|
C-PEPTIDE
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
2299083
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.69 |
| Max. Negotiated Rate |
$285.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$37.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$180.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$37.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$29.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$255.85
|
| Rate for Payer: First Health Commercial |
$270.90
|
| Rate for Payer: First Health Workers Compensation |
$36.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$270.90
|
| Rate for Payer: GEHA Commercial |
$240.80
|
| Rate for Payer: GEHA Medicare |
$20.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$270.90
|
| Rate for Payer: Humana ChoiceCare |
$22.89
|
| Rate for Payer: Humana Medicare Advantage |
$20.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$34.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20.81
|
| Rate for Payer: Multiplan All |
$273.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.38
|
| Rate for Payer: OMNI Networks Commercial |
$210.70
|
| Rate for Payer: One Health Plan PPO/POS |
$270.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$34.96
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$30.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$285.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$41.62
|
| Rate for Payer: Three Rivers Provider Network All |
$225.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$20.39
|
| Rate for Payer: United Healthcare Commercial |
$255.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$279.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$20.81
|
| Rate for Payer: Zelis Auto |
$120.40
|
| Rate for Payer: Zelis Medicare |
$17.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24.97
|
| Rate for Payer: Zelis Worker's Compensation |
$26.12
|
|
|
C-PEPTIDE
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
2299083
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.12 |
| Max. Negotiated Rate |
$285.95 |
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$255.85
|
| Rate for Payer: First Health Commercial |
$270.90
|
| Rate for Payer: First Health Workers Compensation |
$36.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$270.90
|
| Rate for Payer: GEHA Commercial |
$210.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$270.90
|
| Rate for Payer: Multiplan All |
$273.91
|
| Rate for Payer: OMNI Networks Commercial |
$210.70
|
| Rate for Payer: One Health Plan PPO/POS |
$270.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$285.95
|
| Rate for Payer: Three Rivers Provider Network All |
$225.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$279.93
|
| Rate for Payer: Zelis Auto |
$120.40
|
| Rate for Payer: Zelis Worker's Compensation |
$26.12
|
|
|
c-peptide REF010108
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
2246085
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.69 |
| Max. Negotiated Rate |
$285.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$37.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$180.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$37.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$29.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$255.85
|
| Rate for Payer: First Health Commercial |
$270.90
|
| Rate for Payer: First Health Workers Compensation |
$36.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$270.90
|
| Rate for Payer: GEHA Commercial |
$240.80
|
| Rate for Payer: GEHA Medicare |
$20.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$270.90
|
| Rate for Payer: Humana ChoiceCare |
$22.89
|
| Rate for Payer: Humana Medicare Advantage |
$20.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$34.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20.81
|
| Rate for Payer: Multiplan All |
$273.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$35.38
|
| Rate for Payer: OMNI Networks Commercial |
$210.70
|
| Rate for Payer: One Health Plan PPO/POS |
$270.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$34.96
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$30.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$285.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$41.62
|
| Rate for Payer: Three Rivers Provider Network All |
$225.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$20.39
|
| Rate for Payer: United Healthcare Commercial |
$255.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$279.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$20.81
|
| Rate for Payer: Zelis Auto |
$120.40
|
| Rate for Payer: Zelis Medicare |
$17.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24.97
|
| Rate for Payer: Zelis Worker's Compensation |
$26.12
|
|
|
c-peptide REF010108
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
2246085
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.12 |
| Max. Negotiated Rate |
$285.95 |
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$255.85
|
| Rate for Payer: First Health Commercial |
$270.90
|
| Rate for Payer: First Health Workers Compensation |
$36.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$270.90
|
| Rate for Payer: GEHA Commercial |
$210.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$270.90
|
| Rate for Payer: Multiplan All |
$273.91
|
| Rate for Payer: OMNI Networks Commercial |
$210.70
|
| Rate for Payer: One Health Plan PPO/POS |
$270.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$285.95
|
| Rate for Payer: Three Rivers Provider Network All |
$225.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$279.93
|
| Rate for Payer: Zelis Auto |
$120.40
|
| Rate for Payer: Zelis Worker's Compensation |
$26.12
|
|
|
CPR
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
4092950
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$477.75 |
| Max. Negotiated Rate |
$1,662.50 |
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,487.50
|
| Rate for Payer: First Health Commercial |
$1,575.00
|
| Rate for Payer: First Health Workers Compensation |
$675.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,575.00
|
| Rate for Payer: GEHA Commercial |
$1,225.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,575.00
|
| Rate for Payer: Multiplan All |
$1,592.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,225.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,575.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,662.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,312.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,627.50
|
| Rate for Payer: Zelis Auto |
$700.00
|
| Rate for Payer: Zelis Worker's Compensation |
$477.75
|
|
|
CPR
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
4092950
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$196.66 |
| Max. Negotiated Rate |
$1,662.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$248.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$248.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$196.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$295.69
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,487.50
|
| Rate for Payer: First Health Commercial |
$1,575.00
|
| Rate for Payer: First Health Workers Compensation |
$675.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,575.00
|
| Rate for Payer: GEHA Commercial |
$1,400.00
|
| Rate for Payer: GEHA Medicare |
$295.69
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,575.00
|
| Rate for Payer: Humana ChoiceCare |
$325.26
|
| Rate for Payer: Humana Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$496.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$200.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$295.69
|
| Rate for Payer: Multiplan All |
$1,592.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$502.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,225.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,575.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$231.70
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$200.67
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$295.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,662.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$591.38
|
| Rate for Payer: Three Rivers Provider Network All |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$289.78
|
| Rate for Payer: United Healthcare Commercial |
$1,487.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$200.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,627.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$295.69
|
| Rate for Payer: Zelis Auto |
$700.00
|
| Rate for Payer: Zelis Medicare |
$251.34
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$354.83
|
| Rate for Payer: Zelis Worker's Compensation |
$477.75
|
|
|
CPR
|
Facility
|
OP
|
$1,750.00
|
|
| Hospital Charge Code |
8192950
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$437.50 |
| Max. Negotiated Rate |
$1,662.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,487.50
|
| Rate for Payer: First Health Commercial |
$1,575.00
|
| Rate for Payer: First Health Workers Compensation |
$675.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,575.00
|
| Rate for Payer: GEHA Commercial |
$1,400.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,575.00
|
| Rate for Payer: Humana ChoiceCare |
$455.00
|
| Rate for Payer: Multiplan All |
$1,592.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,050.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,225.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,575.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,662.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,540.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$437.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,627.50
|
| Rate for Payer: Zelis Auto |
$700.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$875.00
|
| Rate for Payer: Zelis Worker's Compensation |
$477.75
|
|
|
CPR
|
Facility
|
IP
|
$1,750.00
|
|
| Hospital Charge Code |
8192950
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$477.75 |
| Max. Negotiated Rate |
$1,662.50 |
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,487.50
|
| Rate for Payer: First Health Commercial |
$1,575.00
|
| Rate for Payer: First Health Workers Compensation |
$675.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,575.00
|
| Rate for Payer: GEHA Commercial |
$1,225.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,575.00
|
| Rate for Payer: Multiplan All |
$1,592.50
|
| Rate for Payer: OMNI Networks Commercial |
$1,225.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,575.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,662.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,312.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,627.50
|
| Rate for Payer: Zelis Auto |
$700.00
|
| Rate for Payer: Zelis Worker's Compensation |
$477.75
|
|
|
CPT DRAIN/PERCUS INIT
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
4020018
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$89.27 |
| Max. Negotiated Rate |
$310.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$246.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$196.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$246.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$195.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cigna Commercial |
$277.95
|
| Rate for Payer: First Health Commercial |
$294.30
|
| Rate for Payer: First Health Workers Compensation |
$126.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$294.30
|
| Rate for Payer: GEHA Commercial |
$261.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$294.30
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$199.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$297.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$228.90
|
| Rate for Payer: One Health Plan PPO/POS |
$294.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$230.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$199.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$310.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$245.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Commercial |
$277.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$199.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$304.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$130.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$89.27
|
|
|
CPT DRAIN/PERCUS INIT
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
4020018
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$89.27 |
| Max. Negotiated Rate |
$310.65 |
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cigna Commercial |
$277.95
|
| Rate for Payer: First Health Commercial |
$294.30
|
| Rate for Payer: First Health Workers Compensation |
$126.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$294.30
|
| Rate for Payer: GEHA Commercial |
$228.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$294.30
|
| Rate for Payer: Multiplan All |
$297.57
|
| Rate for Payer: OMNI Networks Commercial |
$228.90
|
| Rate for Payer: One Health Plan PPO/POS |
$294.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$310.65
|
| Rate for Payer: Three Rivers Provider Network All |
$245.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$304.11
|
| Rate for Payer: Zelis Auto |
$130.80
|
| Rate for Payer: Zelis Worker's Compensation |
$89.27
|
|
|
CPT DRAIN/PERCUS SUBSEQUENT
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
4020019
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$61.70 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$135.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$192.10
|
| Rate for Payer: First Health Commercial |
$203.40
|
| Rate for Payer: First Health Workers Compensation |
$87.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$203.40
|
| Rate for Payer: GEHA Commercial |
$180.80
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$203.40
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$205.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$158.20
|
| Rate for Payer: One Health Plan PPO/POS |
$203.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$214.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$169.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Commercial |
$192.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$210.18
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$90.40
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$61.70
|
|
|
CPT DRAIN/PERCUS SUBSEQUENT
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
4020019
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$61.70 |
| Max. Negotiated Rate |
$214.70 |
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$192.10
|
| Rate for Payer: First Health Commercial |
$203.40
|
| Rate for Payer: First Health Workers Compensation |
$87.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$203.40
|
| Rate for Payer: GEHA Commercial |
$158.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$203.40
|
| Rate for Payer: Multiplan All |
$205.66
|
| Rate for Payer: OMNI Networks Commercial |
$158.20
|
| Rate for Payer: One Health Plan PPO/POS |
$203.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$214.70
|
| Rate for Payer: Three Rivers Provider Network All |
$169.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$210.18
|
| Rate for Payer: Zelis Auto |
$90.40
|
| Rate for Payer: Zelis Worker's Compensation |
$61.70
|
|
|
CPTR-ASST DIR MS PX
|
Facility
|
IP
|
$463.00
|
|
|
Service Code
|
CPT 20985
|
| Hospital Charge Code |
6120985
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$439.85 |
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$393.55
|
| Rate for Payer: First Health Commercial |
$416.70
|
| Rate for Payer: First Health Workers Compensation |
$178.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$416.70
|
| Rate for Payer: GEHA Commercial |
$324.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$416.70
|
| Rate for Payer: Multiplan All |
$421.33
|
| Rate for Payer: OMNI Networks Commercial |
$324.10
|
| Rate for Payer: One Health Plan PPO/POS |
$416.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$439.85
|
| Rate for Payer: Three Rivers Provider Network All |
$347.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$430.59
|
| Rate for Payer: Zelis Auto |
$185.20
|
| Rate for Payer: Zelis Worker's Compensation |
$126.40
|
|
|
CPTR-ASST DIR MS PX
|
Facility
|
OP
|
$463.00
|
|
|
Service Code
|
CPT 20985
|
| Hospital Charge Code |
6120985
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$115.75 |
| Max. Negotiated Rate |
$439.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$277.80
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$393.55
|
| Rate for Payer: First Health Commercial |
$416.70
|
| Rate for Payer: First Health Workers Compensation |
$178.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$416.70
|
| Rate for Payer: GEHA Commercial |
$370.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$416.70
|
| Rate for Payer: Humana ChoiceCare |
$120.38
|
| Rate for Payer: Multiplan All |
$421.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$277.80
|
| Rate for Payer: OMNI Networks Commercial |
$324.10
|
| Rate for Payer: One Health Plan PPO/POS |
$416.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$439.85
|
| Rate for Payer: Three Rivers Provider Network All |
$347.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$407.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$430.59
|
| Rate for Payer: Zelis Auto |
$185.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.50
|
| Rate for Payer: Zelis Worker's Compensation |
$126.40
|
|
|
CPTR-ASST MUSCSKEL NAVIGJ ORTHO CT/MRI
|
Facility
|
OP
|
$15,340.70
|
|
|
Service Code
|
CPT 0055T
|
| Hospital Charge Code |
6100055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,835.18 |
| Max. Negotiated Rate |
$14,573.67 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,204.42
|
| Rate for Payer: Cash Price |
$9,204.42
|
| Rate for Payer: Cigna Commercial |
$13,039.59
|
| Rate for Payer: First Health Commercial |
$13,806.63
|
| Rate for Payer: First Health Workers Compensation |
$5,923.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13,806.63
|
| Rate for Payer: GEHA Commercial |
$12,272.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13,806.63
|
| Rate for Payer: Humana ChoiceCare |
$3,988.58
|
| Rate for Payer: Multiplan All |
$13,960.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,204.42
|
| Rate for Payer: OMNI Networks Commercial |
$10,738.49
|
| Rate for Payer: One Health Plan PPO/POS |
$13,806.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14,573.67
|
| Rate for Payer: Three Rivers Provider Network All |
$11,505.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$13,499.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,835.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14,266.85
|
| Rate for Payer: Zelis Auto |
$6,136.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,670.35
|
| Rate for Payer: Zelis Worker's Compensation |
$4,188.01
|
|
|
CPTR-ASST MUSCSKEL NAVIGJ ORTHO CT/MRI
|
Facility
|
IP
|
$15,340.70
|
|
|
Service Code
|
CPT 0055T
|
| Hospital Charge Code |
6100055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,188.01 |
| Max. Negotiated Rate |
$14,573.67 |
| Rate for Payer: Cash Price |
$9,204.42
|
| Rate for Payer: Cigna Commercial |
$13,039.59
|
| Rate for Payer: First Health Commercial |
$13,806.63
|
| Rate for Payer: First Health Workers Compensation |
$5,923.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13,806.63
|
| Rate for Payer: GEHA Commercial |
$10,738.49
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13,806.63
|
| Rate for Payer: Multiplan All |
$13,960.04
|
| Rate for Payer: OMNI Networks Commercial |
$10,738.49
|
| Rate for Payer: One Health Plan PPO/POS |
$13,806.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14,573.67
|
| Rate for Payer: Three Rivers Provider Network All |
$11,505.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14,266.85
|
| Rate for Payer: Zelis Auto |
$6,136.28
|
| Rate for Payer: Zelis Worker's Compensation |
$4,188.01
|
|
|
CPT/VEST PERCUS INT
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
4000211
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$89.27 |
| Max. Negotiated Rate |
$310.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$246.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$196.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$246.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$195.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cigna Commercial |
$277.95
|
| Rate for Payer: First Health Commercial |
$294.30
|
| Rate for Payer: First Health Workers Compensation |
$126.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$294.30
|
| Rate for Payer: GEHA Commercial |
$261.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$294.30
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$199.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$297.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$228.90
|
| Rate for Payer: One Health Plan PPO/POS |
$294.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$230.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$199.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$310.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$245.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Commercial |
$277.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$199.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$304.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$130.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$89.27
|
|
|
CPT/VEST PERCUS INT
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
4000211
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$89.27 |
| Max. Negotiated Rate |
$310.65 |
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cigna Commercial |
$277.95
|
| Rate for Payer: First Health Commercial |
$294.30
|
| Rate for Payer: First Health Workers Compensation |
$126.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$294.30
|
| Rate for Payer: GEHA Commercial |
$228.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$294.30
|
| Rate for Payer: Multiplan All |
$297.57
|
| Rate for Payer: OMNI Networks Commercial |
$228.90
|
| Rate for Payer: One Health Plan PPO/POS |
$294.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$310.65
|
| Rate for Payer: Three Rivers Provider Network All |
$245.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$304.11
|
| Rate for Payer: Zelis Auto |
$130.80
|
| Rate for Payer: Zelis Worker's Compensation |
$89.27
|
|
|
CPT/VEST PERCUS SUBSEQUENT
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
4000913
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$114.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
CPT/VEST PERCUS SUBSEQUENT
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
4000913
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$97.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$78.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$62.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$138.55
|
| Rate for Payer: First Health Commercial |
$146.70
|
| Rate for Payer: First Health Workers Compensation |
$62.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$146.70
|
| Rate for Payer: GEHA Commercial |
$130.40
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$146.70
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$63.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$148.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$114.10
|
| Rate for Payer: One Health Plan PPO/POS |
$146.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$73.29
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$63.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$154.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$122.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Commercial |
$138.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$63.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$151.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$65.20
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$44.50
|
|
|
CPT VIA ACAPELLA INTIAL
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
4000212
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$89.27 |
| Max. Negotiated Rate |
$310.65 |
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cigna Commercial |
$277.95
|
| Rate for Payer: First Health Commercial |
$294.30
|
| Rate for Payer: First Health Workers Compensation |
$126.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$294.30
|
| Rate for Payer: GEHA Commercial |
$228.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$294.30
|
| Rate for Payer: Multiplan All |
$297.57
|
| Rate for Payer: OMNI Networks Commercial |
$228.90
|
| Rate for Payer: One Health Plan PPO/POS |
$294.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$310.65
|
| Rate for Payer: Three Rivers Provider Network All |
$245.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$304.11
|
| Rate for Payer: Zelis Auto |
$130.80
|
| Rate for Payer: Zelis Worker's Compensation |
$89.27
|
|
|
CPT VIA ACAPELLA INTIAL
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
4000212
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$89.27 |
| Max. Negotiated Rate |
$310.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$246.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$196.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$246.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$195.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cigna Commercial |
$277.95
|
| Rate for Payer: First Health Commercial |
$294.30
|
| Rate for Payer: First Health Workers Compensation |
$126.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$294.30
|
| Rate for Payer: GEHA Commercial |
$261.60
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$294.30
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$199.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$297.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$228.90
|
| Rate for Payer: One Health Plan PPO/POS |
$294.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$230.38
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$199.53
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$310.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$245.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Commercial |
$277.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$199.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$304.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$130.80
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$89.27
|
|
|
CRANBERRY CAP
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 87651042067
|
| Hospital Charge Code |
3300210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$2.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
CRANBERRY CAP
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 87651042067
|
| Hospital Charge Code |
3300210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.60
|
| Rate for Payer: First Health Workers Compensation |
$1.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3.60
|
| Rate for Payer: GEHA Commercial |
$3.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3.60
|
| Rate for Payer: Humana ChoiceCare |
$1.04
|
| Rate for Payer: Multiplan All |
$3.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2.40
|
| Rate for Payer: OMNI Networks Commercial |
$2.80
|
| Rate for Payer: One Health Plan PPO/POS |
$3.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3.80
|
| Rate for Payer: Three Rivers Provider Network All |
$3.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3.72
|
| Rate for Payer: Zelis Auto |
$1.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2.00
|
| Rate for Payer: Zelis Worker's Compensation |
$1.09
|
|
|
CRANIAL NEUROSTIM COMPLEX
|
Facility
|
IP
|
$629.00
|
|
|
Service Code
|
CPT 95974
|
| Hospital Charge Code |
21900142
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$171.72 |
| Max. Negotiated Rate |
$597.55 |
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cigna Commercial |
$534.65
|
| Rate for Payer: First Health Commercial |
$566.10
|
| Rate for Payer: First Health Workers Compensation |
$242.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$566.10
|
| Rate for Payer: GEHA Commercial |
$440.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$566.10
|
| Rate for Payer: Multiplan All |
$572.39
|
| Rate for Payer: OMNI Networks Commercial |
$440.30
|
| Rate for Payer: One Health Plan PPO/POS |
$566.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$597.55
|
| Rate for Payer: Three Rivers Provider Network All |
$471.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$584.97
|
| Rate for Payer: Zelis Auto |
$251.60
|
| Rate for Payer: Zelis Worker's Compensation |
$171.72
|
|
