|
MEAS POST-VOID RESIDUAL URINE&/BLADDER
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
23551798
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$31.12 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: First Health Workers Compensation |
$44.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$102.60
|
| Rate for Payer: GEHA Commercial |
$79.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$102.60
|
| Rate for Payer: Multiplan All |
$103.74
|
| Rate for Payer: OMNI Networks Commercial |
$79.80
|
| Rate for Payer: One Health Plan PPO/POS |
$102.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$108.30
|
| Rate for Payer: Three Rivers Provider Network All |
$85.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$106.02
|
| Rate for Payer: Zelis Auto |
$45.60
|
| Rate for Payer: Zelis Worker's Compensation |
$31.12
|
|
|
MEASURE BLOOD OXYGEN LEVE
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
21600339
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$65.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Humana ChoiceCare |
$21.32
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$49.20
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$72.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$41.00
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
|
MEASURE BLOOD OXYGEN LEVE
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
21600339
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$57.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
|
MEASURE BLOOD OXYGEN LEVE
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
8594760
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$65.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Humana ChoiceCare |
$21.32
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$49.20
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$72.16
|
| Rate for Payer: United Healthcare Commercial |
$69.70
|
| Rate for Payer: United Healthcare Managed Medicaid |
$20.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$41.00
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
|
MEASURE BLOOD OXYGEN LEVE
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
8594760
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$69.70
|
| Rate for Payer: First Health Commercial |
$73.80
|
| Rate for Payer: First Health Workers Compensation |
$31.66
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$73.80
|
| Rate for Payer: GEHA Commercial |
$57.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$73.80
|
| Rate for Payer: Multiplan All |
$74.62
|
| Rate for Payer: OMNI Networks Commercial |
$57.40
|
| Rate for Payer: One Health Plan PPO/POS |
$73.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$77.90
|
| Rate for Payer: Three Rivers Provider Network All |
$61.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$76.26
|
| Rate for Payer: Zelis Auto |
$32.80
|
| Rate for Payer: Zelis Worker's Compensation |
$22.39
|
|
|
MEASURE URETER PRESSURE
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT 50686
|
| Hospital Charge Code |
6150686
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$74.53 |
| Max. Negotiated Rate |
$259.35 |
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna Commercial |
$232.05
|
| Rate for Payer: First Health Commercial |
$245.70
|
| Rate for Payer: First Health Workers Compensation |
$105.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$245.70
|
| Rate for Payer: GEHA Commercial |
$191.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$245.70
|
| Rate for Payer: Multiplan All |
$248.43
|
| Rate for Payer: OMNI Networks Commercial |
$191.10
|
| Rate for Payer: One Health Plan PPO/POS |
$245.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$259.35
|
| Rate for Payer: Three Rivers Provider Network All |
$204.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$253.89
|
| Rate for Payer: Zelis Auto |
$109.20
|
| Rate for Payer: Zelis Worker's Compensation |
$74.53
|
|
|
MEASURE URETER PRESSURE
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
CPT 50686
|
| Hospital Charge Code |
6150686
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$74.53 |
| Max. Negotiated Rate |
$297.14 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$163.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$87.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$148.57
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna Commercial |
$232.05
|
| Rate for Payer: First Health Commercial |
$245.70
|
| Rate for Payer: First Health Workers Compensation |
$105.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$245.70
|
| Rate for Payer: GEHA Commercial |
$218.40
|
| Rate for Payer: GEHA Medicare |
$148.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$245.70
|
| Rate for Payer: Humana ChoiceCare |
$163.43
|
| Rate for Payer: Humana Medicare Advantage |
$148.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$249.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$89.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$148.57
|
| Rate for Payer: Multiplan All |
$248.43
|
| Rate for Payer: New Mexico Health Connections Medicare |
$252.57
|
| Rate for Payer: OMNI Networks Commercial |
$191.10
|
| Rate for Payer: One Health Plan PPO/POS |
$245.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$103.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$89.56
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$148.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$259.35
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$297.14
|
| Rate for Payer: Three Rivers Provider Network All |
$204.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$145.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$89.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$253.89
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$148.57
|
| Rate for Payer: Zelis Auto |
$109.20
|
| Rate for Payer: Zelis Medicare |
$126.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.28
|
| Rate for Payer: Zelis Worker's Compensation |
$74.53
|
|
|
MECHANICAL DEBRIDEMENT
|
Facility
|
OP
|
$436.05
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
9697602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$414.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$261.63
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$261.63
|
| Rate for Payer: Cash Price |
$261.63
|
| Rate for Payer: Cigna Commercial |
$370.64
|
| Rate for Payer: First Health Commercial |
$392.44
|
| Rate for Payer: First Health Workers Compensation |
$168.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$392.44
|
| Rate for Payer: GEHA Commercial |
$348.84
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$392.44
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$396.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$305.24
|
| Rate for Payer: One Health Plan PPO/POS |
$392.44
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$414.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$327.04
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$405.53
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$174.42
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$119.04
|
|
|
MECHANICAL DEBRIDEMENT
|
Facility
|
IP
|
$436.05
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
9697602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.04 |
| Max. Negotiated Rate |
$414.25 |
| Rate for Payer: Cash Price |
$261.63
|
| Rate for Payer: Cigna Commercial |
$370.64
|
| Rate for Payer: First Health Commercial |
$392.44
|
| Rate for Payer: First Health Workers Compensation |
$168.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$392.44
|
| Rate for Payer: GEHA Commercial |
$305.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$392.44
|
| Rate for Payer: Multiplan All |
$396.81
|
| Rate for Payer: OMNI Networks Commercial |
$305.24
|
| Rate for Payer: One Health Plan PPO/POS |
$392.44
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$414.25
|
| Rate for Payer: Three Rivers Provider Network All |
$327.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$405.53
|
| Rate for Payer: Zelis Auto |
$174.42
|
| Rate for Payer: Zelis Worker's Compensation |
$119.04
|
|
|
MECH REM TUNNEL CV CATH
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
6193001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$51.05 |
| Max. Negotiated Rate |
$2,950.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,128.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,128.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$894.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,475.05
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$158.95
|
| Rate for Payer: First Health Commercial |
$168.30
|
| Rate for Payer: First Health Workers Compensation |
$72.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$168.30
|
| Rate for Payer: GEHA Commercial |
$149.60
|
| Rate for Payer: GEHA Medicare |
$1,475.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$168.30
|
| Rate for Payer: Humana ChoiceCare |
$1,622.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,475.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,478.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$912.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,475.05
|
| Rate for Payer: Multiplan All |
$170.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,507.59
|
| Rate for Payer: OMNI Networks Commercial |
$130.90
|
| Rate for Payer: One Health Plan PPO/POS |
$168.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,053.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$912.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,475.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$177.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,950.10
|
| Rate for Payer: Three Rivers Provider Network All |
$140.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,445.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$912.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,475.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$173.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,475.05
|
| Rate for Payer: Zelis Auto |
$74.80
|
| Rate for Payer: Zelis Medicare |
$1,253.79
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,770.06
|
| Rate for Payer: Zelis Worker's Compensation |
$51.05
|
|
|
MECH REM TUNNEL CV CATH
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
6193001
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$51.05 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$158.95
|
| Rate for Payer: First Health Commercial |
$168.30
|
| Rate for Payer: First Health Workers Compensation |
$72.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$168.30
|
| Rate for Payer: GEHA Commercial |
$130.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$168.30
|
| Rate for Payer: Multiplan All |
$170.17
|
| Rate for Payer: OMNI Networks Commercial |
$130.90
|
| Rate for Payer: One Health Plan PPO/POS |
$168.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$177.65
|
| Rate for Payer: Three Rivers Provider Network All |
$140.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$173.91
|
| Rate for Payer: Zelis Auto |
$74.80
|
| Rate for Payer: Zelis Worker's Compensation |
$51.05
|
|
|
MECH RMVL INTRACATH OBSTRUCTION
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
CPT 75902
|
| Hospital Charge Code |
2450090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.26 |
| Max. Negotiated Rate |
$842.65 |
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cigna Commercial |
$753.95
|
| Rate for Payer: First Health Commercial |
$798.30
|
| Rate for Payer: First Health Workers Compensation |
$110.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$798.30
|
| Rate for Payer: GEHA Commercial |
$620.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$798.30
|
| Rate for Payer: Multiplan All |
$807.17
|
| Rate for Payer: OMNI Networks Commercial |
$620.90
|
| Rate for Payer: One Health Plan PPO/POS |
$798.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$842.65
|
| Rate for Payer: Three Rivers Provider Network All |
$665.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$824.91
|
| Rate for Payer: Zelis Auto |
$354.80
|
| Rate for Payer: Zelis Worker's Compensation |
$78.26
|
|
|
MECH RMVL INTRACATH OBSTRUCTION
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
CPT 75902
|
| Hospital Charge Code |
2450090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.26 |
| Max. Negotiated Rate |
$842.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$532.20
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cigna Commercial |
$753.95
|
| Rate for Payer: First Health Commercial |
$798.30
|
| Rate for Payer: First Health Workers Compensation |
$110.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$798.30
|
| Rate for Payer: GEHA Commercial |
$709.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$798.30
|
| Rate for Payer: Humana ChoiceCare |
$230.62
|
| Rate for Payer: Multiplan All |
$807.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$532.20
|
| Rate for Payer: OMNI Networks Commercial |
$620.90
|
| Rate for Payer: One Health Plan PPO/POS |
$798.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$842.65
|
| Rate for Payer: Three Rivers Provider Network All |
$665.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$780.56
|
| Rate for Payer: United Healthcare Commercial |
$753.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$221.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$824.91
|
| Rate for Payer: Zelis Auto |
$354.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$443.50
|
| Rate for Payer: Zelis Worker's Compensation |
$78.26
|
|
|
MECLIZINE HCL 12.5MG TAB
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
NDC 50268052215
|
| Hospital Charge Code |
3300557
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$7.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
|
|
MECLIZINE HCL 12.5MG TAB
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
NDC 50268052215
|
| Hospital Charge Code |
3300557
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.00
|
| Rate for Payer: First Health Workers Compensation |
$3.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$9.00
|
| Rate for Payer: GEHA Commercial |
$8.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$9.00
|
| Rate for Payer: Humana ChoiceCare |
$2.60
|
| Rate for Payer: Multiplan All |
$9.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6.00
|
| Rate for Payer: OMNI Networks Commercial |
$7.00
|
| Rate for Payer: One Health Plan PPO/POS |
$9.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$9.50
|
| Rate for Payer: Three Rivers Provider Network All |
$7.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$9.30
|
| Rate for Payer: Zelis Auto |
$4.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5.00
|
| Rate for Payer: Zelis Worker's Compensation |
$2.73
|
|
|
MEDICAL NUTRI RE-ASSMT&IVNTJ INDIV 15MIN
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
21997803
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$66.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$54.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$66.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$52.91
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$77.35
|
| Rate for Payer: First Health Commercial |
$81.90
|
| Rate for Payer: First Health Workers Compensation |
$35.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.90
|
| Rate for Payer: GEHA Commercial |
$72.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.90
|
| Rate for Payer: Humana ChoiceCare |
$23.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$53.99
|
| Rate for Payer: Multiplan All |
$82.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$54.60
|
| Rate for Payer: OMNI Networks Commercial |
$63.70
|
| Rate for Payer: One Health Plan PPO/POS |
$81.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$62.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$53.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$86.45
|
| Rate for Payer: Three Rivers Provider Network All |
$68.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$80.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$84.63
|
| Rate for Payer: Zelis Auto |
$36.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$45.50
|
| Rate for Payer: Zelis Worker's Compensation |
$24.84
|
|
|
MEDICAL NUTRI RE-ASSMT&IVNTJ INDIV 15MIN
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
21799453
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$77.35
|
| Rate for Payer: First Health Commercial |
$81.90
|
| Rate for Payer: First Health Workers Compensation |
$35.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.90
|
| Rate for Payer: GEHA Commercial |
$63.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.90
|
| Rate for Payer: Multiplan All |
$82.81
|
| Rate for Payer: OMNI Networks Commercial |
$63.70
|
| Rate for Payer: One Health Plan PPO/POS |
$81.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$86.45
|
| Rate for Payer: Three Rivers Provider Network All |
$68.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$84.63
|
| Rate for Payer: Zelis Auto |
$36.40
|
| Rate for Payer: Zelis Worker's Compensation |
$24.84
|
|
|
MEDICAL NUTRI RE-ASSMT&IVNTJ INDIV 15MIN
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
21997803
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$77.35
|
| Rate for Payer: First Health Commercial |
$81.90
|
| Rate for Payer: First Health Workers Compensation |
$35.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.90
|
| Rate for Payer: GEHA Commercial |
$63.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.90
|
| Rate for Payer: Multiplan All |
$82.81
|
| Rate for Payer: OMNI Networks Commercial |
$63.70
|
| Rate for Payer: One Health Plan PPO/POS |
$81.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$86.45
|
| Rate for Payer: Three Rivers Provider Network All |
$68.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$84.63
|
| Rate for Payer: Zelis Auto |
$36.40
|
| Rate for Payer: Zelis Worker's Compensation |
$24.84
|
|
|
MEDICAL NUTRI RE-ASSMT&IVNTJ INDIV 15MIN
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
21799453
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$66.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$54.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$66.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$52.91
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$77.35
|
| Rate for Payer: First Health Commercial |
$81.90
|
| Rate for Payer: First Health Workers Compensation |
$35.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$81.90
|
| Rate for Payer: GEHA Commercial |
$72.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$81.90
|
| Rate for Payer: Humana ChoiceCare |
$23.66
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$53.99
|
| Rate for Payer: Multiplan All |
$82.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$54.60
|
| Rate for Payer: OMNI Networks Commercial |
$63.70
|
| Rate for Payer: One Health Plan PPO/POS |
$81.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$62.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$53.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$86.45
|
| Rate for Payer: Three Rivers Provider Network All |
$68.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$80.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$84.63
|
| Rate for Payer: Zelis Auto |
$36.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$45.50
|
| Rate for Payer: Zelis Worker's Compensation |
$24.84
|
|
|
MEDICAL NUTRITION ASSMT&INVTJ INDIV 15MI
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
21799452
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.82 |
| Max. Negotiated Rate |
$101.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$76.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$64.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$76.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$60.77
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$90.95
|
| Rate for Payer: First Health Commercial |
$96.30
|
| Rate for Payer: First Health Workers Compensation |
$41.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$96.30
|
| Rate for Payer: GEHA Commercial |
$85.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$96.30
|
| Rate for Payer: Humana ChoiceCare |
$27.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$62.01
|
| Rate for Payer: Multiplan All |
$97.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$64.20
|
| Rate for Payer: OMNI Networks Commercial |
$74.90
|
| Rate for Payer: One Health Plan PPO/POS |
$96.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$71.60
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$62.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$101.65
|
| Rate for Payer: Three Rivers Provider Network All |
$80.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$94.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$62.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$99.51
|
| Rate for Payer: Zelis Auto |
$42.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$53.50
|
| Rate for Payer: Zelis Worker's Compensation |
$29.21
|
|
|
MEDICAL NUTRITION ASSMT&INVTJ INDIV 15MI
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
21799452
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.21 |
| Max. Negotiated Rate |
$101.65 |
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$90.95
|
| Rate for Payer: First Health Commercial |
$96.30
|
| Rate for Payer: First Health Workers Compensation |
$41.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$96.30
|
| Rate for Payer: GEHA Commercial |
$74.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$96.30
|
| Rate for Payer: Multiplan All |
$97.37
|
| Rate for Payer: OMNI Networks Commercial |
$74.90
|
| Rate for Payer: One Health Plan PPO/POS |
$96.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$101.65
|
| Rate for Payer: Three Rivers Provider Network All |
$80.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$99.51
|
| Rate for Payer: Zelis Auto |
$42.80
|
| Rate for Payer: Zelis Worker's Compensation |
$29.21
|
|
|
MEDICAL NUTRITION ASSMT&IVNTJ INDIV 15MI
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
21997802
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.21 |
| Max. Negotiated Rate |
$101.65 |
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$90.95
|
| Rate for Payer: First Health Commercial |
$96.30
|
| Rate for Payer: First Health Workers Compensation |
$41.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$96.30
|
| Rate for Payer: GEHA Commercial |
$74.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$96.30
|
| Rate for Payer: Multiplan All |
$97.37
|
| Rate for Payer: OMNI Networks Commercial |
$74.90
|
| Rate for Payer: One Health Plan PPO/POS |
$96.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$101.65
|
| Rate for Payer: Three Rivers Provider Network All |
$80.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$99.51
|
| Rate for Payer: Zelis Auto |
$42.80
|
| Rate for Payer: Zelis Worker's Compensation |
$29.21
|
|
|
MEDICAL NUTRITION ASSMT&IVNTJ INDIV 15MI
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
21997802
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.82 |
| Max. Negotiated Rate |
$101.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$76.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$64.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$76.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$60.77
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$90.95
|
| Rate for Payer: First Health Commercial |
$96.30
|
| Rate for Payer: First Health Workers Compensation |
$41.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$96.30
|
| Rate for Payer: GEHA Commercial |
$85.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$96.30
|
| Rate for Payer: Humana ChoiceCare |
$27.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$62.01
|
| Rate for Payer: Multiplan All |
$97.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$64.20
|
| Rate for Payer: OMNI Networks Commercial |
$74.90
|
| Rate for Payer: One Health Plan PPO/POS |
$96.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$71.60
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$62.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$101.65
|
| Rate for Payer: Three Rivers Provider Network All |
$80.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$94.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$62.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$99.51
|
| Rate for Payer: Zelis Auto |
$42.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$53.50
|
| Rate for Payer: Zelis Worker's Compensation |
$29.21
|
|
|
MEDICAL NUTRITION GROUP
|
Facility
|
OP
|
$47.43
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
8597804
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$45.06 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$35.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$28.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$35.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$28.00
|
| Rate for Payer: Cash Price |
$28.46
|
| Rate for Payer: Cash Price |
$28.46
|
| Rate for Payer: Cigna Commercial |
$40.32
|
| Rate for Payer: First Health Commercial |
$42.69
|
| Rate for Payer: First Health Workers Compensation |
$18.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$42.69
|
| Rate for Payer: GEHA Commercial |
$37.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$42.69
|
| Rate for Payer: Humana ChoiceCare |
$12.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$28.57
|
| Rate for Payer: Multiplan All |
$43.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28.46
|
| Rate for Payer: OMNI Networks Commercial |
$33.20
|
| Rate for Payer: One Health Plan PPO/POS |
$42.69
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$32.98
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$28.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$45.06
|
| Rate for Payer: Three Rivers Provider Network All |
$35.57
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$41.74
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$44.11
|
| Rate for Payer: Zelis Auto |
$18.97
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$23.71
|
| Rate for Payer: Zelis Worker's Compensation |
$12.95
|
|
|
MEDICAL NUTRITION GROUP
|
Facility
|
IP
|
$47.43
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
8597804
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$45.06 |
| Rate for Payer: Cash Price |
$28.46
|
| Rate for Payer: Cigna Commercial |
$40.32
|
| Rate for Payer: First Health Commercial |
$42.69
|
| Rate for Payer: First Health Workers Compensation |
$18.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$42.69
|
| Rate for Payer: GEHA Commercial |
$33.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$42.69
|
| Rate for Payer: Multiplan All |
$43.16
|
| Rate for Payer: OMNI Networks Commercial |
$33.20
|
| Rate for Payer: One Health Plan PPO/POS |
$42.69
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$45.06
|
| Rate for Payer: Three Rivers Provider Network All |
$35.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$44.11
|
| Rate for Payer: Zelis Auto |
$18.97
|
| Rate for Payer: Zelis Worker's Compensation |
$12.95
|
|
