|
CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE, OR DORSAL SLIT; OLDER THAN 28 DAYS OF AGE
|
Facility
|
OP
|
$3,890.28
|
|
|
Service Code
|
CPT 54161
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,653.37 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: First Health Workers Compensation |
$2,503.40
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$1,770.08
|
|
|
CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK
|
Facility
|
IP
|
$471.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
9200026
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$128.58 |
| Max. Negotiated Rate |
$447.45 |
| Rate for Payer: Cash Price |
$282.60
|
| Rate for Payer: Cigna Commercial |
$400.35
|
| Rate for Payer: First Health Commercial |
$423.90
|
| Rate for Payer: First Health Workers Compensation |
$181.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$423.90
|
| Rate for Payer: GEHA Commercial |
$329.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$423.90
|
| Rate for Payer: Multiplan All |
$428.61
|
| Rate for Payer: OMNI Networks Commercial |
$329.70
|
| Rate for Payer: One Health Plan PPO/POS |
$423.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$447.45
|
| Rate for Payer: Three Rivers Provider Network All |
$353.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.03
|
| Rate for Payer: Zelis Auto |
$188.40
|
| Rate for Payer: Zelis Worker's Compensation |
$128.58
|
|
|
CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK
|
Facility
|
OP
|
$471.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
20300080
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.58 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$282.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$282.60
|
| Rate for Payer: Cash Price |
$282.60
|
| Rate for Payer: Cigna Commercial |
$400.35
|
| Rate for Payer: First Health Commercial |
$423.90
|
| Rate for Payer: First Health Workers Compensation |
$181.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$423.90
|
| Rate for Payer: GEHA Commercial |
$376.80
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$423.90
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$428.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$329.70
|
| Rate for Payer: One Health Plan PPO/POS |
$423.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$447.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$353.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$188.40
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$128.58
|
|
|
CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
6154150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$84.90 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$186.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$186.60
|
| Rate for Payer: Cash Price |
$186.60
|
| Rate for Payer: Cigna Commercial |
$264.35
|
| Rate for Payer: First Health Commercial |
$279.90
|
| Rate for Payer: First Health Workers Compensation |
$120.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.90
|
| Rate for Payer: GEHA Commercial |
$248.80
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.90
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$283.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$217.70
|
| Rate for Payer: One Health Plan PPO/POS |
$279.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$295.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$233.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$289.23
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$124.40
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$84.90
|
|
|
CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK
|
Facility
|
IP
|
$471.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
20300080
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.58 |
| Max. Negotiated Rate |
$447.45 |
| Rate for Payer: Cash Price |
$282.60
|
| Rate for Payer: Cigna Commercial |
$400.35
|
| Rate for Payer: First Health Commercial |
$423.90
|
| Rate for Payer: First Health Workers Compensation |
$181.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$423.90
|
| Rate for Payer: GEHA Commercial |
$329.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$423.90
|
| Rate for Payer: Multiplan All |
$428.61
|
| Rate for Payer: OMNI Networks Commercial |
$329.70
|
| Rate for Payer: One Health Plan PPO/POS |
$423.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$447.45
|
| Rate for Payer: Three Rivers Provider Network All |
$353.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.03
|
| Rate for Payer: Zelis Auto |
$188.40
|
| Rate for Payer: Zelis Worker's Compensation |
$128.58
|
|
|
CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
6154150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$84.90 |
| Max. Negotiated Rate |
$295.45 |
| Rate for Payer: Cash Price |
$186.60
|
| Rate for Payer: Cigna Commercial |
$264.35
|
| Rate for Payer: First Health Commercial |
$279.90
|
| Rate for Payer: First Health Workers Compensation |
$120.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$279.90
|
| Rate for Payer: GEHA Commercial |
$217.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$279.90
|
| Rate for Payer: Multiplan All |
$283.01
|
| Rate for Payer: OMNI Networks Commercial |
$217.70
|
| Rate for Payer: One Health Plan PPO/POS |
$279.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$295.45
|
| Rate for Payer: Three Rivers Provider Network All |
$233.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$289.23
|
| Rate for Payer: Zelis Auto |
$124.40
|
| Rate for Payer: Zelis Worker's Compensation |
$84.90
|
|
|
CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK
|
Facility
|
OP
|
$471.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
9200026
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$128.58 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$282.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$282.60
|
| Rate for Payer: Cash Price |
$282.60
|
| Rate for Payer: Cigna Commercial |
$400.35
|
| Rate for Payer: First Health Commercial |
$423.90
|
| Rate for Payer: First Health Workers Compensation |
$181.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$423.90
|
| Rate for Payer: GEHA Commercial |
$376.80
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$423.90
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$428.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$329.70
|
| Rate for Payer: One Health Plan PPO/POS |
$423.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$447.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$353.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$188.40
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$128.58
|
|
|
CISATRACURIUM BES 10MG/5ML INJ
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
NDC 00074437805
|
| Hospital Charge Code |
3300183
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$24.65
|
| Rate for Payer: First Health Commercial |
$26.10
|
| Rate for Payer: First Health Workers Compensation |
$11.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$26.10
|
| Rate for Payer: GEHA Commercial |
$23.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$26.10
|
| Rate for Payer: Humana ChoiceCare |
$7.54
|
| Rate for Payer: Multiplan All |
$26.39
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17.40
|
| Rate for Payer: OMNI Networks Commercial |
$20.30
|
| Rate for Payer: One Health Plan PPO/POS |
$26.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$27.55
|
| Rate for Payer: Three Rivers Provider Network All |
$21.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$25.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$26.97
|
| Rate for Payer: Zelis Auto |
$11.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14.50
|
| Rate for Payer: Zelis Worker's Compensation |
$7.92
|
|
|
CISATRACURIUM BES 10MG/5ML INJ
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
NDC 00074437805
|
| Hospital Charge Code |
3300183
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$24.65
|
| Rate for Payer: First Health Commercial |
$26.10
|
| Rate for Payer: First Health Workers Compensation |
$11.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$26.10
|
| Rate for Payer: GEHA Commercial |
$20.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$26.10
|
| Rate for Payer: Multiplan All |
$26.39
|
| Rate for Payer: OMNI Networks Commercial |
$20.30
|
| Rate for Payer: One Health Plan PPO/POS |
$26.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$27.55
|
| Rate for Payer: Three Rivers Provider Network All |
$21.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$26.97
|
| Rate for Payer: Zelis Auto |
$11.60
|
| Rate for Payer: Zelis Worker's Compensation |
$7.92
|
|
|
CISTERNOGRM SHNT DRG
|
Facility
|
IP
|
$2,361.00
|
|
| Hospital Charge Code |
2410061
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$644.55 |
| Max. Negotiated Rate |
$2,242.95 |
| Rate for Payer: Cash Price |
$1,416.60
|
| Rate for Payer: Cigna Commercial |
$2,006.85
|
| Rate for Payer: First Health Commercial |
$2,124.90
|
| Rate for Payer: First Health Workers Compensation |
$911.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,124.90
|
| Rate for Payer: GEHA Commercial |
$1,652.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,124.90
|
| Rate for Payer: Multiplan All |
$2,148.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,652.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,124.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,242.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,770.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,195.73
|
| Rate for Payer: Zelis Auto |
$944.40
|
| Rate for Payer: Zelis Worker's Compensation |
$644.55
|
|
|
CISTERNOGRM SHNT DRG
|
Facility
|
OP
|
$2,361.00
|
|
| Hospital Charge Code |
2410061
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$590.25 |
| Max. Negotiated Rate |
$2,242.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,416.60
|
| Rate for Payer: Cash Price |
$1,416.60
|
| Rate for Payer: Cigna Commercial |
$2,006.85
|
| Rate for Payer: First Health Commercial |
$2,124.90
|
| Rate for Payer: First Health Workers Compensation |
$911.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,124.90
|
| Rate for Payer: GEHA Commercial |
$1,888.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,124.90
|
| Rate for Payer: Humana ChoiceCare |
$613.86
|
| Rate for Payer: Multiplan All |
$2,148.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,416.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,652.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,124.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,242.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,770.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,077.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$590.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,195.73
|
| Rate for Payer: Zelis Auto |
$944.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,180.50
|
| Rate for Payer: Zelis Worker's Compensation |
$644.55
|
|
|
CITALOPRAM 20MG TAB
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 00904608561
|
| Hospital Charge Code |
3300185
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$1.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$4.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Humana ChoiceCare |
$1.30
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3.00
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1.36
|
|
|
CITALOPRAM 20MG TAB
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 00904608561
|
| Hospital Charge Code |
3300185
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: First Health Workers Compensation |
$1.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4.50
|
| Rate for Payer: GEHA Commercial |
$3.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4.50
|
| Rate for Payer: Multiplan All |
$4.55
|
| Rate for Payer: OMNI Networks Commercial |
$3.50
|
| Rate for Payer: One Health Plan PPO/POS |
$4.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4.75
|
| Rate for Payer: Three Rivers Provider Network All |
$3.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4.65
|
| Rate for Payer: Zelis Auto |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.36
|
|
|
CITRATE URINE POP
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
2299378
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.63 |
| Max. Negotiated Rate |
$209.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$50.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$50.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$39.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$27.80
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$187.85
|
| Rate for Payer: First Health Commercial |
$198.90
|
| Rate for Payer: First Health Workers Compensation |
$48.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$198.90
|
| Rate for Payer: GEHA Commercial |
$176.80
|
| Rate for Payer: GEHA Medicare |
$27.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$198.90
|
| Rate for Payer: Humana ChoiceCare |
$30.58
|
| Rate for Payer: Humana Medicare Advantage |
$27.80
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$46.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$40.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$27.80
|
| Rate for Payer: Multiplan All |
$201.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$47.26
|
| Rate for Payer: OMNI Networks Commercial |
$154.70
|
| Rate for Payer: One Health Plan PPO/POS |
$198.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$46.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$40.45
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$27.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$209.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$55.60
|
| Rate for Payer: Three Rivers Provider Network All |
$165.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.24
|
| Rate for Payer: United Healthcare Commercial |
$187.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$40.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.80
|
| Rate for Payer: United Payors & United Providers UP&UP |
$205.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$27.80
|
| Rate for Payer: Zelis Auto |
$88.40
|
| Rate for Payer: Zelis Medicare |
$23.63
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.36
|
| Rate for Payer: Zelis Worker's Compensation |
$34.28
|
|
|
CITRATE URINE POP
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
2299378
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.28 |
| Max. Negotiated Rate |
$209.95 |
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$187.85
|
| Rate for Payer: First Health Commercial |
$198.90
|
| Rate for Payer: First Health Workers Compensation |
$48.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$198.90
|
| Rate for Payer: GEHA Commercial |
$154.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$198.90
|
| Rate for Payer: Multiplan All |
$201.11
|
| Rate for Payer: OMNI Networks Commercial |
$154.70
|
| Rate for Payer: One Health Plan PPO/POS |
$198.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$209.95
|
| Rate for Payer: Three Rivers Provider Network All |
$165.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$205.53
|
| Rate for Payer: Zelis Auto |
$88.40
|
| Rate for Payer: Zelis Worker's Compensation |
$34.28
|
|
|
citric acid 24hr urine REF016865
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
22990746
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.28 |
| Max. Negotiated Rate |
$209.95 |
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$187.85
|
| Rate for Payer: First Health Commercial |
$198.90
|
| Rate for Payer: First Health Workers Compensation |
$48.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$198.90
|
| Rate for Payer: GEHA Commercial |
$154.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$198.90
|
| Rate for Payer: Multiplan All |
$201.11
|
| Rate for Payer: OMNI Networks Commercial |
$154.70
|
| Rate for Payer: One Health Plan PPO/POS |
$198.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$209.95
|
| Rate for Payer: Three Rivers Provider Network All |
$165.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$205.53
|
| Rate for Payer: Zelis Auto |
$88.40
|
| Rate for Payer: Zelis Worker's Compensation |
$34.28
|
|
|
citric acid 24hr urine REF016865
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
22990746
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.63 |
| Max. Negotiated Rate |
$209.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$50.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$132.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$50.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$39.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$27.80
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$187.85
|
| Rate for Payer: First Health Commercial |
$198.90
|
| Rate for Payer: First Health Workers Compensation |
$48.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$198.90
|
| Rate for Payer: GEHA Commercial |
$176.80
|
| Rate for Payer: GEHA Medicare |
$27.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$198.90
|
| Rate for Payer: Humana ChoiceCare |
$30.58
|
| Rate for Payer: Humana Medicare Advantage |
$27.80
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$46.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$40.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$27.80
|
| Rate for Payer: Multiplan All |
$201.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$47.26
|
| Rate for Payer: OMNI Networks Commercial |
$154.70
|
| Rate for Payer: One Health Plan PPO/POS |
$198.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$46.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$40.45
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$27.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$209.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$55.60
|
| Rate for Payer: Three Rivers Provider Network All |
$165.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.24
|
| Rate for Payer: United Healthcare Commercial |
$187.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$40.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.80
|
| Rate for Payer: United Payors & United Providers UP&UP |
$205.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$27.80
|
| Rate for Payer: Zelis Auto |
$88.40
|
| Rate for Payer: Zelis Medicare |
$23.63
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.36
|
| Rate for Payer: Zelis Worker's Compensation |
$34.28
|
|
|
CITY ARTESIA DOA UR AGH
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
2200220
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.63 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$250.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$111.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$88.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$354.45
|
| Rate for Payer: First Health Commercial |
$375.30
|
| Rate for Payer: First Health Workers Compensation |
$74.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$375.30
|
| Rate for Payer: GEHA Commercial |
$333.60
|
| Rate for Payer: GEHA Medicare |
$62.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$375.30
|
| Rate for Payer: Humana ChoiceCare |
$68.35
|
| Rate for Payer: Humana Medicare Advantage |
$62.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$104.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$90.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$62.14
|
| Rate for Payer: Multiplan All |
$379.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$105.64
|
| Rate for Payer: OMNI Networks Commercial |
$291.90
|
| Rate for Payer: One Health Plan PPO/POS |
$375.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$104.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$90.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$62.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$396.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$124.28
|
| Rate for Payer: Three Rivers Provider Network All |
$312.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$60.90
|
| Rate for Payer: United Healthcare Commercial |
$354.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$90.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$387.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$62.14
|
| Rate for Payer: Zelis Auto |
$166.80
|
| Rate for Payer: Zelis Medicare |
$52.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$74.57
|
| Rate for Payer: Zelis Worker's Compensation |
$52.63
|
|
|
CITY ARTESIA DOA UR AGH
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
2200220
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.63 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$354.45
|
| Rate for Payer: First Health Commercial |
$375.30
|
| Rate for Payer: First Health Workers Compensation |
$74.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$375.30
|
| Rate for Payer: GEHA Commercial |
$291.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$375.30
|
| Rate for Payer: Multiplan All |
$379.47
|
| Rate for Payer: OMNI Networks Commercial |
$291.90
|
| Rate for Payer: One Health Plan PPO/POS |
$375.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$396.15
|
| Rate for Payer: Three Rivers Provider Network All |
$312.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$387.81
|
| Rate for Payer: Zelis Auto |
$166.80
|
| Rate for Payer: Zelis Worker's Compensation |
$52.63
|
|
|
CITY ARTESIA EMPSALIVA ALC
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
2200221
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$27.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$17.00
|
| Rate for Payer: First Health Commercial |
$18.00
|
| Rate for Payer: First Health Workers Compensation |
$27.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.00
|
| Rate for Payer: GEHA Commercial |
$16.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.00
|
| Rate for Payer: Humana ChoiceCare |
$5.20
|
| Rate for Payer: Multiplan All |
$18.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$12.00
|
| Rate for Payer: OMNI Networks Commercial |
$14.00
|
| Rate for Payer: One Health Plan PPO/POS |
$18.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.00
|
| Rate for Payer: Three Rivers Provider Network All |
$15.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.60
|
| Rate for Payer: United Healthcare Commercial |
$17.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$18.60
|
| Rate for Payer: Zelis Auto |
$8.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10.00
|
| Rate for Payer: Zelis Worker's Compensation |
$19.29
|
|
|
CITY ARTESIA EMPSALIVA ALC
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
2200221
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$27.28 |
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$17.00
|
| Rate for Payer: First Health Commercial |
$18.00
|
| Rate for Payer: First Health Workers Compensation |
$27.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$18.00
|
| Rate for Payer: GEHA Commercial |
$14.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$18.00
|
| Rate for Payer: Multiplan All |
$18.20
|
| Rate for Payer: OMNI Networks Commercial |
$14.00
|
| Rate for Payer: One Health Plan PPO/POS |
$18.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$19.00
|
| Rate for Payer: Three Rivers Provider Network All |
$15.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$18.60
|
| Rate for Payer: Zelis Auto |
$8.00
|
| Rate for Payer: Zelis Worker's Compensation |
$19.29
|
|
|
CITY ARTESIA SYNTHETIC CANNABINOIDS EMP
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 80347
|
| Hospital Charge Code |
2200222
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$43.35
|
| Rate for Payer: First Health Commercial |
$45.90
|
| Rate for Payer: First Health Workers Compensation |
$19.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.90
|
| Rate for Payer: GEHA Commercial |
$40.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.90
|
| Rate for Payer: Humana ChoiceCare |
$13.26
|
| Rate for Payer: Multiplan All |
$46.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.60
|
| Rate for Payer: OMNI Networks Commercial |
$35.70
|
| Rate for Payer: One Health Plan PPO/POS |
$45.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$48.45
|
| Rate for Payer: Three Rivers Provider Network All |
$38.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$44.88
|
| Rate for Payer: United Healthcare Commercial |
$43.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$47.43
|
| Rate for Payer: Zelis Auto |
$20.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$25.50
|
| Rate for Payer: Zelis Worker's Compensation |
$13.92
|
|
|
CITY ARTESIA SYNTHETIC CANNABINOIDS EMP
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 80347
|
| Hospital Charge Code |
2200222
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$43.35
|
| Rate for Payer: First Health Commercial |
$45.90
|
| Rate for Payer: First Health Workers Compensation |
$19.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.90
|
| Rate for Payer: GEHA Commercial |
$35.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.90
|
| Rate for Payer: Multiplan All |
$46.41
|
| Rate for Payer: OMNI Networks Commercial |
$35.70
|
| Rate for Payer: One Health Plan PPO/POS |
$45.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$48.45
|
| Rate for Payer: Three Rivers Provider Network All |
$38.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$47.43
|
| Rate for Payer: Zelis Auto |
$20.40
|
| Rate for Payer: Zelis Worker's Compensation |
$13.92
|
|
|
CITY OF ARTESIA OFFICE VISIT
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
8500092
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$31.75 |
| Max. Negotiated Rate |
$120.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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 |
$49.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$114.30
|
| Rate for Payer: GEHA Commercial |
$101.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$114.30
|
| Rate for Payer: Humana ChoiceCare |
$33.02
|
| Rate for Payer: Multiplan All |
$115.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$76.20
|
| 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: TriWest Veterans Administration/VAPC3 |
$111.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$118.11
|
| Rate for Payer: Zelis Auto |
$50.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$63.50
|
| Rate for Payer: Zelis Worker's Compensation |
$34.67
|
|
|
CITY OF ARTESIA OFFICE VISIT
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
8500092
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$34.67 |
| Max. Negotiated Rate |
$120.65 |
| 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 |
$49.03
|
| 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 |
$34.67
|
|
