|
ELBOW ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$990.00
|
|
|
Service Code
|
CPT 29834
|
| Hospital Charge Code |
6129834
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$270.27 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$594.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna Commercial |
$841.50
|
| Rate for Payer: First Health Commercial |
$891.00
|
| Rate for Payer: First Health Workers Compensation |
$382.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$891.00
|
| Rate for Payer: GEHA Commercial |
$792.00
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$891.00
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$900.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$693.00
|
| Rate for Payer: One Health Plan PPO/POS |
$891.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$940.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$742.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$920.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$396.00
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$270.27
|
|
|
ELBOW ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,199.00
|
|
|
Service Code
|
CPT 29838
|
| Hospital Charge Code |
6129838
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$327.33 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$719.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$719.40
|
| Rate for Payer: Cash Price |
$719.40
|
| Rate for Payer: Cigna Commercial |
$1,019.15
|
| Rate for Payer: First Health Commercial |
$1,079.10
|
| Rate for Payer: First Health Workers Compensation |
$462.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,079.10
|
| Rate for Payer: GEHA Commercial |
$959.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,079.10
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,091.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$839.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,079.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,139.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$899.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,115.07
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$479.60
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$327.33
|
|
|
ELBOW ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,068.00
|
|
|
Service Code
|
CPT 29837
|
| Hospital Charge Code |
6129837
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$291.56 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$640.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,025.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,396.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cigna Commercial |
$907.80
|
| Rate for Payer: First Health Commercial |
$961.20
|
| Rate for Payer: First Health Workers Compensation |
$412.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$961.20
|
| Rate for Payer: GEHA Commercial |
$854.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$961.20
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,445.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$971.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$747.60
|
| Rate for Payer: One Health Plan PPO/POS |
$961.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,823.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,445.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,014.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$801.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,445.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$993.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$427.20
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$291.56
|
|
|
ELBOW EXTENSION BRACE
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
CPT L3960
|
| Hospital Charge Code |
8233960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$152.88 |
| Max. Negotiated Rate |
$1,481.79 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,481.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$352.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,481.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,173.87
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cigna Commercial |
$499.80
|
| Rate for Payer: First Health Commercial |
$529.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$529.20
|
| Rate for Payer: GEHA Commercial |
$470.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$529.20
|
| Rate for Payer: Humana ChoiceCare |
$152.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,197.78
|
| Rate for Payer: Multiplan All |
$535.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$352.80
|
| Rate for Payer: OMNI Networks Commercial |
$411.60
|
| Rate for Payer: One Health Plan PPO/POS |
$529.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,383.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,197.78
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$558.60
|
| Rate for Payer: Three Rivers Provider Network All |
$441.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$517.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,197.78
|
| Rate for Payer: United Payors & United Providers UP&UP |
$546.84
|
| Rate for Payer: Zelis Auto |
$235.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$294.00
|
|
|
ELBOW EXTENSION BRACE
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
CPT L3960
|
| Hospital Charge Code |
8233960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$235.20 |
| Max. Negotiated Rate |
$558.60 |
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cigna Commercial |
$499.80
|
| Rate for Payer: First Health Commercial |
$529.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$529.20
|
| Rate for Payer: GEHA Commercial |
$411.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$529.20
|
| Rate for Payer: Multiplan All |
$535.08
|
| Rate for Payer: OMNI Networks Commercial |
$411.60
|
| Rate for Payer: One Health Plan PPO/POS |
$529.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$558.60
|
| Rate for Payer: Three Rivers Provider Network All |
$441.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$546.84
|
| Rate for Payer: Zelis Auto |
$235.20
|
|
|
ELBOW ORTHOTIC
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT L3962
|
| Hospital Charge Code |
8233961
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: First Health Commercial |
$32.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$25.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: OMNI Networks Commercial |
$25.20
|
| Rate for Payer: One Health Plan PPO/POS |
$32.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: Zelis Auto |
$14.40
|
|
|
ELBOW ORTHOTIC
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT L3962
|
| Hospital Charge Code |
8233961
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$1,186.47 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,186.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,186.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$939.92
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$30.60
|
| Rate for Payer: First Health Commercial |
$32.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$32.40
|
| Rate for Payer: GEHA Commercial |
$28.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$32.40
|
| Rate for Payer: Humana ChoiceCare |
$9.36
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$959.06
|
| Rate for Payer: Multiplan All |
$32.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.60
|
| Rate for Payer: OMNI Networks Commercial |
$25.20
|
| Rate for Payer: One Health Plan PPO/POS |
$32.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,107.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$959.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$34.20
|
| Rate for Payer: Three Rivers Provider Network All |
$27.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$31.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$959.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$33.48
|
| Rate for Payer: Zelis Auto |
$14.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$18.00
|
|
|
ELEC ALYS IMPLT BRN NPGT PRGRMG 1ST 15 M
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 95983
|
| Hospital Charge Code |
21900183
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.86 |
| Max. Negotiated Rate |
$174.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$55.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$94.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$55.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$44.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.16
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$125.60
|
| Rate for Payer: GEHA Medicare |
$87.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Humana ChoiceCare |
$95.88
|
| Rate for Payer: Humana Medicare Advantage |
$87.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$146.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$45.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.16
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$148.17
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$52.02
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$45.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$174.32
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$85.42
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.16
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Medicare |
$74.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$104.59
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
ELEC ALYS IMPLT BRN NPGT PRGRMG 1ST 15 M
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 95983
|
| Hospital Charge Code |
21799447
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.86 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$109.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
ELEC ALYS IMPLT BRN NPGT PRGRMG 1ST 15 M
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 95983
|
| Hospital Charge Code |
21999311
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.86 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$109.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
ELEC ALYS IMPLT BRN NPGT PRGRMG 1ST 15 M
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 95983
|
| Hospital Charge Code |
21900183
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.86 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$109.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
ELEC ALYS IMPLT BRN NPGT PRGRMG 1ST 15 M
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 95983
|
| Hospital Charge Code |
21799447
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.86 |
| Max. Negotiated Rate |
$174.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$55.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$94.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$55.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$44.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.16
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$125.60
|
| Rate for Payer: GEHA Medicare |
$87.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Humana ChoiceCare |
$95.88
|
| Rate for Payer: Humana Medicare Advantage |
$87.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$146.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$45.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.16
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$148.17
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$52.02
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$45.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$174.32
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$85.42
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.16
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Medicare |
$74.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$104.59
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
ELEC ALYS IMPLT BRN NPGT PRGRMG 1ST 15 M
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 95983
|
| Hospital Charge Code |
21999311
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.86 |
| Max. Negotiated Rate |
$174.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$55.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$94.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$55.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$44.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.16
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$133.45
|
| Rate for Payer: First Health Commercial |
$141.30
|
| Rate for Payer: First Health Workers Compensation |
$60.62
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$141.30
|
| Rate for Payer: GEHA Commercial |
$125.60
|
| Rate for Payer: GEHA Medicare |
$87.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$141.30
|
| Rate for Payer: Humana ChoiceCare |
$95.88
|
| Rate for Payer: Humana Medicare Advantage |
$87.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$146.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$45.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.16
|
| Rate for Payer: Multiplan All |
$142.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$148.17
|
| Rate for Payer: OMNI Networks Commercial |
$109.90
|
| Rate for Payer: One Health Plan PPO/POS |
$141.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$52.02
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$45.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$149.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$174.32
|
| Rate for Payer: Three Rivers Provider Network All |
$117.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$85.42
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$146.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.16
|
| Rate for Payer: Zelis Auto |
$62.80
|
| Rate for Payer: Zelis Medicare |
$74.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$104.59
|
| Rate for Payer: Zelis Worker's Compensation |
$42.86
|
|
|
ELEC ALYS IMPLT NPGT CPLX SP/PN PRGRMG
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 95972
|
| Hospital Charge Code |
6195972
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$35.49 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$110.50
|
| Rate for Payer: First Health Commercial |
$117.00
|
| Rate for Payer: First Health Workers Compensation |
$50.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.00
|
| Rate for Payer: GEHA Commercial |
$91.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.00
|
| Rate for Payer: Multiplan All |
$118.30
|
| Rate for Payer: OMNI Networks Commercial |
$91.00
|
| Rate for Payer: One Health Plan PPO/POS |
$117.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$123.50
|
| Rate for Payer: Three Rivers Provider Network All |
$97.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$120.90
|
| Rate for Payer: Zelis Auto |
$52.00
|
| Rate for Payer: Zelis Worker's Compensation |
$35.49
|
|
|
ELEC ALYS IMPLT NPGT CPLX SP/PN PRGRMG
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 95972
|
| Hospital Charge Code |
6195972
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$35.49 |
| Max. Negotiated Rate |
$174.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$161.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$78.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$161.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$128.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.16
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$110.50
|
| Rate for Payer: First Health Commercial |
$117.00
|
| Rate for Payer: First Health Workers Compensation |
$50.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.00
|
| Rate for Payer: GEHA Commercial |
$104.00
|
| Rate for Payer: GEHA Medicare |
$87.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.00
|
| Rate for Payer: Humana ChoiceCare |
$95.88
|
| Rate for Payer: Humana Medicare Advantage |
$87.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$146.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$130.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.16
|
| Rate for Payer: Multiplan All |
$118.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$148.17
|
| Rate for Payer: OMNI Networks Commercial |
$91.00
|
| Rate for Payer: One Health Plan PPO/POS |
$117.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$150.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$130.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$123.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$174.32
|
| Rate for Payer: Three Rivers Provider Network All |
$97.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$85.42
|
| Rate for Payer: United Healthcare Managed Medicaid |
$130.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$120.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.16
|
| Rate for Payer: Zelis Auto |
$52.00
|
| Rate for Payer: Zelis Medicare |
$74.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$104.59
|
| Rate for Payer: Zelis Worker's Compensation |
$35.49
|
|
|
ELEC ALYS IMPLT NPGT PHYS/QHP W/O PROGRA
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
CPT 95970
|
| Hospital Charge Code |
6195970
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$15.83 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$142.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$34.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$142.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$112.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$49.30
|
| Rate for Payer: First Health Commercial |
$52.20
|
| Rate for Payer: First Health Workers Compensation |
$22.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$52.20
|
| Rate for Payer: GEHA Commercial |
$46.40
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$52.20
|
| 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 |
$115.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$52.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$40.60
|
| Rate for Payer: One Health Plan PPO/POS |
$52.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$132.90
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$115.10
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$55.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$43.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$115.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.94
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$23.20
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$15.83
|
|
|
ELEC ALYS IMPLT NPGT PHYS/QHP W/O PROGRA
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 95970
|
| Hospital Charge Code |
6195970
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$15.83 |
| Max. Negotiated Rate |
$55.10 |
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$49.30
|
| Rate for Payer: First Health Commercial |
$52.20
|
| Rate for Payer: First Health Workers Compensation |
$22.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$52.20
|
| Rate for Payer: GEHA Commercial |
$40.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$52.20
|
| Rate for Payer: Multiplan All |
$52.78
|
| Rate for Payer: OMNI Networks Commercial |
$40.60
|
| Rate for Payer: One Health Plan PPO/POS |
$52.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$55.10
|
| Rate for Payer: Three Rivers Provider Network All |
$43.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.94
|
| Rate for Payer: Zelis Auto |
$23.20
|
| Rate for Payer: Zelis Worker's Compensation |
$15.83
|
|
|
ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRG
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 95971
|
| Hospital Charge Code |
6195971
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$174.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$161.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$76.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$161.78
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$128.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.16
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$108.80
|
| Rate for Payer: First Health Commercial |
$115.20
|
| Rate for Payer: First Health Workers Compensation |
$49.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$115.20
|
| Rate for Payer: GEHA Commercial |
$102.40
|
| Rate for Payer: GEHA Medicare |
$87.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$115.20
|
| Rate for Payer: Humana ChoiceCare |
$95.88
|
| Rate for Payer: Humana Medicare Advantage |
$87.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$146.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$130.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.16
|
| Rate for Payer: Multiplan All |
$116.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$148.17
|
| Rate for Payer: OMNI Networks Commercial |
$89.60
|
| Rate for Payer: One Health Plan PPO/POS |
$115.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$150.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$130.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$121.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$174.32
|
| Rate for Payer: Three Rivers Provider Network All |
$96.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$85.42
|
| Rate for Payer: United Healthcare Managed Medicaid |
$130.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$119.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.16
|
| Rate for Payer: Zelis Auto |
$51.20
|
| Rate for Payer: Zelis Medicare |
$74.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$104.59
|
| Rate for Payer: Zelis Worker's Compensation |
$34.94
|
|
|
ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRG
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 95971
|
| Hospital Charge Code |
6195971
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$121.60 |
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$108.80
|
| Rate for Payer: First Health Commercial |
$115.20
|
| Rate for Payer: First Health Workers Compensation |
$49.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$115.20
|
| Rate for Payer: GEHA Commercial |
$89.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$115.20
|
| Rate for Payer: Multiplan All |
$116.48
|
| Rate for Payer: OMNI Networks Commercial |
$89.60
|
| Rate for Payer: One Health Plan PPO/POS |
$115.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$121.60
|
| Rate for Payer: Three Rivers Provider Network All |
$96.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$119.04
|
| Rate for Payer: Zelis Auto |
$51.20
|
| Rate for Payer: Zelis Worker's Compensation |
$34.94
|
|
|
ELEC ALYS IMPLT SMPL CN NPGT PRGRMG
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 95976
|
| Hospital Charge Code |
7699216
|
|
Hospital Revenue Code
|
511
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$55.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$74.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$55.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$44.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.41
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$47.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$99.20
|
| Rate for Payer: GEHA Medicare |
$35.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Humana ChoiceCare |
$38.95
|
| Rate for Payer: Humana Medicare Advantage |
$35.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$59.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$45.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.41
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$60.20
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$52.02
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$45.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.82
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.41
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Medicare |
$30.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.49
|
| Rate for Payer: Zelis Worker's Compensation |
$33.85
|
|
|
ELEC ALYS IMPLT SMPL CN NPGT PRGRMG
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 95976
|
| Hospital Charge Code |
21999400
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.85 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$47.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$86.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Worker's Compensation |
$33.85
|
|
|
ELEC ALYS IMPLT SMPL CN NPGT PRGRMG
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 95977
|
| Hospital Charge Code |
21999310
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.05 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$140.25
|
| Rate for Payer: First Health Commercial |
$148.50
|
| Rate for Payer: First Health Workers Compensation |
$63.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$148.50
|
| Rate for Payer: GEHA Commercial |
$115.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$148.50
|
| Rate for Payer: Multiplan All |
$150.15
|
| Rate for Payer: OMNI Networks Commercial |
$115.50
|
| Rate for Payer: One Health Plan PPO/POS |
$148.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$156.75
|
| Rate for Payer: Three Rivers Provider Network All |
$123.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$153.45
|
| Rate for Payer: Zelis Auto |
$66.00
|
| Rate for Payer: Zelis Worker's Compensation |
$45.05
|
|
|
ELEC ALYS IMPLT SMPL CN NPGT PRGRMG
|
Facility
|
OP
|
$138.00
|
|
| Hospital Charge Code |
8195976
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$117.30
|
| Rate for Payer: First Health Commercial |
$124.20
|
| Rate for Payer: First Health Workers Compensation |
$53.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$124.20
|
| Rate for Payer: GEHA Commercial |
$110.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Humana ChoiceCare |
$35.88
|
| Rate for Payer: Multiplan All |
$125.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$82.80
|
| Rate for Payer: OMNI Networks Commercial |
$96.60
|
| Rate for Payer: One Health Plan PPO/POS |
$124.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$131.10
|
| Rate for Payer: Three Rivers Provider Network All |
$103.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$121.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$34.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: Zelis Auto |
$55.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$69.00
|
| Rate for Payer: Zelis Worker's Compensation |
$37.67
|
|
|
ELEC ALYS IMPLT SMPL CN NPGT PRGRMG
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 95976
|
| Hospital Charge Code |
21999400
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$55.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$74.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$55.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$44.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.41
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$47.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$99.20
|
| Rate for Payer: GEHA Medicare |
$35.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Humana ChoiceCare |
$38.95
|
| Rate for Payer: Humana Medicare Advantage |
$35.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$59.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$45.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.41
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$60.20
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$52.02
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$45.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.82
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.41
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Medicare |
$30.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.49
|
| Rate for Payer: Zelis Worker's Compensation |
$33.85
|
|
|
ELEC ALYS IMPLT SMPL CN NPGT PRGRMG
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 95976
|
| Hospital Charge Code |
6195976
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$55.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$74.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$55.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$44.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$35.41
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$105.40
|
| Rate for Payer: First Health Commercial |
$111.60
|
| Rate for Payer: First Health Workers Compensation |
$47.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$111.60
|
| Rate for Payer: GEHA Commercial |
$99.20
|
| Rate for Payer: GEHA Medicare |
$35.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$111.60
|
| Rate for Payer: Humana ChoiceCare |
$38.95
|
| Rate for Payer: Humana Medicare Advantage |
$35.41
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$59.49
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$45.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$35.41
|
| Rate for Payer: Multiplan All |
$112.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$60.20
|
| Rate for Payer: OMNI Networks Commercial |
$86.80
|
| Rate for Payer: One Health Plan PPO/POS |
$111.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$52.02
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$45.06
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.41
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$117.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.82
|
| Rate for Payer: Three Rivers Provider Network All |
$93.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.41
|
| Rate for Payer: United Payors & United Providers UP&UP |
$115.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$35.41
|
| Rate for Payer: Zelis Auto |
$49.60
|
| Rate for Payer: Zelis Medicare |
$30.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$42.49
|
| Rate for Payer: Zelis Worker's Compensation |
$33.85
|
|
