28
|
| Rate for Payer: Zelis Worker's Compensation |
$27.38
|
|
|
CHARGE ONLY HEMOGRAM
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
2205029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$45.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: First Health Workers Compensation |
$12.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$68.40
|
| Rate for Payer: GEHA Commercial |
$60.80
|
| Rate for Payer: GEHA Medicare |
$6.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$68.40
|
| Rate for Payer: Humana ChoiceCare |
$7.12
|
| Rate for Payer: Humana Medicare Advantage |
$6.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.47
|
| Rate for Payer: Multiplan All |
$69.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.00
|
| Rate for Payer: OMNI Networks Commercial |
$53.20
|
| Rate for Payer: One Health Plan PPO/POS |
$68.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$72.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12.94
|
| Rate for Payer: Three Rivers Provider Network All |
$57.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.34
|
| Rate for Payer: United Healthcare Commercial |
$64.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$70.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.47
|
| Rate for Payer: Zelis Auto |
$30.40
|
| Rate for Payer: Zelis Medicare |
$5.50
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.76
|
| Rate for Payer: Zelis Worker's Compensation |
$8.89
|
|
|
CHARGE ONLY HEMOGRAM
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
2205029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: First Health Workers Compensation |
$12.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$68.40
|
| Rate for Payer: GEHA Commercial |
$53.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$68.40
|
| Rate for Payer: Multiplan All |
$69.16
|
| Rate for Payer: OMNI Networks Commercial |
$53.20
|
| Rate for Payer: One Health Plan PPO/POS |
$68.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$72.20
|
| Rate for Payer: Three Rivers Provider Network All |
$57.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$70.68
|
| Rate for Payer: Zelis Auto |
$30.40
|
| Rate for Payer: Zelis Worker's Compensation |
$8.89
|
|
|
CHARGE ONLY MAN DIF ADD
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
2205030
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$5.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$88.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Worker's Compensation |
$3.96
|
|
|
CHARGE ONLY MAN DIF ADD
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
2205030
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5.42
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3.80
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$107.95
|
| Rate for Payer: First Health Commercial |
$114.30
|
| Rate for Payer: First Health Workers Compensation |
$5.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$101.60
|
| Rate for Payer: GEHA Medicare |
$3.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Humana ChoiceCare |
$4.18
|
| Rate for Payer: Humana Medicare Advantage |
$3.80
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3.80
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.46
|
| Rate for Payer: OMNI Networks Commercial |
$88.90
|
| Rate for Payer: One Health Plan PPO/POS |
$114.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$120.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7.60
|
| Rate for Payer: Three Rivers Provider Network All |
$95.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.72
|
| Rate for Payer: United Healthcare Commercial |
$107.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.80
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3.80
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Medicare |
$3.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4.56
|
| Rate for Payer: Zelis Worker's Compensation |
$3.96
|
|
|
CHEMICAL CAUTERIZATION GRANULATION TISSU
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
6117250
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$79.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
CHEMICAL CAUTERIZATION GRANULATION TISSU
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
7917250
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$60.25 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$144.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: First Health Workers Compensation |
$93.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$192.80
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| 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 Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$96.40
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$65.79
|
|
|
CHEMICAL CAUTERIZATION GRANULATION TISSU
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
20300038
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.79 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: First Health Workers Compensation |
$93.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$168.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: Zelis Auto |
$96.40
|
| Rate for Payer: Zelis Worker's Compensation |
$65.79
|
|
|
CHEMICAL CAUTERIZATION GRANULATION TISSU
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
20300038
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.25 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$144.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: First Health Workers Compensation |
$93.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$192.80
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| 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 Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$96.40
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$65.79
|
|
|
CHEMICAL CAUTERIZATION GRANULATION TISSU
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
7917250
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$65.79 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$204.85
|
| Rate for Payer: First Health Commercial |
$216.90
|
| Rate for Payer: First Health Workers Compensation |
$93.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$216.90
|
| Rate for Payer: GEHA Commercial |
$168.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$216.90
|
| Rate for Payer: Multiplan All |
$219.31
|
| Rate for Payer: OMNI Networks Commercial |
$168.70
|
| Rate for Payer: One Health Plan PPO/POS |
$216.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$228.95
|
| Rate for Payer: Three Rivers Provider Network All |
$180.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$224.13
|
| Rate for Payer: Zelis Auto |
$96.40
|
| Rate for Payer: Zelis Worker's Compensation |
$65.79
|
|
|
CHEMICAL CAUTERIZATION GRANULATION TISSU
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
21600089
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$90.40
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| 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 Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
CHEMICAL CAUTERIZATION GRANULATION TISSU
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
6117250
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$90.40
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| 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 Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
CHEMICAL CAUTERIZATION GRANULATION TISSU
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
1900038
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.37 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$405.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$573.75
|
| Rate for Payer: First Health Commercial |
$607.50
|
| Rate for Payer: First Health Workers Compensation |
$260.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$607.50
|
| Rate for Payer: GEHA Commercial |
$540.00
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$607.50
|
| 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 Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$614.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$472.50
|
| Rate for Payer: One Health Plan PPO/POS |
$607.50
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$641.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$506.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$168.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$627.75
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$270.00
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$184.28
|
|
|
CHEMICAL CAUTERIZATION GRANULATION TISSU
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
21600089
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$79.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
CHEMICAL CAUTERIZATION GRANULATION TISSU
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
1900038
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$184.28 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$573.75
|
| Rate for Payer: First Health Commercial |
$607.50
|
| Rate for Payer: First Health Workers Compensation |
$260.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$607.50
|
| Rate for Payer: GEHA Commercial |
$472.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$607.50
|
| Rate for Payer: Multiplan All |
$614.25
|
| Rate for Payer: OMNI Networks Commercial |
$472.50
|
| Rate for Payer: One Health Plan PPO/POS |
$607.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$641.25
|
| Rate for Payer: Three Rivers Provider Network All |
$506.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$627.75
|
| Rate for Payer: Zelis Auto |
$270.00
|
| Rate for Payer: Zelis Worker's Compensation |
$184.28
|
|
|
CHEMICAL CAUTERIZATION OF GRANULATION TI
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
9617250
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$160.37 |
| Max. Negotiated Rate |
$631.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$399.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$565.25
|
| Rate for Payer: First Health Commercial |
$598.50
|
| Rate for Payer: First Health Workers Compensation |
$256.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$598.50
|
| Rate for Payer: GEHA Commercial |
$532.00
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$598.50
|
| 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 Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$605.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$465.50
|
| Rate for Payer: One Health Plan PPO/POS |
$598.50
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$631.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$498.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$166.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$618.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$266.00
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$181.54
|
|
|
CHEMICAL CAUTERIZATION OF GRANULATION TI
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
9617250
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$181.54 |
| Max. Negotiated Rate |
$631.75 |
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$565.25
|
| Rate for Payer: First Health Commercial |
$598.50
|
| Rate for Payer: First Health Workers Compensation |
$256.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$598.50
|
| Rate for Payer: GEHA Commercial |
$465.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$598.50
|
| Rate for Payer: Multiplan All |
$605.15
|
| Rate for Payer: OMNI Networks Commercial |
$465.50
|
| Rate for Payer: One Health Plan PPO/POS |
$598.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$631.75
|
| Rate for Payer: Three Rivers Provider Network All |
$498.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$618.45
|
| Rate for Payer: Zelis Auto |
$266.00
|
| Rate for Payer: Zelis Worker's Compensation |
$181.54
|
|
|
CHEMODENER MUSCLE LARYNX EMG
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
CPT 64617
|
| Hospital Charge Code |
6164617
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$107.29 |
| Max. Negotiated Rate |
$1,315.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$492.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$235.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$492.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$390.15
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$657.58
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cigna Commercial |
$334.05
|
| Rate for Payer: First Health Commercial |
$353.70
|
| Rate for Payer: First Health Workers Compensation |
$151.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$353.70
|
| Rate for Payer: GEHA Commercial |
$314.40
|
| Rate for Payer: GEHA Medicare |
$657.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$353.70
|
| Rate for Payer: Humana ChoiceCare |
$723.34
|
| Rate for Payer: Humana Medicare Advantage |
$657.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,104.73
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$398.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$657.58
|
| Rate for Payer: Multiplan All |
$357.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,117.89
|
| Rate for Payer: OMNI Networks Commercial |
$275.10
|
| Rate for Payer: One Health Plan PPO/POS |
$353.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$459.66
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$398.10
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$657.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$373.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,315.16
|
| Rate for Payer: Three Rivers Provider Network All |
$294.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$644.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$398.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$657.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$365.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$657.58
|
| Rate for Payer: Zelis Auto |
$157.20
|
| Rate for Payer: Zelis Medicare |
$558.94
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$789.10
|
| Rate for Payer: Zelis Worker's Compensation |
$107.29
|
|
|
CHEMODENER MUSCLE LARYNX EMG
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
CPT 64617
|
| Hospital Charge Code |
6164617
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$107.29 |
| Max. Negotiated Rate |
$373.35 |
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cigna Commercial |
$334.05
|
| Rate for Payer: First Health Commercial |
$353.70
|
| Rate for Payer: First Health Workers Compensation |
$151.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$353.70
|
| Rate for Payer: GEHA Commercial |
$275.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$353.70
|
| Rate for Payer: Multiplan All |
$357.63
|
| Rate for Payer: OMNI Networks Commercial |
$275.10
|
| Rate for Payer: One Health Plan PPO/POS |
$353.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$373.35
|
| Rate for Payer: Three Rivers Provider Network All |
$294.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$365.49
|
| Rate for Payer: Zelis Auto |
$157.20
|
| Rate for Payer: Zelis Worker's Compensation |
$107.29
|
|
