|
COMPLX CYSTOMETRO W/VOID PRESS & URETHRA
|
Facility
|
OP
|
$826.00
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
23500049
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$225.50 |
| Max. Negotiated Rate |
$1,267.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$305.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$495.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$305.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$242.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$633.79
|
| Rate for Payer: Cash Price |
$495.60
|
| Rate for Payer: Cash Price |
$495.60
|
| Rate for Payer: Cigna Commercial |
$702.10
|
| Rate for Payer: First Health Commercial |
$743.40
|
| Rate for Payer: First Health Workers Compensation |
$318.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$743.40
|
| Rate for Payer: GEHA Commercial |
$660.80
|
| Rate for Payer: GEHA Medicare |
$633.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$743.40
|
| Rate for Payer: Humana ChoiceCare |
$697.17
|
| Rate for Payer: Humana Medicare Advantage |
$633.79
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,064.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$246.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$633.79
|
| Rate for Payer: Multiplan All |
$751.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,077.44
|
| Rate for Payer: OMNI Networks Commercial |
$578.20
|
| Rate for Payer: One Health Plan PPO/POS |
$743.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$285.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$246.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$633.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$784.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,267.58
|
| Rate for Payer: Three Rivers Provider Network All |
$619.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$621.11
|
| Rate for Payer: United Healthcare Managed Medicaid |
$246.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$633.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$768.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$633.79
|
| Rate for Payer: Zelis Auto |
$330.40
|
| Rate for Payer: Zelis Medicare |
$538.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$760.55
|
| Rate for Payer: Zelis Worker's Compensation |
$225.50
|
|
|
COMPLX CYSTOMETRO W/VOID PRESS & URETHRA
|
Facility
|
OP
|
$975.36
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
8951729
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$242.01 |
| Max. Negotiated Rate |
$1,267.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$305.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$585.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$305.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$242.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$633.79
|
| Rate for Payer: Cash Price |
$585.22
|
| Rate for Payer: Cash Price |
$585.22
|
| Rate for Payer: Cigna Commercial |
$829.06
|
| Rate for Payer: First Health Commercial |
$877.82
|
| Rate for Payer: First Health Workers Compensation |
$376.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$877.82
|
| Rate for Payer: GEHA Commercial |
$780.29
|
| Rate for Payer: GEHA Medicare |
$633.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$877.82
|
| Rate for Payer: Humana ChoiceCare |
$697.17
|
| Rate for Payer: Humana Medicare Advantage |
$633.79
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,064.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$246.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$633.79
|
| Rate for Payer: Multiplan All |
$887.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,077.44
|
| Rate for Payer: OMNI Networks Commercial |
$682.75
|
| Rate for Payer: One Health Plan PPO/POS |
$877.82
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$285.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$246.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$633.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$926.59
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,267.58
|
| Rate for Payer: Three Rivers Provider Network All |
$731.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$621.11
|
| Rate for Payer: United Healthcare Managed Medicaid |
$246.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$633.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$907.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$633.79
|
| Rate for Payer: Zelis Auto |
$390.14
|
| Rate for Payer: Zelis Medicare |
$538.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$760.55
|
| Rate for Payer: Zelis Worker's Compensation |
$266.27
|
|
|
COMP METABOLIC PANEL (Vitros)
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
2232185
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$388.55 |
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$347.65
|
| Rate for Payer: First Health Commercial |
$368.10
|
| Rate for Payer: First Health Workers Compensation |
$18.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$368.10
|
| Rate for Payer: GEHA Commercial |
$286.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$368.10
|
| Rate for Payer: Multiplan All |
$372.19
|
| Rate for Payer: OMNI Networks Commercial |
$286.30
|
| Rate for Payer: One Health Plan PPO/POS |
$368.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$388.55
|
| Rate for Payer: Three Rivers Provider Network All |
$306.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$380.37
|
| Rate for Payer: Zelis Auto |
$163.60
|
| Rate for Payer: Zelis Worker's Compensation |
$13.03
|
|
|
COMP METABOLIC PANEL (Vitros)
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
2232185
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$388.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$19.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$245.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$19.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$15.06
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10.56
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$347.65
|
| Rate for Payer: First Health Commercial |
$368.10
|
| Rate for Payer: First Health Workers Compensation |
$18.43
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$368.10
|
| Rate for Payer: GEHA Commercial |
$327.20
|
| Rate for Payer: GEHA Medicare |
$10.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$368.10
|
| Rate for Payer: Humana ChoiceCare |
$11.62
|
| Rate for Payer: Humana Medicare Advantage |
$10.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$17.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$15.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10.56
|
| Rate for Payer: Multiplan All |
$372.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$17.95
|
| Rate for Payer: OMNI Networks Commercial |
$286.30
|
| Rate for Payer: One Health Plan PPO/POS |
$368.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$17.74
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$15.36
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$388.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$21.12
|
| Rate for Payer: Three Rivers Provider Network All |
$306.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10.35
|
| Rate for Payer: United Healthcare Commercial |
$347.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$380.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10.56
|
| Rate for Payer: Zelis Auto |
$163.60
|
| Rate for Payer: Zelis Medicare |
$8.98
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12.67
|
| Rate for Payer: Zelis Worker's Compensation |
$13.03
|
|
|
COMP MULTIPLANE EXT FIXATION
|
Facility
|
OP
|
$2,477.00
|
|
|
Service Code
|
CPT 20696
|
| Hospital Charge Code |
6120696
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$676.22 |
| Max. Negotiated Rate |
$34,924.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,486.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,212.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,544.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17,462.09
|
| Rate for Payer: Cash Price |
$1,486.20
|
| Rate for Payer: Cash Price |
$1,486.20
|
| Rate for Payer: Cigna Commercial |
$2,105.45
|
| Rate for Payer: First Health Commercial |
$2,229.30
|
| Rate for Payer: First Health Workers Compensation |
$956.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,229.30
|
| Rate for Payer: GEHA Commercial |
$1,981.60
|
| Rate for Payer: GEHA Medicare |
$17,462.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,229.30
|
| Rate for Payer: Humana ChoiceCare |
$19,208.30
|
| Rate for Payer: Humana Medicare Advantage |
$17,462.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$29,336.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,596.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,462.09
|
| Rate for Payer: Multiplan All |
$2,254.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29,685.55
|
| Rate for Payer: OMNI Networks Commercial |
$1,733.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,229.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,998.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,596.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17,462.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,353.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34,924.18
|
| Rate for Payer: Three Rivers Provider Network All |
$1,857.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17,112.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,596.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,462.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,303.61
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17,462.09
|
| Rate for Payer: Zelis Auto |
$990.80
|
| Rate for Payer: Zelis Medicare |
$14,842.78
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20,954.51
|
| Rate for Payer: Zelis Worker's Compensation |
$676.22
|
|
|
COMP MULTIPLANE EXT FIXATION
|
Facility
|
IP
|
$2,477.00
|
|
|
Service Code
|
CPT 20696
|
| Hospital Charge Code |
6120696
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$676.22 |
| Max. Negotiated Rate |
$2,353.15 |
| Rate for Payer: Cash Price |
$1,486.20
|
| Rate for Payer: Cigna Commercial |
$2,105.45
|
| Rate for Payer: First Health Commercial |
$2,229.30
|
| Rate for Payer: First Health Workers Compensation |
$956.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,229.30
|
| Rate for Payer: GEHA Commercial |
$1,733.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,229.30
|
| Rate for Payer: Multiplan All |
$2,254.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,733.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,229.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,353.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,857.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,303.61
|
| Rate for Payer: Zelis Auto |
$990.80
|
| Rate for Payer: Zelis Worker's Compensation |
$676.22
|
|
|
COMPOSITE SKIN GRAFT
|
Facility
|
IP
|
$1,445.00
|
|
|
Service Code
|
CPT 15760
|
| Hospital Charge Code |
6115760
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$394.49 |
| Max. Negotiated Rate |
$1,372.75 |
| Rate for Payer: Cash Price |
$867.00
|
| Rate for Payer: Cigna Commercial |
$1,228.25
|
| Rate for Payer: First Health Commercial |
$1,300.50
|
| Rate for Payer: First Health Workers Compensation |
$557.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,300.50
|
| Rate for Payer: GEHA Commercial |
$1,011.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,300.50
|
| Rate for Payer: Multiplan All |
$1,314.95
|
| Rate for Payer: OMNI Networks Commercial |
$1,011.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,300.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,372.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,083.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,343.85
|
| Rate for Payer: Zelis Auto |
$578.00
|
| Rate for Payer: Zelis Worker's Compensation |
$394.49
|
|
|
COMPOSITE SKIN GRAFT
|
Facility
|
OP
|
$1,445.00
|
|
|
Service Code
|
CPT 15760
|
| Hospital Charge Code |
6115760
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$394.49 |
| Max. Negotiated Rate |
$3,473.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$867.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,419.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,916.89
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,736.93
|
| Rate for Payer: Cash Price |
$867.00
|
| Rate for Payer: Cash Price |
$867.00
|
| Rate for Payer: Cigna Commercial |
$1,228.25
|
| Rate for Payer: First Health Commercial |
$1,300.50
|
| Rate for Payer: First Health Workers Compensation |
$557.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,300.50
|
| Rate for Payer: GEHA Commercial |
$1,156.00
|
| Rate for Payer: GEHA Medicare |
$1,736.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,300.50
|
| 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 |
$1,955.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,736.93
|
| Rate for Payer: Multiplan All |
$1,314.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,952.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,011.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,300.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,258.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,955.93
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,736.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,372.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,473.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,083.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,702.19
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,955.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,736.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,343.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,736.93
|
| Rate for Payer: Zelis Auto |
$578.00
|
| 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 |
$394.49
|
|
|
COMPUTER-ASSISTED SURGICAL NAVIGATIONAL PROCEDURE FOR MUSCULOSKELETAL PROCEDURES, IMAGE-LESS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$439.37
|
|
|
Service Code
|
CPT 20985
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$310.66 |
| Max. Negotiated Rate |
$439.37 |
| Rate for Payer: First Health Workers Compensation |
$439.37
|
| Rate for Payer: Zelis Worker's Compensation |
$310.66
|
|
|
CONCURRENT INFUSION
|
Facility
|
OP
|
$582.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
6180019
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$145.50 |
| Max. Negotiated Rate |
$552.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$349.20
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna Commercial |
$494.70
|
| Rate for Payer: First Health Commercial |
$523.80
|
| Rate for Payer: First Health Workers Compensation |
$224.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$523.80
|
| Rate for Payer: GEHA Commercial |
$465.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$523.80
|
| Rate for Payer: Humana ChoiceCare |
$151.32
|
| Rate for Payer: Multiplan All |
$529.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$349.20
|
| Rate for Payer: OMNI Networks Commercial |
$407.40
|
| Rate for Payer: One Health Plan PPO/POS |
$523.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$552.90
|
| Rate for Payer: Three Rivers Provider Network All |
$436.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$512.16
|
| Rate for Payer: United Healthcare Commercial |
$494.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$145.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$541.26
|
| Rate for Payer: Zelis Auto |
$232.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$291.00
|
| Rate for Payer: Zelis Worker's Compensation |
$158.89
|
|
|
CONCURRENT INFUSION
|
Facility
|
IP
|
$582.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
6180019
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$158.89 |
| Max. Negotiated Rate |
$552.90 |
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna Commercial |
$494.70
|
| Rate for Payer: First Health Commercial |
$523.80
|
| Rate for Payer: First Health Workers Compensation |
$224.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$523.80
|
| Rate for Payer: GEHA Commercial |
$407.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$523.80
|
| Rate for Payer: Multiplan All |
$529.62
|
| Rate for Payer: OMNI Networks Commercial |
$407.40
|
| Rate for Payer: One Health Plan PPO/POS |
$523.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$552.90
|
| Rate for Payer: Three Rivers Provider Network All |
$436.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$541.26
|
| Rate for Payer: Zelis Auto |
$232.80
|
| Rate for Payer: Zelis Worker's Compensation |
$158.89
|
|
|
confirmation oral fluid doa 701687s
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT G0482
|
| Hospital Charge Code |
2200010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$166.26 |
| Max. Negotiated Rate |
$578.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$447.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$365.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$447.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$354.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$198.74
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$517.65
|
| Rate for Payer: First Health Commercial |
$548.10
|
| Rate for Payer: First Health Workers Compensation |
$235.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$548.10
|
| Rate for Payer: GEHA Commercial |
$487.20
|
| Rate for Payer: GEHA Medicare |
$198.74
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$548.10
|
| Rate for Payer: Humana ChoiceCare |
$218.61
|
| Rate for Payer: Humana Medicare Advantage |
$198.74
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$333.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$361.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$198.74
|
| Rate for Payer: Multiplan All |
$554.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$337.86
|
| Rate for Payer: OMNI Networks Commercial |
$426.30
|
| Rate for Payer: One Health Plan PPO/POS |
$548.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$417.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$361.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$198.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$578.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$397.48
|
| Rate for Payer: Three Rivers Provider Network All |
$456.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$194.77
|
| Rate for Payer: United Healthcare Commercial |
$517.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$361.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.74
|
| Rate for Payer: United Payors & United Providers UP&UP |
$566.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$198.74
|
| Rate for Payer: Zelis Auto |
$243.60
|
| Rate for Payer: Zelis Medicare |
$168.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$238.49
|
| Rate for Payer: Zelis Worker's Compensation |
$166.26
|
|
|
confirmation oral fluid doa 701687s
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT G0482
|
| Hospital Charge Code |
2200010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$166.26 |
| Max. Negotiated Rate |
$578.55 |
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$517.65
|
| Rate for Payer: First Health Commercial |
$548.10
|
| Rate for Payer: First Health Workers Compensation |
$235.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$548.10
|
| Rate for Payer: GEHA Commercial |
$426.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$548.10
|
| Rate for Payer: Multiplan All |
$554.19
|
| Rate for Payer: OMNI Networks Commercial |
$426.30
|
| Rate for Payer: One Health Plan PPO/POS |
$548.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$578.55
|
| Rate for Payer: Three Rivers Provider Network All |
$456.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$566.37
|
| Rate for Payer: Zelis Auto |
$243.60
|
| Rate for Payer: Zelis Worker's Compensation |
$166.26
|
|
|
confirmation urine medical doa 790600s
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT G0482
|
| Hospital Charge Code |
2200011
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$166.26 |
| Max. Negotiated Rate |
$578.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$447.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$365.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$447.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$354.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$198.74
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$517.65
|
| Rate for Payer: First Health Commercial |
$548.10
|
| Rate for Payer: First Health Workers Compensation |
$235.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$548.10
|
| Rate for Payer: GEHA Commercial |
$487.20
|
| Rate for Payer: GEHA Medicare |
$198.74
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$548.10
|
| Rate for Payer: Humana ChoiceCare |
$218.61
|
| Rate for Payer: Humana Medicare Advantage |
$198.74
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$333.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$361.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$198.74
|
| Rate for Payer: Multiplan All |
$554.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$337.86
|
| Rate for Payer: OMNI Networks Commercial |
$426.30
|
| Rate for Payer: One Health Plan PPO/POS |
$548.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$417.35
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$361.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$198.74
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$578.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$397.48
|
| Rate for Payer: Three Rivers Provider Network All |
$456.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$194.77
|
| Rate for Payer: United Healthcare Commercial |
$517.65
|
| Rate for Payer: United Healthcare Managed Medicaid |
$361.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.74
|
| Rate for Payer: United Payors & United Providers UP&UP |
$566.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$198.74
|
| Rate for Payer: Zelis Auto |
$243.60
|
| Rate for Payer: Zelis Medicare |
$168.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$238.49
|
| Rate for Payer: Zelis Worker's Compensation |
$166.26
|
|
|
confirmation urine medical doa 790600s
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT G0482
|
| Hospital Charge Code |
2200011
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$166.26 |
| Max. Negotiated Rate |
$578.55 |
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$517.65
|
| Rate for Payer: First Health Commercial |
$548.10
|
| Rate for Payer: First Health Workers Compensation |
$235.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$548.10
|
| Rate for Payer: GEHA Commercial |
$426.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$548.10
|
| Rate for Payer: Multiplan All |
$554.19
|
| Rate for Payer: OMNI Networks Commercial |
$426.30
|
| Rate for Payer: One Health Plan PPO/POS |
$548.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$578.55
|
| Rate for Payer: Three Rivers Provider Network All |
$456.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$566.37
|
| Rate for Payer: Zelis Auto |
$243.60
|
| Rate for Payer: Zelis Worker's Compensation |
$166.26
|
|
|
CONIZATION OF CERVIX
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
6157522
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$167.90 |
| Max. Negotiated Rate |
$584.25 |
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cigna Commercial |
$522.75
|
| Rate for Payer: First Health Commercial |
$553.50
|
| Rate for Payer: First Health Workers Compensation |
$237.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$553.50
|
| Rate for Payer: GEHA Commercial |
$430.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$553.50
|
| Rate for Payer: Multiplan All |
$559.65
|
| Rate for Payer: OMNI Networks Commercial |
$430.50
|
| Rate for Payer: One Health Plan PPO/POS |
$553.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$584.25
|
| Rate for Payer: Three Rivers Provider Network All |
$461.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$571.95
|
| Rate for Payer: Zelis Auto |
$246.00
|
| Rate for Payer: Zelis Worker's Compensation |
$167.90
|
|
|
CONIZATION OF CERVIX
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
6157522
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$167.90 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$369.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cigna Commercial |
$522.75
|
| Rate for Payer: First Health Commercial |
$553.50
|
| Rate for Payer: First Health Workers Compensation |
$237.45
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$553.50
|
| Rate for Payer: GEHA Commercial |
$492.00
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$553.50
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$559.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$430.50
|
| Rate for Payer: One Health Plan PPO/POS |
$553.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$584.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$461.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$571.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$246.00
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$167.90
|
|
|
CONIZATION OF CERVIX
|
Facility
|
OP
|
$697.00
|
|
|
Service Code
|
CPT 57520
|
| Hospital Charge Code |
6157520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$190.28 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$418.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$418.20
|
| Rate for Payer: Cash Price |
$418.20
|
| Rate for Payer: Cigna Commercial |
$592.45
|
| Rate for Payer: First Health Commercial |
$627.30
|
| Rate for Payer: First Health Workers Compensation |
$269.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$627.30
|
| Rate for Payer: GEHA Commercial |
$557.60
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$627.30
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$634.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$487.90
|
| Rate for Payer: One Health Plan PPO/POS |
$627.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$662.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$522.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$648.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$278.80
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$190.28
|
|
|
CONIZATION OF CERVIX
|
Facility
|
IP
|
$697.00
|
|
|
Service Code
|
CPT 57520
|
| Hospital Charge Code |
6157520
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$190.28 |
| Max. Negotiated Rate |
$662.15 |
| Rate for Payer: Cash Price |
$418.20
|
| Rate for Payer: Cigna Commercial |
$592.45
|
| Rate for Payer: First Health Commercial |
$627.30
|
| Rate for Payer: First Health Workers Compensation |
$269.11
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$627.30
|
| Rate for Payer: GEHA Commercial |
$487.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$627.30
|
| Rate for Payer: Multiplan All |
$634.27
|
| Rate for Payer: OMNI Networks Commercial |
$487.90
|
| Rate for Payer: One Health Plan PPO/POS |
$627.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$662.15
|
| Rate for Payer: Three Rivers Provider Network All |
$522.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$648.21
|
| Rate for Payer: Zelis Auto |
$278.80
|
| Rate for Payer: Zelis Worker's Compensation |
$190.28
|
|
|
CONJUGATED ESTROGEN-MEDROXYPROGEST ACETA
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
NDC 00046087505
|
| Hospital Charge Code |
3300206
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$19.00 |
| 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 |
$7.72
|
| 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 |
$5.46
|
|
|
CONJUGATED ESTROGEN-MEDROXYPROGEST ACETA
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
NDC 00046087505
|
| Hospital Charge Code |
3300206
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$19.00 |
| 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: Cigna Commercial |
$17.00
|
| Rate for Payer: First Health Commercial |
$18.00
|
| Rate for Payer: First Health Workers Compensation |
$7.72
|
| 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 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 |
$5.46
|
|
|
CONS SED 1ST 15 MIN, 5YR>
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 99152
|
| Hospital Charge Code |
8199144
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$134.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cigna Commercial |
$120.70
|
| Rate for Payer: First Health Commercial |
$127.80
|
| Rate for Payer: First Health Workers Compensation |
$54.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$127.80
|
| Rate for Payer: GEHA Commercial |
$113.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$127.80
|
| Rate for Payer: Humana ChoiceCare |
$36.92
|
| Rate for Payer: Multiplan All |
$129.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$85.20
|
| Rate for Payer: OMNI Networks Commercial |
$99.40
|
| Rate for Payer: One Health Plan PPO/POS |
$127.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$134.90
|
| Rate for Payer: Three Rivers Provider Network All |
$106.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$124.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$35.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.06
|
| Rate for Payer: Zelis Auto |
$56.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$71.00
|
| Rate for Payer: Zelis Worker's Compensation |
$38.77
|
|
|
CONS SED 1ST 15 MIN, 5YR>
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 99152
|
| Hospital Charge Code |
8199144
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.77 |
| Max. Negotiated Rate |
$134.90 |
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cigna Commercial |
$120.70
|
| Rate for Payer: First Health Commercial |
$127.80
|
| Rate for Payer: First Health Workers Compensation |
$54.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$127.80
|
| Rate for Payer: GEHA Commercial |
$99.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$127.80
|
| Rate for Payer: Multiplan All |
$129.22
|
| Rate for Payer: OMNI Networks Commercial |
$99.40
|
| Rate for Payer: One Health Plan PPO/POS |
$127.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$134.90
|
| Rate for Payer: Three Rivers Provider Network All |
$106.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.06
|
| Rate for Payer: Zelis Auto |
$56.80
|
| Rate for Payer: Zelis Worker's Compensation |
$38.77
|
|
|
CONS SED 1ST 15 MIN,<5YR
|
Facility
|
OP
|
$1,423.00
|
|
|
Service Code
|
CPT 99151
|
| Hospital Charge Code |
8199143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$355.75 |
| Max. Negotiated Rate |
$1,351.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$853.80
|
| Rate for Payer: Cash Price |
$853.80
|
| Rate for Payer: Cigna Commercial |
$1,209.55
|
| Rate for Payer: First Health Commercial |
$1,280.70
|
| Rate for Payer: First Health Workers Compensation |
$549.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,280.70
|
| Rate for Payer: GEHA Commercial |
$1,138.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,280.70
|
| Rate for Payer: Humana ChoiceCare |
$369.98
|
| Rate for Payer: Multiplan All |
$1,294.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$853.80
|
| Rate for Payer: OMNI Networks Commercial |
$996.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,280.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,351.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,067.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,252.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$355.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,323.39
|
| Rate for Payer: Zelis Auto |
$569.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$711.50
|
| Rate for Payer: Zelis Worker's Compensation |
$388.48
|
|
|
CONS SED 1ST 15 MIN,<5YR
|
Facility
|
IP
|
$1,423.00
|
|
|
Service Code
|
CPT 99151
|
| Hospital Charge Code |
8199143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$388.48 |
| Max. Negotiated Rate |
$1,351.85 |
| Rate for Payer: Cash Price |
$853.80
|
| Rate for Payer: Cigna Commercial |
$1,209.55
|
| Rate for Payer: First Health Commercial |
$1,280.70
|
| Rate for Payer: First Health Workers Compensation |
$549.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,280.70
|
| Rate for Payer: GEHA Commercial |
$996.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,280.70
|
| Rate for Payer: Multiplan All |
$1,294.93
|
| Rate for Payer: OMNI Networks Commercial |
$996.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,280.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,351.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,067.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,323.39
|
| Rate for Payer: Zelis Auto |
$569.20
|
| Rate for Payer: Zelis Worker's Compensation |
$388.48
|
|
