|
PERQ THRMBC/NFS DIALYSIS CIR IMG DX ANG
|
Facility
|
IP
|
$14,941.00
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
1000044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,078.89 |
| Max. Negotiated Rate |
$14,193.95 |
| Rate for Payer: Cash Price |
$8,964.60
|
| Rate for Payer: Cigna Commercial |
$12,699.85
|
| Rate for Payer: First Health Commercial |
$13,446.90
|
| Rate for Payer: First Health Workers Compensation |
$5,768.72
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13,446.90
|
| Rate for Payer: GEHA Commercial |
$10,458.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13,446.90
|
| Rate for Payer: Multiplan All |
$13,596.31
|
| Rate for Payer: OMNI Networks Commercial |
$10,458.70
|
| Rate for Payer: One Health Plan PPO/POS |
$13,446.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14,193.95
|
| Rate for Payer: Three Rivers Provider Network All |
$11,205.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,895.13
|
| Rate for Payer: Zelis Auto |
$5,976.40
|
| Rate for Payer: Zelis Worker's Compensation |
$4,078.89
|
|
|
PERQ THRMBC/NFS DIALYSIS CIR IMG DX ANG
|
Facility
|
OP
|
$7,343.00
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
6191050
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,004.64 |
| Max. Negotiated Rate |
$10,827.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7,234.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,405.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7,234.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,731.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,413.82
|
| Rate for Payer: Cash Price |
$4,405.80
|
| Rate for Payer: Cash Price |
$4,405.80
|
| Rate for Payer: Cigna Commercial |
$6,241.55
|
| Rate for Payer: First Health Commercial |
$6,608.70
|
| Rate for Payer: First Health Workers Compensation |
$2,835.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,608.70
|
| Rate for Payer: GEHA Commercial |
$5,874.40
|
| Rate for Payer: GEHA Medicare |
$5,413.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,608.70
|
| Rate for Payer: Humana ChoiceCare |
$5,955.20
|
| Rate for Payer: Humana Medicare Advantage |
$5,413.82
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,095.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,848.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,413.82
|
| Rate for Payer: Multiplan All |
$6,682.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,203.49
|
| Rate for Payer: OMNI Networks Commercial |
$5,140.10
|
| Rate for Payer: One Health Plan PPO/POS |
$6,608.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,752.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,848.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,413.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,975.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10,827.64
|
| Rate for Payer: Three Rivers Provider Network All |
$5,507.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,305.54
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,848.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,413.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,828.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,413.82
|
| Rate for Payer: Zelis Auto |
$2,937.20
|
| Rate for Payer: Zelis Medicare |
$4,601.75
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,496.58
|
| Rate for Payer: Zelis Worker's Compensation |
$2,004.64
|
|
|
PERQ THRMBC/NFS DIALYSIS CIR IMG DX ANG
|
Facility
|
IP
|
$7,343.00
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
6191050
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,004.64 |
| Max. Negotiated Rate |
$6,975.85 |
| Rate for Payer: Cash Price |
$4,405.80
|
| Rate for Payer: Cigna Commercial |
$6,241.55
|
| Rate for Payer: First Health Commercial |
$6,608.70
|
| Rate for Payer: First Health Workers Compensation |
$2,835.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,608.70
|
| Rate for Payer: GEHA Commercial |
$5,140.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,608.70
|
| Rate for Payer: Multiplan All |
$6,682.13
|
| Rate for Payer: OMNI Networks Commercial |
$5,140.10
|
| Rate for Payer: One Health Plan PPO/POS |
$6,608.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,975.85
|
| Rate for Payer: Three Rivers Provider Network All |
$5,507.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,828.99
|
| Rate for Payer: Zelis Auto |
$2,937.20
|
| Rate for Payer: Zelis Worker's Compensation |
$2,004.64
|
|
|
PERQ TRANSCATH CLS AORTIC
|
Facility
|
IP
|
$22,496.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
6191048
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$6,141.41 |
| Max. Negotiated Rate |
$21,371.20 |
| Rate for Payer: Cash Price |
$13,497.60
|
| Rate for Payer: Cigna Commercial |
$19,121.60
|
| Rate for Payer: First Health Commercial |
$20,246.40
|
| Rate for Payer: First Health Workers Compensation |
$8,685.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$20,246.40
|
| Rate for Payer: GEHA Commercial |
$15,747.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$20,246.40
|
| Rate for Payer: Multiplan All |
$20,471.36
|
| Rate for Payer: OMNI Networks Commercial |
$15,747.20
|
| Rate for Payer: One Health Plan PPO/POS |
$20,246.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$21,371.20
|
| Rate for Payer: Three Rivers Provider Network All |
$16,872.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$20,921.28
|
| Rate for Payer: Zelis Auto |
$8,998.40
|
| Rate for Payer: Zelis Worker's Compensation |
$6,141.41
|
|
|
PERQ TRANSCATH CLS AORTIC
|
Facility
|
OP
|
$22,496.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
6191048
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$6,141.41 |
| Max. Negotiated Rate |
$34,101.24 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$22,163.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13,497.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$22,163.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17,558.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17,050.62
|
| Rate for Payer: Cash Price |
$13,497.60
|
| Rate for Payer: Cash Price |
$13,497.60
|
| Rate for Payer: Cigna Commercial |
$19,121.60
|
| Rate for Payer: First Health Commercial |
$20,246.40
|
| Rate for Payer: First Health Workers Compensation |
$8,685.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$20,246.40
|
| Rate for Payer: GEHA Commercial |
$17,996.80
|
| Rate for Payer: GEHA Medicare |
$17,050.62
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$20,246.40
|
| Rate for Payer: Humana ChoiceCare |
$18,755.68
|
| Rate for Payer: Humana Medicare Advantage |
$17,050.62
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28,645.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17,915.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,050.62
|
| Rate for Payer: Multiplan All |
$20,471.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28,986.05
|
| Rate for Payer: OMNI Networks Commercial |
$15,747.20
|
| Rate for Payer: One Health Plan PPO/POS |
$20,246.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20,686.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17,915.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17,050.62
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$21,371.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34,101.24
|
| Rate for Payer: Three Rivers Provider Network All |
$16,872.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16,709.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17,915.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,050.62
|
| Rate for Payer: United Payors & United Providers UP&UP |
$20,921.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17,050.62
|
| Rate for Payer: Zelis Auto |
$8,998.40
|
| Rate for Payer: Zelis Medicare |
$14,493.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20,460.74
|
| Rate for Payer: Zelis Worker's Compensation |
$6,141.41
|
|
|
PERQ TRANSCATH CLS MITRAL
|
Facility
|
IP
|
$22,496.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
6191049
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$6,141.41 |
| Max. Negotiated Rate |
$21,371.20 |
| Rate for Payer: Cash Price |
$13,497.60
|
| Rate for Payer: Cigna Commercial |
$19,121.60
|
| Rate for Payer: First Health Commercial |
$20,246.40
|
| Rate for Payer: First Health Workers Compensation |
$8,685.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$20,246.40
|
| Rate for Payer: GEHA Commercial |
$15,747.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$20,246.40
|
| Rate for Payer: Multiplan All |
$20,471.36
|
| Rate for Payer: OMNI Networks Commercial |
$15,747.20
|
| Rate for Payer: One Health Plan PPO/POS |
$20,246.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$21,371.20
|
| Rate for Payer: Three Rivers Provider Network All |
$16,872.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$20,921.28
|
| Rate for Payer: Zelis Auto |
$8,998.40
|
| Rate for Payer: Zelis Worker's Compensation |
$6,141.41
|
|
|
PERQ TRANSCATH CLS MITRAL
|
Facility
|
OP
|
$22,496.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
6191049
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$6,141.41 |
| Max. Negotiated Rate |
$34,101.24 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$22,163.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13,497.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$22,163.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17,558.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17,050.62
|
| Rate for Payer: Cash Price |
$13,497.60
|
| Rate for Payer: Cash Price |
$13,497.60
|
| Rate for Payer: Cigna Commercial |
$19,121.60
|
| Rate for Payer: First Health Commercial |
$20,246.40
|
| Rate for Payer: First Health Workers Compensation |
$8,685.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$20,246.40
|
| Rate for Payer: GEHA Commercial |
$17,996.80
|
| Rate for Payer: GEHA Medicare |
$17,050.62
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$20,246.40
|
| Rate for Payer: Humana ChoiceCare |
$18,755.68
|
| Rate for Payer: Humana Medicare Advantage |
$17,050.62
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28,645.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17,915.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,050.62
|
| Rate for Payer: Multiplan All |
$20,471.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28,986.05
|
| Rate for Payer: OMNI Networks Commercial |
$15,747.20
|
| Rate for Payer: One Health Plan PPO/POS |
$20,246.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20,686.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17,915.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17,050.62
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$21,371.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34,101.24
|
| Rate for Payer: Three Rivers Provider Network All |
$16,872.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16,709.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17,915.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,050.62
|
| Rate for Payer: United Payors & United Providers UP&UP |
$20,921.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17,050.62
|
| Rate for Payer: Zelis Auto |
$8,998.40
|
| Rate for Payer: Zelis Medicare |
$14,493.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20,460.74
|
| Rate for Payer: Zelis Worker's Compensation |
$6,141.41
|
|
|
PERQ TX MALAR FRACTURE
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
CPT 21355
|
| Hospital Charge Code |
6121355
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$223.86 |
| Max. Negotiated Rate |
$779.00 |
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cigna Commercial |
$697.00
|
| Rate for Payer: First Health Commercial |
$738.00
|
| Rate for Payer: First Health Workers Compensation |
$316.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$738.00
|
| Rate for Payer: GEHA Commercial |
$574.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$738.00
|
| Rate for Payer: Multiplan All |
$746.20
|
| Rate for Payer: OMNI Networks Commercial |
$574.00
|
| Rate for Payer: One Health Plan PPO/POS |
$738.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$779.00
|
| Rate for Payer: Three Rivers Provider Network All |
$615.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$762.60
|
| Rate for Payer: Zelis Auto |
$328.00
|
| Rate for Payer: Zelis Worker's Compensation |
$223.86
|
|
|
PERQ TX MALAR FRACTURE
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT 21355
|
| Hospital Charge Code |
6121355
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$223.86 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$492.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cigna Commercial |
$697.00
|
| Rate for Payer: First Health Commercial |
$738.00
|
| Rate for Payer: First Health Workers Compensation |
$316.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$738.00
|
| Rate for Payer: GEHA Commercial |
$656.00
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$738.00
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$746.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$574.00
|
| Rate for Payer: One Health Plan PPO/POS |
$738.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$779.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$615.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$762.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$328.00
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$223.86
|
|
|
PERQ TX NASOETHMOID FX
|
Facility
|
OP
|
$1,547.00
|
|
|
Service Code
|
CPT 21340
|
| Hospital Charge Code |
6121340
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$422.33 |
| Max. Negotiated Rate |
$6,158.84 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$928.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,345.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,442.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,079.42
|
| Rate for Payer: Cash Price |
$928.20
|
| Rate for Payer: Cash Price |
$928.20
|
| Rate for Payer: Cigna Commercial |
$1,314.95
|
| Rate for Payer: First Health Commercial |
$1,392.30
|
| Rate for Payer: First Health Workers Compensation |
$597.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,392.30
|
| Rate for Payer: GEHA Commercial |
$1,237.60
|
| Rate for Payer: GEHA Medicare |
$3,079.42
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,392.30
|
| Rate for Payer: Humana ChoiceCare |
$3,387.36
|
| Rate for Payer: Humana Medicare Advantage |
$3,079.42
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,173.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,079.42
|
| Rate for Payer: Multiplan All |
$1,407.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,235.01
|
| Rate for Payer: OMNI Networks Commercial |
$1,082.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,392.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,056.21
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,512.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,079.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,469.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,158.84
|
| Rate for Payer: Three Rivers Provider Network All |
$1,160.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,017.83
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,079.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,438.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,079.42
|
| Rate for Payer: Zelis Auto |
$618.80
|
| Rate for Payer: Zelis Medicare |
$2,617.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,695.30
|
| Rate for Payer: Zelis Worker's Compensation |
$422.33
|
|
|
PERQ TX NASOETHMOID FX
|
Facility
|
IP
|
$1,547.00
|
|
|
Service Code
|
CPT 21340
|
| Hospital Charge Code |
6121340
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$422.33 |
| Max. Negotiated Rate |
$1,469.65 |
| Rate for Payer: Cash Price |
$928.20
|
| Rate for Payer: Cigna Commercial |
$1,314.95
|
| Rate for Payer: First Health Commercial |
$1,392.30
|
| Rate for Payer: First Health Workers Compensation |
$597.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,392.30
|
| Rate for Payer: GEHA Commercial |
$1,082.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,392.30
|
| Rate for Payer: Multiplan All |
$1,407.77
|
| Rate for Payer: OMNI Networks Commercial |
$1,082.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,392.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,469.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,160.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,438.71
|
| Rate for Payer: Zelis Auto |
$618.80
|
| Rate for Payer: Zelis Worker's Compensation |
$422.33
|
|
|
PERTECHNETATE PER MC
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT A9512
|
| Hospital Charge Code |
2410053
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$25.66 |
| Max. Negotiated Rate |
$89.30 |
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$79.90
|
| Rate for Payer: First Health Commercial |
$84.60
|
| Rate for Payer: First Health Workers Compensation |
$36.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$84.60
|
| Rate for Payer: GEHA Commercial |
$65.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$84.60
|
| Rate for Payer: Multiplan All |
$85.54
|
| Rate for Payer: OMNI Networks Commercial |
$65.80
|
| Rate for Payer: One Health Plan PPO/POS |
$84.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$89.30
|
| Rate for Payer: Three Rivers Provider Network All |
$70.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$87.42
|
| Rate for Payer: Zelis Auto |
$37.60
|
| Rate for Payer: Zelis Worker's Compensation |
$25.66
|
|
|
PERTECHNETATE PER MC
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT A9512
|
| Hospital Charge Code |
2410053
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$89.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$79.90
|
| Rate for Payer: First Health Commercial |
$84.60
|
| Rate for Payer: First Health Workers Compensation |
$36.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$84.60
|
| Rate for Payer: GEHA Commercial |
$75.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$84.60
|
| Rate for Payer: Humana ChoiceCare |
$24.44
|
| Rate for Payer: Multiplan All |
$85.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$56.40
|
| Rate for Payer: OMNI Networks Commercial |
$65.80
|
| Rate for Payer: One Health Plan PPO/POS |
$84.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$89.30
|
| Rate for Payer: Three Rivers Provider Network All |
$70.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$82.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$87.42
|
| Rate for Payer: Zelis Auto |
$37.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$47.00
|
| Rate for Payer: Zelis Worker's Compensation |
$25.66
|
|
|
PERTUSSIS NASOPHARNGEAL REF
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
2300121
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$78.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.63
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$10.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$104.80
|
| Rate for Payer: GEHA Medicare |
$6.63
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Humana ChoiceCare |
$7.29
|
| Rate for Payer: Humana Medicare Advantage |
$6.63
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.65
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.63
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.27
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$11.14
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.65
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13.26
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.50
|
| Rate for Payer: United Healthcare Commercial |
$111.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.63
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.63
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Medicare |
$5.64
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.96
|
| Rate for Payer: Zelis Worker's Compensation |
$7.64
|
|
|
PERTUSSIS NASOPHARNGEAL REF
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
2300121
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$111.35
|
| Rate for Payer: First Health Commercial |
$117.90
|
| Rate for Payer: First Health Workers Compensation |
$10.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$117.90
|
| Rate for Payer: GEHA Commercial |
$91.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$117.90
|
| Rate for Payer: Multiplan All |
$119.21
|
| Rate for Payer: OMNI Networks Commercial |
$91.70
|
| Rate for Payer: One Health Plan PPO/POS |
$117.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$124.45
|
| Rate for Payer: Three Rivers Provider Network All |
$98.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$121.83
|
| Rate for Payer: Zelis Auto |
$52.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.64
|
|
|
PESSARY CUBE #0
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT A4561
|
| Hospital Charge Code |
7007001
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.25 |
| Max. Negotiated Rate |
$339.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$303.45
|
| Rate for Payer: First Health Commercial |
$321.30
|
| Rate for Payer: First Health Workers Compensation |
$137.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$321.30
|
| Rate for Payer: GEHA Commercial |
$285.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$321.30
|
| Rate for Payer: Humana ChoiceCare |
$92.82
|
| Rate for Payer: Multiplan All |
$324.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$214.20
|
| Rate for Payer: OMNI Networks Commercial |
$249.90
|
| Rate for Payer: One Health Plan PPO/POS |
$321.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$339.15
|
| Rate for Payer: Three Rivers Provider Network All |
$267.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$314.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$89.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$332.01
|
| Rate for Payer: Zelis Auto |
$142.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$178.50
|
| Rate for Payer: Zelis Worker's Compensation |
$97.46
|
|
|
PESSARY CUBE #0
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT A4561
|
| Hospital Charge Code |
7007001
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$97.46 |
| Max. Negotiated Rate |
$339.15 |
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$303.45
|
| Rate for Payer: First Health Commercial |
$321.30
|
| Rate for Payer: First Health Workers Compensation |
$137.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$321.30
|
| Rate for Payer: GEHA Commercial |
$249.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$321.30
|
| Rate for Payer: Multiplan All |
$324.87
|
| Rate for Payer: OMNI Networks Commercial |
$249.90
|
| Rate for Payer: One Health Plan PPO/POS |
$321.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$339.15
|
| Rate for Payer: Three Rivers Provider Network All |
$267.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$332.01
|
| Rate for Payer: Zelis Auto |
$142.80
|
| Rate for Payer: Zelis Worker's Compensation |
$97.46
|
|
|
PESSARY, NON RUBBER, ANY TYPE
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT A4562
|
| Hospital Charge Code |
23500038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$134.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cigna Commercial |
$120.70
|
| Rate for Payer: First Health Commercial |
$127.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$127.80
|
| Rate for Payer: GEHA Commercial |
$113.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$127.80
|
| Rate for Payer: Humana ChoiceCare |
$36.92
|
| Rate for Payer: Multiplan All |
$129.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$85.20
|
| Rate for Payer: OMNI Networks Commercial |
$99.40
|
| Rate for Payer: One Health Plan PPO/POS |
$127.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$134.90
|
| Rate for Payer: Three Rivers Provider Network All |
$106.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$124.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$35.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.06
|
| Rate for Payer: Zelis Auto |
$56.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$71.00
|
|
|
PESSARY, NON RUBBER, ANY TYPE
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT A4562
|
| Hospital Charge Code |
23500038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$134.90 |
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cigna Commercial |
$120.70
|
| Rate for Payer: First Health Commercial |
$127.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$127.80
|
| Rate for Payer: GEHA Commercial |
$99.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$127.80
|
| Rate for Payer: Multiplan All |
$129.22
|
| Rate for Payer: OMNI Networks Commercial |
$99.40
|
| Rate for Payer: One Health Plan PPO/POS |
$127.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$134.90
|
| Rate for Payer: Three Rivers Provider Network All |
$106.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$132.06
|
| Rate for Payer: Zelis Auto |
$56.80
|
|
|
PET CT BRAIN
|
Facility
|
IP
|
$7,708.00
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
31000004
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,607.89 |
| Max. Negotiated Rate |
$7,322.60 |
| Rate for Payer: Cash Price |
$4,624.80
|
| Rate for Payer: Cash Price |
$4,624.80
|
| Rate for Payer: Cigna Commercial |
$6,551.80
|
| Rate for Payer: First Health Commercial |
$6,937.20
|
| Rate for Payer: First Health Workers Compensation |
$2,274.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,937.20
|
| Rate for Payer: GEHA Commercial |
$5,395.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,937.20
|
| Rate for Payer: Multiplan All |
$7,014.28
|
| Rate for Payer: OMNI Networks Commercial |
$5,395.60
|
| Rate for Payer: One Health Plan PPO/POS |
$6,937.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,322.60
|
| Rate for Payer: Three Rivers Provider Network All |
$5,781.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,168.44
|
| Rate for Payer: Zelis Auto |
$3,083.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,607.89
|
|
|
PET CT BRAIN
|
Facility
|
OP
|
$7,708.00
|
|
|
Service Code
|
CPT 78608
|
| Hospital Charge Code |
31000004
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,177.24 |
| Max. Negotiated Rate |
$7,322.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,556.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,624.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,556.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,232.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,384.99
|
| Rate for Payer: Cash Price |
$4,624.80
|
| Rate for Payer: Cash Price |
$4,624.80
|
| Rate for Payer: Cigna Commercial |
$6,551.80
|
| Rate for Payer: First Health Commercial |
$6,937.20
|
| Rate for Payer: First Health Workers Compensation |
$2,274.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,937.20
|
| Rate for Payer: GEHA Commercial |
$6,166.40
|
| Rate for Payer: GEHA Medicare |
$1,384.99
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,937.20
|
| Rate for Payer: Humana ChoiceCare |
$1,523.49
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.99
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,326.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,257.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,384.99
|
| Rate for Payer: Multiplan All |
$7,014.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,354.48
|
| Rate for Payer: OMNI Networks Commercial |
$5,395.60
|
| Rate for Payer: One Health Plan PPO/POS |
$6,937.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,452.28
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,257.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,384.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,322.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,769.98
|
| Rate for Payer: Three Rivers Provider Network All |
$5,781.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,357.29
|
| Rate for Payer: United Healthcare Commercial |
$6,551.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,257.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,384.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,168.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,384.99
|
| Rate for Payer: Zelis Auto |
$3,083.20
|
| Rate for Payer: Zelis Medicare |
$1,177.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,661.99
|
| Rate for Payer: Zelis Worker's Compensation |
$1,607.89
|
|
|
PET CT LIMITED
|
Facility
|
OP
|
$7,546.00
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
31000001
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,177.24 |
| Max. Negotiated Rate |
$7,168.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,556.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,527.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,556.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,232.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,384.99
|
| Rate for Payer: Cash Price |
$4,527.60
|
| Rate for Payer: Cash Price |
$4,527.60
|
| Rate for Payer: Cigna Commercial |
$6,414.10
|
| Rate for Payer: First Health Commercial |
$6,791.40
|
| Rate for Payer: First Health Workers Compensation |
$2,201.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,791.40
|
| Rate for Payer: GEHA Commercial |
$6,036.80
|
| Rate for Payer: GEHA Medicare |
$1,384.99
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,791.40
|
| Rate for Payer: Humana ChoiceCare |
$1,523.49
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.99
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,326.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,257.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,384.99
|
| Rate for Payer: Multiplan All |
$6,866.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,354.48
|
| Rate for Payer: OMNI Networks Commercial |
$5,282.20
|
| Rate for Payer: One Health Plan PPO/POS |
$6,791.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,452.28
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,257.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,384.99
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,168.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,769.98
|
| Rate for Payer: Three Rivers Provider Network All |
$5,659.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,357.29
|
| Rate for Payer: United Healthcare Commercial |
$6,414.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,257.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,384.99
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,017.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,384.99
|
| Rate for Payer: Zelis Auto |
$3,018.40
|
| Rate for Payer: Zelis Medicare |
$1,177.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,661.99
|
| Rate for Payer: Zelis Worker's Compensation |
$1,556.30
|
|
|
PET CT LIMITED
|
Facility
|
IP
|
$7,546.00
|
|
|
Service Code
|
CPT 78814
|
| Hospital Charge Code |
31000001
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,556.30 |
| Max. Negotiated Rate |
$7,168.70 |
| Rate for Payer: Cash Price |
$4,527.60
|
| Rate for Payer: Cash Price |
$4,527.60
|
| Rate for Payer: Cigna Commercial |
$6,414.10
|
| Rate for Payer: First Health Commercial |
$6,791.40
|
| Rate for Payer: First Health Workers Compensation |
$2,201.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,791.40
|
| Rate for Payer: GEHA Commercial |
$5,282.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,791.40
|
| Rate for Payer: Multiplan All |
$6,866.86
|
| Rate for Payer: OMNI Networks Commercial |
$5,282.20
|
| Rate for Payer: One Health Plan PPO/POS |
$6,791.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$7,168.70
|
| Rate for Payer: Three Rivers Provider Network All |
$5,659.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$7,017.78
|
| Rate for Payer: Zelis Auto |
$3,018.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,556.30
|
|
|
PET CT PERFUSION
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
CPT 78609
|
| Hospital Charge Code |
31000005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$58.25 |
| Max. Negotiated Rate |
$1,940.79 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$139.80
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$198.05
|
| Rate for Payer: First Health Commercial |
$209.70
|
| Rate for Payer: First Health Workers Compensation |
$1,940.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$209.70
|
| Rate for Payer: GEHA Commercial |
$186.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$209.70
|
| Rate for Payer: Humana ChoiceCare |
$60.58
|
| Rate for Payer: Multiplan All |
$212.03
|
| Rate for Payer: New Mexico Health Connections Medicare |
$139.80
|
| Rate for Payer: OMNI Networks Commercial |
$163.10
|
| Rate for Payer: One Health Plan PPO/POS |
$209.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$221.35
|
| Rate for Payer: Three Rivers Provider Network All |
$174.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$205.04
|
| Rate for Payer: United Healthcare Commercial |
$198.05
|
| Rate for Payer: United Healthcare Managed Medicaid |
$58.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$216.69
|
| Rate for Payer: Zelis Auto |
$93.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$116.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,372.27
|
|
|
PET CT PERFUSION
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 78609
|
| Hospital Charge Code |
31000005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$93.20 |
| Max. Negotiated Rate |
$1,940.79 |
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$198.05
|
| Rate for Payer: First Health Commercial |
$209.70
|
| Rate for Payer: First Health Workers Compensation |
$1,940.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$209.70
|
| Rate for Payer: GEHA Commercial |
$163.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$209.70
|
| Rate for Payer: Multiplan All |
$212.03
|
| Rate for Payer: OMNI Networks Commercial |
$163.10
|
| Rate for Payer: One Health Plan PPO/POS |
$209.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$221.35
|
| Rate for Payer: Three Rivers Provider Network All |
$174.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$216.69
|
| Rate for Payer: Zelis Auto |
$93.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,372.27
|
|
