|
ED KIDNEY/RENAL/AORTA
|
Facility
|
OP
|
$1,013.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
8176775
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.82 |
| Max. Negotiated Rate |
$962.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$607.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$115.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$607.80
|
| Rate for Payer: Cash Price |
$607.80
|
| Rate for Payer: Cigna Commercial |
$861.05
|
| Rate for Payer: First Health Commercial |
$911.70
|
| Rate for Payer: First Health Workers Compensation |
$104.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$911.70
|
| Rate for Payer: GEHA Commercial |
$810.40
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$911.70
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$117.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$921.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$709.10
|
| Rate for Payer: One Health Plan PPO/POS |
$911.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$136.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$117.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$962.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$759.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$942.09
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$405.20
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$73.82
|
|
|
ED OCULAR
|
Facility
|
OP
|
$557.00
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
8176512
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.14 |
| Max. Negotiated Rate |
$529.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$334.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$145.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$115.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$334.20
|
| Rate for Payer: Cash Price |
$334.20
|
| Rate for Payer: Cigna Commercial |
$473.45
|
| Rate for Payer: First Health Commercial |
$501.30
|
| Rate for Payer: First Health Workers Compensation |
$107.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$501.30
|
| Rate for Payer: GEHA Commercial |
$445.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$501.30
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$117.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$506.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$389.90
|
| Rate for Payer: One Health Plan PPO/POS |
$501.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$136.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$117.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$529.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$417.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$117.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$222.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$76.14
|
|
|
ED OCULAR
|
Facility
|
IP
|
$557.00
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
8176512
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.14 |
| Max. Negotiated Rate |
$529.15 |
| Rate for Payer: Cash Price |
$334.20
|
| Rate for Payer: Cash Price |
$334.20
|
| Rate for Payer: Cigna Commercial |
$473.45
|
| Rate for Payer: First Health Commercial |
$501.30
|
| Rate for Payer: First Health Workers Compensation |
$107.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$501.30
|
| Rate for Payer: GEHA Commercial |
$389.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$501.30
|
| Rate for Payer: Multiplan All |
$506.87
|
| Rate for Payer: OMNI Networks Commercial |
$389.90
|
| Rate for Payer: One Health Plan PPO/POS |
$501.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$529.15
|
| Rate for Payer: Three Rivers Provider Network All |
$417.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$518.01
|
| Rate for Payer: Zelis Auto |
$222.80
|
| Rate for Payer: Zelis Worker's Compensation |
$76.14
|
|
|
ED PERICARDIOCENTESIS
|
Facility
|
IP
|
$732.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
8133016
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$199.84 |
| Max. Negotiated Rate |
$695.40 |
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$622.20
|
| Rate for Payer: First Health Commercial |
$658.80
|
| Rate for Payer: First Health Workers Compensation |
$282.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$658.80
|
| Rate for Payer: GEHA Commercial |
$512.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$658.80
|
| Rate for Payer: Multiplan All |
$666.12
|
| Rate for Payer: OMNI Networks Commercial |
$512.40
|
| Rate for Payer: One Health Plan PPO/POS |
$658.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$695.40
|
| Rate for Payer: Three Rivers Provider Network All |
$549.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$680.76
|
| Rate for Payer: Zelis Auto |
$292.80
|
| Rate for Payer: Zelis Worker's Compensation |
$199.84
|
|
|
ED PERICARDIOCENTESIS
|
Facility
|
OP
|
$732.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
8133016
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$199.84 |
| Max. Negotiated Rate |
$2,950.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,446.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$439.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,446.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,938.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,475.05
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$622.20
|
| Rate for Payer: First Health Commercial |
$658.80
|
| Rate for Payer: First Health Workers Compensation |
$282.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$658.80
|
| Rate for Payer: GEHA Commercial |
$585.60
|
| Rate for Payer: GEHA Medicare |
$1,475.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$658.80
|
| Rate for Payer: Humana ChoiceCare |
$1,622.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,475.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,478.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,977.75
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,475.05
|
| Rate for Payer: Multiplan All |
$666.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,507.59
|
| Rate for Payer: OMNI Networks Commercial |
$512.40
|
| Rate for Payer: One Health Plan PPO/POS |
$658.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,283.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,977.75
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,475.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$695.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,950.10
|
| Rate for Payer: Three Rivers Provider Network All |
$549.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,445.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,977.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,475.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$680.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,475.05
|
| Rate for Payer: Zelis Auto |
$292.80
|
| Rate for Payer: Zelis Medicare |
$1,253.79
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,770.06
|
| Rate for Payer: Zelis Worker's Compensation |
$199.84
|
|
|
ED PREGNANT TRANSABDOMINAL
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
8176815
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.81 |
| Max. Negotiated Rate |
$771.40 |
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cigna Commercial |
$690.20
|
| Rate for Payer: First Health Commercial |
$730.80
|
| Rate for Payer: First Health Workers Compensation |
$100.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$730.80
|
| Rate for Payer: GEHA Commercial |
$568.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$730.80
|
| Rate for Payer: Multiplan All |
$738.92
|
| Rate for Payer: OMNI Networks Commercial |
$568.40
|
| Rate for Payer: One Health Plan PPO/POS |
$730.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$771.40
|
| Rate for Payer: Three Rivers Provider Network All |
$609.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$755.16
|
| Rate for Payer: Zelis Auto |
$324.80
|
| Rate for Payer: Zelis Worker's Compensation |
$70.81
|
|
|
ED PREGNANT TRANSABDOMINAL
|
Facility
|
OP
|
$812.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
8176815
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.81 |
| Max. Negotiated Rate |
$771.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$93.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$487.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$93.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$74.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cash Price |
$487.20
|
| Rate for Payer: Cigna Commercial |
$690.20
|
| Rate for Payer: First Health Commercial |
$730.80
|
| Rate for Payer: First Health Workers Compensation |
$100.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$730.80
|
| Rate for Payer: GEHA Commercial |
$649.60
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$730.80
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$75.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$738.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$568.40
|
| Rate for Payer: One Health Plan PPO/POS |
$730.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$87.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$75.74
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$771.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$609.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$75.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$755.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$324.80
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$70.81
|
|
|
ED SOFT TISSUE/MSK
|
Facility
|
IP
|
$731.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
8176882
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.35 |
| Max. Negotiated Rate |
$694.45 |
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$621.35
|
| Rate for Payer: First Health Commercial |
$657.90
|
| Rate for Payer: First Health Workers Compensation |
$68.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$657.90
|
| Rate for Payer: GEHA Commercial |
$511.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$657.90
|
| Rate for Payer: Multiplan All |
$665.21
|
| Rate for Payer: OMNI Networks Commercial |
$511.70
|
| Rate for Payer: One Health Plan PPO/POS |
$657.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$694.45
|
| Rate for Payer: Three Rivers Provider Network All |
$548.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$679.83
|
| Rate for Payer: Zelis Auto |
$292.40
|
| Rate for Payer: Zelis Worker's Compensation |
$48.35
|
|
|
ED SOFT TISSUE/MSK
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
8176882
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.35 |
| Max. Negotiated Rate |
$694.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$137.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$438.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$137.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$621.35
|
| Rate for Payer: First Health Commercial |
$657.90
|
| Rate for Payer: First Health Workers Compensation |
$68.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$657.90
|
| Rate for Payer: GEHA Commercial |
$584.80
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$657.90
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$111.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$665.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$511.70
|
| Rate for Payer: One Health Plan PPO/POS |
$657.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$128.32
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$111.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$694.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$548.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$111.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$679.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$292.40
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$48.35
|
|
|
ED THORACIC/PULMONARY
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
8180002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.11 |
| Max. Negotiated Rate |
$786.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$93.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$496.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$93.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$74.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cigna Commercial |
$703.80
|
| Rate for Payer: First Health Commercial |
$745.20
|
| Rate for Payer: First Health Workers Compensation |
$103.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$745.20
|
| Rate for Payer: GEHA Commercial |
$662.40
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$745.20
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$75.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$753.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$579.60
|
| Rate for Payer: One Health Plan PPO/POS |
$745.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$87.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$75.74
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$786.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$621.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$75.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$770.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$331.20
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$73.11
|
|
|
ED THORACIC/PULMONARY
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
8180002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.11 |
| Max. Negotiated Rate |
$786.60 |
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cigna Commercial |
$703.80
|
| Rate for Payer: First Health Commercial |
$745.20
|
| Rate for Payer: First Health Workers Compensation |
$103.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$745.20
|
| Rate for Payer: GEHA Commercial |
$579.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$745.20
|
| Rate for Payer: Multiplan All |
$753.48
|
| Rate for Payer: OMNI Networks Commercial |
$579.60
|
| Rate for Payer: One Health Plan PPO/POS |
$745.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$786.60
|
| Rate for Payer: Three Rivers Provider Network All |
$621.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$770.04
|
| Rate for Payer: Zelis Auto |
$331.20
|
| Rate for Payer: Zelis Worker's Compensation |
$73.11
|
|
|
ED ULTRASOUND GUIDED VASCULAR ACCESS
|
Facility
|
OP
|
$896.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
8180004
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.35 |
| Max. Negotiated Rate |
$851.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$537.60
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$761.60
|
| Rate for Payer: First Health Commercial |
$806.40
|
| Rate for Payer: First Health Workers Compensation |
$47.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$806.40
|
| Rate for Payer: GEHA Commercial |
$716.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$806.40
|
| Rate for Payer: Humana ChoiceCare |
$232.96
|
| Rate for Payer: Multiplan All |
$815.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$537.60
|
| Rate for Payer: OMNI Networks Commercial |
$627.20
|
| Rate for Payer: One Health Plan PPO/POS |
$806.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$851.20
|
| Rate for Payer: Three Rivers Provider Network All |
$672.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$788.48
|
| Rate for Payer: United Healthcare Commercial |
$761.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$224.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$833.28
|
| Rate for Payer: Zelis Auto |
$358.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$448.00
|
| Rate for Payer: Zelis Worker's Compensation |
$33.35
|
|
|
ED ULTRASOUND GUIDED VASCULAR ACCESS
|
Facility
|
IP
|
$896.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
8180004
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.35 |
| Max. Negotiated Rate |
$851.20 |
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$761.60
|
| Rate for Payer: First Health Commercial |
$806.40
|
| Rate for Payer: First Health Workers Compensation |
$47.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$806.40
|
| Rate for Payer: GEHA Commercial |
$627.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$806.40
|
| Rate for Payer: Multiplan All |
$815.36
|
| Rate for Payer: OMNI Networks Commercial |
$627.20
|
| Rate for Payer: One Health Plan PPO/POS |
$806.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$851.20
|
| Rate for Payer: Three Rivers Provider Network All |
$672.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$833.28
|
| Rate for Payer: Zelis Auto |
$358.40
|
| Rate for Payer: Zelis Worker's Compensation |
$33.35
|
|
|
ED US GUIDE PROCDUR THORA/PARA/ABCESS/FB
|
Facility
|
IP
|
$1,320.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
8176942
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$1,254.00 |
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna Commercial |
$1,122.00
|
| Rate for Payer: First Health Commercial |
$1,188.00
|
| Rate for Payer: First Health Workers Compensation |
$117.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,188.00
|
| Rate for Payer: GEHA Commercial |
$924.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,188.00
|
| Rate for Payer: Multiplan All |
$1,201.20
|
| Rate for Payer: OMNI Networks Commercial |
$924.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,188.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,254.00
|
| Rate for Payer: Three Rivers Provider Network All |
$990.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,227.60
|
| Rate for Payer: Zelis Auto |
$528.00
|
| Rate for Payer: Zelis Worker's Compensation |
$83.26
|
|
|
ED US GUIDE PROCDUR THORA/PARA/ABCESS/FB
|
Facility
|
OP
|
$1,320.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
8176942
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$1,254.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna Commercial |
$1,122.00
|
| Rate for Payer: First Health Commercial |
$1,188.00
|
| Rate for Payer: First Health Workers Compensation |
$117.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,188.00
|
| Rate for Payer: GEHA Commercial |
$1,056.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,188.00
|
| Rate for Payer: Humana ChoiceCare |
$343.20
|
| Rate for Payer: Multiplan All |
$1,201.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$792.00
|
| Rate for Payer: OMNI Networks Commercial |
$924.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,188.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,254.00
|
| Rate for Payer: Three Rivers Provider Network All |
$990.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,161.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$330.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,227.60
|
| Rate for Payer: Zelis Auto |
$528.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$660.00
|
| Rate for Payer: Zelis Worker's Compensation |
$83.26
|
|
|
ED US PELVC NONOBS IMAG DCMTN LIMITD/F/U
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
8176857
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$755.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$93.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$477.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$93.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$74.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$100.97
|
| Rate for Payer: Cash Price |
$477.00
|
| Rate for Payer: Cash Price |
$477.00
|
| Rate for Payer: Cigna Commercial |
$675.75
|
| Rate for Payer: First Health Commercial |
$715.50
|
| Rate for Payer: First Health Workers Compensation |
$94.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$715.50
|
| Rate for Payer: GEHA Commercial |
$636.00
|
| Rate for Payer: GEHA Medicare |
$100.97
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$715.50
|
| Rate for Payer: Humana ChoiceCare |
$111.07
|
| Rate for Payer: Humana Medicare Advantage |
$100.97
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$169.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$75.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$100.97
|
| Rate for Payer: Multiplan All |
$723.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$171.65
|
| Rate for Payer: OMNI Networks Commercial |
$556.50
|
| Rate for Payer: One Health Plan PPO/POS |
$715.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$87.46
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$75.74
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$100.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$755.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$201.94
|
| Rate for Payer: Three Rivers Provider Network All |
$596.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$98.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$75.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.97
|
| Rate for Payer: United Payors & United Providers UP&UP |
$739.35
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$100.97
|
| Rate for Payer: Zelis Auto |
$318.00
|
| Rate for Payer: Zelis Medicare |
$85.82
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.16
|
| Rate for Payer: Zelis Worker's Compensation |
$66.60
|
|
|
ED US PELVC NONOBS IMAG DCMTN LIMITD/F/U
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
8176857
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$755.25 |
| Rate for Payer: Cash Price |
$477.00
|
| Rate for Payer: Cash Price |
$477.00
|
| Rate for Payer: Cigna Commercial |
$675.75
|
| Rate for Payer: First Health Commercial |
$715.50
|
| Rate for Payer: First Health Workers Compensation |
$94.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$715.50
|
| Rate for Payer: GEHA Commercial |
$556.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$715.50
|
| Rate for Payer: Multiplan All |
$723.45
|
| Rate for Payer: OMNI Networks Commercial |
$556.50
|
| Rate for Payer: One Health Plan PPO/POS |
$715.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$755.25
|
| Rate for Payer: Three Rivers Provider Network All |
$596.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$739.35
|
| Rate for Payer: Zelis Auto |
$318.00
|
| Rate for Payer: Zelis Worker's Compensation |
$66.60
|
|
|
ED VISIT HIGH MDM
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
8199285
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$147.42 |
| Max. Negotiated Rate |
$1,164.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$494.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$324.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$494.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$391.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$582.16
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$459.00
|
| Rate for Payer: First Health Commercial |
$486.00
|
| Rate for Payer: First Health Workers Compensation |
$208.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$486.00
|
| Rate for Payer: GEHA Commercial |
$432.00
|
| Rate for Payer: GEHA Medicare |
$582.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$486.00
|
| Rate for Payer: Humana ChoiceCare |
$640.38
|
| Rate for Payer: Humana Medicare Advantage |
$582.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$978.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$399.80
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$582.16
|
| Rate for Payer: Multiplan All |
$491.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$989.67
|
| Rate for Payer: OMNI Networks Commercial |
$378.00
|
| Rate for Payer: One Health Plan PPO/POS |
$486.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$461.62
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$399.80
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$582.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$513.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,164.32
|
| Rate for Payer: Three Rivers Provider Network All |
$405.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$570.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$399.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$582.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$502.20
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$582.16
|
| Rate for Payer: Zelis Auto |
$216.00
|
| Rate for Payer: Zelis Medicare |
$494.84
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$698.59
|
| Rate for Payer: Zelis Worker's Compensation |
$147.42
|
|
|
ED VISIT HIGH MDM
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
8199285
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$147.42 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$459.00
|
| Rate for Payer: First Health Commercial |
$486.00
|
| Rate for Payer: First Health Workers Compensation |
$208.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$486.00
|
| Rate for Payer: GEHA Commercial |
$378.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$486.00
|
| Rate for Payer: Multiplan All |
$491.40
|
| Rate for Payer: OMNI Networks Commercial |
$378.00
|
| Rate for Payer: One Health Plan PPO/POS |
$486.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$513.00
|
| Rate for Payer: Three Rivers Provider Network All |
$405.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$502.20
|
| Rate for Payer: Zelis Auto |
$216.00
|
| Rate for Payer: Zelis Worker's Compensation |
$147.42
|
|
|
ED VISIT LOW MDM
|
Facility
|
OP
|
$574.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
6199283
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$156.70 |
| Max. Negotiated Rate |
$545.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$210.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$344.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$210.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$166.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$262.92
|
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cigna Commercial |
$487.90
|
| Rate for Payer: First Health Commercial |
$516.60
|
| Rate for Payer: First Health Workers Compensation |
$221.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$516.60
|
| Rate for Payer: GEHA Commercial |
$459.20
|
| Rate for Payer: GEHA Medicare |
$262.92
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$516.60
|
| Rate for Payer: Humana ChoiceCare |
$289.21
|
| Rate for Payer: Humana Medicare Advantage |
$262.92
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$441.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$169.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$262.92
|
| Rate for Payer: Multiplan All |
$522.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$446.96
|
| Rate for Payer: OMNI Networks Commercial |
$401.80
|
| Rate for Payer: One Health Plan PPO/POS |
$516.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$196.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$169.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$262.92
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$545.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$525.84
|
| Rate for Payer: Three Rivers Provider Network All |
$430.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$257.66
|
| Rate for Payer: United Healthcare Managed Medicaid |
$169.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$262.92
|
| Rate for Payer: United Payors & United Providers UP&UP |
$533.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$262.92
|
| Rate for Payer: Zelis Auto |
$229.60
|
| Rate for Payer: Zelis Medicare |
$223.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$315.50
|
| Rate for Payer: Zelis Worker's Compensation |
$156.70
|
|
|
ED VISIT LOW MDM
|
Facility
|
IP
|
$574.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
6199283
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$156.70 |
| Max. Negotiated Rate |
$545.30 |
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cigna Commercial |
$487.90
|
| Rate for Payer: First Health Commercial |
$516.60
|
| Rate for Payer: First Health Workers Compensation |
$221.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$516.60
|
| Rate for Payer: GEHA Commercial |
$401.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$516.60
|
| Rate for Payer: Multiplan All |
$522.34
|
| Rate for Payer: OMNI Networks Commercial |
$401.80
|
| Rate for Payer: One Health Plan PPO/POS |
$516.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$545.30
|
| Rate for Payer: Three Rivers Provider Network All |
$430.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$533.82
|
| Rate for Payer: Zelis Auto |
$229.60
|
| Rate for Payer: Zelis Worker's Compensation |
$156.70
|
|
|
ED VISIT LOW MDM
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
8199283
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$52.69 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$164.05
|
| Rate for Payer: First Health Commercial |
$173.70
|
| Rate for Payer: First Health Workers Compensation |
$74.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$173.70
|
| Rate for Payer: GEHA Commercial |
$135.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$173.70
|
| Rate for Payer: Multiplan All |
$175.63
|
| Rate for Payer: OMNI Networks Commercial |
$135.10
|
| Rate for Payer: One Health Plan PPO/POS |
$173.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$183.35
|
| Rate for Payer: Three Rivers Provider Network All |
$144.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$179.49
|
| Rate for Payer: Zelis Auto |
$77.20
|
| Rate for Payer: Zelis Worker's Compensation |
$52.69
|
|
|
ED VISIT LOW MDM
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
8199283
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$52.69 |
| Max. Negotiated Rate |
$525.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$210.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$115.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$210.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$166.58
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$262.92
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$164.05
|
| Rate for Payer: First Health Commercial |
$173.70
|
| Rate for Payer: First Health Workers Compensation |
$74.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$173.70
|
| Rate for Payer: GEHA Commercial |
$154.40
|
| Rate for Payer: GEHA Medicare |
$262.92
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$173.70
|
| Rate for Payer: Humana ChoiceCare |
$289.21
|
| Rate for Payer: Humana Medicare Advantage |
$262.92
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$441.71
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$169.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$262.92
|
| Rate for Payer: Multiplan All |
$175.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$446.96
|
| Rate for Payer: OMNI Networks Commercial |
$135.10
|
| Rate for Payer: One Health Plan PPO/POS |
$173.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$196.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$169.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$262.92
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$183.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$525.84
|
| Rate for Payer: Three Rivers Provider Network All |
$144.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$257.66
|
| Rate for Payer: United Healthcare Managed Medicaid |
$169.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$262.92
|
| Rate for Payer: United Payors & United Providers UP&UP |
$179.49
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$262.92
|
| Rate for Payer: Zelis Auto |
$77.20
|
| Rate for Payer: Zelis Medicare |
$223.48
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$315.50
|
| Rate for Payer: Zelis Worker's Compensation |
$52.69
|
|
|
ED VISIT MODERATE MDM
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
8199284
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$99.92 |
| Max. Negotiated Rate |
$347.70 |
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$311.10
|
| Rate for Payer: First Health Commercial |
$329.40
|
| Rate for Payer: First Health Workers Compensation |
$141.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$329.40
|
| Rate for Payer: GEHA Commercial |
$256.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$329.40
|
| Rate for Payer: Multiplan All |
$333.06
|
| Rate for Payer: OMNI Networks Commercial |
$256.20
|
| Rate for Payer: One Health Plan PPO/POS |
$329.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$347.70
|
| Rate for Payer: Three Rivers Provider Network All |
$274.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$340.38
|
| Rate for Payer: Zelis Auto |
$146.40
|
| Rate for Payer: Zelis Worker's Compensation |
$99.92
|
|
|
ED VISIT MODERATE MDM
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
8199284
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$99.92 |
| Max. Negotiated Rate |
$808.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$334.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$219.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$334.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$265.19
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$404.33
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$311.10
|
| Rate for Payer: First Health Commercial |
$329.40
|
| Rate for Payer: First Health Workers Compensation |
$141.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$329.40
|
| Rate for Payer: GEHA Commercial |
$292.80
|
| Rate for Payer: GEHA Medicare |
$404.33
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$329.40
|
| Rate for Payer: Humana ChoiceCare |
$444.76
|
| Rate for Payer: Humana Medicare Advantage |
$404.33
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$679.27
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$270.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$404.33
|
| Rate for Payer: Multiplan All |
$333.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$687.36
|
| Rate for Payer: OMNI Networks Commercial |
$256.20
|
| Rate for Payer: One Health Plan PPO/POS |
$329.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$312.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$270.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$404.33
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$347.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$808.66
|
| Rate for Payer: Three Rivers Provider Network All |
$274.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$396.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$270.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$404.33
|
| Rate for Payer: United Payors & United Providers UP&UP |
$340.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$404.33
|
| Rate for Payer: Zelis Auto |
$146.40
|
| Rate for Payer: Zelis Medicare |
$343.68
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$485.20
|
| Rate for Payer: Zelis Worker's Compensation |
$99.92
|
|
