|
ELEC ALYS IMPLT SMPL CN NPGT PRGRMG
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 95977
|
| Hospital Charge Code |
21999310
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.05 |
| Max. Negotiated Rate |
$176.31 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$176.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$176.31
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$139.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.16
|
| Rate for Payer: Cash Price |
$99.00
|
| 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 |
$132.00
|
| Rate for Payer: GEHA Medicare |
$87.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$148.50
|
| 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 |
$142.52
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.16
|
| Rate for Payer: Multiplan All |
$150.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$148.17
|
| Rate for Payer: OMNI Networks Commercial |
$115.50
|
| Rate for Payer: One Health Plan PPO/POS |
$148.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$164.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$142.52
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$156.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$174.32
|
| Rate for Payer: Three Rivers Provider Network All |
$123.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$85.42
|
| Rate for Payer: United Healthcare Managed Medicaid |
$142.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$153.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.16
|
| Rate for Payer: Zelis Auto |
$66.00
|
| Rate for Payer: Zelis Medicare |
$74.09
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$104.59
|
| Rate for Payer: Zelis Worker's Compensation |
$45.05
|
|
|
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
|
$138.00
|
|
| Hospital Charge Code |
8195976
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.67 |
| Max. Negotiated Rate |
$131.10 |
| 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 |
$96.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$124.20
|
| Rate for Payer: Multiplan All |
$125.58
|
| 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: United Payors & United Providers UP&UP |
$128.34
|
| Rate for Payer: Zelis Auto |
$55.20
|
| 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 |
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
|
|
|
ELECTRICAL BONE STIMULATION
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 20974
|
| Hospital Charge Code |
6120974
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$40.30 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$67.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$93.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$67.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$53.60
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$59.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$124.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Humana ChoiceCare |
$40.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$54.70
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$93.00
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$63.15
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$54.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$136.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$54.70
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$77.50
|
| Rate for Payer: Zelis Worker's Compensation |
$42.31
|
|
|
ELECTRICAL BONE STIMULATION
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 20975
|
| Hospital Charge Code |
6120975
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$528.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$333.60
|
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Cigna Commercial |
$472.60
|
| Rate for Payer: First Health Commercial |
$500.40
|
| Rate for Payer: First Health Workers Compensation |
$214.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$500.40
|
| Rate for Payer: GEHA Commercial |
$444.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$500.40
|
| Rate for Payer: Humana ChoiceCare |
$144.56
|
| Rate for Payer: Multiplan All |
$505.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$333.60
|
| Rate for Payer: OMNI Networks Commercial |
$389.20
|
| Rate for Payer: One Health Plan PPO/POS |
$500.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$528.20
|
| Rate for Payer: Three Rivers Provider Network All |
$417.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$489.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$139.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$517.08
|
| Rate for Payer: Zelis Auto |
$222.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$278.00
|
| Rate for Payer: Zelis Worker's Compensation |
$151.79
|
|
|
ELECTRICAL BONE STIMULATION
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 20975
|
| Hospital Charge Code |
6120975
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$151.79 |
| Max. Negotiated Rate |
$528.20 |
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Cigna Commercial |
$472.60
|
| Rate for Payer: First Health Commercial |
$500.40
|
| Rate for Payer: First Health Workers Compensation |
$214.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$500.40
|
| Rate for Payer: GEHA Commercial |
$389.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$500.40
|
| Rate for Payer: Multiplan All |
$505.96
|
| Rate for Payer: OMNI Networks Commercial |
$389.20
|
| Rate for Payer: One Health Plan PPO/POS |
$500.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$528.20
|
| Rate for Payer: Three Rivers Provider Network All |
$417.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$517.08
|
| Rate for Payer: Zelis Auto |
$222.40
|
| Rate for Payer: Zelis Worker's Compensation |
$151.79
|
|
|
ELECTRICAL BONE STIMULATION
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 20974
|
| Hospital Charge Code |
6120974
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$42.31 |
| Max. Negotiated Rate |
$147.25 |
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$131.75
|
| Rate for Payer: First Health Commercial |
$139.50
|
| Rate for Payer: First Health Workers Compensation |
$59.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$139.50
|
| Rate for Payer: GEHA Commercial |
$108.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$139.50
|
| Rate for Payer: Multiplan All |
$141.05
|
| Rate for Payer: OMNI Networks Commercial |
$108.50
|
| Rate for Payer: One Health Plan PPO/POS |
$139.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$147.25
|
| Rate for Payer: Three Rivers Provider Network All |
$116.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$144.15
|
| Rate for Payer: Zelis Auto |
$62.00
|
| Rate for Payer: Zelis Worker's Compensation |
$42.31
|
|
|
ELECTROCONVULSIVE THERAPY
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
CPT 90870
|
| Hospital Charge Code |
8590870
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$135.68 |
| Max. Negotiated Rate |
$472.15 |
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cigna Commercial |
$422.45
|
| Rate for Payer: First Health Commercial |
$447.30
|
| Rate for Payer: First Health Workers Compensation |
$191.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$447.30
|
| Rate for Payer: GEHA Commercial |
$347.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$447.30
|
| Rate for Payer: Multiplan All |
$452.27
|
| Rate for Payer: OMNI Networks Commercial |
$347.90
|
| Rate for Payer: One Health Plan PPO/POS |
$447.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$472.15
|
| Rate for Payer: Three Rivers Provider Network All |
$372.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$462.21
|
| Rate for Payer: Zelis Auto |
$198.80
|
| Rate for Payer: Zelis Worker's Compensation |
$135.68
|
|
|
ELECTROCONVULSIVE THERAPY
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 90870
|
| Hospital Charge Code |
9599243
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$143.87 |
| Max. Negotiated Rate |
$500.65 |
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$447.95
|
| Rate for Payer: First Health Commercial |
$474.30
|
| Rate for Payer: First Health Workers Compensation |
$203.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$474.30
|
| Rate for Payer: GEHA Commercial |
$368.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$474.30
|
| Rate for Payer: Multiplan All |
$479.57
|
| Rate for Payer: OMNI Networks Commercial |
$368.90
|
| Rate for Payer: One Health Plan PPO/POS |
$474.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$500.65
|
| Rate for Payer: Three Rivers Provider Network All |
$395.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$490.11
|
| Rate for Payer: Zelis Auto |
$210.80
|
| Rate for Payer: Zelis Worker's Compensation |
$143.87
|
|
|
ELECTROCONVULSIVE THERAPY
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 90870
|
| Hospital Charge Code |
8499241
|
|
Hospital Revenue Code
|
513
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$1,007.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$653.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$316.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$653.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$517.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$503.83
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$447.95
|
| Rate for Payer: First Health Commercial |
$474.30
|
| Rate for Payer: First Health Workers Compensation |
$203.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$474.30
|
| Rate for Payer: GEHA Commercial |
$421.60
|
| Rate for Payer: GEHA Medicare |
$503.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$474.30
|
| Rate for Payer: Humana ChoiceCare |
$554.21
|
| Rate for Payer: Humana Medicare Advantage |
$503.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$846.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$528.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$503.83
|
| Rate for Payer: Multiplan All |
$479.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$856.51
|
| Rate for Payer: OMNI Networks Commercial |
$368.90
|
| Rate for Payer: One Health Plan PPO/POS |
$474.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$610.18
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$80.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$503.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$500.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,007.66
|
| Rate for Payer: Three Rivers Provider Network All |
$395.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$493.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$528.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$503.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$490.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$503.83
|
| Rate for Payer: Zelis Auto |
$210.80
|
| Rate for Payer: Zelis Medicare |
$428.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$604.60
|
| Rate for Payer: Zelis Worker's Compensation |
$143.87
|
|
|
ELECTROCONVULSIVE THERAPY
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 90870
|
| Hospital Charge Code |
8499241
|
|
Hospital Revenue Code
|
513
|
| Min. Negotiated Rate |
$143.87 |
| Max. Negotiated Rate |
$500.65 |
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$447.95
|
| Rate for Payer: First Health Commercial |
$474.30
|
| Rate for Payer: First Health Workers Compensation |
$203.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$474.30
|
| Rate for Payer: GEHA Commercial |
$368.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$474.30
|
| Rate for Payer: Multiplan All |
$479.57
|
| Rate for Payer: OMNI Networks Commercial |
$368.90
|
| Rate for Payer: One Health Plan PPO/POS |
$474.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$500.65
|
| Rate for Payer: Three Rivers Provider Network All |
$395.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$490.11
|
| Rate for Payer: Zelis Auto |
$210.80
|
| Rate for Payer: Zelis Worker's Compensation |
$143.87
|
|
|
ELECTROCONVULSIVE THERAPY
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
CPT 90870
|
| Hospital Charge Code |
8590870
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$135.68 |
| Max. Negotiated Rate |
$1,007.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$653.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$298.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$653.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$517.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$503.83
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cigna Commercial |
$422.45
|
| Rate for Payer: First Health Commercial |
$447.30
|
| Rate for Payer: First Health Workers Compensation |
$191.89
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$447.30
|
| Rate for Payer: GEHA Commercial |
$397.60
|
| Rate for Payer: GEHA Medicare |
$503.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$447.30
|
| Rate for Payer: Humana ChoiceCare |
$554.21
|
| Rate for Payer: Humana Medicare Advantage |
$503.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$846.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$528.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$503.83
|
| Rate for Payer: Multiplan All |
$452.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$856.51
|
| Rate for Payer: OMNI Networks Commercial |
$347.90
|
| Rate for Payer: One Health Plan PPO/POS |
$447.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$610.18
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$528.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$503.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$472.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,007.66
|
| Rate for Payer: Three Rivers Provider Network All |
$372.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$493.75
|
| Rate for Payer: United Healthcare Commercial |
$422.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$528.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$503.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$462.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$503.83
|
| Rate for Payer: Zelis Auto |
$198.80
|
| Rate for Payer: Zelis Medicare |
$428.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$604.60
|
| Rate for Payer: Zelis Worker's Compensation |
$135.68
|
|
|
ELECTROCONVULSIVE THERAPY
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 90870
|
| Hospital Charge Code |
9599243
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$143.87 |
| Max. Negotiated Rate |
$1,007.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$653.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$316.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$653.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$517.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$503.83
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$447.95
|
| Rate for Payer: First Health Commercial |
$474.30
|
| Rate for Payer: First Health Workers Compensation |
$203.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$474.30
|
| Rate for Payer: GEHA Commercial |
$421.60
|
| Rate for Payer: GEHA Medicare |
$503.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$474.30
|
| Rate for Payer: Humana ChoiceCare |
$554.21
|
| Rate for Payer: Humana Medicare Advantage |
$503.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$846.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$528.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$503.83
|
| Rate for Payer: Multiplan All |
$479.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$856.51
|
| Rate for Payer: OMNI Networks Commercial |
$368.90
|
| Rate for Payer: One Health Plan PPO/POS |
$474.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$610.18
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$528.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$503.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$500.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,007.66
|
| Rate for Payer: Three Rivers Provider Network All |
$395.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$493.75
|
| Rate for Payer: United Healthcare Managed Medicaid |
$528.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$503.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$490.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$503.83
|
| Rate for Payer: Zelis Auto |
$210.80
|
| Rate for Payer: Zelis Medicare |
$428.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$604.60
|
| Rate for Payer: Zelis Worker's Compensation |
$143.87
|
|
|
ELECTROEJACULATION
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 55870
|
| Hospital Charge Code |
6155870
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$1,653.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$265.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$826.80
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$375.70
|
| Rate for Payer: First Health Commercial |
$397.80
|
| Rate for Payer: First Health Workers Compensation |
$170.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$397.80
|
| Rate for Payer: GEHA Commercial |
$353.60
|
| Rate for Payer: GEHA Medicare |
$826.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$397.80
|
| Rate for Payer: Humana ChoiceCare |
$909.48
|
| Rate for Payer: Humana Medicare Advantage |
$826.80
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,389.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$826.80
|
| Rate for Payer: Multiplan All |
$402.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,405.56
|
| Rate for Payer: OMNI Networks Commercial |
$309.40
|
| Rate for Payer: One Health Plan PPO/POS |
$397.80
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$826.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$419.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,653.60
|
| Rate for Payer: Three Rivers Provider Network All |
$331.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$810.26
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$826.80
|
| Rate for Payer: United Payors & United Providers UP&UP |
$411.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$826.80
|
| Rate for Payer: Zelis Auto |
$176.80
|
| Rate for Payer: Zelis Medicare |
$702.78
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$992.16
|
| Rate for Payer: Zelis Worker's Compensation |
$120.67
|
|
|
ELECTROEJACULATION
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 55870
|
| Hospital Charge Code |
6155870
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$375.70
|
| Rate for Payer: First Health Commercial |
$397.80
|
| Rate for Payer: First Health Workers Compensation |
$170.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$397.80
|
| Rate for Payer: GEHA Commercial |
$309.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$397.80
|
| Rate for Payer: Multiplan All |
$402.22
|
| Rate for Payer: OMNI Networks Commercial |
$309.40
|
| Rate for Payer: One Health Plan PPO/POS |
$397.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$419.90
|
| Rate for Payer: Three Rivers Provider Network All |
$331.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$411.06
|
| Rate for Payer: Zelis Auto |
$176.80
|
| Rate for Payer: Zelis Worker's Compensation |
$120.67
|
|
|
ELECTROLYTE PANEL (Vitros)
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
2232213
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$12.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$120.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$12.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$7.01
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$170.85
|
| Rate for Payer: First Health Commercial |
$180.90
|
| Rate for Payer: First Health Workers Compensation |
$12.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.90
|
| Rate for Payer: GEHA Commercial |
$160.80
|
| Rate for Payer: GEHA Medicare |
$7.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.90
|
| Rate for Payer: Humana ChoiceCare |
$7.71
|
| Rate for Payer: Humana Medicare Advantage |
$7.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$10.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$7.01
|
| Rate for Payer: Multiplan All |
$182.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.92
|
| Rate for Payer: OMNI Networks Commercial |
$140.70
|
| Rate for Payer: One Health Plan PPO/POS |
$180.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11.77
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$10.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$7.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$190.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$14.02
|
| Rate for Payer: Three Rivers Provider Network All |
$150.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.87
|
| Rate for Payer: United Healthcare Commercial |
$170.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$10.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$7.01
|
| Rate for Payer: Zelis Auto |
$80.40
|
| Rate for Payer: Zelis Medicare |
$5.96
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.41
|
| Rate for Payer: Zelis Worker's Compensation |
$8.69
|
|
|
ELECTROLYTE PANEL (Vitros)
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
2232213
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$170.85
|
| Rate for Payer: First Health Commercial |
$180.90
|
| Rate for Payer: First Health Workers Compensation |
$12.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$180.90
|
| Rate for Payer: GEHA Commercial |
$140.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$180.90
|
| Rate for Payer: Multiplan All |
$182.91
|
| Rate for Payer: OMNI Networks Commercial |
$140.70
|
| Rate for Payer: One Health Plan PPO/POS |
$180.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$190.95
|
| Rate for Payer: Three Rivers Provider Network All |
$150.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$186.93
|
| Rate for Payer: Zelis Auto |
$80.40
|
| Rate for Payer: Zelis Worker's Compensation |
$8.69
|
|
|
elm, american IgE REF602476
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299147
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
elm, american IgE REF602476
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299147
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
E/M ANNUAL NURS FAC ASSESS STABLE 30 MIN
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT 99318
|
| Hospital Charge Code |
8599318
|
|
Hospital Revenue Code
|
524
|
| Min. Negotiated Rate |
$79.72 |
| Max. Negotiated Rate |
$277.40 |
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cigna Commercial |
$248.20
|
| Rate for Payer: First Health Commercial |
$262.80
|
| Rate for Payer: First Health Workers Compensation |
$112.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$262.80
|
| Rate for Payer: GEHA Commercial |
$204.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$262.80
|
| Rate for Payer: Multiplan All |
$265.72
|
| Rate for Payer: OMNI Networks Commercial |
$204.40
|
| Rate for Payer: One Health Plan PPO/POS |
$262.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$277.40
|
| Rate for Payer: Three Rivers Provider Network All |
$219.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$271.56
|
| Rate for Payer: Zelis Auto |
$116.80
|
| Rate for Payer: Zelis Worker's Compensation |
$79.72
|
|
|
E/M ANNUAL NURS FAC ASSESS STABLE 30 MIN
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT 99318
|
| Hospital Charge Code |
8599318
|
|
Hospital Revenue Code
|
524
|
| Min. Negotiated Rate |
$73.00 |
| Max. Negotiated Rate |
$277.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cigna Commercial |
$248.20
|
| Rate for Payer: First Health Commercial |
$262.80
|
| Rate for Payer: First Health Workers Compensation |
$112.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$262.80
|
| Rate for Payer: GEHA Commercial |
$233.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$262.80
|
| Rate for Payer: Humana ChoiceCare |
$75.92
|
| Rate for Payer: Multiplan All |
$265.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$175.20
|
| Rate for Payer: OMNI Networks Commercial |
$204.40
|
| Rate for Payer: One Health Plan PPO/POS |
$262.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$277.40
|
| Rate for Payer: Three Rivers Provider Network All |
$219.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$256.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$73.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$271.56
|
| Rate for Payer: Zelis Auto |
$116.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.00
|
| Rate for Payer: Zelis Worker's Compensation |
$79.72
|
|
|
EMBEDDED IP CATH EXIT-SITE
|
Facility
|
IP
|
$584.00
|
|
|
Service Code
|
CPT 49436
|
| Hospital Charge Code |
6149436
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$159.43 |
| Max. Negotiated Rate |
$554.80 |
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cigna Commercial |
$496.40
|
| Rate for Payer: First Health Commercial |
$525.60
|
| Rate for Payer: First Health Workers Compensation |
$225.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$525.60
|
| Rate for Payer: GEHA Commercial |
$408.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$525.60
|
| Rate for Payer: Multiplan All |
$531.44
|
| Rate for Payer: OMNI Networks Commercial |
$408.80
|
| Rate for Payer: One Health Plan PPO/POS |
$525.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$554.80
|
| Rate for Payer: Three Rivers Provider Network All |
$438.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$543.12
|
| Rate for Payer: Zelis Auto |
$233.60
|
| Rate for Payer: Zelis Worker's Compensation |
$159.43
|
|
|
EMBEDDED IP CATH EXIT-SITE
|
Facility
|
OP
|
$584.00
|
|
|
Service Code
|
CPT 49436
|
| Hospital Charge Code |
6149436
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$159.43 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,548.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$350.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,548.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,226.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cigna Commercial |
$496.40
|
| Rate for Payer: First Health Commercial |
$525.60
|
| Rate for Payer: First Health Workers Compensation |
$225.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$525.60
|
| Rate for Payer: GEHA Commercial |
$467.20
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$525.60
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,251.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$531.44
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$408.80
|
| Rate for Payer: One Health Plan PPO/POS |
$525.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,444.81
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,251.31
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$554.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$438.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,251.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$543.12
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$233.60
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$159.43
|
|
|
E/M ESTAB PATIENT NURSE VISIT - FACILITY
|
Facility
|
OP
|
$433.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
1999211
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.25 |
| Max. Negotiated Rate |
$411.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$259.80
|
| Rate for Payer: Cash Price |
$259.80
|
| Rate for Payer: Cigna Commercial |
$368.05
|
| Rate for Payer: First Health Commercial |
$389.70
|
| Rate for Payer: First Health Workers Compensation |
$167.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$389.70
|
| Rate for Payer: GEHA Commercial |
$346.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$389.70
|
| Rate for Payer: Humana ChoiceCare |
$112.58
|
| Rate for Payer: Multiplan All |
$394.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$259.80
|
| Rate for Payer: OMNI Networks Commercial |
$303.10
|
| Rate for Payer: One Health Plan PPO/POS |
$389.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$411.35
|
| Rate for Payer: Three Rivers Provider Network All |
$324.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$381.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$108.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$402.69
|
| Rate for Payer: Zelis Auto |
$173.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$216.50
|
| Rate for Payer: Zelis Worker's Compensation |
$118.21
|
|
