|
INJX/INFUS NEURO SBST EPIDURAL CERV/THOR
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT 62281
|
| Hospital Charge Code |
6162281
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$129.40 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$402.90
|
| Rate for Payer: First Health Commercial |
$426.60
|
| Rate for Payer: First Health Workers Compensation |
$183.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$426.60
|
| Rate for Payer: GEHA Commercial |
$331.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: Zelis Auto |
$189.60
|
| Rate for Payer: Zelis Worker's Compensation |
$129.40
|
|
|
INJX/INFUS NEURO SBST EPIDURAL CERV/THOR
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT 62281
|
| Hospital Charge Code |
6162281
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$129.40 |
| Max. Negotiated Rate |
$1,690.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$284.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$576.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$845.37
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$402.90
|
| Rate for Payer: First Health Commercial |
$426.60
|
| Rate for Payer: First Health Workers Compensation |
$183.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$426.60
|
| Rate for Payer: GEHA Commercial |
$379.20
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$426.60
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$431.34
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$331.80
|
| Rate for Payer: One Health Plan PPO/POS |
$426.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$679.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$588.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$450.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$355.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$440.82
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$189.60
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$129.40
|
|
|
INJX/INFUS NEURO SBST EPIDURAL LUMB/SAC
|
Facility
|
IP
|
$427.00
|
|
|
Service Code
|
CPT 62282
|
| Hospital Charge Code |
6162282
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$116.57 |
| Max. Negotiated Rate |
$405.65 |
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cigna Commercial |
$362.95
|
| Rate for Payer: First Health Commercial |
$384.30
|
| Rate for Payer: First Health Workers Compensation |
$164.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$384.30
|
| Rate for Payer: GEHA Commercial |
$298.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$384.30
|
| Rate for Payer: Multiplan All |
$388.57
|
| Rate for Payer: OMNI Networks Commercial |
$298.90
|
| Rate for Payer: One Health Plan PPO/POS |
$384.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$405.65
|
| Rate for Payer: Three Rivers Provider Network All |
$320.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$397.11
|
| Rate for Payer: Zelis Auto |
$170.80
|
| Rate for Payer: Zelis Worker's Compensation |
$116.57
|
|
|
INJX/INFUS NEURO SBST EPIDURAL LUMB/SAC
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
CPT 62282
|
| Hospital Charge Code |
6162282
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$116.57 |
| Max. Negotiated Rate |
$1,690.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$256.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$728.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$576.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$845.37
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cigna Commercial |
$362.95
|
| Rate for Payer: First Health Commercial |
$384.30
|
| Rate for Payer: First Health Workers Compensation |
$164.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$384.30
|
| Rate for Payer: GEHA Commercial |
$341.60
|
| Rate for Payer: GEHA Medicare |
$845.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$384.30
|
| Rate for Payer: Humana ChoiceCare |
$929.91
|
| Rate for Payer: Humana Medicare Advantage |
$845.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,420.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$588.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$845.37
|
| Rate for Payer: Multiplan All |
$388.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,437.13
|
| Rate for Payer: OMNI Networks Commercial |
$298.90
|
| Rate for Payer: One Health Plan PPO/POS |
$384.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$679.48
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$588.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$845.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$405.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,690.74
|
| Rate for Payer: Three Rivers Provider Network All |
$320.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.46
|
| Rate for Payer: United Healthcare Managed Medicaid |
$588.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$845.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$397.11
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$845.37
|
| Rate for Payer: Zelis Auto |
$170.80
|
| Rate for Payer: Zelis Medicare |
$718.56
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,014.44
|
| Rate for Payer: Zelis Worker's Compensation |
$116.57
|
|
|
Inpatient Respite Care
|
Facility
|
IP
|
$86.00
|
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$86.00 |
| Rate for Payer: Lakeview Christian Hospice Medicare |
$86.00
|
|
|
INPLT GUIDE PIN
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$245.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$154.80
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cigna Commercial |
$219.30
|
| Rate for Payer: First Health Commercial |
$232.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$232.20
|
| Rate for Payer: GEHA Commercial |
$206.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$232.20
|
| Rate for Payer: Humana ChoiceCare |
$67.08
|
| Rate for Payer: Multiplan All |
$234.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$154.80
|
| Rate for Payer: OMNI Networks Commercial |
$180.60
|
| Rate for Payer: One Health Plan PPO/POS |
$232.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$245.10
|
| Rate for Payer: Three Rivers Provider Network All |
$193.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$227.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$64.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$239.94
|
| Rate for Payer: Zelis Auto |
$103.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$129.00
|
|
|
INPLT GUIDE PIN
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7000224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.20 |
| Max. Negotiated Rate |
$245.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$206.40
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cigna Commercial |
$219.30
|
| Rate for Payer: First Health Commercial |
$232.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$232.20
|
| Rate for Payer: GEHA Commercial |
$180.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$232.20
|
| Rate for Payer: Multiplan All |
$234.78
|
| Rate for Payer: OMNI Networks Commercial |
$180.60
|
| Rate for Payer: One Health Plan PPO/POS |
$232.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$245.10
|
| Rate for Payer: Three Rivers Provider Network All |
$193.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$239.94
|
| Rate for Payer: Zelis Auto |
$103.20
|
|
|
INPT/OBS E/M INCL ADM/DC SAME DT/45 MIN>
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
9899234
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$111.38 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$285.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
INPT/OBS E/M INCL ADM/DC SAME DT/45 MIN>
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
21999416
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$326.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Humana ChoiceCare |
$106.08
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$244.80
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$359.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$204.00
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
INPT/OBS E/M INCL ADM/DC SAME DT/45 MIN>
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
21799485
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$111.38 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$285.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
INPT/OBS E/M INCL ADM/DC SAME DT/45 MIN>
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
21999416
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$111.38 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$285.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
INPT/OBS E/M INCL ADM/DC SAME DT/45 MIN>
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
21799485
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$346.80
|
| Rate for Payer: First Health Commercial |
$367.20
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$367.20
|
| Rate for Payer: GEHA Commercial |
$326.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$367.20
|
| Rate for Payer: Humana ChoiceCare |
$106.08
|
| Rate for Payer: Multiplan All |
$371.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$244.80
|
| Rate for Payer: OMNI Networks Commercial |
$285.60
|
| Rate for Payer: One Health Plan PPO/POS |
$367.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.60
|
| Rate for Payer: Three Rivers Provider Network All |
$306.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$359.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$102.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.44
|
| Rate for Payer: Zelis Auto |
$163.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$204.00
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
INPT/OBS E/M INCL ADM/DC SAME DT/70 MIN>
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
21999417
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$132.68 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$413.10
|
| Rate for Payer: First Health Commercial |
$437.40
|
| Rate for Payer: First Health Workers Compensation |
$187.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$437.40
|
| Rate for Payer: GEHA Commercial |
$340.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$437.40
|
| Rate for Payer: Multiplan All |
$442.26
|
| Rate for Payer: OMNI Networks Commercial |
$340.20
|
| Rate for Payer: One Health Plan PPO/POS |
$437.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$461.70
|
| Rate for Payer: Three Rivers Provider Network All |
$364.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$451.98
|
| Rate for Payer: Zelis Auto |
$194.40
|
| Rate for Payer: Zelis Worker's Compensation |
$132.68
|
|
|
INPT/OBS E/M INCL ADM/DC SAME DT/70 MIN>
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
21799486
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$132.68 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$413.10
|
| Rate for Payer: First Health Commercial |
$437.40
|
| Rate for Payer: First Health Workers Compensation |
$187.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$437.40
|
| Rate for Payer: GEHA Commercial |
$340.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$437.40
|
| Rate for Payer: Multiplan All |
$442.26
|
| Rate for Payer: OMNI Networks Commercial |
$340.20
|
| Rate for Payer: One Health Plan PPO/POS |
$437.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$461.70
|
| Rate for Payer: Three Rivers Provider Network All |
$364.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$451.98
|
| Rate for Payer: Zelis Auto |
$194.40
|
| Rate for Payer: Zelis Worker's Compensation |
$132.68
|
|
|
INPT/OBS E/M INCL ADM/DC SAME DT/70 MIN>
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
9899235
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$132.68 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$413.10
|
| Rate for Payer: First Health Commercial |
$437.40
|
| Rate for Payer: First Health Workers Compensation |
$187.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$437.40
|
| Rate for Payer: GEHA Commercial |
$340.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$437.40
|
| Rate for Payer: Multiplan All |
$442.26
|
| Rate for Payer: OMNI Networks Commercial |
$340.20
|
| Rate for Payer: One Health Plan PPO/POS |
$437.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$461.70
|
| Rate for Payer: Three Rivers Provider Network All |
$364.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$451.98
|
| Rate for Payer: Zelis Auto |
$194.40
|
| Rate for Payer: Zelis Worker's Compensation |
$132.68
|
|
|
INPT/OBS E/M INCL ADM/DC SAME DT/70 MIN>
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
21999417
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$413.10
|
| Rate for Payer: First Health Commercial |
$437.40
|
| Rate for Payer: First Health Workers Compensation |
$187.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$437.40
|
| Rate for Payer: GEHA Commercial |
$388.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$437.40
|
| Rate for Payer: Humana ChoiceCare |
$126.36
|
| Rate for Payer: Multiplan All |
$442.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$291.60
|
| Rate for Payer: OMNI Networks Commercial |
$340.20
|
| Rate for Payer: One Health Plan PPO/POS |
$437.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$461.70
|
| Rate for Payer: Three Rivers Provider Network All |
$364.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$427.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$121.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$451.98
|
| Rate for Payer: Zelis Auto |
$194.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$243.00
|
| Rate for Payer: Zelis Worker's Compensation |
$132.68
|
|
|
INPT/OBS E/M INCL ADM/DC SAME DT/70 MIN>
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
21799486
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$413.10
|
| Rate for Payer: First Health Commercial |
$437.40
|
| Rate for Payer: First Health Workers Compensation |
$187.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$437.40
|
| Rate for Payer: GEHA Commercial |
$388.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$437.40
|
| Rate for Payer: Humana ChoiceCare |
$126.36
|
| Rate for Payer: Multiplan All |
$442.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$291.60
|
| Rate for Payer: OMNI Networks Commercial |
$340.20
|
| Rate for Payer: One Health Plan PPO/POS |
$437.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$461.70
|
| Rate for Payer: Three Rivers Provider Network All |
$364.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$427.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$121.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$451.98
|
| Rate for Payer: Zelis Auto |
$194.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$243.00
|
| Rate for Payer: Zelis Worker's Compensation |
$132.68
|
|
|
INPT/OBS E/M INCL ADM/DC SAME DT/85 MIN>
|
Facility
|
OP
|
$627.00
|
|
|
Service Code
|
CPT 99236
|
| Hospital Charge Code |
21799487
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$156.75 |
| Max. Negotiated Rate |
$595.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$376.20
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cigna Commercial |
$532.95
|
| Rate for Payer: First Health Commercial |
$564.30
|
| Rate for Payer: First Health Workers Compensation |
$242.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$564.30
|
| Rate for Payer: GEHA Commercial |
$501.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$564.30
|
| Rate for Payer: Humana ChoiceCare |
$163.02
|
| Rate for Payer: Multiplan All |
$570.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$376.20
|
| Rate for Payer: OMNI Networks Commercial |
$438.90
|
| Rate for Payer: One Health Plan PPO/POS |
$564.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$595.65
|
| Rate for Payer: Three Rivers Provider Network All |
$470.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$551.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$156.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$583.11
|
| Rate for Payer: Zelis Auto |
$250.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$313.50
|
| Rate for Payer: Zelis Worker's Compensation |
$171.17
|
|
|
INPT/OBS E/M INCL ADM/DC SAME DT/85 MIN>
|
Facility
|
OP
|
$627.00
|
|
|
Service Code
|
CPT 99236
|
| Hospital Charge Code |
21999418
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$156.75 |
| Max. Negotiated Rate |
$595.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$376.20
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cigna Commercial |
$532.95
|
| Rate for Payer: First Health Commercial |
$564.30
|
| Rate for Payer: First Health Workers Compensation |
$242.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$564.30
|
| Rate for Payer: GEHA Commercial |
$501.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$564.30
|
| Rate for Payer: Humana ChoiceCare |
$163.02
|
| Rate for Payer: Multiplan All |
$570.57
|
| Rate for Payer: New Mexico Health Connections Medicare |
$376.20
|
| Rate for Payer: OMNI Networks Commercial |
$438.90
|
| Rate for Payer: One Health Plan PPO/POS |
$564.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$595.65
|
| Rate for Payer: Three Rivers Provider Network All |
$470.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$551.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$156.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$583.11
|
| Rate for Payer: Zelis Auto |
$250.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$313.50
|
| Rate for Payer: Zelis Worker's Compensation |
$171.17
|
|
|
INPT/OBS E/M INCL ADM/DC SAME DT/85 MIN>
|
Facility
|
IP
|
$627.00
|
|
|
Service Code
|
CPT 99236
|
| Hospital Charge Code |
21999418
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$171.17 |
| Max. Negotiated Rate |
$595.65 |
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cigna Commercial |
$532.95
|
| Rate for Payer: First Health Commercial |
$564.30
|
| Rate for Payer: First Health Workers Compensation |
$242.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$564.30
|
| Rate for Payer: GEHA Commercial |
$438.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$564.30
|
| Rate for Payer: Multiplan All |
$570.57
|
| Rate for Payer: OMNI Networks Commercial |
$438.90
|
| Rate for Payer: One Health Plan PPO/POS |
$564.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$595.65
|
| Rate for Payer: Three Rivers Provider Network All |
$470.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$583.11
|
| Rate for Payer: Zelis Auto |
$250.80
|
| Rate for Payer: Zelis Worker's Compensation |
$171.17
|
|
|
INPT/OBS E/M INCL ADM/DC SAME DT/85 MIN>
|
Facility
|
IP
|
$627.00
|
|
|
Service Code
|
CPT 99236
|
| Hospital Charge Code |
21799487
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$171.17 |
| Max. Negotiated Rate |
$595.65 |
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cigna Commercial |
$532.95
|
| Rate for Payer: First Health Commercial |
$564.30
|
| Rate for Payer: First Health Workers Compensation |
$242.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$564.30
|
| Rate for Payer: GEHA Commercial |
$438.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$564.30
|
| Rate for Payer: Multiplan All |
$570.57
|
| Rate for Payer: OMNI Networks Commercial |
$438.90
|
| Rate for Payer: One Health Plan PPO/POS |
$564.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$595.65
|
| Rate for Payer: Three Rivers Provider Network All |
$470.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$583.11
|
| Rate for Payer: Zelis Auto |
$250.80
|
| Rate for Payer: Zelis Worker's Compensation |
$171.17
|
|
|
INPT/OBS E/M INCL ADM/DC SAME DT/85 MIN>
|
Facility
|
IP
|
$627.00
|
|
|
Service Code
|
CPT 99236
|
| Hospital Charge Code |
9899236
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$171.17 |
| Max. Negotiated Rate |
$595.65 |
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cigna Commercial |
$532.95
|
| Rate for Payer: First Health Commercial |
$564.30
|
| Rate for Payer: First Health Workers Compensation |
$242.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$564.30
|
| Rate for Payer: GEHA Commercial |
$438.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$564.30
|
| Rate for Payer: Multiplan All |
$570.57
|
| Rate for Payer: OMNI Networks Commercial |
$438.90
|
| Rate for Payer: One Health Plan PPO/POS |
$564.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$595.65
|
| Rate for Payer: Three Rivers Provider Network All |
$470.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$583.11
|
| Rate for Payer: Zelis Auto |
$250.80
|
| Rate for Payer: Zelis Worker's Compensation |
$171.17
|
|
|
INS AQUEOUS DRAIN DEV EACH
|
Facility
|
IP
|
$1,523.00
|
|
|
Service Code
|
CPT 0450T
|
| Hospital Charge Code |
6191083
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$415.78 |
| Max. Negotiated Rate |
$1,446.85 |
| Rate for Payer: Cash Price |
$913.80
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: First Health Commercial |
$1,370.70
|
| Rate for Payer: First Health Workers Compensation |
$588.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,370.70
|
| Rate for Payer: GEHA Commercial |
$1,066.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,370.70
|
| Rate for Payer: Multiplan All |
$1,385.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,066.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,370.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,446.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,142.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,416.39
|
| Rate for Payer: Zelis Auto |
$609.20
|
| Rate for Payer: Zelis Worker's Compensation |
$415.78
|
|
|
INS AQUEOUS DRAIN DEV EACH
|
Facility
|
OP
|
$1,523.00
|
|
|
Service Code
|
CPT 0450T
|
| Hospital Charge Code |
6191083
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$380.75 |
| Max. Negotiated Rate |
$1,446.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$913.80
|
| Rate for Payer: Cash Price |
$913.80
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: First Health Commercial |
$1,370.70
|
| Rate for Payer: First Health Workers Compensation |
$588.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,370.70
|
| Rate for Payer: GEHA Commercial |
$1,218.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,370.70
|
| Rate for Payer: Humana ChoiceCare |
$395.98
|
| Rate for Payer: Multiplan All |
$1,385.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$913.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,066.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,370.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,446.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,142.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,340.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$380.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,416.39
|
| Rate for Payer: Zelis Auto |
$609.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$761.50
|
| Rate for Payer: Zelis Worker's Compensation |
$415.78
|
|
|
INS BIOMECH DVC TO INTERVERTEBRAL DISC S
|
Facility
|
IP
|
$1,523.00
|
|
|
Service Code
|
CPT 22853
|
| Hospital Charge Code |
6191084
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$415.78 |
| Max. Negotiated Rate |
$1,446.85 |
| Rate for Payer: Cash Price |
$913.80
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: First Health Commercial |
$1,370.70
|
| Rate for Payer: First Health Workers Compensation |
$588.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,370.70
|
| Rate for Payer: GEHA Commercial |
$1,066.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,370.70
|
| Rate for Payer: Multiplan All |
$1,385.93
|
| Rate for Payer: OMNI Networks Commercial |
$1,066.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,370.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,446.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,142.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,416.39
|
| Rate for Payer: Zelis Auto |
$609.20
|
| Rate for Payer: Zelis Worker's Compensation |
$415.78
|
|
