|
RELEASE SHOULDER JOINT
|
Facility
|
OP
|
$1,409.00
|
|
|
Service Code
|
CPT 23020
|
| Hospital Charge Code |
6123020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$384.66 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$845.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$845.40
|
| Rate for Payer: Cash Price |
$845.40
|
| Rate for Payer: Cigna Commercial |
$1,197.65
|
| Rate for Payer: First Health Commercial |
$1,268.10
|
| Rate for Payer: First Health Workers Compensation |
$544.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,268.10
|
| Rate for Payer: GEHA Commercial |
$1,127.20
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,268.10
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,282.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$986.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,268.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,338.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,056.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,310.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$563.60
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$384.66
|
|
|
RELEASE SHOULDER JOINT
|
Facility
|
IP
|
$1,409.00
|
|
|
Service Code
|
CPT 23020
|
| Hospital Charge Code |
6123020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$384.66 |
| Max. Negotiated Rate |
$1,338.55 |
| Rate for Payer: Cash Price |
$845.40
|
| Rate for Payer: Cigna Commercial |
$1,197.65
|
| Rate for Payer: First Health Commercial |
$1,268.10
|
| Rate for Payer: First Health Workers Compensation |
$544.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,268.10
|
| Rate for Payer: GEHA Commercial |
$986.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,268.10
|
| Rate for Payer: Multiplan All |
$1,282.19
|
| Rate for Payer: OMNI Networks Commercial |
$986.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,268.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,338.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,056.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,310.37
|
| Rate for Payer: Zelis Auto |
$563.60
|
| Rate for Payer: Zelis Worker's Compensation |
$384.66
|
|
|
RELEASE THUMB CONTRACTURE
|
Facility
|
IP
|
$1,268.00
|
|
|
Service Code
|
CPT 26508
|
| Hospital Charge Code |
6126508
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$346.16 |
| Max. Negotiated Rate |
$1,204.60 |
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cigna Commercial |
$1,077.80
|
| Rate for Payer: First Health Commercial |
$1,141.20
|
| Rate for Payer: First Health Workers Compensation |
$489.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,141.20
|
| Rate for Payer: GEHA Commercial |
$887.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,141.20
|
| Rate for Payer: Multiplan All |
$1,153.88
|
| Rate for Payer: OMNI Networks Commercial |
$887.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,141.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,204.60
|
| Rate for Payer: Three Rivers Provider Network All |
$951.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,179.24
|
| Rate for Payer: Zelis Auto |
$507.20
|
| Rate for Payer: Zelis Worker's Compensation |
$346.16
|
|
|
RELEASE THUMB CONTRACTURE
|
Facility
|
OP
|
$1,268.00
|
|
|
Service Code
|
CPT 26508
|
| Hospital Charge Code |
6126508
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$346.16 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$760.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,723.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,365.04
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cigna Commercial |
$1,077.80
|
| Rate for Payer: First Health Commercial |
$1,141.20
|
| Rate for Payer: First Health Workers Compensation |
$489.57
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,141.20
|
| Rate for Payer: GEHA Commercial |
$1,014.40
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,141.20
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,392.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,153.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$887.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,141.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,608.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,392.84
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,204.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$951.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,392.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,179.24
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$507.20
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$346.16
|
|
|
RELEASE WRIST/FOREARM TENDON
|
Facility
|
OP
|
$1,062.00
|
|
|
Service Code
|
CPT 25295
|
| Hospital Charge Code |
6125295
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$289.93 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$637.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,225.91
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,763.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cigna Commercial |
$902.70
|
| Rate for Payer: First Health Commercial |
$955.80
|
| Rate for Payer: First Health Workers Compensation |
$410.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$955.80
|
| Rate for Payer: GEHA Commercial |
$849.60
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$955.80
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,799.28
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$966.42
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$743.40
|
| Rate for Payer: One Health Plan PPO/POS |
$955.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,077.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,799.28
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,008.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$796.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,799.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$987.66
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$424.80
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$289.93
|
|
|
RELEASE WRIST/FOREARM TENDON
|
Facility
|
IP
|
$1,062.00
|
|
|
Service Code
|
CPT 25295
|
| Hospital Charge Code |
6125295
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$289.93 |
| Max. Negotiated Rate |
$1,008.90 |
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cigna Commercial |
$902.70
|
| Rate for Payer: First Health Commercial |
$955.80
|
| Rate for Payer: First Health Workers Compensation |
$410.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$955.80
|
| Rate for Payer: GEHA Commercial |
$743.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$955.80
|
| Rate for Payer: Multiplan All |
$966.42
|
| Rate for Payer: OMNI Networks Commercial |
$743.40
|
| Rate for Payer: One Health Plan PPO/POS |
$955.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,008.90
|
| Rate for Payer: Three Rivers Provider Network All |
$796.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$987.66
|
| Rate for Payer: Zelis Auto |
$424.80
|
| Rate for Payer: Zelis Worker's Compensation |
$289.93
|
|
|
RELIEVE BLADDER CONTRACTURE
|
Facility
|
OP
|
$802.00
|
|
|
Service Code
|
CPT 52640
|
| Hospital Charge Code |
6152640
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$218.95 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$481.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$481.20
|
| Rate for Payer: Cash Price |
$481.20
|
| Rate for Payer: Cigna Commercial |
$681.70
|
| Rate for Payer: First Health Commercial |
$721.80
|
| Rate for Payer: First Health Workers Compensation |
$309.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$721.80
|
| Rate for Payer: GEHA Commercial |
$641.60
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$721.80
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$729.82
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$561.40
|
| Rate for Payer: One Health Plan PPO/POS |
$721.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$761.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$601.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$745.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$320.80
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$218.95
|
|
|
RELIEVE BLADDER CONTRACTURE
|
Facility
|
IP
|
$802.00
|
|
|
Service Code
|
CPT 52640
|
| Hospital Charge Code |
6152640
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$218.95 |
| Max. Negotiated Rate |
$761.90 |
| Rate for Payer: Cash Price |
$481.20
|
| Rate for Payer: Cigna Commercial |
$681.70
|
| Rate for Payer: First Health Commercial |
$721.80
|
| Rate for Payer: First Health Workers Compensation |
$309.65
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$721.80
|
| Rate for Payer: GEHA Commercial |
$561.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$721.80
|
| Rate for Payer: Multiplan All |
$729.82
|
| Rate for Payer: OMNI Networks Commercial |
$561.40
|
| Rate for Payer: One Health Plan PPO/POS |
$721.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$761.90
|
| Rate for Payer: Three Rivers Provider Network All |
$601.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$745.86
|
| Rate for Payer: Zelis Auto |
$320.80
|
| Rate for Payer: Zelis Worker's Compensation |
$218.95
|
|
|
RELIEVE PRESSURE ON NERVE(S)
|
Facility
|
IP
|
$944.00
|
|
|
Service Code
|
CPT 64722
|
| Hospital Charge Code |
6164722
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$257.71 |
| Max. Negotiated Rate |
$896.80 |
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Cigna Commercial |
$802.40
|
| Rate for Payer: First Health Commercial |
$849.60
|
| Rate for Payer: First Health Workers Compensation |
$364.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$849.60
|
| Rate for Payer: GEHA Commercial |
$660.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$849.60
|
| Rate for Payer: Multiplan All |
$859.04
|
| Rate for Payer: OMNI Networks Commercial |
$660.80
|
| Rate for Payer: One Health Plan PPO/POS |
$849.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$896.80
|
| Rate for Payer: Three Rivers Provider Network All |
$708.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$877.92
|
| Rate for Payer: Zelis Auto |
$377.60
|
| Rate for Payer: Zelis Worker's Compensation |
$257.71
|
|
|
RELIEVE PRESSURE ON NERVE(S)
|
Facility
|
OP
|
$944.00
|
|
|
Service Code
|
CPT 64722
|
| Hospital Charge Code |
6164722
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$257.71 |
| Max. Negotiated Rate |
$3,708.46 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$566.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,892.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,499.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,854.23
|
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Cigna Commercial |
$802.40
|
| Rate for Payer: First Health Commercial |
$849.60
|
| Rate for Payer: First Health Workers Compensation |
$364.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$849.60
|
| Rate for Payer: GEHA Commercial |
$755.20
|
| Rate for Payer: GEHA Medicare |
$1,854.23
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$849.60
|
| Rate for Payer: Humana ChoiceCare |
$2,039.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,854.23
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,115.11
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,529.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,854.23
|
| Rate for Payer: Multiplan All |
$859.04
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,152.19
|
| Rate for Payer: OMNI Networks Commercial |
$660.80
|
| Rate for Payer: One Health Plan PPO/POS |
$849.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,766.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,529.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,854.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$896.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,708.46
|
| Rate for Payer: Three Rivers Provider Network All |
$708.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,817.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,529.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,854.23
|
| Rate for Payer: United Payors & United Providers UP&UP |
$877.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,854.23
|
| Rate for Payer: Zelis Auto |
$377.60
|
| Rate for Payer: Zelis Medicare |
$1,576.10
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,225.08
|
| Rate for Payer: Zelis Worker's Compensation |
$257.71
|
|
|
RELOCATION OF TESTIS(ES)
|
Facility
|
IP
|
$1,631.00
|
|
|
Service Code
|
CPT 54680
|
| Hospital Charge Code |
6154680
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$445.26 |
| Max. Negotiated Rate |
$1,549.45 |
| Rate for Payer: Cash Price |
$978.60
|
| Rate for Payer: Cigna Commercial |
$1,386.35
|
| Rate for Payer: First Health Commercial |
$1,467.90
|
| Rate for Payer: First Health Workers Compensation |
$629.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,467.90
|
| Rate for Payer: GEHA Commercial |
$1,141.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,467.90
|
| Rate for Payer: Multiplan All |
$1,484.21
|
| Rate for Payer: OMNI Networks Commercial |
$1,141.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,467.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,549.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,223.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,516.83
|
| Rate for Payer: Zelis Auto |
$652.40
|
| Rate for Payer: Zelis Worker's Compensation |
$445.26
|
|
|
RELOCATION OF TESTIS(ES)
|
Facility
|
OP
|
$1,631.00
|
|
|
Service Code
|
CPT 54680
|
| Hospital Charge Code |
6154680
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$445.26 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$978.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,354.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,865.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$978.60
|
| Rate for Payer: Cash Price |
$978.60
|
| Rate for Payer: Cigna Commercial |
$1,386.35
|
| Rate for Payer: First Health Commercial |
$1,467.90
|
| Rate for Payer: First Health Workers Compensation |
$629.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,467.90
|
| Rate for Payer: GEHA Commercial |
$1,304.80
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,467.90
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,902.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$1,484.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$1,141.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,467.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,197.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,902.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,549.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$1,223.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,902.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,516.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$652.40
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$445.26
|
|
|
REMDESIVIR 100 MG/ 20 ML INJ
|
Facility
|
OP
|
$559.00
|
|
|
Service Code
|
NDC 61958290201
|
| Hospital Charge Code |
3302941
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$139.75 |
| Max. Negotiated Rate |
$531.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$335.40
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cigna Commercial |
$475.15
|
| Rate for Payer: First Health Commercial |
$503.10
|
| Rate for Payer: First Health Workers Compensation |
$215.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$503.10
|
| Rate for Payer: GEHA Commercial |
$447.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$503.10
|
| Rate for Payer: Humana ChoiceCare |
$145.34
|
| Rate for Payer: Multiplan All |
$508.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$335.40
|
| Rate for Payer: OMNI Networks Commercial |
$391.30
|
| Rate for Payer: One Health Plan PPO/POS |
$503.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$531.05
|
| Rate for Payer: Three Rivers Provider Network All |
$419.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$491.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$139.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$519.87
|
| Rate for Payer: Zelis Auto |
$223.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$279.50
|
| Rate for Payer: Zelis Worker's Compensation |
$152.61
|
|
|
REMDESIVIR 100 MG/ 20 ML INJ
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
NDC 61958290201
|
| Hospital Charge Code |
3302941
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$531.05 |
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cigna Commercial |
$475.15
|
| Rate for Payer: First Health Commercial |
$503.10
|
| Rate for Payer: First Health Workers Compensation |
$215.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$503.10
|
| Rate for Payer: GEHA Commercial |
$391.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$503.10
|
| Rate for Payer: Multiplan All |
$508.69
|
| Rate for Payer: OMNI Networks Commercial |
$391.30
|
| Rate for Payer: One Health Plan PPO/POS |
$503.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$531.05
|
| Rate for Payer: Three Rivers Provider Network All |
$419.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$519.87
|
| Rate for Payer: Zelis Auto |
$223.60
|
| Rate for Payer: Zelis Worker's Compensation |
$152.61
|
|
|
REMDESIVIR 100 MG POWD INJ SDV
|
Facility
|
OP
|
$2,345.00
|
|
|
Service Code
|
CPT J0248
|
| Hospital Charge Code |
3302944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$2,227.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,407.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.55
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.73
|
| Rate for Payer: Cash Price |
$1,407.00
|
| Rate for Payer: Cash Price |
$1,407.00
|
| Rate for Payer: Cigna Commercial |
$1,993.25
|
| Rate for Payer: First Health Commercial |
$2,110.50
|
| Rate for Payer: First Health Workers Compensation |
$905.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,110.50
|
| Rate for Payer: GEHA Commercial |
$7.40
|
| Rate for Payer: GEHA Medicare |
$6.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,110.50
|
| Rate for Payer: Humana ChoiceCare |
$7.40
|
| Rate for Payer: Humana Medicare Advantage |
$6.73
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.73
|
| Rate for Payer: Multiplan All |
$2,133.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,641.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,110.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.89
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.70
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.73
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,227.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13.46
|
| Rate for Payer: Three Rivers Provider Network All |
$1,758.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.73
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,180.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.73
|
| Rate for Payer: Zelis Auto |
$938.00
|
| Rate for Payer: Zelis Medicare |
$5.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.08
|
| Rate for Payer: Zelis Worker's Compensation |
$640.18
|
|
|
REMDESIVIR 100 MG POWD INJ SDV
|
Facility
|
IP
|
$2,345.00
|
|
|
Service Code
|
CPT J0248
|
| Hospital Charge Code |
3302944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$640.18 |
| Max. Negotiated Rate |
$2,227.75 |
| Rate for Payer: Cash Price |
$1,407.00
|
| Rate for Payer: Cigna Commercial |
$1,993.25
|
| Rate for Payer: First Health Commercial |
$2,110.50
|
| Rate for Payer: First Health Workers Compensation |
$905.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,110.50
|
| Rate for Payer: GEHA Commercial |
$1,641.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,110.50
|
| Rate for Payer: Multiplan All |
$2,133.95
|
| Rate for Payer: OMNI Networks Commercial |
$1,641.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,110.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,227.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,758.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,180.85
|
| Rate for Payer: Zelis Auto |
$938.00
|
| Rate for Payer: Zelis Worker's Compensation |
$640.18
|
|
|
REMDESIVIR 30 MG / NS 25 ML SYRINGE
|
Facility
|
OP
|
$559.00
|
|
|
Service Code
|
NDC 61958290101
|
| Hospital Charge Code |
3302974
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$139.75 |
| Max. Negotiated Rate |
$531.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$335.40
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cigna Commercial |
$475.15
|
| Rate for Payer: First Health Commercial |
$503.10
|
| Rate for Payer: First Health Workers Compensation |
$215.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$503.10
|
| Rate for Payer: GEHA Commercial |
$447.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$503.10
|
| Rate for Payer: Humana ChoiceCare |
$145.34
|
| Rate for Payer: Multiplan All |
$508.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$335.40
|
| Rate for Payer: OMNI Networks Commercial |
$391.30
|
| Rate for Payer: One Health Plan PPO/POS |
$503.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$531.05
|
| Rate for Payer: Three Rivers Provider Network All |
$419.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$491.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$139.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$519.87
|
| Rate for Payer: Zelis Auto |
$223.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$279.50
|
| Rate for Payer: Zelis Worker's Compensation |
$152.61
|
|
|
REMDESIVIR 30 MG / NS 25 ML SYRINGE
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
NDC 61958290101
|
| Hospital Charge Code |
3302974
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$531.05 |
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cigna Commercial |
$475.15
|
| Rate for Payer: First Health Commercial |
$503.10
|
| Rate for Payer: First Health Workers Compensation |
$215.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$503.10
|
| Rate for Payer: GEHA Commercial |
$391.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$503.10
|
| Rate for Payer: Multiplan All |
$508.69
|
| Rate for Payer: OMNI Networks Commercial |
$391.30
|
| Rate for Payer: One Health Plan PPO/POS |
$503.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$531.05
|
| Rate for Payer: Three Rivers Provider Network All |
$419.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$519.87
|
| Rate for Payer: Zelis Auto |
$223.60
|
| Rate for Payer: Zelis Worker's Compensation |
$152.61
|
|
|
REM ENDOVAS VENA CAVA FILTER
|
Facility
|
IP
|
$1,122.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
6137193
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$306.31 |
| Max. Negotiated Rate |
$1,065.90 |
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cigna Commercial |
$953.70
|
| Rate for Payer: First Health Commercial |
$1,009.80
|
| Rate for Payer: First Health Workers Compensation |
$433.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,009.80
|
| Rate for Payer: GEHA Commercial |
$785.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,009.80
|
| Rate for Payer: Multiplan All |
$1,021.02
|
| Rate for Payer: OMNI Networks Commercial |
$785.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,009.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,065.90
|
| Rate for Payer: Three Rivers Provider Network All |
$841.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,043.46
|
| Rate for Payer: Zelis Auto |
$448.80
|
| Rate for Payer: Zelis Worker's Compensation |
$306.31
|
|
|
REM ENDOVAS VENA CAVA FILTER
|
Facility
|
OP
|
$1,122.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
6137193
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$306.31 |
| Max. Negotiated Rate |
$5,977.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,353.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$673.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,353.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,656.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cigna Commercial |
$953.70
|
| Rate for Payer: First Health Commercial |
$1,009.80
|
| Rate for Payer: First Health Workers Compensation |
$433.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,009.80
|
| Rate for Payer: GEHA Commercial |
$897.60
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,009.80
|
| 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 |
$2,710.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$1,021.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$785.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,009.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,129.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,710.42
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,065.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$841.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,710.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,043.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$448.80
|
| 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 |
$306.31
|
|
|
REMICADE 100 MG VIAL
|
Facility
|
IP
|
$4,138.00
|
|
|
Service Code
|
CPT J1745
|
| Hospital Charge Code |
3301689
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,129.67 |
| Max. Negotiated Rate |
$3,931.10 |
| Rate for Payer: Cash Price |
$2,482.80
|
| Rate for Payer: Cigna Commercial |
$3,517.30
|
| Rate for Payer: First Health Commercial |
$3,724.20
|
| Rate for Payer: First Health Workers Compensation |
$1,597.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,724.20
|
| Rate for Payer: GEHA Commercial |
$2,896.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,724.20
|
| Rate for Payer: Multiplan All |
$3,765.58
|
| Rate for Payer: OMNI Networks Commercial |
$2,896.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,724.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,931.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,103.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,848.34
|
| Rate for Payer: Zelis Auto |
$1,655.20
|
| Rate for Payer: Zelis Worker's Compensation |
$1,129.67
|
|
|
REMICADE 100 MG VIAL
|
Facility
|
OP
|
$4,138.00
|
|
|
Service Code
|
CPT J1745
|
| Hospital Charge Code |
3301689
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.43 |
| Max. Negotiated Rate |
$3,931.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$114.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,482.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$114.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$90.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$31.09
|
| Rate for Payer: Cash Price |
$2,482.80
|
| Rate for Payer: Cash Price |
$2,482.80
|
| Rate for Payer: Cigna Commercial |
$3,517.30
|
| Rate for Payer: First Health Commercial |
$3,724.20
|
| Rate for Payer: First Health Workers Compensation |
$1,597.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,724.20
|
| Rate for Payer: GEHA Commercial |
$34.20
|
| Rate for Payer: GEHA Medicare |
$31.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,724.20
|
| Rate for Payer: Humana ChoiceCare |
$34.20
|
| Rate for Payer: Humana Medicare Advantage |
$31.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$52.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$92.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$31.09
|
| Rate for Payer: Multiplan All |
$3,765.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$52.85
|
| Rate for Payer: OMNI Networks Commercial |
$2,896.60
|
| Rate for Payer: One Health Plan PPO/POS |
$3,724.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$107.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$92.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$31.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,931.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$62.18
|
| Rate for Payer: Three Rivers Provider Network All |
$3,103.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$30.47
|
| Rate for Payer: United Healthcare Managed Medicaid |
$92.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,848.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$31.09
|
| Rate for Payer: Zelis Auto |
$1,655.20
|
| Rate for Payer: Zelis Medicare |
$26.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$37.31
|
| Rate for Payer: Zelis Worker's Compensation |
$1,129.67
|
|
|
REMICADE 100 MG VIAL PT OWN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT J1745
|
| Hospital Charge Code |
3303201
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$114.77 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$114.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$114.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$90.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$31.09
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$34.20
|
| Rate for Payer: GEHA Medicare |
$31.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Humana ChoiceCare |
$34.20
|
| Rate for Payer: Humana Medicare Advantage |
$31.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$52.23
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$92.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$31.09
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$52.85
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$107.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$92.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$31.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$62.18
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$30.47
|
| Rate for Payer: United Healthcare Managed Medicaid |
$92.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$31.09
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Medicare |
$26.43
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$37.31
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
REMICADE 100 MG VIAL PT OWN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT J1745
|
| Hospital Charge Code |
3303201
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: First Health Workers Compensation |
$0.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$0.01
|
| Rate for Payer: GEHA Commercial |
$0.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$0.01
|
| Rate for Payer: Multiplan All |
$0.01
|
| Rate for Payer: OMNI Networks Commercial |
$0.01
|
| Rate for Payer: One Health Plan PPO/POS |
$0.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$0.01
|
| Rate for Payer: Three Rivers Provider Network All |
$0.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$0.01
|
| Rate for Payer: Zelis Auto |
$0.00
|
| Rate for Payer: Zelis Worker's Compensation |
$0.00
|
|
|
REM INTERROG <30 ICPMS/SCRMS
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 93299
|
| Hospital Charge Code |
8699254
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$30.75 |
| Max. Negotiated Rate |
$116.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$73.80
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$104.55
|
| Rate for Payer: First Health Commercial |
$110.70
|
| Rate for Payer: First Health Workers Compensation |
$47.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$110.70
|
| Rate for Payer: GEHA Commercial |
$98.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$110.70
|
| Rate for Payer: Humana ChoiceCare |
$31.98
|
| Rate for Payer: Multiplan All |
$111.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$73.80
|
| Rate for Payer: OMNI Networks Commercial |
$86.10
|
| Rate for Payer: One Health Plan PPO/POS |
$110.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$116.85
|
| Rate for Payer: Three Rivers Provider Network All |
$92.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$108.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$30.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$114.39
|
| Rate for Payer: Zelis Auto |
$49.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$61.50
|
| Rate for Payer: Zelis Worker's Compensation |
$33.58
|
|
