|
HOME/RES VISIT EST PATNT MOD MDM 40 MIN
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 99349
|
| Hospital Charge Code |
8599349
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$97.75 |
| Max. Negotiated Rate |
$371.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$234.60
|
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cigna Commercial |
$332.35
|
| Rate for Payer: First Health Commercial |
$351.90
|
| Rate for Payer: First Health Workers Compensation |
$150.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$351.90
|
| Rate for Payer: GEHA Commercial |
$312.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$351.90
|
| Rate for Payer: Humana ChoiceCare |
$101.66
|
| Rate for Payer: Multiplan All |
$355.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$234.60
|
| Rate for Payer: OMNI Networks Commercial |
$273.70
|
| Rate for Payer: One Health Plan PPO/POS |
$351.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$371.45
|
| Rate for Payer: Three Rivers Provider Network All |
$293.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$344.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$97.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$363.63
|
| Rate for Payer: Zelis Auto |
$156.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$195.50
|
| Rate for Payer: Zelis Worker's Compensation |
$106.74
|
|
|
HOME/RES VISIT EST PATNT MOD MDM 40 MIN
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 99349
|
| Hospital Charge Code |
8599349
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$106.74 |
| Max. Negotiated Rate |
$371.45 |
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cigna Commercial |
$332.35
|
| Rate for Payer: First Health Commercial |
$351.90
|
| Rate for Payer: First Health Workers Compensation |
$150.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$351.90
|
| Rate for Payer: GEHA Commercial |
$273.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$351.90
|
| Rate for Payer: Multiplan All |
$355.81
|
| Rate for Payer: OMNI Networks Commercial |
$273.70
|
| Rate for Payer: One Health Plan PPO/POS |
$351.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$371.45
|
| Rate for Payer: Three Rivers Provider Network All |
$293.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$363.63
|
| Rate for Payer: Zelis Auto |
$156.40
|
| Rate for Payer: Zelis Worker's Compensation |
$106.74
|
|
|
HOME/RES VISIT NEW PATIENT SF MDM 15 MIN
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 99341
|
| Hospital Charge Code |
8599341
|
|
Hospital Revenue Code
|
580
|
| 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
|
|
|
HOME/RES VISIT NEW PATIENT SF MDM 15 MIN
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 99341
|
| Hospital Charge Code |
8499341
|
|
Hospital Revenue Code
|
522
|
| 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
|
|
|
HOME/RES VISIT NEW PATIENT SF MDM 15 MIN
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 99341
|
| Hospital Charge Code |
8499341
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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: Great West Healthcare (Cigna) Commercial |
$148.50
|
| Rate for Payer: Humana ChoiceCare |
$42.90
|
| Rate for Payer: Multiplan All |
$150.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$99.00
|
| 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: TriWest Veterans Administration/VAPC3 |
$145.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$41.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$153.45
|
| Rate for Payer: Zelis Auto |
$66.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$82.50
|
| Rate for Payer: Zelis Worker's Compensation |
$45.05
|
|
|
HOME/RES VISIT NEW PATIENT SF MDM 15 MIN
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 99341
|
| Hospital Charge Code |
8599341
|
|
Hospital Revenue Code
|
580
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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: Great West Healthcare (Cigna) Commercial |
$148.50
|
| Rate for Payer: Humana ChoiceCare |
$42.90
|
| Rate for Payer: Multiplan All |
$150.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$99.00
|
| 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: TriWest Veterans Administration/VAPC3 |
$145.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$41.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$153.45
|
| Rate for Payer: Zelis Auto |
$66.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$82.50
|
| Rate for Payer: Zelis Worker's Compensation |
$45.05
|
|
|
HOME/RES VISIT NEW PATNT HIGH MDM 75 MIN
|
Facility
|
IP
|
$676.00
|
|
|
Service Code
|
CPT 99345
|
| Hospital Charge Code |
8499345
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$184.55 |
| Max. Negotiated Rate |
$642.20 |
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cigna Commercial |
$574.60
|
| Rate for Payer: First Health Commercial |
$608.40
|
| Rate for Payer: First Health Workers Compensation |
$261.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$608.40
|
| Rate for Payer: GEHA Commercial |
$473.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$608.40
|
| Rate for Payer: Multiplan All |
$615.16
|
| Rate for Payer: OMNI Networks Commercial |
$473.20
|
| Rate for Payer: One Health Plan PPO/POS |
$608.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$642.20
|
| Rate for Payer: Three Rivers Provider Network All |
$507.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$628.68
|
| Rate for Payer: Zelis Auto |
$270.40
|
| Rate for Payer: Zelis Worker's Compensation |
$184.55
|
|
|
HOME/RES VISIT NEW PATNT HIGH MDM 75 MIN
|
Facility
|
OP
|
$676.00
|
|
|
Service Code
|
CPT 99345
|
| Hospital Charge Code |
8499345
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$642.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$405.60
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cigna Commercial |
$574.60
|
| Rate for Payer: First Health Commercial |
$608.40
|
| Rate for Payer: First Health Workers Compensation |
$261.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$608.40
|
| Rate for Payer: GEHA Commercial |
$540.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$608.40
|
| Rate for Payer: Humana ChoiceCare |
$175.76
|
| Rate for Payer: Multiplan All |
$615.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$405.60
|
| Rate for Payer: OMNI Networks Commercial |
$473.20
|
| Rate for Payer: One Health Plan PPO/POS |
$608.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$642.20
|
| Rate for Payer: Three Rivers Provider Network All |
$507.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$594.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$169.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$628.68
|
| Rate for Payer: Zelis Auto |
$270.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$338.00
|
| Rate for Payer: Zelis Worker's Compensation |
$184.55
|
|
|
HOME/RES VISIT NEW PATNT LOW MDM 30 MIN
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT 99342
|
| Hospital Charge Code |
8499342
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$59.75 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$203.15
|
| Rate for Payer: First Health Commercial |
$215.10
|
| Rate for Payer: First Health Workers Compensation |
$92.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$215.10
|
| Rate for Payer: GEHA Commercial |
$191.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$215.10
|
| Rate for Payer: Humana ChoiceCare |
$62.14
|
| Rate for Payer: Multiplan All |
$217.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$143.40
|
| Rate for Payer: OMNI Networks Commercial |
$167.30
|
| Rate for Payer: One Health Plan PPO/POS |
$215.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$227.05
|
| Rate for Payer: Three Rivers Provider Network All |
$179.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$210.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$59.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$222.27
|
| Rate for Payer: Zelis Auto |
$95.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$119.50
|
| Rate for Payer: Zelis Worker's Compensation |
$65.25
|
|
|
HOME/RES VISIT NEW PATNT LOW MDM 30 MIN
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 99342
|
| Hospital Charge Code |
8499342
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$65.25 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$203.15
|
| Rate for Payer: First Health Commercial |
$215.10
|
| Rate for Payer: First Health Workers Compensation |
$92.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$215.10
|
| Rate for Payer: GEHA Commercial |
$167.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$215.10
|
| Rate for Payer: Multiplan All |
$217.49
|
| Rate for Payer: OMNI Networks Commercial |
$167.30
|
| Rate for Payer: One Health Plan PPO/POS |
$215.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$227.05
|
| Rate for Payer: Three Rivers Provider Network All |
$179.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$222.27
|
| Rate for Payer: Zelis Auto |
$95.60
|
| Rate for Payer: Zelis Worker's Compensation |
$65.25
|
|
|
HOME/RES VISIT NEW PATNT LOW MDM 30 MIN
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 99342
|
| Hospital Charge Code |
9400090
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$231.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$207.40
|
| Rate for Payer: First Health Commercial |
$219.60
|
| Rate for Payer: First Health Workers Compensation |
$94.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$219.60
|
| Rate for Payer: GEHA Commercial |
$195.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$219.60
|
| Rate for Payer: Humana ChoiceCare |
$63.44
|
| Rate for Payer: Multiplan All |
$222.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$146.40
|
| Rate for Payer: OMNI Networks Commercial |
$170.80
|
| Rate for Payer: One Health Plan PPO/POS |
$219.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$231.80
|
| Rate for Payer: Three Rivers Provider Network All |
$183.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$214.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$61.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$226.92
|
| Rate for Payer: Zelis Auto |
$97.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$122.00
|
| Rate for Payer: Zelis Worker's Compensation |
$66.61
|
|
|
HOME/RES VISIT NEW PATNT LOW MDM 30 MIN
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 99342
|
| Hospital Charge Code |
9400090
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.61 |
| Max. Negotiated Rate |
$231.80 |
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$207.40
|
| Rate for Payer: First Health Commercial |
$219.60
|
| Rate for Payer: First Health Workers Compensation |
$94.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$219.60
|
| Rate for Payer: GEHA Commercial |
$170.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$219.60
|
| Rate for Payer: Multiplan All |
$222.04
|
| Rate for Payer: OMNI Networks Commercial |
$170.80
|
| Rate for Payer: One Health Plan PPO/POS |
$219.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$231.80
|
| Rate for Payer: Three Rivers Provider Network All |
$183.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$226.92
|
| Rate for Payer: Zelis Auto |
$97.60
|
| Rate for Payer: Zelis Worker's Compensation |
$66.61
|
|
|
HOME/RES VISIT NEW PATNT MOD MDM 60 MIN
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT 99344
|
| Hospital Charge Code |
8499344
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$138.75 |
| Max. Negotiated Rate |
$527.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna Commercial |
$471.75
|
| Rate for Payer: First Health Commercial |
$499.50
|
| Rate for Payer: First Health Workers Compensation |
$214.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$499.50
|
| Rate for Payer: GEHA Commercial |
$444.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$499.50
|
| Rate for Payer: Humana ChoiceCare |
$144.30
|
| Rate for Payer: Multiplan All |
$505.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$333.00
|
| Rate for Payer: OMNI Networks Commercial |
$388.50
|
| Rate for Payer: One Health Plan PPO/POS |
$499.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$527.25
|
| Rate for Payer: Three Rivers Provider Network All |
$416.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$488.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$138.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$516.15
|
| Rate for Payer: Zelis Auto |
$222.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.50
|
| Rate for Payer: Zelis Worker's Compensation |
$151.51
|
|
|
HOME/RES VISIT NEW PATNT MOD MDM 60 MIN
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
CPT 99344
|
| Hospital Charge Code |
8499344
|
|
Hospital Revenue Code
|
522
|
| Min. Negotiated Rate |
$151.51 |
| Max. Negotiated Rate |
$527.25 |
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna Commercial |
$471.75
|
| Rate for Payer: First Health Commercial |
$499.50
|
| Rate for Payer: First Health Workers Compensation |
$214.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$499.50
|
| Rate for Payer: GEHA Commercial |
$388.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$499.50
|
| Rate for Payer: Multiplan All |
$505.05
|
| Rate for Payer: OMNI Networks Commercial |
$388.50
|
| Rate for Payer: One Health Plan PPO/POS |
$499.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$527.25
|
| Rate for Payer: Three Rivers Provider Network All |
$416.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$516.15
|
| Rate for Payer: Zelis Auto |
$222.00
|
| Rate for Payer: Zelis Worker's Compensation |
$151.51
|
|
|
homocysteine REF501700
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
2207291
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.13 |
| Max. Negotiated Rate |
$316.35 |
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cigna Commercial |
$283.05
|
| Rate for Payer: First Health Commercial |
$299.70
|
| Rate for Payer: First Health Workers Compensation |
$29.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$299.70
|
| Rate for Payer: GEHA Commercial |
$233.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$299.70
|
| Rate for Payer: Multiplan All |
$303.03
|
| Rate for Payer: OMNI Networks Commercial |
$233.10
|
| Rate for Payer: One Health Plan PPO/POS |
$299.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$316.35
|
| Rate for Payer: Three Rivers Provider Network All |
$249.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$309.69
|
| Rate for Payer: Zelis Auto |
$133.20
|
| Rate for Payer: Zelis Worker's Compensation |
$21.13
|
|
|
homocysteine REF501700
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
2207291
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.23 |
| Max. Negotiated Rate |
$316.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$199.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$32.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$25.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17.92
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cigna Commercial |
$283.05
|
| Rate for Payer: First Health Commercial |
$299.70
|
| Rate for Payer: First Health Workers Compensation |
$29.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$299.70
|
| Rate for Payer: GEHA Commercial |
$266.40
|
| Rate for Payer: GEHA Medicare |
$17.92
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$299.70
|
| Rate for Payer: Humana ChoiceCare |
$19.71
|
| Rate for Payer: Humana Medicare Advantage |
$17.92
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$30.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$26.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17.92
|
| Rate for Payer: Multiplan All |
$303.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.46
|
| Rate for Payer: OMNI Networks Commercial |
$233.10
|
| Rate for Payer: One Health Plan PPO/POS |
$299.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$30.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$26.07
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17.92
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$316.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$35.84
|
| Rate for Payer: Three Rivers Provider Network All |
$249.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$17.56
|
| Rate for Payer: United Healthcare Commercial |
$283.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.92
|
| Rate for Payer: United Payors & United Providers UP&UP |
$309.69
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17.92
|
| Rate for Payer: Zelis Auto |
$133.20
|
| Rate for Payer: Zelis Medicare |
$15.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$21.50
|
| Rate for Payer: Zelis Worker's Compensation |
$21.13
|
|
|
HOOK PLATE
|
Facility
|
IP
|
$4,750.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$4,512.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,800.00
|
| Rate for Payer: Cash Price |
$2,850.00
|
| Rate for Payer: Cash Price |
$2,850.00
|
| Rate for Payer: Cigna Commercial |
$4,037.50
|
| Rate for Payer: First Health Commercial |
$4,275.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,275.00
|
| Rate for Payer: GEHA Commercial |
$3,325.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,275.00
|
| Rate for Payer: Multiplan All |
$4,322.50
|
| Rate for Payer: OMNI Networks Commercial |
$3,325.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,275.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,512.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,562.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,417.50
|
| Rate for Payer: Zelis Auto |
$1,900.00
|
|
|
HOOK PLATE
|
Facility
|
OP
|
$4,750.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7006804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,187.50 |
| Max. Negotiated Rate |
$4,512.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,850.00
|
| Rate for Payer: Cash Price |
$2,850.00
|
| Rate for Payer: Cash Price |
$2,850.00
|
| Rate for Payer: Cigna Commercial |
$4,037.50
|
| Rate for Payer: First Health Commercial |
$4,275.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,275.00
|
| Rate for Payer: GEHA Commercial |
$3,800.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,275.00
|
| Rate for Payer: Humana ChoiceCare |
$1,235.00
|
| Rate for Payer: Multiplan All |
$4,322.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,850.00
|
| Rate for Payer: OMNI Networks Commercial |
$3,325.00
|
| Rate for Payer: One Health Plan PPO/POS |
$4,275.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,512.50
|
| Rate for Payer: Three Rivers Provider Network All |
$3,562.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,180.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,187.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,417.50
|
| Rate for Payer: Zelis Auto |
$1,900.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,375.00
|
|
|
HOPD COVID19 SPEC COLLECT
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT C9803
|
| Hospital Charge Code |
2222222
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$67.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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 |
$27.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$63.90
|
| Rate for Payer: GEHA Commercial |
$56.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$63.90
|
| Rate for Payer: Humana ChoiceCare |
$18.46
|
| Rate for Payer: Multiplan All |
$64.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$42.60
|
| 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: TriWest Veterans Administration/VAPC3 |
$62.48
|
| Rate for Payer: United Healthcare Commercial |
$60.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$66.03
|
| Rate for Payer: Zelis Auto |
$28.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$35.50
|
| Rate for Payer: Zelis Worker's Compensation |
$19.38
|
|
|
HOPD COVID19 SPEC COLLECT
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT C9803
|
| Hospital Charge Code |
2202024
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$67.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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 |
$27.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$63.90
|
| Rate for Payer: GEHA Commercial |
$56.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$63.90
|
| Rate for Payer: Humana ChoiceCare |
$18.46
|
| Rate for Payer: Multiplan All |
$64.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$42.60
|
| 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: TriWest Veterans Administration/VAPC3 |
$62.48
|
| Rate for Payer: United Healthcare Commercial |
$60.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$66.03
|
| Rate for Payer: Zelis Auto |
$28.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$35.50
|
| Rate for Payer: Zelis Worker's Compensation |
$19.38
|
|
|
HOPD COVID19 SPEC COLLECT
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT C9803
|
| Hospital Charge Code |
2202024
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$67.45 |
| 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 |
$27.41
|
| 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 |
$19.38
|
|
|
HOPD COVID19 SPEC COLLECT
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT C9803
|
| Hospital Charge Code |
2222222
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$67.45 |
| 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 |
$27.41
|
| 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 |
$19.38
|
|
|
hopd covid19 spec collect pop
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT G2023
|
| Hospital Charge Code |
2200018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$67.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$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 |
$27.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$63.90
|
| Rate for Payer: GEHA Commercial |
$56.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$63.90
|
| Rate for Payer: Humana ChoiceCare |
$18.46
|
| Rate for Payer: Multiplan All |
$64.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$42.60
|
| 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: TriWest Veterans Administration/VAPC3 |
$62.48
|
| Rate for Payer: United Healthcare Commercial |
$60.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$66.03
|
| Rate for Payer: Zelis Auto |
$28.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$35.50
|
| Rate for Payer: Zelis Worker's Compensation |
$19.38
|
|
|
hopd covid19 spec collect pop
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT G2023
|
| Hospital Charge Code |
2200018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$67.45 |
| 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 |
$27.41
|
| 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 |
$19.38
|
|
|
HORIZON CLINIC COV19 AND INFLU A&B
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT 87428
|
| Hospital Charge Code |
7300030
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$279.65
|
| Rate for Payer: First Health Commercial |
$296.10
|
| Rate for Payer: First Health Workers Compensation |
$127.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$296.10
|
| Rate for Payer: GEHA Commercial |
$230.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$296.10
|
| Rate for Payer: Multiplan All |
$299.39
|
| Rate for Payer: OMNI Networks Commercial |
$230.30
|
| Rate for Payer: One Health Plan PPO/POS |
$296.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$312.55
|
| Rate for Payer: Three Rivers Provider Network All |
$246.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$305.97
|
| Rate for Payer: Zelis Auto |
$131.60
|
| Rate for Payer: Zelis Worker's Compensation |
$89.82
|
|
