|
NS 3% - 1000ML
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
NDC 00338005403
|
| Hospital Charge Code |
3300844
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$20.90 |
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$18.70
|
| Rate for Payer: First Health Commercial |
$19.80
|
| Rate for Payer: First Health Workers Compensation |
$8.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$19.80
|
| Rate for Payer: GEHA Commercial |
$15.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$19.80
|
| Rate for Payer: Multiplan All |
$20.02
|
| Rate for Payer: OMNI Networks Commercial |
$15.40
|
| Rate for Payer: One Health Plan PPO/POS |
$19.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$20.90
|
| Rate for Payer: Three Rivers Provider Network All |
$16.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$20.46
|
| Rate for Payer: Zelis Auto |
$8.80
|
| Rate for Payer: Zelis Worker's Compensation |
$6.01
|
|
|
NS 3% - 1000ML
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
NDC 00338005403
|
| Hospital Charge Code |
3300844
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$20.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$18.70
|
| Rate for Payer: First Health Commercial |
$19.80
|
| Rate for Payer: First Health Workers Compensation |
$8.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$19.80
|
| Rate for Payer: GEHA Commercial |
$17.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$19.80
|
| Rate for Payer: Humana ChoiceCare |
$5.72
|
| Rate for Payer: Multiplan All |
$20.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$13.20
|
| Rate for Payer: OMNI Networks Commercial |
$15.40
|
| Rate for Payer: One Health Plan PPO/POS |
$19.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$20.90
|
| Rate for Payer: Three Rivers Provider Network All |
$16.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19.36
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$20.46
|
| Rate for Payer: Zelis Auto |
$8.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$11.00
|
| Rate for Payer: Zelis Worker's Compensation |
$6.01
|
|
|
NSL/SINS NDSC SPHN TISS RMVL
|
Facility
|
OP
|
$2,470.00
|
|
|
Service Code
|
CPT 31259
|
| Hospital Charge Code |
6169667
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$674.31 |
| Max. Negotiated Rate |
$13,415.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7,295.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,482.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7,295.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,779.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,707.73
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cigna Commercial |
$2,099.50
|
| Rate for Payer: First Health Commercial |
$2,223.00
|
| Rate for Payer: First Health Workers Compensation |
$953.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,223.00
|
| Rate for Payer: GEHA Commercial |
$1,976.00
|
| Rate for Payer: GEHA Medicare |
$6,707.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,223.00
|
| Rate for Payer: Humana ChoiceCare |
$7,378.50
|
| Rate for Payer: Humana Medicare Advantage |
$6,707.73
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,268.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,897.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,707.73
|
| Rate for Payer: Multiplan All |
$2,247.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,403.14
|
| Rate for Payer: OMNI Networks Commercial |
$1,729.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,223.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,809.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,897.39
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,707.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,346.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,415.46
|
| Rate for Payer: Three Rivers Provider Network All |
$1,852.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,573.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,897.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,707.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,297.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,707.73
|
| Rate for Payer: Zelis Auto |
$988.00
|
| Rate for Payer: Zelis Medicare |
$5,701.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,049.28
|
| Rate for Payer: Zelis Worker's Compensation |
$674.31
|
|
|
NSL/SINS NDSC SPHN TISS RMVL
|
Facility
|
IP
|
$2,470.00
|
|
|
Service Code
|
CPT 31259
|
| Hospital Charge Code |
6169667
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$674.31 |
| Max. Negotiated Rate |
$2,346.50 |
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cigna Commercial |
$2,099.50
|
| Rate for Payer: First Health Commercial |
$2,223.00
|
| Rate for Payer: First Health Workers Compensation |
$953.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,223.00
|
| Rate for Payer: GEHA Commercial |
$1,729.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,223.00
|
| Rate for Payer: Multiplan All |
$2,247.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,729.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,223.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,346.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,852.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,297.10
|
| Rate for Payer: Zelis Auto |
$988.00
|
| Rate for Payer: Zelis Worker's Compensation |
$674.31
|
|
|
NSL/SINS NDSC TOTAL
|
Facility
|
OP
|
$2,470.00
|
|
|
Service Code
|
CPT 31253
|
| Hospital Charge Code |
6169665
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$674.31 |
| Max. Negotiated Rate |
$13,415.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7,295.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,482.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7,295.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,779.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,707.73
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cigna Commercial |
$2,099.50
|
| Rate for Payer: First Health Commercial |
$2,223.00
|
| Rate for Payer: First Health Workers Compensation |
$953.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,223.00
|
| Rate for Payer: GEHA Commercial |
$1,976.00
|
| Rate for Payer: GEHA Medicare |
$6,707.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,223.00
|
| Rate for Payer: Humana ChoiceCare |
$7,378.50
|
| Rate for Payer: Humana Medicare Advantage |
$6,707.73
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,268.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,897.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,707.73
|
| Rate for Payer: Multiplan All |
$2,247.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,403.14
|
| Rate for Payer: OMNI Networks Commercial |
$1,729.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,223.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,809.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,897.39
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,707.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,346.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,415.46
|
| Rate for Payer: Three Rivers Provider Network All |
$1,852.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,573.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,897.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,707.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,297.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,707.73
|
| Rate for Payer: Zelis Auto |
$988.00
|
| Rate for Payer: Zelis Medicare |
$5,701.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,049.28
|
| Rate for Payer: Zelis Worker's Compensation |
$674.31
|
|
|
NSL/SINS NDSC TOTAL
|
Facility
|
IP
|
$2,470.00
|
|
|
Service Code
|
CPT 31253
|
| Hospital Charge Code |
6169665
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$674.31 |
| Max. Negotiated Rate |
$2,346.50 |
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cigna Commercial |
$2,099.50
|
| Rate for Payer: First Health Commercial |
$2,223.00
|
| Rate for Payer: First Health Workers Compensation |
$953.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,223.00
|
| Rate for Payer: GEHA Commercial |
$1,729.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,223.00
|
| Rate for Payer: Multiplan All |
$2,247.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,729.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,223.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,346.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,852.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,297.10
|
| Rate for Payer: Zelis Auto |
$988.00
|
| Rate for Payer: Zelis Worker's Compensation |
$674.31
|
|
|
NSL/SINS NDSC TOT W/SPHENDT
|
Facility
|
IP
|
$2,470.00
|
|
|
Service Code
|
CPT 31257
|
| Hospital Charge Code |
6169666
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$674.31 |
| Max. Negotiated Rate |
$2,346.50 |
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cigna Commercial |
$2,099.50
|
| Rate for Payer: First Health Commercial |
$2,223.00
|
| Rate for Payer: First Health Workers Compensation |
$953.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,223.00
|
| Rate for Payer: GEHA Commercial |
$1,729.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,223.00
|
| Rate for Payer: Multiplan All |
$2,247.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,729.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,223.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,346.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,852.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,297.10
|
| Rate for Payer: Zelis Auto |
$988.00
|
| Rate for Payer: Zelis Worker's Compensation |
$674.31
|
|
|
NSL/SINS NDSC TOT W/SPHENDT
|
Facility
|
OP
|
$2,470.00
|
|
|
Service Code
|
CPT 31257
|
| Hospital Charge Code |
6169666
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$674.31 |
| Max. Negotiated Rate |
$13,415.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7,295.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,482.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7,295.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,779.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,707.73
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cigna Commercial |
$2,099.50
|
| Rate for Payer: First Health Commercial |
$2,223.00
|
| Rate for Payer: First Health Workers Compensation |
$953.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,223.00
|
| Rate for Payer: GEHA Commercial |
$1,976.00
|
| Rate for Payer: GEHA Medicare |
$6,707.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,223.00
|
| Rate for Payer: Humana ChoiceCare |
$7,378.50
|
| Rate for Payer: Humana Medicare Advantage |
$6,707.73
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,268.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,897.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,707.73
|
| Rate for Payer: Multiplan All |
$2,247.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,403.14
|
| Rate for Payer: OMNI Networks Commercial |
$1,729.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,223.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,809.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,897.39
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,707.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,346.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,415.46
|
| Rate for Payer: Three Rivers Provider Network All |
$1,852.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,573.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,897.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,707.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,297.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,707.73
|
| Rate for Payer: Zelis Auto |
$988.00
|
| Rate for Payer: Zelis Medicare |
$5,701.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,049.28
|
| Rate for Payer: Zelis Worker's Compensation |
$674.31
|
|
|
NSL/SINS NDSC W/ARTERY LIG
|
Facility
|
IP
|
$2,470.00
|
|
|
Service Code
|
CPT 31241
|
| Hospital Charge Code |
6169664
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$674.31 |
| Max. Negotiated Rate |
$2,346.50 |
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cigna Commercial |
$2,099.50
|
| Rate for Payer: First Health Commercial |
$2,223.00
|
| Rate for Payer: First Health Workers Compensation |
$953.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,223.00
|
| Rate for Payer: GEHA Commercial |
$1,729.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,223.00
|
| Rate for Payer: Multiplan All |
$2,247.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,729.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,223.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,346.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,852.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,297.10
|
| Rate for Payer: Zelis Auto |
$988.00
|
| Rate for Payer: Zelis Worker's Compensation |
$674.31
|
|
|
NSL/SINS NDSC W/ARTERY LIG
|
Facility
|
OP
|
$2,470.00
|
|
|
Service Code
|
CPT 31241
|
| Hospital Charge Code |
6169664
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$674.31 |
| Max. Negotiated Rate |
$3,341.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,053.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,482.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,053.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,627.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,670.98
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cigna Commercial |
$2,099.50
|
| Rate for Payer: First Health Commercial |
$2,223.00
|
| Rate for Payer: First Health Workers Compensation |
$953.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,223.00
|
| Rate for Payer: GEHA Commercial |
$1,976.00
|
| Rate for Payer: GEHA Medicare |
$1,670.98
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,223.00
|
| Rate for Payer: Humana ChoiceCare |
$1,838.08
|
| Rate for Payer: Humana Medicare Advantage |
$1,670.98
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,807.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,660.26
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,670.98
|
| Rate for Payer: Multiplan All |
$2,247.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,840.67
|
| Rate for Payer: OMNI Networks Commercial |
$1,729.00
|
| Rate for Payer: One Health Plan PPO/POS |
$2,223.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,917.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,660.26
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,670.98
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,346.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,341.96
|
| Rate for Payer: Three Rivers Provider Network All |
$1,852.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,637.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,660.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,670.98
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,297.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,670.98
|
| Rate for Payer: Zelis Auto |
$988.00
|
| Rate for Payer: Zelis Medicare |
$1,420.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,005.18
|
| Rate for Payer: Zelis Worker's Compensation |
$674.31
|
|
|
NSL/SINS NDSC W/SINS DILAT
|
Facility
|
IP
|
$807.00
|
|
|
Service Code
|
CPT 31298
|
| Hospital Charge Code |
6169668
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$220.31 |
| Max. Negotiated Rate |
$766.65 |
| Rate for Payer: Cash Price |
$484.20
|
| Rate for Payer: Cigna Commercial |
$685.95
|
| Rate for Payer: First Health Commercial |
$726.30
|
| Rate for Payer: First Health Workers Compensation |
$311.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$726.30
|
| Rate for Payer: GEHA Commercial |
$564.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$726.30
|
| Rate for Payer: Multiplan All |
$734.37
|
| Rate for Payer: OMNI Networks Commercial |
$564.90
|
| Rate for Payer: One Health Plan PPO/POS |
$726.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$766.65
|
| Rate for Payer: Three Rivers Provider Network All |
$605.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$750.51
|
| Rate for Payer: Zelis Auto |
$322.80
|
| Rate for Payer: Zelis Worker's Compensation |
$220.31
|
|
|
NSL/SINS NDSC W/SINS DILAT
|
Facility
|
OP
|
$807.00
|
|
|
Service Code
|
CPT 31298
|
| Hospital Charge Code |
6169668
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$220.31 |
| Max. Negotiated Rate |
$13,415.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7,295.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$484.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7,295.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,779.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,707.73
|
| Rate for Payer: Cash Price |
$484.20
|
| Rate for Payer: Cash Price |
$484.20
|
| Rate for Payer: Cigna Commercial |
$685.95
|
| Rate for Payer: First Health Commercial |
$726.30
|
| Rate for Payer: First Health Workers Compensation |
$311.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$726.30
|
| Rate for Payer: GEHA Commercial |
$645.60
|
| Rate for Payer: GEHA Medicare |
$6,707.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$726.30
|
| Rate for Payer: Humana ChoiceCare |
$7,378.50
|
| Rate for Payer: Humana Medicare Advantage |
$6,707.73
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,268.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,897.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,707.73
|
| Rate for Payer: Multiplan All |
$734.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,403.14
|
| Rate for Payer: OMNI Networks Commercial |
$564.90
|
| Rate for Payer: One Health Plan PPO/POS |
$726.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,809.36
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,897.39
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,707.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$766.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,415.46
|
| Rate for Payer: Three Rivers Provider Network All |
$605.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,573.58
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,897.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,707.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$750.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,707.73
|
| Rate for Payer: Zelis Auto |
$322.80
|
| Rate for Payer: Zelis Medicare |
$5,701.57
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,049.28
|
| Rate for Payer: Zelis Worker's Compensation |
$220.31
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
8300068
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$90.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Humana ChoiceCare |
$29.38
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.80
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$99.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.50
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
8700005
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$90.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Humana ChoiceCare |
$29.38
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.80
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$99.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.50
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
8700005
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$79.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
14099216
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$32.38
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$67.80
|
| Rate for Payer: Cimarron Advantage Cimarron Advantage PPO |
$45.33
|
| Rate for Payer: First Health Workers Compensation |
$61.44
|
| Rate for Payer: GEHA Commercial |
$32.38
|
| Rate for Payer: GEHA Medicare |
$32.38
|
| Rate for Payer: Health Net Federal Services Government |
$32.38
|
| Rate for Payer: HealthSmart Commercial |
$45.33
|
| Rate for Payer: HealthSmart Worker's Compensation |
$58.96
|
| Rate for Payer: Humana ChoiceCare |
$35.62
|
| Rate for Payer: Humana Medicare Advantage |
$32.38
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$45.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$30.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$32.38
|
| Rate for Payer: Multiplan All |
$84.75
|
| Rate for Payer: National Preferred Provider Network Commercial |
$107.35
|
| Rate for Payer: National Preferred Provider Network Worker's Compensation |
$62.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.00
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$43.40
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$19.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$35.54
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$70.26
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$31.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.38
|
| Rate for Payer: Zelis Medicare |
$27.52
|
| Rate for Payer: Zelis Worker's Compensation |
$43.44
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
7599216
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$90.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Humana ChoiceCare |
$29.38
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.80
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$99.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.50
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
9200027
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$79.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
8600012
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$90.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Humana ChoiceCare |
$29.38
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.80
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$99.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.50
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
21700035
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$90.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Humana ChoiceCare |
$29.38
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.80
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$99.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.50
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
8800029
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$90.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Humana ChoiceCare |
$29.38
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: New Mexico Health Connections Medicare |
$67.80
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$99.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$28.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$56.50
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
8600012
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$79.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
1999218
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$92.65
|
| Rate for Payer: First Health Commercial |
$98.10
|
| Rate for Payer: First Health Workers Compensation |
$42.08
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$98.10
|
| Rate for Payer: GEHA Commercial |
$76.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$98.10
|
| Rate for Payer: Multiplan All |
$99.19
|
| Rate for Payer: OMNI Networks Commercial |
$76.30
|
| Rate for Payer: One Health Plan PPO/POS |
$98.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$103.55
|
| Rate for Payer: Three Rivers Provider Network All |
$81.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$101.37
|
| Rate for Payer: Zelis Auto |
$43.60
|
| Rate for Payer: Zelis Worker's Compensation |
$29.76
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
9399216
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$79.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
|
NTRPROF PH1/NTRNET/EHR 5/>
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 99451
|
| Hospital Charge Code |
20399219
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$96.05
|
| Rate for Payer: First Health Commercial |
$101.70
|
| Rate for Payer: First Health Workers Compensation |
$43.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$101.70
|
| Rate for Payer: GEHA Commercial |
$79.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$101.70
|
| Rate for Payer: Multiplan All |
$102.83
|
| Rate for Payer: OMNI Networks Commercial |
$79.10
|
| Rate for Payer: One Health Plan PPO/POS |
$101.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$107.35
|
| Rate for Payer: Three Rivers Provider Network All |
$84.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$105.09
|
| Rate for Payer: Zelis Auto |
$45.20
|
| Rate for Payer: Zelis Worker's Compensation |
$30.85
|
|
