|
REDUCT HAND DISLOC
|
Facility
|
IP
|
$1,495.00
|
|
| Hospital Charge Code |
8126670
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$408.13 |
| Max. Negotiated Rate |
$1,420.25 |
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$1,270.75
|
| Rate for Payer: First Health Commercial |
$1,345.50
|
| Rate for Payer: First Health Workers Compensation |
$577.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,345.50
|
| Rate for Payer: GEHA Commercial |
$1,046.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,345.50
|
| Rate for Payer: Multiplan All |
$1,360.45
|
| Rate for Payer: OMNI Networks Commercial |
$1,046.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,345.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,420.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,121.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,390.35
|
| Rate for Payer: Zelis Auto |
$598.00
|
| Rate for Payer: Zelis Worker's Compensation |
$408.13
|
|
|
REDUCT HAND DISLOC
|
Facility
|
OP
|
$1,495.00
|
|
| Hospital Charge Code |
8126670
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$373.75 |
| Max. Negotiated Rate |
$1,420.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$897.00
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$1,270.75
|
| Rate for Payer: First Health Commercial |
$1,345.50
|
| Rate for Payer: First Health Workers Compensation |
$577.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,345.50
|
| Rate for Payer: GEHA Commercial |
$1,196.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,345.50
|
| Rate for Payer: Humana ChoiceCare |
$388.70
|
| Rate for Payer: Multiplan All |
$1,360.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$897.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,046.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,345.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,420.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,121.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,315.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$373.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,390.35
|
| Rate for Payer: Zelis Auto |
$598.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$747.50
|
| Rate for Payer: Zelis Worker's Compensation |
$408.13
|
|
|
REDUCTION OF LARGE BREAST
|
Facility
|
IP
|
$3,422.00
|
|
|
Service Code
|
CPT 19318
|
| Hospital Charge Code |
6119318
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$934.21 |
| Max. Negotiated Rate |
$3,250.90 |
| Rate for Payer: Cash Price |
$2,053.20
|
| Rate for Payer: Cigna Commercial |
$2,908.70
|
| Rate for Payer: First Health Commercial |
$3,079.80
|
| Rate for Payer: First Health Workers Compensation |
$1,321.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,079.80
|
| Rate for Payer: GEHA Commercial |
$2,395.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,079.80
|
| Rate for Payer: Multiplan All |
$3,114.02
|
| Rate for Payer: OMNI Networks Commercial |
$2,395.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,079.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,250.90
|
| Rate for Payer: Three Rivers Provider Network All |
$2,566.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,182.46
|
| Rate for Payer: Zelis Auto |
$1,368.80
|
| Rate for Payer: Zelis Worker's Compensation |
$934.21
|
|
|
REDUCTION OF LARGE BREAST
|
Facility
|
OP
|
$3,422.00
|
|
|
Service Code
|
CPT 19318
|
| Hospital Charge Code |
6119318
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$934.21 |
| Max. Negotiated Rate |
$12,384.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,246.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,053.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,246.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,364.11
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,192.39
|
| Rate for Payer: Cash Price |
$2,053.20
|
| Rate for Payer: Cash Price |
$2,053.20
|
| Rate for Payer: Cigna Commercial |
$2,908.70
|
| Rate for Payer: First Health Commercial |
$3,079.80
|
| Rate for Payer: First Health Workers Compensation |
$1,321.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,079.80
|
| Rate for Payer: GEHA Commercial |
$2,737.60
|
| Rate for Payer: GEHA Medicare |
$6,192.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,079.80
|
| Rate for Payer: Humana ChoiceCare |
$6,811.63
|
| Rate for Payer: Humana Medicare Advantage |
$6,192.39
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10,403.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,432.62
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,192.39
|
| Rate for Payer: Multiplan All |
$3,114.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$10,527.06
|
| Rate for Payer: OMNI Networks Commercial |
$2,395.40
|
| Rate for Payer: One Health Plan PPO/POS |
$3,079.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,963.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,432.62
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,192.39
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,250.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12,384.78
|
| Rate for Payer: Three Rivers Provider Network All |
$2,566.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,068.54
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,432.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,192.39
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,182.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,192.39
|
| Rate for Payer: Zelis Auto |
$1,368.80
|
| Rate for Payer: Zelis Medicare |
$5,263.53
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7,430.87
|
| Rate for Payer: Zelis Worker's Compensation |
$934.21
|
|
|
REDUCTION OF RECTAL PROLAPSE
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT 45900
|
| Hospital Charge Code |
6145900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$143.32 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$446.25
|
| Rate for Payer: First Health Commercial |
$472.50
|
| Rate for Payer: First Health Workers Compensation |
$202.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$472.50
|
| Rate for Payer: GEHA Commercial |
$367.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$472.50
|
| Rate for Payer: Multiplan All |
$477.75
|
| Rate for Payer: OMNI Networks Commercial |
$367.50
|
| Rate for Payer: One Health Plan PPO/POS |
$472.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$498.75
|
| Rate for Payer: Three Rivers Provider Network All |
$393.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$488.25
|
| Rate for Payer: Zelis Auto |
$210.00
|
| Rate for Payer: Zelis Worker's Compensation |
$143.32
|
|
|
REDUCTION OF RECTAL PROLAPSE
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT 45900
|
| Hospital Charge Code |
6145900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$143.32 |
| Max. Negotiated Rate |
$1,731.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$542.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$315.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$542.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$429.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$865.71
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$446.25
|
| Rate for Payer: First Health Commercial |
$472.50
|
| Rate for Payer: First Health Workers Compensation |
$202.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$472.50
|
| Rate for Payer: GEHA Commercial |
$420.00
|
| Rate for Payer: GEHA Medicare |
$865.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$472.50
|
| Rate for Payer: Humana ChoiceCare |
$952.28
|
| Rate for Payer: Humana Medicare Advantage |
$865.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,454.39
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$438.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$865.71
|
| Rate for Payer: Multiplan All |
$477.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,471.71
|
| Rate for Payer: OMNI Networks Commercial |
$367.50
|
| Rate for Payer: One Health Plan PPO/POS |
$472.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$506.28
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$438.48
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$865.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$498.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,731.42
|
| Rate for Payer: Three Rivers Provider Network All |
$393.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$848.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$438.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$865.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$488.25
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$865.71
|
| Rate for Payer: Zelis Auto |
$210.00
|
| Rate for Payer: Zelis Medicare |
$735.85
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,038.85
|
| Rate for Payer: Zelis Worker's Compensation |
$143.32
|
|
|
REDUCT KNEE DISLOC;W/ANESTH
|
Facility
|
OP
|
$2,377.00
|
|
| Hospital Charge Code |
8127552
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$594.25 |
| Max. Negotiated Rate |
$2,258.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,426.20
|
| Rate for Payer: Cash Price |
$1,426.20
|
| Rate for Payer: Cigna Commercial |
$2,020.45
|
| Rate for Payer: First Health Commercial |
$2,139.30
|
| Rate for Payer: First Health Workers Compensation |
$917.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,139.30
|
| Rate for Payer: GEHA Commercial |
$1,901.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,139.30
|
| Rate for Payer: Humana ChoiceCare |
$618.02
|
| Rate for Payer: Multiplan All |
$2,163.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,426.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,663.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,139.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,258.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,782.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,091.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$594.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,210.61
|
| Rate for Payer: Zelis Auto |
$950.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,188.50
|
| Rate for Payer: Zelis Worker's Compensation |
$648.92
|
|
|
REDUCT KNEE DISLOC;W/ANESTH
|
Facility
|
IP
|
$2,377.00
|
|
| Hospital Charge Code |
8127552
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$648.92 |
| Max. Negotiated Rate |
$2,258.15 |
| Rate for Payer: Cash Price |
$1,426.20
|
| Rate for Payer: Cigna Commercial |
$2,020.45
|
| Rate for Payer: First Health Commercial |
$2,139.30
|
| Rate for Payer: First Health Workers Compensation |
$917.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,139.30
|
| Rate for Payer: GEHA Commercial |
$1,663.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,139.30
|
| Rate for Payer: Multiplan All |
$2,163.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,663.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,139.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,258.15
|
| Rate for Payer: Three Rivers Provider Network All |
$1,782.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,210.61
|
| Rate for Payer: Zelis Auto |
$950.80
|
| Rate for Payer: Zelis Worker's Compensation |
$648.92
|
|
|
REDUCT KNEE DISLOC;W/OUT ANESTH
|
Facility
|
IP
|
$1,770.00
|
|
| Hospital Charge Code |
8127550
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$483.21 |
| Max. Negotiated Rate |
$1,681.50 |
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cigna Commercial |
$1,504.50
|
| Rate for Payer: First Health Commercial |
$1,593.00
|
| Rate for Payer: First Health Workers Compensation |
$683.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,593.00
|
| Rate for Payer: GEHA Commercial |
$1,239.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,593.00
|
| Rate for Payer: Multiplan All |
$1,610.70
|
| Rate for Payer: OMNI Networks Commercial |
$1,239.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,593.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,681.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,327.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,646.10
|
| Rate for Payer: Zelis Auto |
$708.00
|
| Rate for Payer: Zelis Worker's Compensation |
$483.21
|
|
|
REDUCT KNEE DISLOC;W/OUT ANESTH
|
Facility
|
OP
|
$1,770.00
|
|
| Hospital Charge Code |
8127550
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$442.50 |
| Max. Negotiated Rate |
$1,681.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cigna Commercial |
$1,504.50
|
| Rate for Payer: First Health Commercial |
$1,593.00
|
| Rate for Payer: First Health Workers Compensation |
$683.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,593.00
|
| Rate for Payer: GEHA Commercial |
$1,416.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,593.00
|
| Rate for Payer: Humana ChoiceCare |
$460.20
|
| Rate for Payer: Multiplan All |
$1,610.70
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,062.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,239.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,593.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,681.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,327.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,557.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$442.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,646.10
|
| Rate for Payer: Zelis Auto |
$708.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$885.00
|
| Rate for Payer: Zelis Worker's Compensation |
$483.21
|
|
|
REDUCT TRAUMATIC HIP DISLOC
|
Facility
|
IP
|
$4,717.00
|
|
| Hospital Charge Code |
8150081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,287.74 |
| Max. Negotiated Rate |
$4,481.15 |
| Rate for Payer: Cash Price |
$2,830.20
|
| Rate for Payer: Cigna Commercial |
$4,009.45
|
| Rate for Payer: First Health Commercial |
$4,245.30
|
| Rate for Payer: First Health Workers Compensation |
$1,821.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,245.30
|
| Rate for Payer: GEHA Commercial |
$3,301.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,245.30
|
| Rate for Payer: Multiplan All |
$4,292.47
|
| Rate for Payer: OMNI Networks Commercial |
$3,301.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,245.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,481.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,537.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,386.81
|
| Rate for Payer: Zelis Auto |
$1,886.80
|
| Rate for Payer: Zelis Worker's Compensation |
$1,287.74
|
|
|
REDUCT TRAUMATIC HIP DISLOC
|
Facility
|
OP
|
$4,717.00
|
|
| Hospital Charge Code |
8150081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,179.25 |
| Max. Negotiated Rate |
$4,481.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,830.20
|
| Rate for Payer: Cash Price |
$2,830.20
|
| Rate for Payer: Cigna Commercial |
$4,009.45
|
| Rate for Payer: First Health Commercial |
$4,245.30
|
| Rate for Payer: First Health Workers Compensation |
$1,821.23
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,245.30
|
| Rate for Payer: GEHA Commercial |
$3,773.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,245.30
|
| Rate for Payer: Humana ChoiceCare |
$1,226.42
|
| Rate for Payer: Multiplan All |
$4,292.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,830.20
|
| Rate for Payer: OMNI Networks Commercial |
$3,301.90
|
| Rate for Payer: One Health Plan PPO/POS |
$4,245.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$4,481.15
|
| Rate for Payer: Three Rivers Provider Network All |
$3,537.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,150.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,179.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,386.81
|
| Rate for Payer: Zelis Auto |
$1,886.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,358.50
|
| Rate for Payer: Zelis Worker's Compensation |
$1,287.74
|
|
|
RE-EXPLORATION OF CHEST
|
Facility
|
OP
|
$1,830.00
|
|
|
Service Code
|
CPT 32120
|
| Hospital Charge Code |
6132120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$457.50 |
| Max. Negotiated Rate |
$1,738.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,098.00
|
| Rate for Payer: Cash Price |
$1,098.00
|
| Rate for Payer: Cigna Commercial |
$1,555.50
|
| Rate for Payer: First Health Commercial |
$1,647.00
|
| Rate for Payer: First Health Workers Compensation |
$706.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,647.00
|
| Rate for Payer: GEHA Commercial |
$1,464.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,647.00
|
| Rate for Payer: Humana ChoiceCare |
$475.80
|
| Rate for Payer: Multiplan All |
$1,665.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,098.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,281.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,647.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,738.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,372.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,610.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$457.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,701.90
|
| Rate for Payer: Zelis Auto |
$732.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$915.00
|
| Rate for Payer: Zelis Worker's Compensation |
$499.59
|
|
|
RE-EXPLORATION OF CHEST
|
Facility
|
IP
|
$1,830.00
|
|
|
Service Code
|
CPT 32120
|
| Hospital Charge Code |
6132120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$499.59 |
| Max. Negotiated Rate |
$1,738.50 |
| Rate for Payer: Cash Price |
$1,098.00
|
| Rate for Payer: Cigna Commercial |
$1,555.50
|
| Rate for Payer: First Health Commercial |
$1,647.00
|
| Rate for Payer: First Health Workers Compensation |
$706.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,647.00
|
| Rate for Payer: GEHA Commercial |
$1,281.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,647.00
|
| Rate for Payer: Multiplan All |
$1,665.30
|
| Rate for Payer: OMNI Networks Commercial |
$1,281.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,647.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,738.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,372.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,701.90
|
| Rate for Payer: Zelis Auto |
$732.00
|
| Rate for Payer: Zelis Worker's Compensation |
$499.59
|
|
|
RE-EXPLORE PARATHYROIDS
|
Facility
|
OP
|
$2,691.00
|
|
|
Service Code
|
CPT 60502
|
| Hospital Charge Code |
6160502
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$734.64 |
| Max. Negotiated Rate |
$11,234.32 |
| 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 |
$1,614.60
|
| 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 |
$5,617.16
|
| Rate for Payer: Cash Price |
$1,614.60
|
| Rate for Payer: Cash Price |
$1,614.60
|
| Rate for Payer: Cigna Commercial |
$2,287.35
|
| Rate for Payer: First Health Commercial |
$2,421.90
|
| Rate for Payer: First Health Workers Compensation |
$1,039.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,421.90
|
| Rate for Payer: GEHA Commercial |
$2,152.80
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,421.90
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,512.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$2,448.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$1,883.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,421.90
|
| 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 |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,556.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$2,018.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,512.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,502.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$1,076.40
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$734.64
|
|
|
RE-EXPLORE PARATHYROIDS
|
Facility
|
IP
|
$2,691.00
|
|
|
Service Code
|
CPT 60502
|
| Hospital Charge Code |
6160502
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$734.64 |
| Max. Negotiated Rate |
$2,556.45 |
| Rate for Payer: Cash Price |
$1,614.60
|
| Rate for Payer: Cigna Commercial |
$2,287.35
|
| Rate for Payer: First Health Commercial |
$2,421.90
|
| Rate for Payer: First Health Workers Compensation |
$1,039.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,421.90
|
| Rate for Payer: GEHA Commercial |
$1,883.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,421.90
|
| Rate for Payer: Multiplan All |
$2,448.81
|
| Rate for Payer: OMNI Networks Commercial |
$1,883.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,421.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,556.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,018.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,502.63
|
| Rate for Payer: Zelis Auto |
$1,076.40
|
| Rate for Payer: Zelis Worker's Compensation |
$734.64
|
|
|
REF ANTIBODY ID TITER.. BLOOD BANK
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
22990917
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$325.42 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$106.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$162.71
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: First Health Workers Compensation |
$9.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$142.40
|
| Rate for Payer: GEHA Medicare |
$162.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Humana ChoiceCare |
$178.98
|
| Rate for Payer: Humana Medicare Advantage |
$162.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$273.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$162.71
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$276.61
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.71
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$162.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$325.42
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$159.46
|
| Rate for Payer: United Healthcare Commercial |
$151.30
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$162.71
|
| Rate for Payer: Zelis Auto |
$71.20
|
| Rate for Payer: Zelis Medicare |
$138.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$195.25
|
| Rate for Payer: Zelis Worker's Compensation |
$6.62
|
|
|
REF ANTIBODY ID TITER.. BLOOD BANK
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
22990917
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$151.30
|
| Rate for Payer: First Health Commercial |
$160.20
|
| Rate for Payer: First Health Workers Compensation |
$9.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$160.20
|
| Rate for Payer: GEHA Commercial |
$124.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$160.20
|
| Rate for Payer: Multiplan All |
$161.98
|
| Rate for Payer: OMNI Networks Commercial |
$124.60
|
| Rate for Payer: One Health Plan PPO/POS |
$160.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$169.10
|
| Rate for Payer: Three Rivers Provider Network All |
$133.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$165.54
|
| Rate for Payer: Zelis Auto |
$71.20
|
| Rate for Payer: Zelis Worker's Compensation |
$6.62
|
|
|
REF ANTIGEN ID.. BLOOD BANK
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
22990918
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$235.60 |
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cigna Commercial |
$210.80
|
| Rate for Payer: First Health Commercial |
$223.20
|
| Rate for Payer: First Health Workers Compensation |
$6.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$223.20
|
| Rate for Payer: GEHA Commercial |
$173.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$223.20
|
| Rate for Payer: Multiplan All |
$225.68
|
| Rate for Payer: OMNI Networks Commercial |
$173.60
|
| Rate for Payer: One Health Plan PPO/POS |
$223.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$235.60
|
| Rate for Payer: Three Rivers Provider Network All |
$186.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$230.64
|
| Rate for Payer: Zelis Auto |
$99.20
|
| Rate for Payer: Zelis Worker's Compensation |
$4.51
|
|
|
REF ANTIGEN ID.. BLOOD BANK
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
22990918
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$683.14 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$148.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$341.57
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cigna Commercial |
$210.80
|
| Rate for Payer: First Health Commercial |
$223.20
|
| Rate for Payer: First Health Workers Compensation |
$6.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$223.20
|
| Rate for Payer: GEHA Commercial |
$198.40
|
| Rate for Payer: GEHA Medicare |
$341.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$223.20
|
| Rate for Payer: Humana ChoiceCare |
$375.73
|
| Rate for Payer: Humana Medicare Advantage |
$341.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$573.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5.58
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$341.57
|
| Rate for Payer: Multiplan All |
$225.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$580.67
|
| Rate for Payer: OMNI Networks Commercial |
$173.60
|
| Rate for Payer: One Health Plan PPO/POS |
$223.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5.58
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$341.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$235.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$683.14
|
| Rate for Payer: Three Rivers Provider Network All |
$186.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$334.74
|
| Rate for Payer: United Healthcare Commercial |
$210.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$341.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$230.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$341.57
|
| Rate for Payer: Zelis Auto |
$99.20
|
| Rate for Payer: Zelis Medicare |
$290.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$409.88
|
| Rate for Payer: Zelis Worker's Compensation |
$4.51
|
|
|
REF RBC ANTIBODY IDENTIFICATION (ABID)
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
22990916
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.35 |
| Max. Negotiated Rate |
$276.45 |
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$247.35
|
| Rate for Payer: First Health Commercial |
$261.90
|
| Rate for Payer: First Health Workers Compensation |
$48.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$261.90
|
| Rate for Payer: GEHA Commercial |
$203.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$261.90
|
| Rate for Payer: Multiplan All |
$264.81
|
| Rate for Payer: OMNI Networks Commercial |
$203.70
|
| Rate for Payer: One Health Plan PPO/POS |
$261.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$276.45
|
| Rate for Payer: Three Rivers Provider Network All |
$218.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$270.63
|
| Rate for Payer: Zelis Auto |
$116.40
|
| Rate for Payer: Zelis Worker's Compensation |
$34.35
|
|
|
REF RBC ANTIBODY IDENTIFICATION (ABID)
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
22990916
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.35 |
| Max. Negotiated Rate |
$683.14 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$314.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$174.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$314.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$248.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$341.57
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$247.35
|
| Rate for Payer: First Health Commercial |
$261.90
|
| Rate for Payer: First Health Workers Compensation |
$48.58
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$261.90
|
| Rate for Payer: GEHA Commercial |
$232.80
|
| Rate for Payer: GEHA Medicare |
$341.57
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$261.90
|
| Rate for Payer: Humana ChoiceCare |
$375.73
|
| Rate for Payer: Humana Medicare Advantage |
$341.57
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$573.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$253.92
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$341.57
|
| Rate for Payer: Multiplan All |
$264.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$580.67
|
| Rate for Payer: OMNI Networks Commercial |
$203.70
|
| Rate for Payer: One Health Plan PPO/POS |
$261.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$293.19
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$253.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$341.57
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$276.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$683.14
|
| Rate for Payer: Three Rivers Provider Network All |
$218.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$334.74
|
| Rate for Payer: United Healthcare Commercial |
$247.35
|
| Rate for Payer: United Healthcare Managed Medicaid |
$253.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$341.57
|
| Rate for Payer: United Payors & United Providers UP&UP |
$270.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$341.57
|
| Rate for Payer: Zelis Auto |
$116.40
|
| Rate for Payer: Zelis Medicare |
$290.33
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$409.88
|
| Rate for Payer: Zelis Worker's Compensation |
$34.35
|
|
|
REGADENOSON 0.4MG/5ML IV STRESS TEST
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT J2785
|
| Hospital Charge Code |
3300790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$97.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$65.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$97.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$77.11
|
| Rate for Payer: Cash Price |
$65.40
|
| 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 |
$3.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$98.10
|
| Rate for Payer: Humana ChoiceCare |
$28.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$78.68
|
| Rate for Payer: Multiplan All |
$99.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$65.40
|
| Rate for Payer: OMNI Networks Commercial |
$76.30
|
| Rate for Payer: One Health Plan PPO/POS |
$98.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$90.85
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$78.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$103.55
|
| Rate for Payer: Three Rivers Provider Network All |
$81.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$95.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$78.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$101.37
|
| Rate for Payer: Zelis Auto |
$43.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$54.50
|
| Rate for Payer: Zelis Worker's Compensation |
$29.76
|
|
|
REGADENOSON 0.4MG/5ML IV STRESS TEST
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT J2785
|
| Hospital Charge Code |
3300790
|
|
Hospital Revenue Code
|
636
|
| 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
|
|
|
REGEN-COV 1200 MG/10 ML INJ SUBQ
|
Facility
|
IP
|
$1,370.00
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
3303108
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$374.01 |
| Max. Negotiated Rate |
$1,301.50 |
| Rate for Payer: Cash Price |
$822.00
|
| Rate for Payer: Cigna Commercial |
$1,164.50
|
| Rate for Payer: First Health Commercial |
$1,233.00
|
| Rate for Payer: First Health Workers Compensation |
$528.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,233.00
|
| Rate for Payer: GEHA Commercial |
$959.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,233.00
|
| Rate for Payer: Multiplan All |
$1,246.70
|
| Rate for Payer: OMNI Networks Commercial |
$959.00
|
| Rate for Payer: One Health Plan PPO/POS |
$1,233.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,301.50
|
| Rate for Payer: Three Rivers Provider Network All |
$1,027.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,274.10
|
| Rate for Payer: Zelis Auto |
$548.00
|
| Rate for Payer: Zelis Worker's Compensation |
$374.01
|
|
