|
GRAFT OF AUTOLOGOUS SOFT TIS BY DIRECT E
|
Facility
|
IP
|
$1,488.00
|
|
|
Service Code
|
CPT 15769
|
| Hospital Charge Code |
6115769
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$406.22 |
| Max. Negotiated Rate |
$1,413.60 |
| Rate for Payer: Cash Price |
$892.80
|
| Rate for Payer: Cigna Commercial |
$1,264.80
|
| Rate for Payer: First Health Commercial |
$1,339.20
|
| Rate for Payer: First Health Workers Compensation |
$574.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,339.20
|
| Rate for Payer: GEHA Commercial |
$1,041.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,339.20
|
| Rate for Payer: Multiplan All |
$1,354.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,041.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,339.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,413.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,116.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,383.84
|
| Rate for Payer: Zelis Auto |
$595.20
|
| Rate for Payer: Zelis Worker's Compensation |
$406.22
|
|
|
GRAFT OF AUTOLOGOUS SOFT TIS BY DIRECT E
|
Facility
|
OP
|
$1,488.00
|
|
|
Service Code
|
CPT 15769
|
| Hospital Charge Code |
6115769
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$406.22 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,465.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$892.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,465.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,537.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,476.24
|
| Rate for Payer: Cash Price |
$892.80
|
| Rate for Payer: Cash Price |
$892.80
|
| Rate for Payer: Cigna Commercial |
$1,264.80
|
| Rate for Payer: First Health Commercial |
$1,339.20
|
| Rate for Payer: First Health Workers Compensation |
$574.52
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,339.20
|
| Rate for Payer: GEHA Commercial |
$1,190.40
|
| Rate for Payer: GEHA Medicare |
$3,476.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,339.20
|
| Rate for Payer: Humana ChoiceCare |
$3,823.86
|
| Rate for Payer: Humana Medicare Advantage |
$3,476.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,840.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,609.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,476.24
|
| Rate for Payer: Multiplan All |
$1,354.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,909.61
|
| Rate for Payer: OMNI Networks Commercial |
$1,041.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,339.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,168.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,609.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,476.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,413.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,952.48
|
| Rate for Payer: Three Rivers Provider Network All |
$1,116.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,406.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,609.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,476.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,383.84
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,476.24
|
| Rate for Payer: Zelis Auto |
$595.20
|
| Rate for Payer: Zelis Medicare |
$2,954.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,171.49
|
| Rate for Payer: Zelis Worker's Compensation |
$406.22
|
|
|
GRAM STAIN
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
2207205
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$67.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$42.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$6.08
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$60.35
|
| Rate for Payer: First Health Commercial |
$63.90
|
| Rate for Payer: First Health Workers Compensation |
$7.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$63.90
|
| Rate for Payer: GEHA Commercial |
$56.80
|
| Rate for Payer: GEHA Medicare |
$4.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$63.90
|
| Rate for Payer: Humana ChoiceCare |
$4.70
|
| Rate for Payer: Humana Medicare Advantage |
$4.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$7.17
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$6.21
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4.27
|
| Rate for Payer: Multiplan All |
$64.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$7.26
|
| Rate for Payer: OMNI Networks Commercial |
$49.70
|
| Rate for Payer: One Health Plan PPO/POS |
$63.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$7.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$6.21
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$67.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$8.54
|
| Rate for Payer: Three Rivers Provider Network All |
$53.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4.18
|
| Rate for Payer: United Healthcare Commercial |
$60.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$66.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4.27
|
| Rate for Payer: Zelis Auto |
$28.40
|
| Rate for Payer: Zelis Medicare |
$3.63
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.12
|
| Rate for Payer: Zelis Worker's Compensation |
$5.50
|
|
|
GRAM STAIN
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
2207205
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$67.45 |
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$60.35
|
| Rate for Payer: First Health Commercial |
$63.90
|
| Rate for Payer: First Health Workers Compensation |
$7.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$63.90
|
| Rate for Payer: GEHA Commercial |
$49.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$63.90
|
| Rate for Payer: Multiplan All |
$64.61
|
| Rate for Payer: OMNI Networks Commercial |
$49.70
|
| Rate for Payer: One Health Plan PPO/POS |
$63.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$67.45
|
| Rate for Payer: Three Rivers Provider Network All |
$53.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$66.03
|
| Rate for Payer: Zelis Auto |
$28.40
|
| Rate for Payer: Zelis Worker's Compensation |
$5.50
|
|
|
GREAT TOE-HAND TRANSFER
|
Facility
|
IP
|
$5,847.00
|
|
|
Service Code
|
CPT 26551
|
| Hospital Charge Code |
6126551
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,596.23 |
| Max. Negotiated Rate |
$5,554.65 |
| Rate for Payer: Cash Price |
$3,508.20
|
| Rate for Payer: Cigna Commercial |
$4,969.95
|
| Rate for Payer: First Health Commercial |
$5,262.30
|
| Rate for Payer: First Health Workers Compensation |
$2,257.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,262.30
|
| Rate for Payer: GEHA Commercial |
$4,092.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,262.30
|
| Rate for Payer: Multiplan All |
$5,320.77
|
| Rate for Payer: OMNI Networks Commercial |
$4,092.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,262.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,554.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,385.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,437.71
|
| Rate for Payer: Zelis Auto |
$2,338.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,596.23
|
|
|
GREAT TOE-HAND TRANSFER
|
Facility
|
OP
|
$5,847.00
|
|
|
Service Code
|
CPT 26551
|
| Hospital Charge Code |
6126551
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,461.75 |
| Max. Negotiated Rate |
$5,554.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,508.20
|
| Rate for Payer: Cash Price |
$3,508.20
|
| Rate for Payer: Cigna Commercial |
$4,969.95
|
| Rate for Payer: First Health Commercial |
$5,262.30
|
| Rate for Payer: First Health Workers Compensation |
$2,257.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,262.30
|
| Rate for Payer: GEHA Commercial |
$4,677.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,262.30
|
| Rate for Payer: Humana ChoiceCare |
$1,520.22
|
| Rate for Payer: Multiplan All |
$5,320.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,508.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,092.90
|
| Rate for Payer: One Health Plan PPO/POS |
$5,262.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,554.65
|
| Rate for Payer: Three Rivers Provider Network All |
$4,385.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,145.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,461.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,437.71
|
| Rate for Payer: Zelis Auto |
$2,338.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,923.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,596.23
|
|
|
GRFX CORE SAMPLE, GRAFIXPL COR, PER SQCM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT Q4132
|
| Hospital Charge Code |
9604131
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
GRFX CORE SAMPLE, GRAFIXPL COR, PER SQCM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT Q4132
|
| Hospital Charge Code |
9604131
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$174.88 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$174.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$174.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$138.54
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$117.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$0.00
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$141.37
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$163.23
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$141.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$0.01
|
| Rate for Payer: United Healthcare Managed Medicaid |
$141.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$0.01
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
GRFX PRME,GRFX PL PRME,STRVX &STRVX CORE
|
Facility
|
OP
|
$4,077.00
|
|
|
Service Code
|
CPT Q4132
|
| Hospital Charge Code |
9604132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.37 |
| Max. Negotiated Rate |
$3,873.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$174.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,446.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$174.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$138.54
|
| Rate for Payer: Cash Price |
$2,446.20
|
| Rate for Payer: Cash Price |
$2,446.20
|
| Rate for Payer: Cigna Commercial |
$3,465.45
|
| Rate for Payer: First Health Commercial |
$3,669.30
|
| Rate for Payer: First Health Workers Compensation |
$1,574.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,669.30
|
| Rate for Payer: GEHA Commercial |
$117.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,669.30
|
| Rate for Payer: Humana ChoiceCare |
$1,060.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$141.37
|
| Rate for Payer: Multiplan All |
$3,710.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,446.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,853.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,669.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$163.23
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$141.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,873.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,057.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,587.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$141.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,791.61
|
| Rate for Payer: Zelis Auto |
$1,630.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,038.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,113.02
|
|
|
GRFX PRME,GRFX PL PRME,STRVX &STRVX CORE
|
Facility
|
IP
|
$4,077.00
|
|
|
Service Code
|
CPT Q4132
|
| Hospital Charge Code |
9604132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,113.02 |
| Max. Negotiated Rate |
$3,873.15 |
| Rate for Payer: Cash Price |
$2,446.20
|
| Rate for Payer: Cigna Commercial |
$3,465.45
|
| Rate for Payer: First Health Commercial |
$3,669.30
|
| Rate for Payer: First Health Workers Compensation |
$1,574.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,669.30
|
| Rate for Payer: GEHA Commercial |
$2,853.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,669.30
|
| Rate for Payer: Multiplan All |
$3,710.07
|
| Rate for Payer: OMNI Networks Commercial |
$2,853.90
|
| Rate for Payer: One Health Plan PPO/POS |
$3,669.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,873.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,057.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,791.61
|
| Rate for Payer: Zelis Auto |
$1,630.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,113.02
|
|
|
GRFX PRME,GRFX PL PRME, STRVX &STRVX PL
|
Facility
|
OP
|
$3,673.89
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
9604133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$3,490.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$221.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,204.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$221.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$175.46
|
| Rate for Payer: Cash Price |
$2,204.33
|
| Rate for Payer: Cash Price |
$2,204.33
|
| Rate for Payer: Cigna Commercial |
$3,122.81
|
| Rate for Payer: First Health Commercial |
$3,306.50
|
| Rate for Payer: First Health Workers Compensation |
$1,418.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,306.50
|
| Rate for Payer: GEHA Commercial |
$152.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,306.50
|
| Rate for Payer: Humana ChoiceCare |
$955.21
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$179.04
|
| Rate for Payer: Multiplan All |
$3,343.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,204.33
|
| Rate for Payer: OMNI Networks Commercial |
$2,571.72
|
| Rate for Payer: One Health Plan PPO/POS |
$3,306.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$206.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$179.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,490.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,755.42
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,233.02
|
| Rate for Payer: United Healthcare Managed Medicaid |
$179.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,416.72
|
| Rate for Payer: Zelis Auto |
$1,469.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,836.94
|
| Rate for Payer: Zelis Worker's Compensation |
$1,002.97
|
|
|
GRFX PRME,GRFX PL PRME, STRVX &STRVX PL
|
Facility
|
IP
|
$3,673.89
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
9604133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,002.97 |
| Max. Negotiated Rate |
$3,490.20 |
| Rate for Payer: Cash Price |
$2,204.33
|
| Rate for Payer: Cigna Commercial |
$3,122.81
|
| Rate for Payer: First Health Commercial |
$3,306.50
|
| Rate for Payer: First Health Workers Compensation |
$1,418.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,306.50
|
| Rate for Payer: GEHA Commercial |
$2,571.72
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,306.50
|
| Rate for Payer: Multiplan All |
$3,343.24
|
| Rate for Payer: OMNI Networks Commercial |
$2,571.72
|
| Rate for Payer: One Health Plan PPO/POS |
$3,306.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,490.20
|
| Rate for Payer: Three Rivers Provider Network All |
$2,755.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,416.72
|
| Rate for Payer: Zelis Auto |
$1,469.56
|
| Rate for Payer: Zelis Worker's Compensation |
$1,002.97
|
|
|
GROUP ADAPTIVE BHV TX BY PROTOCOL TECH E
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 97154
|
| Hospital Charge Code |
4397923
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$85.00
|
| Rate for Payer: First Health Commercial |
$90.00
|
| Rate for Payer: First Health Workers Compensation |
$38.61
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$90.00
|
| Rate for Payer: GEHA Commercial |
$70.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$90.00
|
| Rate for Payer: Multiplan All |
$91.00
|
| Rate for Payer: OMNI Networks Commercial |
$70.00
|
| Rate for Payer: One Health Plan PPO/POS |
$90.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$95.00
|
| Rate for Payer: Three Rivers Provider Network All |
$75.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$93.00
|
| Rate for Payer: Zelis Auto |
$40.00
|
| Rate for Payer: Zelis Worker's Compensation |
$27.30
|
|
|
GROUP ADAPTIVE BHV TX BY PROTOCOL TECH E
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 97154
|
| Hospital Charge Code |
4397923
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$28.29
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$85.00
|
| Rate for Payer: First Health Commercial |
$90.00
|
| Rate for Payer: First Health Workers Compensation |
$15.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$90.00
|
| Rate for Payer: GEHA Commercial |
$80.00
|
| Rate for Payer: GEHA Medicare |
$28.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$90.00
|
| Rate for Payer: Humana ChoiceCare |
$31.12
|
| Rate for Payer: Humana Medicare Advantage |
$28.29
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$47.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$28.29
|
| Rate for Payer: Multiplan All |
$91.00
|
| Rate for Payer: New Mexico Health Connections Medicare |
$48.09
|
| Rate for Payer: OMNI Networks Commercial |
$70.00
|
| Rate for Payer: One Health Plan PPO/POS |
$90.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$28.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$95.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$56.58
|
| Rate for Payer: Three Rivers Provider Network All |
$75.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$27.72
|
| Rate for Payer: United Healthcare Commercial |
$85.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$25.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.29
|
| Rate for Payer: United Payors & United Providers UP&UP |
$93.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$28.29
|
| Rate for Payer: Zelis Auto |
$40.00
|
| Rate for Payer: Zelis Medicare |
$24.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$33.95
|
| Rate for Payer: Zelis Worker's Compensation |
$11.21
|
|
|
GROUP A STREP ANTIGEN AGH
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 87430
|
| Hospital Charge Code |
2207112
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.29 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$45.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.81
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: First Health Workers Compensation |
$20.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$68.40
|
| Rate for Payer: GEHA Commercial |
$60.80
|
| Rate for Payer: GEHA Medicare |
$16.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$68.40
|
| Rate for Payer: Humana ChoiceCare |
$18.49
|
| Rate for Payer: Humana Medicare Advantage |
$16.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.24
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.81
|
| Rate for Payer: Multiplan All |
$69.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.58
|
| Rate for Payer: OMNI Networks Commercial |
$53.20
|
| Rate for Payer: One Health Plan PPO/POS |
$68.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.24
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.46
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$72.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.62
|
| Rate for Payer: Three Rivers Provider Network All |
$57.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.47
|
| Rate for Payer: United Healthcare Commercial |
$64.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$70.68
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.81
|
| Rate for Payer: Zelis Auto |
$30.40
|
| Rate for Payer: Zelis Medicare |
$14.29
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.17
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
|
GROUP A STREP ANTIGEN AGH
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 87430
|
| Hospital Charge Code |
2207112
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$64.60
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: First Health Workers Compensation |
$20.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$68.40
|
| Rate for Payer: GEHA Commercial |
$53.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$68.40
|
| Rate for Payer: Multiplan All |
$69.16
|
| Rate for Payer: OMNI Networks Commercial |
$53.20
|
| Rate for Payer: One Health Plan PPO/POS |
$68.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$72.20
|
| Rate for Payer: Three Rivers Provider Network All |
$57.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$70.68
|
| Rate for Payer: Zelis Auto |
$30.40
|
| Rate for Payer: Zelis Worker's Compensation |
$14.71
|
|
|
GROUP PSYCHOTHERAPY
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
8590853
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$175.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$90.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$44.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$90.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$71.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.83
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$62.90
|
| Rate for Payer: First Health Commercial |
$66.60
|
| Rate for Payer: First Health Workers Compensation |
$28.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$66.60
|
| Rate for Payer: GEHA Commercial |
$59.20
|
| Rate for Payer: GEHA Medicare |
$87.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$66.60
|
| Rate for Payer: Humana ChoiceCare |
$96.61
|
| Rate for Payer: Humana Medicare Advantage |
$87.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$147.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$72.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.83
|
| Rate for Payer: Multiplan All |
$67.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.31
|
| Rate for Payer: OMNI Networks Commercial |
$51.80
|
| Rate for Payer: One Health Plan PPO/POS |
$66.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$84.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$72.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$70.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$175.66
|
| Rate for Payer: Three Rivers Provider Network All |
$55.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.07
|
| Rate for Payer: United Healthcare Commercial |
$62.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$72.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$68.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.83
|
| Rate for Payer: Zelis Auto |
$29.60
|
| Rate for Payer: Zelis Medicare |
$74.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.40
|
| Rate for Payer: Zelis Worker's Compensation |
$20.20
|
|
|
GROUP PSYCHOTHERAPY
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
8499238
|
|
Hospital Revenue Code
|
513
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$57.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
|
GROUP PSYCHOTHERAPY
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
8590853
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$62.90
|
| Rate for Payer: First Health Commercial |
$66.60
|
| Rate for Payer: First Health Workers Compensation |
$28.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$66.60
|
| Rate for Payer: GEHA Commercial |
$51.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$66.60
|
| Rate for Payer: Multiplan All |
$67.34
|
| Rate for Payer: OMNI Networks Commercial |
$51.80
|
| Rate for Payer: One Health Plan PPO/POS |
$66.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$70.30
|
| Rate for Payer: Three Rivers Provider Network All |
$55.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$68.82
|
| Rate for Payer: Zelis Auto |
$29.60
|
| Rate for Payer: Zelis Worker's Compensation |
$20.20
|
|
|
GROUP PSYCHOTHERAPY
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
9599238
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$57.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
|
GROUP PSYCHOTHERAPY
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
8499238
|
|
Hospital Revenue Code
|
513
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$175.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$90.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$49.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$90.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$71.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.83
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$65.60
|
| Rate for Payer: GEHA Medicare |
$87.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Humana ChoiceCare |
$96.61
|
| Rate for Payer: Humana Medicare Advantage |
$87.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$147.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$72.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.83
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.31
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$84.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$80.00
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$175.66
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.07
|
| Rate for Payer: United Healthcare Managed Medicaid |
$72.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.83
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Medicare |
$74.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.40
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
|
GROUP PSYCHOTHERAPY
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
9599238
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$175.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$90.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$49.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$90.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$71.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.83
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$65.60
|
| Rate for Payer: GEHA Medicare |
$87.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Humana ChoiceCare |
$96.61
|
| Rate for Payer: Humana Medicare Advantage |
$87.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$147.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$72.79
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.83
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.31
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$84.04
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$72.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$175.66
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.07
|
| Rate for Payer: United Healthcare Managed Medicaid |
$72.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.83
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Medicare |
$74.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.40
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
|
GROUP TRAINING
|
Facility
|
IP
|
$203.00
|
|
| Hospital Charge Code |
20500113
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$55.42 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$78.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$142.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Worker's Compensation |
$55.42
|
|
|
GROUP TRAINING
|
Facility
|
OP
|
$203.00
|
|
| Hospital Charge Code |
20500113
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$50.75 |
| Max. Negotiated Rate |
$192.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$172.55
|
| Rate for Payer: First Health Commercial |
$182.70
|
| Rate for Payer: First Health Workers Compensation |
$78.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.70
|
| Rate for Payer: GEHA Commercial |
$162.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.70
|
| Rate for Payer: Humana ChoiceCare |
$52.78
|
| Rate for Payer: Multiplan All |
$184.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$121.80
|
| Rate for Payer: OMNI Networks Commercial |
$142.10
|
| Rate for Payer: One Health Plan PPO/POS |
$182.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.85
|
| Rate for Payer: Three Rivers Provider Network All |
$152.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$178.64
|
| Rate for Payer: United Healthcare Commercial |
$172.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$50.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.79
|
| Rate for Payer: Zelis Auto |
$81.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$101.50
|
| Rate for Payer: Zelis Worker's Compensation |
$55.42
|
|
|
GROWTH HORMONE
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
2300125
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.17 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$23.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$16.67
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$142.80
|
| Rate for Payer: First Health Commercial |
$151.20
|
| Rate for Payer: First Health Workers Compensation |
$25.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$151.20
|
| Rate for Payer: GEHA Commercial |
$134.40
|
| Rate for Payer: GEHA Medicare |
$16.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$151.20
|
| Rate for Payer: Humana ChoiceCare |
$18.34
|
| Rate for Payer: Humana Medicare Advantage |
$16.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28.01
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$24.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$16.67
|
| Rate for Payer: Multiplan All |
$152.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.34
|
| Rate for Payer: OMNI Networks Commercial |
$117.60
|
| Rate for Payer: One Health Plan PPO/POS |
$151.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$28.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$24.25
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$16.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$159.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$33.34
|
| Rate for Payer: Three Rivers Provider Network All |
$126.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16.34
|
| Rate for Payer: United Healthcare Commercial |
$142.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$24.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$156.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$16.67
|
| Rate for Payer: Zelis Auto |
$67.20
|
| Rate for Payer: Zelis Medicare |
$14.17
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20.00
|
| Rate for Payer: Zelis Worker's Compensation |
$17.97
|
|
