|
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
|
|
|
CRDIOVRSN, ELECTIV, ELECTRI CONV ARRHYTH
|
Facility
|
IP
|
$2,683.57
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
1092960
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$732.61 |
| Max. Negotiated Rate |
$2,549.39 |
| Rate for Payer: Cash Price |
$1,610.14
|
| Rate for Payer: Cigna Commercial |
$2,281.03
|
| Rate for Payer: First Health Commercial |
$2,415.21
|
| Rate for Payer: First Health Workers Compensation |
$1,036.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,415.21
|
| Rate for Payer: GEHA Commercial |
$1,878.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,415.21
|
| Rate for Payer: Multiplan All |
$2,442.05
|
| Rate for Payer: OMNI Networks Commercial |
$1,878.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,415.21
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,549.39
|
| Rate for Payer: Three Rivers Provider Network All |
$2,012.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,495.72
|
| Rate for Payer: Zelis Auto |
$1,073.43
|
| Rate for Payer: Zelis Worker's Compensation |
$732.61
|
|
|
CREATE EARDRUM OPENING
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
CPT 69436
|
| Hospital Charge Code |
6169436
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$133.77 |
| Max. Negotiated Rate |
$2,813.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,406.53
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cigna Commercial |
$416.50
|
| Rate for Payer: First Health Commercial |
$441.00
|
| Rate for Payer: First Health Workers Compensation |
$189.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$441.00
|
| Rate for Payer: GEHA Commercial |
$392.00
|
| Rate for Payer: GEHA Medicare |
$1,406.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$441.00
|
| Rate for Payer: Humana ChoiceCare |
$1,547.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,406.53
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,362.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,406.53
|
| Rate for Payer: Multiplan All |
$445.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,391.10
|
| Rate for Payer: OMNI Networks Commercial |
$343.00
|
| Rate for Payer: One Health Plan PPO/POS |
$441.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,406.53
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$465.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,813.06
|
| Rate for Payer: Three Rivers Provider Network All |
$367.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,378.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,406.53
|
| Rate for Payer: United Payors & United Providers UP&UP |
$455.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,406.53
|
| Rate for Payer: Zelis Auto |
$196.00
|
| Rate for Payer: Zelis Medicare |
$1,195.55
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,687.84
|
| Rate for Payer: Zelis Worker's Compensation |
$133.77
|
|
|
CREATE EARDRUM OPENING
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
CPT 69436
|
| Hospital Charge Code |
6169436
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$133.77 |
| Max. Negotiated Rate |
$465.50 |
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cigna Commercial |
$416.50
|
| Rate for Payer: First Health Commercial |
$441.00
|
| Rate for Payer: First Health Workers Compensation |
$189.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$441.00
|
| Rate for Payer: GEHA Commercial |
$343.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$441.00
|
| Rate for Payer: Multiplan All |
$445.90
|
| Rate for Payer: OMNI Networks Commercial |
$343.00
|
| Rate for Payer: One Health Plan PPO/POS |
$441.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$465.50
|
| Rate for Payer: Three Rivers Provider Network All |
$367.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$455.70
|
| Rate for Payer: Zelis Auto |
$196.00
|
| Rate for Payer: Zelis Worker's Compensation |
$133.77
|
|
|
CREATE PASSAGE TO KIDNEY
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
CPT 52334
|
| Hospital Charge Code |
6152334
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$181.54 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$399.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$565.25
|
| Rate for Payer: First Health Commercial |
$598.50
|
| Rate for Payer: First Health Workers Compensation |
$256.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$598.50
|
| Rate for Payer: GEHA Commercial |
$532.00
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$598.50
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$605.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$465.50
|
| Rate for Payer: One Health Plan PPO/POS |
$598.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$631.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$498.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$618.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$266.00
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$181.54
|
|
|
CREATE PASSAGE TO KIDNEY
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
CPT 52334
|
| Hospital Charge Code |
6152334
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$181.54 |
| Max. Negotiated Rate |
$631.75 |
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$565.25
|
| Rate for Payer: First Health Commercial |
$598.50
|
| Rate for Payer: First Health Workers Compensation |
$256.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$598.50
|
| Rate for Payer: GEHA Commercial |
$465.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$598.50
|
| Rate for Payer: Multiplan All |
$605.15
|
| Rate for Payer: OMNI Networks Commercial |
$465.50
|
| Rate for Payer: One Health Plan PPO/POS |
$598.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$631.75
|
| Rate for Payer: Three Rivers Provider Network All |
$498.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$618.45
|
| Rate for Payer: Zelis Auto |
$266.00
|
| Rate for Payer: Zelis Worker's Compensation |
$181.54
|
|
|
CREATININE UR RANDOM
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
2299125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$194.75 |
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$174.25
|
| Rate for Payer: First Health Commercial |
$184.50
|
| Rate for Payer: First Health Workers Compensation |
$9.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$184.50
|
| Rate for Payer: GEHA Commercial |
$143.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$184.50
|
| Rate for Payer: Multiplan All |
$186.55
|
| Rate for Payer: OMNI Networks Commercial |
$143.50
|
| Rate for Payer: One Health Plan PPO/POS |
$184.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$194.75
|
| Rate for Payer: Three Rivers Provider Network All |
$153.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$190.65
|
| Rate for Payer: Zelis Auto |
$82.00
|
| Rate for Payer: Zelis Worker's Compensation |
$6.50
|
|
|
CREATININE UR RANDOM
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
2299125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$194.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$123.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$174.25
|
| Rate for Payer: First Health Commercial |
$184.50
|
| Rate for Payer: First Health Workers Compensation |
$9.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$184.50
|
| Rate for Payer: GEHA Commercial |
$164.00
|
| Rate for Payer: GEHA Medicare |
$5.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$184.50
|
| Rate for Payer: Humana ChoiceCare |
$5.70
|
| Rate for Payer: Humana Medicare Advantage |
$5.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.18
|
| Rate for Payer: Multiplan All |
$186.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.81
|
| Rate for Payer: OMNI Networks Commercial |
$143.50
|
| Rate for Payer: One Health Plan PPO/POS |
$184.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.71
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$194.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.36
|
| Rate for Payer: Three Rivers Provider Network All |
$153.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$174.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$190.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.18
|
| Rate for Payer: Zelis Auto |
$82.00
|
| Rate for Payer: Zelis Medicare |
$4.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.22
|
| Rate for Payer: Zelis Worker's Compensation |
$6.50
|
|
|
CREATININE (Vitros)
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
2232194
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.21
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.12
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$102.85
|
| Rate for Payer: First Health Commercial |
$108.90
|
| Rate for Payer: First Health Workers Compensation |
$9.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.90
|
| Rate for Payer: GEHA Commercial |
$96.80
|
| Rate for Payer: GEHA Medicare |
$5.12
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.90
|
| Rate for Payer: Humana ChoiceCare |
$5.63
|
| Rate for Payer: Humana Medicare Advantage |
$5.12
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.44
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.12
|
| Rate for Payer: Multiplan All |
$110.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.70
|
| Rate for Payer: OMNI Networks Commercial |
$84.70
|
| Rate for Payer: One Health Plan PPO/POS |
$108.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.60
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.44
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.12
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.24
|
| Rate for Payer: Three Rivers Provider Network All |
$90.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.02
|
| Rate for Payer: United Healthcare Commercial |
$102.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.12
|
| Rate for Payer: United Payors & United Providers UP&UP |
$112.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.12
|
| Rate for Payer: Zelis Auto |
$48.40
|
| Rate for Payer: Zelis Medicare |
$4.35
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.14
|
| Rate for Payer: Zelis Worker's Compensation |
$6.50
|
|
|
CREATININE (Vitros)
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
2232194
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$102.85
|
| Rate for Payer: First Health Commercial |
$108.90
|
| Rate for Payer: First Health Workers Compensation |
$9.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.90
|
| Rate for Payer: GEHA Commercial |
$84.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.90
|
| Rate for Payer: Multiplan All |
$110.11
|
| Rate for Payer: OMNI Networks Commercial |
$84.70
|
| Rate for Payer: One Health Plan PPO/POS |
$108.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.95
|
| Rate for Payer: Three Rivers Provider Network All |
$90.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$112.53
|
| Rate for Payer: Zelis Auto |
$48.40
|
| Rate for Payer: Zelis Worker's Compensation |
$6.50
|
|
|
CRETEC DOSE UP TO 25
|
Facility
|
IP
|
$5,892.00
|
|
|
Service Code
|
CPT A9521
|
| Hospital Charge Code |
2410054
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,608.52 |
| Max. Negotiated Rate |
$5,597.40 |
| Rate for Payer: Cash Price |
$3,535.20
|
| Rate for Payer: Cigna Commercial |
$5,008.20
|
| Rate for Payer: First Health Commercial |
$5,302.80
|
| Rate for Payer: First Health Workers Compensation |
$2,274.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,302.80
|
| Rate for Payer: GEHA Commercial |
$4,124.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,302.80
|
| Rate for Payer: Multiplan All |
$5,361.72
|
| Rate for Payer: OMNI Networks Commercial |
$4,124.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,302.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,597.40
|
| Rate for Payer: Three Rivers Provider Network All |
$4,419.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,479.56
|
| Rate for Payer: Zelis Auto |
$2,356.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,608.52
|
|
|
CRETEC DOSE UP TO 25
|
Facility
|
OP
|
$5,892.00
|
|
|
Service Code
|
CPT A9521
|
| Hospital Charge Code |
2410054
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$681.99 |
| Max. Negotiated Rate |
$5,597.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,535.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$802.34
|
| Rate for Payer: Cash Price |
$3,535.20
|
| Rate for Payer: Cash Price |
$3,535.20
|
| Rate for Payer: Cigna Commercial |
$5,008.20
|
| Rate for Payer: First Health Commercial |
$5,302.80
|
| Rate for Payer: First Health Workers Compensation |
$2,274.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,302.80
|
| Rate for Payer: GEHA Commercial |
$4,713.60
|
| Rate for Payer: GEHA Medicare |
$802.34
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,302.80
|
| Rate for Payer: Humana ChoiceCare |
$882.57
|
| Rate for Payer: Humana Medicare Advantage |
$802.34
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,347.93
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$802.34
|
| Rate for Payer: Multiplan All |
$5,361.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,363.98
|
| Rate for Payer: OMNI Networks Commercial |
$4,124.40
|
| Rate for Payer: One Health Plan PPO/POS |
$5,302.80
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$802.34
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,597.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,604.68
|
| Rate for Payer: Three Rivers Provider Network All |
$4,419.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$786.29
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,473.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$802.34
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,479.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$802.34
|
| Rate for Payer: Zelis Auto |
$2,356.80
|
| Rate for Payer: Zelis Medicare |
$681.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$962.81
|
| Rate for Payer: Zelis Worker's Compensation |
$1,608.52
|
|
|
CRITICAL CARE, ADDL 30 MIN FACILITY
|
Facility
|
OP
|
$1,243.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
10099292
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$310.75 |
| Max. Negotiated Rate |
$1,180.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$745.80
|
| Rate for Payer: Cash Price |
$745.80
|
| Rate for Payer: Cigna Commercial |
$1,056.55
|
| Rate for Payer: First Health Commercial |
$1,118.70
|
| Rate for Payer: First Health Workers Compensation |
$479.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,118.70
|
| Rate for Payer: GEHA Commercial |
$994.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,118.70
|
| Rate for Payer: Humana ChoiceCare |
$323.18
|
| Rate for Payer: Multiplan All |
$1,131.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$745.80
|
| Rate for Payer: OMNI Networks Commercial |
$870.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,118.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,180.85
|
| Rate for Payer: Three Rivers Provider Network All |
$932.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,093.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$310.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,155.99
|
| Rate for Payer: Zelis Auto |
$497.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$621.50
|
| Rate for Payer: Zelis Worker's Compensation |
$339.34
|
|
|
CRITICAL CARE, ADDL 30 MIN FACILITY
|
Facility
|
IP
|
$1,243.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
10099292
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$339.34 |
| Max. Negotiated Rate |
$1,180.85 |
| Rate for Payer: Cash Price |
$745.80
|
| Rate for Payer: Cigna Commercial |
$1,056.55
|
| Rate for Payer: First Health Commercial |
$1,118.70
|
| Rate for Payer: First Health Workers Compensation |
$479.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,118.70
|
| Rate for Payer: GEHA Commercial |
$870.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,118.70
|
| Rate for Payer: Multiplan All |
$1,131.13
|
| Rate for Payer: OMNI Networks Commercial |
$870.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,118.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,180.85
|
| Rate for Payer: Three Rivers Provider Network All |
$932.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,155.99
|
| Rate for Payer: Zelis Auto |
$497.20
|
| Rate for Payer: Zelis Worker's Compensation |
$339.34
|
|
|
CRITICAL CARE, EA ADDL 30 MINUTES
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
9899292
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna Commercial |
$323.85
|
| Rate for Payer: First Health Commercial |
$342.90
|
| Rate for Payer: First Health Workers Compensation |
$147.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$342.90
|
| Rate for Payer: GEHA Commercial |
$266.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$342.90
|
| Rate for Payer: Multiplan All |
$346.71
|
| Rate for Payer: OMNI Networks Commercial |
$266.70
|
| Rate for Payer: One Health Plan PPO/POS |
$342.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$361.95
|
| Rate for Payer: Three Rivers Provider Network All |
$285.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$354.33
|
| Rate for Payer: Zelis Auto |
$152.40
|
| Rate for Payer: Zelis Worker's Compensation |
$104.01
|
|
|
CRITICAL CARE ILL/INJURED PATIENT ADDL
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
21999422
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$95.25 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$228.60
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna Commercial |
$323.85
|
| Rate for Payer: First Health Commercial |
$342.90
|
| Rate for Payer: First Health Workers Compensation |
$147.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$342.90
|
| Rate for Payer: GEHA Commercial |
$304.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$342.90
|
| Rate for Payer: Humana ChoiceCare |
$99.06
|
| Rate for Payer: Multiplan All |
$346.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$228.60
|
| Rate for Payer: OMNI Networks Commercial |
$266.70
|
| Rate for Payer: One Health Plan PPO/POS |
$342.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$361.95
|
| Rate for Payer: Three Rivers Provider Network All |
$285.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$335.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$95.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$354.33
|
| Rate for Payer: Zelis Auto |
$152.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$190.50
|
| Rate for Payer: Zelis Worker's Compensation |
$104.01
|
|
|
CRITICAL CARE ILL/INJURED PATIENT ADDL
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
21799491
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna Commercial |
$323.85
|
| Rate for Payer: First Health Commercial |
$342.90
|
| Rate for Payer: First Health Workers Compensation |
$147.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$342.90
|
| Rate for Payer: GEHA Commercial |
$266.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$342.90
|
| Rate for Payer: Multiplan All |
$346.71
|
| Rate for Payer: OMNI Networks Commercial |
$266.70
|
| Rate for Payer: One Health Plan PPO/POS |
$342.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$361.95
|
| Rate for Payer: Three Rivers Provider Network All |
$285.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$354.33
|
| Rate for Payer: Zelis Auto |
$152.40
|
| Rate for Payer: Zelis Worker's Compensation |
$104.01
|
|
|
CRITICAL CARE ILL/INJURED PATIENT ADDL
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
21999422
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna Commercial |
$323.85
|
| Rate for Payer: First Health Commercial |
$342.90
|
| Rate for Payer: First Health Workers Compensation |
$147.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$342.90
|
| Rate for Payer: GEHA Commercial |
$266.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$342.90
|
| Rate for Payer: Multiplan All |
$346.71
|
| Rate for Payer: OMNI Networks Commercial |
$266.70
|
| Rate for Payer: One Health Plan PPO/POS |
$342.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$361.95
|
| Rate for Payer: Three Rivers Provider Network All |
$285.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$354.33
|
| Rate for Payer: Zelis Auto |
$152.40
|
| Rate for Payer: Zelis Worker's Compensation |
$104.01
|
|
|
CRITICAL CARE ILL/INJURED PATIENT ADDL
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
21799491
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$95.25 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$228.60
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna Commercial |
$323.85
|
| Rate for Payer: First Health Commercial |
$342.90
|
| Rate for Payer: First Health Workers Compensation |
$147.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$342.90
|
| Rate for Payer: GEHA Commercial |
$304.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$342.90
|
| Rate for Payer: Humana ChoiceCare |
$99.06
|
| Rate for Payer: Multiplan All |
$346.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$228.60
|
| Rate for Payer: OMNI Networks Commercial |
$266.70
|
| Rate for Payer: One Health Plan PPO/POS |
$342.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$361.95
|
| Rate for Payer: Three Rivers Provider Network All |
$285.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$335.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$95.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$354.33
|
| Rate for Payer: Zelis Auto |
$152.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$190.50
|
| Rate for Payer: Zelis Worker's Compensation |
$104.01
|
|
|
CRITICAL CARE ILL/INJURED PATIENT INIT 3
|
Facility
|
OP
|
$843.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
21799470
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$230.14 |
| Max. Negotiated Rate |
$1,600.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$743.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$505.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$743.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$588.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$800.09
|
| Rate for Payer: Cash Price |
$505.80
|
| Rate for Payer: Cash Price |
$505.80
|
| Rate for Payer: Cigna Commercial |
$716.55
|
| Rate for Payer: First Health Commercial |
$758.70
|
| Rate for Payer: First Health Workers Compensation |
$325.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$758.70
|
| Rate for Payer: GEHA Commercial |
$674.40
|
| Rate for Payer: GEHA Medicare |
$800.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$758.70
|
| Rate for Payer: Humana ChoiceCare |
$880.10
|
| Rate for Payer: Humana Medicare Advantage |
$800.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,344.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$600.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$800.09
|
| Rate for Payer: Multiplan All |
$767.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,360.15
|
| Rate for Payer: OMNI Networks Commercial |
$590.10
|
| Rate for Payer: One Health Plan PPO/POS |
$758.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$693.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$600.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$800.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$800.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,600.18
|
| Rate for Payer: Three Rivers Provider Network All |
$632.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$784.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$600.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$800.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$800.09
|
| Rate for Payer: Zelis Auto |
$337.20
|
| Rate for Payer: Zelis Medicare |
$680.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$960.11
|
| Rate for Payer: Zelis Worker's Compensation |
$230.14
|
|
|
CRITICAL CARE ILL/INJURED PATIENT INIT 3
|
Facility
|
OP
|
$843.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
21999421
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$230.14 |
| Max. Negotiated Rate |
$1,600.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$743.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$505.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$743.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$588.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$800.09
|
| Rate for Payer: Cash Price |
$505.80
|
| Rate for Payer: Cash Price |
$505.80
|
| Rate for Payer: Cigna Commercial |
$716.55
|
| Rate for Payer: First Health Commercial |
$758.70
|
| Rate for Payer: First Health Workers Compensation |
$325.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$758.70
|
| Rate for Payer: GEHA Commercial |
$674.40
|
| Rate for Payer: GEHA Medicare |
$800.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$758.70
|
| Rate for Payer: Humana ChoiceCare |
$880.10
|
| Rate for Payer: Humana Medicare Advantage |
$800.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,344.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$600.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$800.09
|
| Rate for Payer: Multiplan All |
$767.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,360.15
|
| Rate for Payer: OMNI Networks Commercial |
$590.10
|
| Rate for Payer: One Health Plan PPO/POS |
$758.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$693.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$600.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$800.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$800.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,600.18
|
| Rate for Payer: Three Rivers Provider Network All |
$632.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$784.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$600.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$800.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$800.09
|
| Rate for Payer: Zelis Auto |
$337.20
|
| Rate for Payer: Zelis Medicare |
$680.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$960.11
|
| Rate for Payer: Zelis Worker's Compensation |
$230.14
|
|
|
CRITICAL CARE ILL/INJURED PATIENT INIT 3
|
Facility
|
IP
|
$843.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
21799490
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$230.14 |
| Max. Negotiated Rate |
$800.85 |
| Rate for Payer: Cash Price |
$505.80
|
| Rate for Payer: Cigna Commercial |
$716.55
|
| Rate for Payer: First Health Commercial |
$758.70
|
| Rate for Payer: First Health Workers Compensation |
$325.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$758.70
|
| Rate for Payer: GEHA Commercial |
$590.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$758.70
|
| Rate for Payer: Multiplan All |
$767.13
|
| Rate for Payer: OMNI Networks Commercial |
$590.10
|
| Rate for Payer: One Health Plan PPO/POS |
$758.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$800.85
|
| Rate for Payer: Three Rivers Provider Network All |
$632.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.99
|
| Rate for Payer: Zelis Auto |
$337.20
|
| Rate for Payer: Zelis Worker's Compensation |
$230.14
|
|
|
CRITICAL CARE ILL/INJURED PATIENT INIT 3
|
Facility
|
OP
|
$843.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
21799490
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$230.14 |
| Max. Negotiated Rate |
$1,600.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$743.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$505.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$743.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$588.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$800.09
|
| Rate for Payer: Cash Price |
$505.80
|
| Rate for Payer: Cash Price |
$505.80
|
| Rate for Payer: Cigna Commercial |
$716.55
|
| Rate for Payer: First Health Commercial |
$758.70
|
| Rate for Payer: First Health Workers Compensation |
$325.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$758.70
|
| Rate for Payer: GEHA Commercial |
$674.40
|
| Rate for Payer: GEHA Medicare |
$800.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$758.70
|
| Rate for Payer: Humana ChoiceCare |
$880.10
|
| Rate for Payer: Humana Medicare Advantage |
$800.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,344.15
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$600.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$800.09
|
| Rate for Payer: Multiplan All |
$767.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,360.15
|
| Rate for Payer: OMNI Networks Commercial |
$590.10
|
| Rate for Payer: One Health Plan PPO/POS |
$758.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$693.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$600.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$800.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$800.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,600.18
|
| Rate for Payer: Three Rivers Provider Network All |
$632.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$784.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$600.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$800.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$800.09
|
| Rate for Payer: Zelis Auto |
$337.20
|
| Rate for Payer: Zelis Medicare |
$680.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$960.11
|
| Rate for Payer: Zelis Worker's Compensation |
$230.14
|
|
|
CRITICAL CARE ILL/INJURED PATIENT INIT 3
|
Facility
|
IP
|
$843.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
21799470
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$230.14 |
| Max. Negotiated Rate |
$800.85 |
| Rate for Payer: Cash Price |
$505.80
|
| Rate for Payer: Cigna Commercial |
$716.55
|
| Rate for Payer: First Health Commercial |
$758.70
|
| Rate for Payer: First Health Workers Compensation |
$325.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$758.70
|
| Rate for Payer: GEHA Commercial |
$590.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$758.70
|
| Rate for Payer: Multiplan All |
$767.13
|
| Rate for Payer: OMNI Networks Commercial |
$590.10
|
| Rate for Payer: One Health Plan PPO/POS |
$758.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$800.85
|
| Rate for Payer: Three Rivers Provider Network All |
$632.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.99
|
| Rate for Payer: Zelis Auto |
$337.20
|
| Rate for Payer: Zelis Worker's Compensation |
$230.14
|
|
|
CRITICAL CARE ILL/INJURED PATIENT INIT 3
|
Facility
|
IP
|
$843.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
21999421
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$230.14 |
| Max. Negotiated Rate |
$800.85 |
| Rate for Payer: Cash Price |
$505.80
|
| Rate for Payer: Cigna Commercial |
$716.55
|
| Rate for Payer: First Health Commercial |
$758.70
|
| Rate for Payer: First Health Workers Compensation |
$325.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$758.70
|
| Rate for Payer: GEHA Commercial |
$590.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$758.70
|
| Rate for Payer: Multiplan All |
$767.13
|
| Rate for Payer: OMNI Networks Commercial |
$590.10
|
| Rate for Payer: One Health Plan PPO/POS |
$758.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$800.85
|
| Rate for Payer: Three Rivers Provider Network All |
$632.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.99
|
| Rate for Payer: Zelis Auto |
$337.20
|
| Rate for Payer: Zelis Worker's Compensation |
$230.14
|
|
