|
PLACE CATHETER IN VEIN
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
6136010
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$96.64 |
| Max. Negotiated Rate |
$336.30 |
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cigna Commercial |
$300.90
|
| Rate for Payer: First Health Commercial |
$318.60
|
| Rate for Payer: First Health Workers Compensation |
$136.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$318.60
|
| Rate for Payer: GEHA Commercial |
$247.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$318.60
|
| Rate for Payer: Multiplan All |
$322.14
|
| Rate for Payer: OMNI Networks Commercial |
$247.80
|
| Rate for Payer: One Health Plan PPO/POS |
$318.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$336.30
|
| Rate for Payer: Three Rivers Provider Network All |
$265.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$329.22
|
| Rate for Payer: Zelis Auto |
$141.60
|
| Rate for Payer: Zelis Worker's Compensation |
$96.64
|
|
|
PLACE CATH INTRACRANIAL ART
|
Facility
|
OP
|
$788.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
6136228
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$197.00 |
| Max. Negotiated Rate |
$748.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$472.80
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cigna Commercial |
$669.80
|
| Rate for Payer: First Health Commercial |
$709.20
|
| Rate for Payer: First Health Workers Compensation |
$304.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$709.20
|
| Rate for Payer: GEHA Commercial |
$630.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$709.20
|
| Rate for Payer: Humana ChoiceCare |
$204.88
|
| Rate for Payer: Multiplan All |
$717.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$472.80
|
| Rate for Payer: OMNI Networks Commercial |
$551.60
|
| Rate for Payer: One Health Plan PPO/POS |
$709.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$748.60
|
| Rate for Payer: Three Rivers Provider Network All |
$591.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$693.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$197.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$732.84
|
| Rate for Payer: Zelis Auto |
$315.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$394.00
|
| Rate for Payer: Zelis Worker's Compensation |
$215.12
|
|
|
PLACE CATH INTRACRANIAL ART
|
Facility
|
IP
|
$788.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
6136228
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$215.12 |
| Max. Negotiated Rate |
$748.60 |
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cigna Commercial |
$669.80
|
| Rate for Payer: First Health Commercial |
$709.20
|
| Rate for Payer: First Health Workers Compensation |
$304.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$709.20
|
| Rate for Payer: GEHA Commercial |
$551.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$709.20
|
| Rate for Payer: Multiplan All |
$717.08
|
| Rate for Payer: OMNI Networks Commercial |
$551.60
|
| Rate for Payer: One Health Plan PPO/POS |
$709.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$748.60
|
| Rate for Payer: Three Rivers Provider Network All |
$591.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$732.84
|
| Rate for Payer: Zelis Auto |
$315.20
|
| Rate for Payer: Zelis Worker's Compensation |
$215.12
|
|
|
PLACE CATH SUBCLAVIAN ART
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
6136225
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$279.82 |
| Max. Negotiated Rate |
$973.75 |
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$871.25
|
| Rate for Payer: First Health Commercial |
$922.50
|
| Rate for Payer: First Health Workers Compensation |
$395.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$922.50
|
| Rate for Payer: GEHA Commercial |
$717.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$922.50
|
| Rate for Payer: Multiplan All |
$932.75
|
| Rate for Payer: OMNI Networks Commercial |
$717.50
|
| Rate for Payer: One Health Plan PPO/POS |
$922.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$973.75
|
| Rate for Payer: Three Rivers Provider Network All |
$768.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$953.25
|
| Rate for Payer: Zelis Auto |
$410.00
|
| Rate for Payer: Zelis Worker's Compensation |
$279.82
|
|
|
PLACE CATH SUBCLAVIAN ART
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
6136225
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$279.82 |
| Max. Negotiated Rate |
$5,977.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,147.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$615.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,147.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,493.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$871.25
|
| Rate for Payer: First Health Commercial |
$922.50
|
| Rate for Payer: First Health Workers Compensation |
$395.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$922.50
|
| Rate for Payer: GEHA Commercial |
$820.00
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$922.50
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,544.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$932.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$717.50
|
| Rate for Payer: One Health Plan PPO/POS |
$922.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,937.49
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,544.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$973.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$768.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,544.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$953.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$410.00
|
| Rate for Payer: Zelis Medicare |
$2,540.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,586.42
|
| Rate for Payer: Zelis Worker's Compensation |
$279.82
|
|
|
PLACE CATH THORACIC AORTA
|
Facility
|
IP
|
$649.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
6136221
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$177.18 |
| Max. Negotiated Rate |
$616.55 |
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cigna Commercial |
$551.65
|
| Rate for Payer: First Health Commercial |
$584.10
|
| Rate for Payer: First Health Workers Compensation |
$250.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$584.10
|
| Rate for Payer: GEHA Commercial |
$454.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$584.10
|
| Rate for Payer: Multiplan All |
$590.59
|
| Rate for Payer: OMNI Networks Commercial |
$454.30
|
| Rate for Payer: One Health Plan PPO/POS |
$584.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$616.55
|
| Rate for Payer: Three Rivers Provider Network All |
$486.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$603.57
|
| Rate for Payer: Zelis Auto |
$259.60
|
| Rate for Payer: Zelis Worker's Compensation |
$177.18
|
|
|
PLACE CATH THORACIC AORTA
|
Facility
|
OP
|
$649.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
6136221
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$177.18 |
| Max. Negotiated Rate |
$5,977.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,147.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$389.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,147.32
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,493.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cigna Commercial |
$551.65
|
| Rate for Payer: First Health Commercial |
$584.10
|
| Rate for Payer: First Health Workers Compensation |
$250.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$584.10
|
| Rate for Payer: GEHA Commercial |
$519.20
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$584.10
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,544.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$590.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$454.30
|
| Rate for Payer: One Health Plan PPO/POS |
$584.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,937.49
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,544.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$616.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$486.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,544.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$603.57
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$259.60
|
| Rate for Payer: Zelis Medicare |
$2,540.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,586.42
|
| Rate for Payer: Zelis Worker's Compensation |
$177.18
|
|
|
PLACE CATH VERTEBRAL ART
|
Facility
|
OP
|
$1,155.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
6136226
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$315.31 |
| Max. Negotiated Rate |
$10,265.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,147.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$693.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,147.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,077.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,132.93
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cigna Commercial |
$981.75
|
| Rate for Payer: First Health Commercial |
$1,039.50
|
| Rate for Payer: First Health Workers Compensation |
$445.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,039.50
|
| Rate for Payer: GEHA Commercial |
$924.00
|
| Rate for Payer: GEHA Medicare |
$5,132.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,039.50
|
| Rate for Payer: Humana ChoiceCare |
$5,646.22
|
| Rate for Payer: Humana Medicare Advantage |
$5,132.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,623.32
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,160.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,132.93
|
| Rate for Payer: Multiplan All |
$1,051.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,725.98
|
| Rate for Payer: OMNI Networks Commercial |
$808.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,039.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,804.10
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,160.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,132.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,097.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10,265.86
|
| Rate for Payer: Three Rivers Provider Network All |
$866.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,030.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,160.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,132.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,074.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,132.93
|
| Rate for Payer: Zelis Auto |
$462.00
|
| Rate for Payer: Zelis Medicare |
$4,362.99
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,159.52
|
| Rate for Payer: Zelis Worker's Compensation |
$315.31
|
|
|
PLACE CATH VERTEBRAL ART
|
Facility
|
IP
|
$1,155.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
6136226
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$315.31 |
| Max. Negotiated Rate |
$1,097.25 |
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cigna Commercial |
$981.75
|
| Rate for Payer: First Health Commercial |
$1,039.50
|
| Rate for Payer: First Health Workers Compensation |
$445.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,039.50
|
| Rate for Payer: GEHA Commercial |
$808.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,039.50
|
| Rate for Payer: Multiplan All |
$1,051.05
|
| Rate for Payer: OMNI Networks Commercial |
$808.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,039.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,097.25
|
| Rate for Payer: Three Rivers Provider Network All |
$866.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,074.15
|
| Rate for Payer: Zelis Auto |
$462.00
|
| Rate for Payer: Zelis Worker's Compensation |
$315.31
|
|
|
PLACE CATH XTRNL CAROTID
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
6136227
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$90.75 |
| Max. Negotiated Rate |
$344.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$217.80
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Cigna Commercial |
$308.55
|
| Rate for Payer: First Health Commercial |
$326.70
|
| Rate for Payer: First Health Workers Compensation |
$140.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$326.70
|
| Rate for Payer: GEHA Commercial |
$290.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$326.70
|
| Rate for Payer: Humana ChoiceCare |
$94.38
|
| Rate for Payer: Multiplan All |
$330.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$217.80
|
| Rate for Payer: OMNI Networks Commercial |
$254.10
|
| Rate for Payer: One Health Plan PPO/POS |
$326.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$344.85
|
| Rate for Payer: Three Rivers Provider Network All |
$272.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$319.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$90.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$337.59
|
| Rate for Payer: Zelis Auto |
$145.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$181.50
|
| Rate for Payer: Zelis Worker's Compensation |
$99.10
|
|
|
PLACE CATH XTRNL CAROTID
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
6136227
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$99.10 |
| Max. Negotiated Rate |
$344.85 |
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Cigna Commercial |
$308.55
|
| Rate for Payer: First Health Commercial |
$326.70
|
| Rate for Payer: First Health Workers Compensation |
$140.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$326.70
|
| Rate for Payer: GEHA Commercial |
$254.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$326.70
|
| Rate for Payer: Multiplan All |
$330.33
|
| Rate for Payer: OMNI Networks Commercial |
$254.10
|
| Rate for Payer: One Health Plan PPO/POS |
$326.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$344.85
|
| Rate for Payer: Three Rivers Provider Network All |
$272.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$337.59
|
| Rate for Payer: Zelis Auto |
$145.20
|
| Rate for Payer: Zelis Worker's Compensation |
$99.10
|
|
|
PLACE DUOD/JEJ TUBE PERC
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 49441
|
| Hospital Charge Code |
6149441
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$209.12 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$459.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$700.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$459.60
|
| Rate for Payer: Cash Price |
$459.60
|
| Rate for Payer: Cigna Commercial |
$651.10
|
| Rate for Payer: First Health Commercial |
$689.40
|
| Rate for Payer: First Health Workers Compensation |
$295.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$689.40
|
| Rate for Payer: GEHA Commercial |
$612.80
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$689.40
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$697.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$536.20
|
| Rate for Payer: One Health Plan PPO/POS |
$689.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$825.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$714.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$727.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$574.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$712.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$306.40
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$209.12
|
|
|
PLACE DUOD/JEJ TUBE PERC
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 49441
|
| Hospital Charge Code |
6149441
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$209.12 |
| Max. Negotiated Rate |
$727.70 |
| Rate for Payer: Cash Price |
$459.60
|
| Rate for Payer: Cigna Commercial |
$651.10
|
| Rate for Payer: First Health Commercial |
$689.40
|
| Rate for Payer: First Health Workers Compensation |
$295.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$689.40
|
| Rate for Payer: GEHA Commercial |
$536.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$689.40
|
| Rate for Payer: Multiplan All |
$697.06
|
| Rate for Payer: OMNI Networks Commercial |
$536.20
|
| Rate for Payer: One Health Plan PPO/POS |
$689.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$727.70
|
| Rate for Payer: Three Rivers Provider Network All |
$574.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$712.38
|
| Rate for Payer: Zelis Auto |
$306.40
|
| Rate for Payer: Zelis Worker's Compensation |
$209.12
|
|
|
PLACE GASTROSTOMY TUBE
|
Facility
|
OP
|
$1,214.00
|
|
|
Service Code
|
CPT 43831
|
| Hospital Charge Code |
6143831
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$331.42 |
| Max. Negotiated Rate |
$1,780.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$728.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$700.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$890.25
|
| Rate for Payer: Cash Price |
$728.40
|
| Rate for Payer: Cash Price |
$728.40
|
| Rate for Payer: Cigna Commercial |
$1,031.90
|
| Rate for Payer: First Health Commercial |
$1,092.60
|
| Rate for Payer: First Health Workers Compensation |
$468.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,092.60
|
| Rate for Payer: GEHA Commercial |
$971.20
|
| Rate for Payer: GEHA Medicare |
$890.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,092.60
|
| Rate for Payer: Humana ChoiceCare |
$979.27
|
| Rate for Payer: Humana Medicare Advantage |
$890.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,495.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$890.25
|
| Rate for Payer: Multiplan All |
$1,104.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,513.42
|
| Rate for Payer: OMNI Networks Commercial |
$849.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,092.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$825.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$714.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$890.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,153.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,780.50
|
| Rate for Payer: Three Rivers Provider Network All |
$910.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$872.45
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$890.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,129.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$890.25
|
| Rate for Payer: Zelis Auto |
$485.60
|
| Rate for Payer: Zelis Medicare |
$756.71
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,068.30
|
| Rate for Payer: Zelis Worker's Compensation |
$331.42
|
|
|
PLACE GASTROSTOMY TUBE
|
Facility
|
OP
|
$1,463.00
|
|
|
Service Code
|
CPT 43830
|
| Hospital Charge Code |
6143830
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$399.40 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,453.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$877.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,453.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,944.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$877.80
|
| Rate for Payer: Cash Price |
$877.80
|
| Rate for Payer: Cigna Commercial |
$1,243.55
|
| Rate for Payer: First Health Commercial |
$1,316.70
|
| Rate for Payer: First Health Workers Compensation |
$564.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,316.70
|
| Rate for Payer: GEHA Commercial |
$1,170.40
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,316.70
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,983.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$1,331.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$1,024.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,316.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,290.34
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,983.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,389.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$1,097.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,983.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,360.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$585.20
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$399.40
|
|
|
PLACE GASTROSTOMY TUBE
|
Facility
|
IP
|
$1,463.00
|
|
|
Service Code
|
CPT 43830
|
| Hospital Charge Code |
6143830
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$399.40 |
| Max. Negotiated Rate |
$1,389.85 |
| Rate for Payer: Cash Price |
$877.80
|
| Rate for Payer: Cigna Commercial |
$1,243.55
|
| Rate for Payer: First Health Commercial |
$1,316.70
|
| Rate for Payer: First Health Workers Compensation |
$564.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,316.70
|
| Rate for Payer: GEHA Commercial |
$1,024.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,316.70
|
| Rate for Payer: Multiplan All |
$1,331.33
|
| Rate for Payer: OMNI Networks Commercial |
$1,024.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,316.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,389.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,097.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,360.59
|
| Rate for Payer: Zelis Auto |
$585.20
|
| Rate for Payer: Zelis Worker's Compensation |
$399.40
|
|
|
PLACE GASTROSTOMY TUBE
|
Facility
|
IP
|
$1,214.00
|
|
|
Service Code
|
CPT 43831
|
| Hospital Charge Code |
6143831
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$331.42 |
| Max. Negotiated Rate |
$1,153.30 |
| Rate for Payer: Cash Price |
$728.40
|
| Rate for Payer: Cigna Commercial |
$1,031.90
|
| Rate for Payer: First Health Commercial |
$1,092.60
|
| Rate for Payer: First Health Workers Compensation |
$468.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,092.60
|
| Rate for Payer: GEHA Commercial |
$849.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,092.60
|
| Rate for Payer: Multiplan All |
$1,104.74
|
| Rate for Payer: OMNI Networks Commercial |
$849.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,092.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,153.30
|
| Rate for Payer: Three Rivers Provider Network All |
$910.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,129.02
|
| Rate for Payer: Zelis Auto |
$485.60
|
| Rate for Payer: Zelis Worker's Compensation |
$331.42
|
|
|
PLACE GASTROSTOMY TUBE
|
Facility
|
IP
|
$2,188.00
|
|
|
Service Code
|
CPT 43832
|
| Hospital Charge Code |
6143832
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$597.32 |
| Max. Negotiated Rate |
$2,078.60 |
| Rate for Payer: Cash Price |
$1,312.80
|
| Rate for Payer: Cigna Commercial |
$1,859.80
|
| Rate for Payer: First Health Commercial |
$1,969.20
|
| Rate for Payer: First Health Workers Compensation |
$844.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,969.20
|
| Rate for Payer: GEHA Commercial |
$1,531.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,969.20
|
| Rate for Payer: Multiplan All |
$1,991.08
|
| Rate for Payer: OMNI Networks Commercial |
$1,531.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,969.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,078.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,641.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,034.84
|
| Rate for Payer: Zelis Auto |
$875.20
|
| Rate for Payer: Zelis Worker's Compensation |
$597.32
|
|
|
PLACE GASTROSTOMY TUBE
|
Facility
|
OP
|
$2,188.00
|
|
|
Service Code
|
CPT 43832
|
| Hospital Charge Code |
6143832
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$547.00 |
| Max. Negotiated Rate |
$2,078.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,312.80
|
| Rate for Payer: Cash Price |
$1,312.80
|
| Rate for Payer: Cigna Commercial |
$1,859.80
|
| Rate for Payer: First Health Commercial |
$1,969.20
|
| Rate for Payer: First Health Workers Compensation |
$844.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,969.20
|
| Rate for Payer: GEHA Commercial |
$1,750.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,969.20
|
| Rate for Payer: Humana ChoiceCare |
$568.88
|
| Rate for Payer: Multiplan All |
$1,991.08
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,312.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,531.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,969.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,078.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,641.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,925.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$547.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,034.84
|
| Rate for Payer: Zelis Auto |
$875.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,094.00
|
| Rate for Payer: Zelis Worker's Compensation |
$597.32
|
|
|
PLACE GASTROSTOMY TUBE
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
6143246
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$148.24 |
| Max. Negotiated Rate |
$515.85 |
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$461.55
|
| Rate for Payer: First Health Commercial |
$488.70
|
| Rate for Payer: First Health Workers Compensation |
$209.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$488.70
|
| Rate for Payer: GEHA Commercial |
$380.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$488.70
|
| Rate for Payer: Multiplan All |
$494.13
|
| Rate for Payer: OMNI Networks Commercial |
$380.10
|
| Rate for Payer: One Health Plan PPO/POS |
$488.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$515.85
|
| Rate for Payer: Three Rivers Provider Network All |
$407.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.99
|
| Rate for Payer: Zelis Auto |
$217.20
|
| Rate for Payer: Zelis Worker's Compensation |
$148.24
|
|
|
PLACE GASTROSTOMY TUBE
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
6143246
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$148.24 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$325.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$700.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$461.55
|
| Rate for Payer: First Health Commercial |
$488.70
|
| Rate for Payer: First Health Workers Compensation |
$209.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$488.70
|
| Rate for Payer: GEHA Commercial |
$434.40
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$488.70
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$494.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$380.10
|
| Rate for Payer: One Health Plan PPO/POS |
$488.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$825.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$714.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$515.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$407.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$504.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$217.20
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$148.24
|
|
|
PLACE GASTROSTOMY TUBE PERC
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
CPT 49440
|
| Hospital Charge Code |
6149440
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$177.45 |
| Max. Negotiated Rate |
$617.50 |
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$552.50
|
| Rate for Payer: First Health Commercial |
$585.00
|
| Rate for Payer: First Health Workers Compensation |
$250.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$585.00
|
| Rate for Payer: GEHA Commercial |
$455.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$585.00
|
| Rate for Payer: Multiplan All |
$591.50
|
| Rate for Payer: OMNI Networks Commercial |
$455.00
|
| Rate for Payer: One Health Plan PPO/POS |
$585.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$617.50
|
| Rate for Payer: Three Rivers Provider Network All |
$487.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$604.50
|
| Rate for Payer: Zelis Auto |
$260.00
|
| Rate for Payer: Zelis Worker's Compensation |
$177.45
|
|
|
PLACE GASTROSTOMY TUBE PERC
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
CPT 49440
|
| Hospital Charge Code |
6149440
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$177.45 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$390.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$700.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$552.50
|
| Rate for Payer: First Health Commercial |
$585.00
|
| Rate for Payer: First Health Workers Compensation |
$250.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$585.00
|
| Rate for Payer: GEHA Commercial |
$520.00
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$585.00
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$591.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$455.00
|
| Rate for Payer: One Health Plan PPO/POS |
$585.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$825.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$714.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$617.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$487.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$604.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$260.00
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$177.45
|
|
|
PLACEMENT BILE DUCT SUPPORT
|
Facility
|
OP
|
$2,078.00
|
|
|
Service Code
|
CPT 47801
|
| Hospital Charge Code |
6147801
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$519.50 |
| Max. Negotiated Rate |
$1,974.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,246.80
|
| Rate for Payer: Cash Price |
$1,246.80
|
| Rate for Payer: Cigna Commercial |
$1,766.30
|
| Rate for Payer: First Health Commercial |
$1,870.20
|
| Rate for Payer: First Health Workers Compensation |
$802.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,870.20
|
| Rate for Payer: GEHA Commercial |
$1,662.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,870.20
|
| Rate for Payer: Humana ChoiceCare |
$540.28
|
| Rate for Payer: Multiplan All |
$1,890.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,246.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,454.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,870.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,974.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,558.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,828.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$519.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,932.54
|
| Rate for Payer: Zelis Auto |
$831.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,039.00
|
| Rate for Payer: Zelis Worker's Compensation |
$567.29
|
|
|
PLACEMENT BILE DUCT SUPPORT
|
Facility
|
IP
|
$2,078.00
|
|
|
Service Code
|
CPT 47801
|
| Hospital Charge Code |
6147801
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$567.29 |
| Max. Negotiated Rate |
$1,974.10 |
| Rate for Payer: Cash Price |
$1,246.80
|
| Rate for Payer: Cigna Commercial |
$1,766.30
|
| Rate for Payer: First Health Commercial |
$1,870.20
|
| Rate for Payer: First Health Workers Compensation |
$802.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,870.20
|
| Rate for Payer: GEHA Commercial |
$1,454.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,870.20
|
| Rate for Payer: Multiplan All |
$1,890.98
|
| Rate for Payer: OMNI Networks Commercial |
$1,454.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,870.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,974.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,558.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,932.54
|
| Rate for Payer: Zelis Auto |
$831.20
|
| Rate for Payer: Zelis Worker's Compensation |
$567.29
|
|
