|
MEDICAL NUTRITION GROUP
|
Facility
|
IP
|
$47.43
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
7297804
|
|
Hospital Revenue Code
|
517
|
| 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
|
|
|
MEDICAL NUTRITION GROUP
|
Facility
|
OP
|
$47.43
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
7297804
|
|
Hospital Revenue Code
|
517
|
| 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 INDIV I
|
Facility
|
IP
|
$101.91
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
7297802
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$27.82 |
| Max. Negotiated Rate |
$96.81 |
| Rate for Payer: Cash Price |
$61.15
|
| Rate for Payer: Cigna Commercial |
$86.62
|
| Rate for Payer: First Health Commercial |
$91.72
|
| Rate for Payer: First Health Workers Compensation |
$39.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.72
|
| Rate for Payer: GEHA Commercial |
$71.34
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.72
|
| Rate for Payer: Multiplan All |
$92.74
|
| Rate for Payer: OMNI Networks Commercial |
$71.34
|
| Rate for Payer: One Health Plan PPO/POS |
$91.72
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.81
|
| Rate for Payer: Three Rivers Provider Network All |
$76.43
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.78
|
| Rate for Payer: Zelis Auto |
$40.76
|
| Rate for Payer: Zelis Worker's Compensation |
$27.82
|
|
|
MEDICAL NUTRITION INDIV I
|
Facility
|
OP
|
$101.91
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
7297802
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$96.81 |
| 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 |
$61.15
|
| 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 |
$61.15
|
| Rate for Payer: Cash Price |
$61.15
|
| Rate for Payer: Cigna Commercial |
$86.62
|
| Rate for Payer: First Health Commercial |
$91.72
|
| Rate for Payer: First Health Workers Compensation |
$39.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.72
|
| Rate for Payer: GEHA Commercial |
$81.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.72
|
| Rate for Payer: Humana ChoiceCare |
$26.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$62.01
|
| Rate for Payer: Multiplan All |
$92.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$61.15
|
| Rate for Payer: OMNI Networks Commercial |
$71.34
|
| Rate for Payer: One Health Plan PPO/POS |
$91.72
|
| 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 |
$96.81
|
| Rate for Payer: Three Rivers Provider Network All |
$76.43
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$89.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$62.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.78
|
| Rate for Payer: Zelis Auto |
$40.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$50.95
|
| Rate for Payer: Zelis Worker's Compensation |
$27.82
|
|
|
MEDICAL NUTRITION INDIV I
|
Facility
|
OP
|
$101.91
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
8597802
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$96.81 |
| 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 |
$61.15
|
| 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 |
$61.15
|
| Rate for Payer: Cash Price |
$61.15
|
| Rate for Payer: Cigna Commercial |
$86.62
|
| Rate for Payer: First Health Commercial |
$91.72
|
| Rate for Payer: First Health Workers Compensation |
$39.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.72
|
| Rate for Payer: GEHA Commercial |
$81.53
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.72
|
| Rate for Payer: Humana ChoiceCare |
$26.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$62.01
|
| Rate for Payer: Multiplan All |
$92.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$61.15
|
| Rate for Payer: OMNI Networks Commercial |
$71.34
|
| Rate for Payer: One Health Plan PPO/POS |
$91.72
|
| 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 |
$96.81
|
| Rate for Payer: Three Rivers Provider Network All |
$76.43
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$89.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$62.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.78
|
| Rate for Payer: Zelis Auto |
$40.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$50.95
|
| Rate for Payer: Zelis Worker's Compensation |
$27.82
|
|
|
MEDICAL NUTRITION INDIV I
|
Facility
|
IP
|
$101.91
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
8597802
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$27.82 |
| Max. Negotiated Rate |
$96.81 |
| Rate for Payer: Cash Price |
$61.15
|
| Rate for Payer: Cigna Commercial |
$86.62
|
| Rate for Payer: First Health Commercial |
$91.72
|
| Rate for Payer: First Health Workers Compensation |
$39.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$91.72
|
| Rate for Payer: GEHA Commercial |
$71.34
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$91.72
|
| Rate for Payer: Multiplan All |
$92.74
|
| Rate for Payer: OMNI Networks Commercial |
$71.34
|
| Rate for Payer: One Health Plan PPO/POS |
$91.72
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$96.81
|
| Rate for Payer: Three Rivers Provider Network All |
$76.43
|
| Rate for Payer: United Payors & United Providers UP&UP |
$94.78
|
| Rate for Payer: Zelis Auto |
$40.76
|
| Rate for Payer: Zelis Worker's Compensation |
$27.82
|
|
|
MEDICAL NUTRITION THERAPY GRP2/INDIV 30
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
21799454
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$46.55 |
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$41.65
|
| Rate for Payer: First Health Commercial |
$44.10
|
| Rate for Payer: First Health Workers Compensation |
$18.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$44.10
|
| Rate for Payer: GEHA Commercial |
$34.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$44.10
|
| Rate for Payer: Multiplan All |
$44.59
|
| Rate for Payer: OMNI Networks Commercial |
$34.30
|
| Rate for Payer: One Health Plan PPO/POS |
$44.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$46.55
|
| Rate for Payer: Three Rivers Provider Network All |
$36.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$45.57
|
| Rate for Payer: Zelis Auto |
$19.60
|
| Rate for Payer: Zelis Worker's Compensation |
$13.38
|
|
|
MEDICAL NUTRITION THERAPY GRP2/INDIV 30
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
21799454
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$46.55 |
| 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 |
$29.40
|
| 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 |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$41.65
|
| Rate for Payer: First Health Commercial |
$44.10
|
| Rate for Payer: First Health Workers Compensation |
$18.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$44.10
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$44.10
|
| Rate for Payer: Humana ChoiceCare |
$12.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$28.57
|
| Rate for Payer: Multiplan All |
$44.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29.40
|
| Rate for Payer: OMNI Networks Commercial |
$34.30
|
| Rate for Payer: One Health Plan PPO/POS |
$44.10
|
| 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 |
$46.55
|
| Rate for Payer: Three Rivers Provider Network All |
$36.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$43.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$45.57
|
| Rate for Payer: Zelis Auto |
$19.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24.50
|
| Rate for Payer: Zelis Worker's Compensation |
$13.38
|
|
|
MEDICAL NUTRITION THERAPY GRP2/ INDIV 30
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
21997804
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$46.55 |
| 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 |
$29.40
|
| 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 |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$41.65
|
| Rate for Payer: First Health Commercial |
$44.10
|
| Rate for Payer: First Health Workers Compensation |
$18.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$44.10
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$44.10
|
| Rate for Payer: Humana ChoiceCare |
$12.74
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$28.57
|
| Rate for Payer: Multiplan All |
$44.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$29.40
|
| Rate for Payer: OMNI Networks Commercial |
$34.30
|
| Rate for Payer: One Health Plan PPO/POS |
$44.10
|
| 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 |
$46.55
|
| Rate for Payer: Three Rivers Provider Network All |
$36.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$43.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$45.57
|
| Rate for Payer: Zelis Auto |
$19.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24.50
|
| Rate for Payer: Zelis Worker's Compensation |
$13.38
|
|
|
MEDICAL NUTRITION THERAPY GRP2/ INDIV 30
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
21997804
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$46.55 |
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$41.65
|
| Rate for Payer: First Health Commercial |
$44.10
|
| Rate for Payer: First Health Workers Compensation |
$18.92
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$44.10
|
| Rate for Payer: GEHA Commercial |
$34.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$44.10
|
| Rate for Payer: Multiplan All |
$44.59
|
| Rate for Payer: OMNI Networks Commercial |
$34.30
|
| Rate for Payer: One Health Plan PPO/POS |
$44.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$46.55
|
| Rate for Payer: Three Rivers Provider Network All |
$36.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$45.57
|
| Rate for Payer: Zelis Auto |
$19.60
|
| Rate for Payer: Zelis Worker's Compensation |
$13.38
|
|
|
MED NUTRITION INDIV SUBSE
|
Facility
|
OP
|
$88.86
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
7297803
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$84.42 |
| 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 |
$53.32
|
| 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 |
$53.32
|
| Rate for Payer: Cash Price |
$53.32
|
| Rate for Payer: Cigna Commercial |
$75.53
|
| Rate for Payer: First Health Commercial |
$79.97
|
| Rate for Payer: First Health Workers Compensation |
$34.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$79.97
|
| Rate for Payer: GEHA Commercial |
$71.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$79.97
|
| Rate for Payer: Humana ChoiceCare |
$23.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$53.99
|
| Rate for Payer: Multiplan All |
$80.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$53.32
|
| Rate for Payer: OMNI Networks Commercial |
$62.20
|
| Rate for Payer: One Health Plan PPO/POS |
$79.97
|
| 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 |
$84.42
|
| Rate for Payer: Three Rivers Provider Network All |
$66.64
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$78.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$82.64
|
| Rate for Payer: Zelis Auto |
$35.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$44.43
|
| Rate for Payer: Zelis Worker's Compensation |
$24.26
|
|
|
MED NUTRITION INDIV SUBSE
|
Facility
|
IP
|
$88.86
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
8597803
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$24.26 |
| Max. Negotiated Rate |
$84.42 |
| Rate for Payer: Cash Price |
$53.32
|
| Rate for Payer: Cigna Commercial |
$75.53
|
| Rate for Payer: First Health Commercial |
$79.97
|
| Rate for Payer: First Health Workers Compensation |
$34.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$79.97
|
| Rate for Payer: GEHA Commercial |
$62.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$79.97
|
| Rate for Payer: Multiplan All |
$80.86
|
| Rate for Payer: OMNI Networks Commercial |
$62.20
|
| Rate for Payer: One Health Plan PPO/POS |
$79.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$84.42
|
| Rate for Payer: Three Rivers Provider Network All |
$66.64
|
| Rate for Payer: United Payors & United Providers UP&UP |
$82.64
|
| Rate for Payer: Zelis Auto |
$35.54
|
| Rate for Payer: Zelis Worker's Compensation |
$24.26
|
|
|
MED NUTRITION INDIV SUBSE
|
Facility
|
IP
|
$88.86
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
7297803
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$24.26 |
| Max. Negotiated Rate |
$84.42 |
| Rate for Payer: Cash Price |
$53.32
|
| Rate for Payer: Cigna Commercial |
$75.53
|
| Rate for Payer: First Health Commercial |
$79.97
|
| Rate for Payer: First Health Workers Compensation |
$34.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$79.97
|
| Rate for Payer: GEHA Commercial |
$62.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$79.97
|
| Rate for Payer: Multiplan All |
$80.86
|
| Rate for Payer: OMNI Networks Commercial |
$62.20
|
| Rate for Payer: One Health Plan PPO/POS |
$79.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$84.42
|
| Rate for Payer: Three Rivers Provider Network All |
$66.64
|
| Rate for Payer: United Payors & United Providers UP&UP |
$82.64
|
| Rate for Payer: Zelis Auto |
$35.54
|
| Rate for Payer: Zelis Worker's Compensation |
$24.26
|
|
|
MED NUTRITION INDIV SUBSE
|
Facility
|
OP
|
$88.86
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
8597803
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$84.42 |
| 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 |
$53.32
|
| 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 |
$53.32
|
| Rate for Payer: Cash Price |
$53.32
|
| Rate for Payer: Cigna Commercial |
$75.53
|
| Rate for Payer: First Health Commercial |
$79.97
|
| Rate for Payer: First Health Workers Compensation |
$34.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$79.97
|
| Rate for Payer: GEHA Commercial |
$71.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$79.97
|
| Rate for Payer: Humana ChoiceCare |
$23.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$53.99
|
| Rate for Payer: Multiplan All |
$80.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$53.32
|
| Rate for Payer: OMNI Networks Commercial |
$62.20
|
| Rate for Payer: One Health Plan PPO/POS |
$79.97
|
| 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 |
$84.42
|
| Rate for Payer: Three Rivers Provider Network All |
$66.64
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$78.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$53.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$82.64
|
| Rate for Payer: Zelis Auto |
$35.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$44.43
|
| Rate for Payer: Zelis Worker's Compensation |
$24.26
|
|
|
MED NUT TX REASSESS GRP EA 30 MIN
|
Facility
|
IP
|
$47.43
|
|
|
Service Code
|
CPT G0271
|
| Hospital Charge Code |
8500271
|
|
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
|
|
|
MED NUT TX REASSESS GRP EA 30 MIN
|
Facility
|
OP
|
$47.43
|
|
|
Service Code
|
CPT G0271
|
| Hospital Charge Code |
8500271
|
|
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 |
$23.40
|
| 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 |
$23.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.54
|
| 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 |
$18.91
|
| 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 |
$21.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.91
|
| 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 |
$18.91
|
| 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
|
|
|
MED NUT TX; REASSESS W/PT EA 15 MIN
|
Facility
|
IP
|
$88.86
|
|
|
Service Code
|
CPT G0270
|
| Hospital Charge Code |
8500270
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$24.26 |
| Max. Negotiated Rate |
$84.42 |
| Rate for Payer: Cash Price |
$53.32
|
| Rate for Payer: Cigna Commercial |
$75.53
|
| Rate for Payer: First Health Commercial |
$79.97
|
| Rate for Payer: First Health Workers Compensation |
$34.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$79.97
|
| Rate for Payer: GEHA Commercial |
$62.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$79.97
|
| Rate for Payer: Multiplan All |
$80.86
|
| Rate for Payer: OMNI Networks Commercial |
$62.20
|
| Rate for Payer: One Health Plan PPO/POS |
$79.97
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$84.42
|
| Rate for Payer: Three Rivers Provider Network All |
$66.64
|
| Rate for Payer: United Payors & United Providers UP&UP |
$82.64
|
| Rate for Payer: Zelis Auto |
$35.54
|
| Rate for Payer: Zelis Worker's Compensation |
$24.26
|
|
|
MED NUT TX; REASSESS W/PT EA 15 MIN
|
Facility
|
OP
|
$88.86
|
|
|
Service Code
|
CPT G0270
|
| Hospital Charge Code |
8500270
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$84.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$43.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$53.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$43.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$34.45
|
| Rate for Payer: Cash Price |
$53.32
|
| Rate for Payer: Cash Price |
$53.32
|
| Rate for Payer: Cigna Commercial |
$75.53
|
| Rate for Payer: First Health Commercial |
$79.97
|
| Rate for Payer: First Health Workers Compensation |
$34.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$79.97
|
| Rate for Payer: GEHA Commercial |
$71.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$79.97
|
| Rate for Payer: Humana ChoiceCare |
$23.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$35.15
|
| Rate for Payer: Multiplan All |
$80.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$53.32
|
| Rate for Payer: OMNI Networks Commercial |
$62.20
|
| Rate for Payer: One Health Plan PPO/POS |
$79.97
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$40.59
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$35.15
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$84.42
|
| Rate for Payer: Three Rivers Provider Network All |
$66.64
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$78.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$35.15
|
| Rate for Payer: United Payors & United Providers UP&UP |
$82.64
|
| Rate for Payer: Zelis Auto |
$35.54
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$44.43
|
| Rate for Payer: Zelis Worker's Compensation |
$24.26
|
|
|
MEDRONATE UP TP 30MC
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT A9503
|
| Hospital Charge Code |
2410052
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$66.07 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: First Health Workers Compensation |
$93.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$169.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| Rate for Payer: Multiplan All |
$220.22
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$229.90
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.06
|
| Rate for Payer: Zelis Auto |
$96.80
|
| Rate for Payer: Zelis Worker's Compensation |
$66.07
|
|
|
MEDRONATE UP TP 30MC
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT A9503
|
| Hospital Charge Code |
2410052
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$60.50 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: First Health Workers Compensation |
$93.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$193.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| Rate for Payer: Humana ChoiceCare |
$62.92
|
| Rate for Payer: Multiplan All |
$220.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.20
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$229.90
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$212.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.06
|
| Rate for Payer: Zelis Auto |
$96.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.00
|
| Rate for Payer: Zelis Worker's Compensation |
$66.07
|
|
|
medroxyPROGESTERone IM 150MG/ML
|
Facility
|
IP
|
$406.65
|
|
|
Service Code
|
CPT J1050
|
| Hospital Charge Code |
3300560
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.02 |
| Max. Negotiated Rate |
$386.32 |
| Rate for Payer: Cash Price |
$243.99
|
| Rate for Payer: Cigna Commercial |
$345.65
|
| Rate for Payer: First Health Commercial |
$365.99
|
| Rate for Payer: First Health Workers Compensation |
$157.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$365.99
|
| Rate for Payer: GEHA Commercial |
$284.65
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$365.99
|
| Rate for Payer: Multiplan All |
$370.05
|
| Rate for Payer: OMNI Networks Commercial |
$284.65
|
| Rate for Payer: One Health Plan PPO/POS |
$365.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$386.32
|
| Rate for Payer: Three Rivers Provider Network All |
$304.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$378.18
|
| Rate for Payer: Zelis Auto |
$162.66
|
| Rate for Payer: Zelis Worker's Compensation |
$111.02
|
|
|
medroxyPROGESTERone IM 150MG/ML
|
Facility
|
OP
|
$406.65
|
|
|
Service Code
|
CPT J1050
|
| Hospital Charge Code |
3300560
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.66 |
| Max. Negotiated Rate |
$386.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$243.99
|
| Rate for Payer: Cash Price |
$243.99
|
| Rate for Payer: Cigna Commercial |
$345.65
|
| Rate for Payer: First Health Commercial |
$365.99
|
| Rate for Payer: First Health Workers Compensation |
$157.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$365.99
|
| Rate for Payer: GEHA Commercial |
$325.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$365.99
|
| Rate for Payer: Humana ChoiceCare |
$105.73
|
| Rate for Payer: Multiplan All |
$370.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$243.99
|
| Rate for Payer: OMNI Networks Commercial |
$284.65
|
| Rate for Payer: One Health Plan PPO/POS |
$365.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$386.32
|
| Rate for Payer: Three Rivers Provider Network All |
$304.99
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$357.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$101.66
|
| Rate for Payer: United Payors & United Providers UP&UP |
$378.18
|
| Rate for Payer: Zelis Auto |
$162.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$203.32
|
| Rate for Payer: Zelis Worker's Compensation |
$111.02
|
|
|
MED SURG REGULAR ROOM
|
Facility
|
IP
|
$1,400.00
|
|
| Hospital Charge Code |
31110002
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,330.00 |
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cigna Commercial |
$1,190.00
|
| Rate for Payer: First Health Commercial |
$1,260.00
|
| Rate for Payer: First Health Workers Compensation |
$540.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,260.00
|
| Rate for Payer: GEHA Commercial |
$980.00
|
| Rate for Payer: Gentiva Hospice Medicaid |
$977.29
|
| Rate for Payer: Gentiva Hospice Medicare |
$1,008.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,260.00
|
| Rate for Payer: Lakeview Christian Hospice Medicare |
$366.00
|
| Rate for Payer: Multiplan All |
$1,274.00
|
| Rate for Payer: OMNI Networks Commercial |
$980.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,260.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,330.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,050.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,302.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$360.00
|
| Rate for Payer: Zelis Auto |
$560.00
|
| Rate for Payer: Zelis Worker's Compensation |
$382.20
|
|
|
MED SURG W ISOLATION
|
Facility
|
IP
|
$1,800.00
|
|
| Hospital Charge Code |
31110002
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cigna Commercial |
$1,530.00
|
| Rate for Payer: First Health Commercial |
$1,620.00
|
| Rate for Payer: First Health Workers Compensation |
$694.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,620.00
|
| Rate for Payer: GEHA Commercial |
$1,260.00
|
| Rate for Payer: Gentiva Hospice Medicaid |
$977.29
|
| Rate for Payer: Gentiva Hospice Medicare |
$1,008.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,620.00
|
| Rate for Payer: Lakeview Christian Hospice Medicare |
$366.00
|
| Rate for Payer: Multiplan All |
$1,638.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,260.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,620.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,710.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,350.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,674.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$360.00
|
| Rate for Payer: Zelis Auto |
$720.00
|
| Rate for Payer: Zelis Worker's Compensation |
$491.40
|
|
|
MED SURG W ISOLATION/TELE
|
Facility
|
IP
|
$2,500.00
|
|
| Hospital Charge Code |
31110002
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$2,375.00 |
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,125.00
|
| Rate for Payer: First Health Commercial |
$2,250.00
|
| Rate for Payer: First Health Workers Compensation |
$965.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,250.00
|
| Rate for Payer: GEHA Commercial |
$1,750.00
|
| Rate for Payer: Gentiva Hospice Medicaid |
$977.29
|
| Rate for Payer: Gentiva Hospice Medicare |
$1,008.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,250.00
|
| Rate for Payer: Lakeview Christian Hospice Medicare |
$366.00
|
| Rate for Payer: Multiplan All |
$2,275.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,750.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,250.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,375.00
|
| Rate for Payer: Three Rivers Provider Network All |
$1,875.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,325.00
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$360.00
|
| Rate for Payer: Zelis Auto |
$1,000.00
|
| Rate for Payer: Zelis Worker's Compensation |
$682.50
|
|
