|
ADMINISTRATION INFLUENZA VIRUS VACC
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
6180043
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$135.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$42.50
|
| Rate for Payer: First Health Commercial |
$45.00
|
| Rate for Payer: First Health Workers Compensation |
$19.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.00
|
| Rate for Payer: GEHA Commercial |
$40.00
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.00
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$45.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$35.00
|
| Rate for Payer: One Health Plan PPO/POS |
$45.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$47.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$37.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$46.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$20.00
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$13.65
|
|
|
ADMINISTRATION PNEUMOCOCCAL VACC
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
6180044
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$42.50
|
| Rate for Payer: First Health Commercial |
$45.00
|
| Rate for Payer: First Health Workers Compensation |
$19.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.00
|
| Rate for Payer: GEHA Commercial |
$35.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.00
|
| Rate for Payer: Multiplan All |
$45.50
|
| Rate for Payer: OMNI Networks Commercial |
$35.00
|
| Rate for Payer: One Health Plan PPO/POS |
$45.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$47.50
|
| Rate for Payer: Three Rivers Provider Network All |
$37.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$46.50
|
| Rate for Payer: Zelis Auto |
$20.00
|
| Rate for Payer: Zelis Worker's Compensation |
$13.65
|
|
|
ADMINISTRATION PNEUMOCOCCAL VACC
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
6180044
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$135.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$42.50
|
| Rate for Payer: First Health Commercial |
$45.00
|
| Rate for Payer: First Health Workers Compensation |
$19.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.00
|
| Rate for Payer: GEHA Commercial |
$40.00
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.00
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$45.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$35.00
|
| Rate for Payer: One Health Plan PPO/POS |
$45.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$47.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$37.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$46.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$20.00
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$13.65
|
|
|
ADMINISTRATION PNEUMO VACC NON MC
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
8500009
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$44.77 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$63.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$114.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Worker's Compensation |
$44.77
|
|
|
ADMINISTRATION PNEUMO VACC NON MC
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
8500009
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$155.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$98.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$139.40
|
| Rate for Payer: First Health Commercial |
$147.60
|
| Rate for Payer: First Health Workers Compensation |
$63.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$147.60
|
| Rate for Payer: GEHA Commercial |
$131.20
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$147.60
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$149.24
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$114.80
|
| Rate for Payer: One Health Plan PPO/POS |
$147.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$155.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$123.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$152.52
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$65.60
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$44.77
|
|
|
ADVAIR 100-50MCG/DOSE
|
Facility
|
OP
|
$726.00
|
|
|
Service Code
|
NDC 00173069504
|
| Hospital Charge Code |
3300354
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$181.50 |
| Max. Negotiated Rate |
$689.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$435.60
|
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Cigna Commercial |
$617.10
|
| Rate for Payer: First Health Commercial |
$653.40
|
| Rate for Payer: First Health Workers Compensation |
$280.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$653.40
|
| Rate for Payer: GEHA Commercial |
$580.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$653.40
|
| Rate for Payer: Humana ChoiceCare |
$188.76
|
| Rate for Payer: Multiplan All |
$660.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$435.60
|
| Rate for Payer: OMNI Networks Commercial |
$508.20
|
| Rate for Payer: One Health Plan PPO/POS |
$653.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$689.70
|
| Rate for Payer: Three Rivers Provider Network All |
$544.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$638.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$181.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$675.18
|
| Rate for Payer: Zelis Auto |
$290.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$363.00
|
| Rate for Payer: Zelis Worker's Compensation |
$198.20
|
|
|
ADVAIR 100-50MCG/DOSE
|
Facility
|
IP
|
$726.00
|
|
|
Service Code
|
NDC 00173069504
|
| Hospital Charge Code |
3300354
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$198.20 |
| Max. Negotiated Rate |
$689.70 |
| Rate for Payer: Cash Price |
$435.60
|
| Rate for Payer: Cigna Commercial |
$617.10
|
| Rate for Payer: First Health Commercial |
$653.40
|
| Rate for Payer: First Health Workers Compensation |
$280.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$653.40
|
| Rate for Payer: GEHA Commercial |
$508.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$653.40
|
| Rate for Payer: Multiplan All |
$660.66
|
| Rate for Payer: OMNI Networks Commercial |
$508.20
|
| Rate for Payer: One Health Plan PPO/POS |
$653.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$689.70
|
| Rate for Payer: Three Rivers Provider Network All |
$544.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$675.18
|
| Rate for Payer: Zelis Auto |
$290.40
|
| Rate for Payer: Zelis Worker's Compensation |
$198.20
|
|
|
ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
21099498
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$88.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$182.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Humana ChoiceCare |
$59.28
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$136.80
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$200.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$57.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$114.00
|
| Rate for Payer: Zelis Worker's Compensation |
$62.24
|
|
|
ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
25500080
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.24 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$88.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$159.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Worker's Compensation |
$62.24
|
|
|
ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
21099498
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.24 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$88.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$159.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Worker's Compensation |
$62.24
|
|
|
ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
21600080
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$62.24 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$88.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$159.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Worker's Compensation |
$62.24
|
|
|
ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Facility
|
IP
|
$202.74
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
8599498
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$55.35 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Cash Price |
$121.64
|
| Rate for Payer: Cigna Commercial |
$172.33
|
| Rate for Payer: First Health Commercial |
$182.47
|
| Rate for Payer: First Health Workers Compensation |
$78.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.47
|
| Rate for Payer: GEHA Commercial |
$141.92
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.47
|
| Rate for Payer: Multiplan All |
$184.49
|
| Rate for Payer: OMNI Networks Commercial |
$141.92
|
| Rate for Payer: One Health Plan PPO/POS |
$182.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.60
|
| Rate for Payer: Three Rivers Provider Network All |
$152.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.55
|
| Rate for Payer: Zelis Auto |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$55.35
|
|
|
ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Facility
|
OP
|
$202.74
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
7299498
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$50.69 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$121.64
|
| Rate for Payer: Cash Price |
$121.64
|
| Rate for Payer: Cigna Commercial |
$172.33
|
| Rate for Payer: First Health Commercial |
$182.47
|
| Rate for Payer: First Health Workers Compensation |
$78.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.47
|
| Rate for Payer: GEHA Commercial |
$162.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.47
|
| Rate for Payer: Humana ChoiceCare |
$52.71
|
| Rate for Payer: Multiplan All |
$184.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$121.64
|
| Rate for Payer: OMNI Networks Commercial |
$141.92
|
| Rate for Payer: One Health Plan PPO/POS |
$182.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.60
|
| Rate for Payer: Three Rivers Provider Network All |
$152.06
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$178.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$50.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.55
|
| Rate for Payer: Zelis Auto |
$81.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$101.37
|
| Rate for Payer: Zelis Worker's Compensation |
$55.35
|
|
|
ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Facility
|
IP
|
$202.74
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
7299498
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$55.35 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Cash Price |
$121.64
|
| Rate for Payer: Cigna Commercial |
$172.33
|
| Rate for Payer: First Health Commercial |
$182.47
|
| Rate for Payer: First Health Workers Compensation |
$78.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.47
|
| Rate for Payer: GEHA Commercial |
$141.92
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.47
|
| Rate for Payer: Multiplan All |
$184.49
|
| Rate for Payer: OMNI Networks Commercial |
$141.92
|
| Rate for Payer: One Health Plan PPO/POS |
$182.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.60
|
| Rate for Payer: Three Rivers Provider Network All |
$152.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.55
|
| Rate for Payer: Zelis Auto |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$55.35
|
|
|
ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
21599498
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.24 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$88.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$159.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Worker's Compensation |
$62.24
|
|
|
ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
21599498
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$88.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$182.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Humana ChoiceCare |
$59.28
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$136.80
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$200.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$57.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$114.00
|
| Rate for Payer: Zelis Worker's Compensation |
$62.24
|
|
|
ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
21600080
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$88.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$182.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Humana ChoiceCare |
$59.28
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$136.80
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$200.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$57.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$114.00
|
| Rate for Payer: Zelis Worker's Compensation |
$62.24
|
|
|
ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Facility
|
OP
|
$202.74
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
8599498
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$50.69 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$121.64
|
| Rate for Payer: Cash Price |
$121.64
|
| Rate for Payer: Cigna Commercial |
$172.33
|
| Rate for Payer: First Health Commercial |
$182.47
|
| Rate for Payer: First Health Workers Compensation |
$78.28
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$182.47
|
| Rate for Payer: GEHA Commercial |
$162.19
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$182.47
|
| Rate for Payer: Humana ChoiceCare |
$52.71
|
| Rate for Payer: Multiplan All |
$184.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$121.64
|
| Rate for Payer: OMNI Networks Commercial |
$141.92
|
| Rate for Payer: One Health Plan PPO/POS |
$182.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$192.60
|
| Rate for Payer: Three Rivers Provider Network All |
$152.06
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$178.41
|
| Rate for Payer: United Healthcare Managed Medicaid |
$50.69
|
| Rate for Payer: United Payors & United Providers UP&UP |
$188.55
|
| Rate for Payer: Zelis Auto |
$81.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$101.37
|
| Rate for Payer: Zelis Worker's Compensation |
$55.35
|
|
|
ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
25500080
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: First Health Workers Compensation |
$88.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$205.20
|
| Rate for Payer: GEHA Commercial |
$182.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$205.20
|
| Rate for Payer: Humana ChoiceCare |
$59.28
|
| Rate for Payer: Multiplan All |
$207.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$136.80
|
| Rate for Payer: OMNI Networks Commercial |
$159.60
|
| Rate for Payer: One Health Plan PPO/POS |
$205.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$216.60
|
| Rate for Payer: Three Rivers Provider Network All |
$171.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$200.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$57.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$212.04
|
| Rate for Payer: Zelis Auto |
$91.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$114.00
|
| Rate for Payer: Zelis Worker's Compensation |
$62.24
|
|
|
ADVANCE CARE PLANNING FIRST 30 MINS
|
Facility
|
OP
|
$232.71
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
8599497
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$63.53 |
| Max. Negotiated Rate |
$221.07 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$81.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$139.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$81.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$64.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.83
|
| Rate for Payer: Cash Price |
$139.63
|
| Rate for Payer: Cash Price |
$139.63
|
| Rate for Payer: Cigna Commercial |
$197.80
|
| Rate for Payer: First Health Commercial |
$209.44
|
| Rate for Payer: First Health Workers Compensation |
$89.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$209.44
|
| Rate for Payer: GEHA Commercial |
$186.17
|
| Rate for Payer: GEHA Medicare |
$87.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$209.44
|
| 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 |
$65.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.83
|
| Rate for Payer: Multiplan All |
$211.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.31
|
| Rate for Payer: OMNI Networks Commercial |
$162.90
|
| Rate for Payer: One Health Plan PPO/POS |
$209.44
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$76.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$65.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$221.07
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$175.66
|
| Rate for Payer: Three Rivers Provider Network All |
$174.53
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.07
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$216.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.83
|
| Rate for Payer: Zelis Auto |
$93.08
|
| Rate for Payer: Zelis Medicare |
$74.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.40
|
| Rate for Payer: Zelis Worker's Compensation |
$63.53
|
|
|
ADVANCE CARE PLANNING FIRST 30 MINS
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
21599497
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.71 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$220.15
|
| Rate for Payer: First Health Commercial |
$233.10
|
| Rate for Payer: First Health Workers Compensation |
$100.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$233.10
|
| Rate for Payer: GEHA Commercial |
$181.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$233.10
|
| Rate for Payer: Multiplan All |
$235.69
|
| Rate for Payer: OMNI Networks Commercial |
$181.30
|
| Rate for Payer: One Health Plan PPO/POS |
$233.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$246.05
|
| Rate for Payer: Three Rivers Provider Network All |
$194.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$240.87
|
| Rate for Payer: Zelis Auto |
$103.60
|
| Rate for Payer: Zelis Worker's Compensation |
$70.71
|
|
|
ADVANCE CARE PLANNING FIRST 30 MINS
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
21099497
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.71 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$220.15
|
| Rate for Payer: First Health Commercial |
$233.10
|
| Rate for Payer: First Health Workers Compensation |
$100.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$233.10
|
| Rate for Payer: GEHA Commercial |
$181.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$233.10
|
| Rate for Payer: Multiplan All |
$235.69
|
| Rate for Payer: OMNI Networks Commercial |
$181.30
|
| Rate for Payer: One Health Plan PPO/POS |
$233.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$246.05
|
| Rate for Payer: Three Rivers Provider Network All |
$194.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$240.87
|
| Rate for Payer: Zelis Auto |
$103.60
|
| Rate for Payer: Zelis Worker's Compensation |
$70.71
|
|
|
ADVANCE CARE PLANNING FIRST 30 MINS
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
21600079
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$64.66 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$81.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$155.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$81.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$64.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.83
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$220.15
|
| Rate for Payer: First Health Commercial |
$233.10
|
| Rate for Payer: First Health Workers Compensation |
$100.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$233.10
|
| Rate for Payer: GEHA Commercial |
$207.20
|
| Rate for Payer: GEHA Medicare |
$87.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$233.10
|
| 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 |
$65.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.83
|
| Rate for Payer: Multiplan All |
$235.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.31
|
| Rate for Payer: OMNI Networks Commercial |
$181.30
|
| Rate for Payer: One Health Plan PPO/POS |
$233.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$76.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$65.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$246.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$175.66
|
| Rate for Payer: Three Rivers Provider Network All |
$194.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.07
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$240.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.83
|
| Rate for Payer: Zelis Auto |
$103.60
|
| Rate for Payer: Zelis Medicare |
$74.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.40
|
| Rate for Payer: Zelis Worker's Compensation |
$70.71
|
|
|
ADVANCE CARE PLANNING FIRST 30 MINS
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
21099497
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.66 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$81.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$155.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$81.61
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$64.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.83
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$220.15
|
| Rate for Payer: First Health Commercial |
$233.10
|
| Rate for Payer: First Health Workers Compensation |
$100.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$233.10
|
| Rate for Payer: GEHA Commercial |
$207.20
|
| Rate for Payer: GEHA Medicare |
$87.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$233.10
|
| 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 |
$65.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.83
|
| Rate for Payer: Multiplan All |
$235.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.31
|
| Rate for Payer: OMNI Networks Commercial |
$181.30
|
| Rate for Payer: One Health Plan PPO/POS |
$233.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$76.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$65.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$246.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$175.66
|
| Rate for Payer: Three Rivers Provider Network All |
$194.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.07
|
| Rate for Payer: United Healthcare Managed Medicaid |
$65.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$240.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.83
|
| Rate for Payer: Zelis Auto |
$103.60
|
| Rate for Payer: Zelis Medicare |
$74.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.40
|
| Rate for Payer: Zelis Worker's Compensation |
$70.71
|
|
|
ADVANCE CARE PLANNING FIRST 30 MINS
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
21600079
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$70.71 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$220.15
|
| Rate for Payer: First Health Commercial |
$233.10
|
| Rate for Payer: First Health Workers Compensation |
$100.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$233.10
|
| Rate for Payer: GEHA Commercial |
$181.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$233.10
|
| Rate for Payer: Multiplan All |
$235.69
|
| Rate for Payer: OMNI Networks Commercial |
$181.30
|
| Rate for Payer: One Health Plan PPO/POS |
$233.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$246.05
|
| Rate for Payer: Three Rivers Provider Network All |
$194.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$240.87
|
| Rate for Payer: Zelis Auto |
$103.60
|
| Rate for Payer: Zelis Worker's Compensation |
$70.71
|
|
