|
RMVL NDWELLG TUNNELD PLEURAL CATH W/CUFF
|
Facility
|
OP
|
$3,309.00
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
7732552
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$463.20 |
| Max. Negotiated Rate |
$3,143.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$584.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,985.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$584.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$463.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$599.08
|
| Rate for Payer: Cash Price |
$1,985.40
|
| Rate for Payer: Cash Price |
$1,985.40
|
| Rate for Payer: Cigna Commercial |
$2,812.65
|
| Rate for Payer: First Health Commercial |
$2,978.10
|
| Rate for Payer: First Health Workers Compensation |
$771.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,978.10
|
| Rate for Payer: GEHA Commercial |
$2,647.20
|
| Rate for Payer: GEHA Medicare |
$599.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,978.10
|
| Rate for Payer: Humana ChoiceCare |
$658.99
|
| Rate for Payer: Humana Medicare Advantage |
$599.08
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,006.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$472.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$599.08
|
| Rate for Payer: Multiplan All |
$3,011.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,018.44
|
| Rate for Payer: OMNI Networks Commercial |
$2,316.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,978.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$545.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$472.63
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$599.08
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,143.55
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,198.16
|
| Rate for Payer: Three Rivers Provider Network All |
$2,481.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$587.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$472.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$599.08
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,077.37
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$599.08
|
| Rate for Payer: Zelis Auto |
$1,323.60
|
| Rate for Payer: Zelis Medicare |
$509.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$718.90
|
| Rate for Payer: Zelis Worker's Compensation |
$545.16
|
|
|
RMVL NDWELLG TUNNELD PLEURAL CATH W/CUFF
|
Facility
|
IP
|
$3,309.00
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
7732552
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$903.36 |
| Max. Negotiated Rate |
$3,143.55 |
| Rate for Payer: Zelis Auto |
$1,323.60
|
| Rate for Payer: Zelis Worker's Compensation |
$903.36
|
| Rate for Payer: Cash Price |
$1,985.40
|
| Rate for Payer: Cigna Commercial |
$2,812.65
|
| Rate for Payer: First Health Commercial |
$2,978.10
|
| Rate for Payer: First Health Workers Compensation |
$1,277.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,978.10
|
| Rate for Payer: GEHA Commercial |
$2,316.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,978.10
|
| Rate for Payer: Multiplan All |
$3,011.19
|
| Rate for Payer: OMNI Networks Commercial |
$2,316.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,978.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,143.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,481.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,077.37
|
|
|
RMVL NINFCT MESH AA/PARASTML HRNA RPR-AD
|
Facility
|
IP
|
$583.41
|
|
|
Service Code
|
CPT 49623
|
| Hospital Charge Code |
6149623
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$159.27 |
| Max. Negotiated Rate |
$554.24 |
| Rate for Payer: Cash Price |
$350.05
|
| Rate for Payer: Cigna Commercial |
$495.90
|
| Rate for Payer: First Health Commercial |
$525.07
|
| Rate for Payer: First Health Workers Compensation |
$225.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$525.07
|
| Rate for Payer: GEHA Commercial |
$408.39
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$525.07
|
| Rate for Payer: Multiplan All |
$530.90
|
| Rate for Payer: OMNI Networks Commercial |
$408.39
|
| Rate for Payer: One Health Plan PPO/POS |
$525.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$554.24
|
| Rate for Payer: Three Rivers Provider Network All |
$437.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$542.57
|
| Rate for Payer: Zelis Auto |
$233.36
|
| Rate for Payer: Zelis Worker's Compensation |
$159.27
|
|
|
RMVL NINFCT MESH AA/PARASTML HRNA RPR-AD
|
Facility
|
OP
|
$583.41
|
|
|
Service Code
|
CPT 49623
|
| Hospital Charge Code |
6149623
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$145.85 |
| Max. Negotiated Rate |
$554.24 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$350.05
|
| Rate for Payer: Cash Price |
$350.05
|
| Rate for Payer: Cigna Commercial |
$495.90
|
| Rate for Payer: First Health Commercial |
$525.07
|
| Rate for Payer: First Health Workers Compensation |
$225.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$525.07
|
| Rate for Payer: GEHA Commercial |
$466.73
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$525.07
|
| Rate for Payer: Humana ChoiceCare |
$151.69
|
| Rate for Payer: Multiplan All |
$530.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$350.05
|
| Rate for Payer: OMNI Networks Commercial |
$408.39
|
| Rate for Payer: One Health Plan PPO/POS |
$525.07
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$554.24
|
| Rate for Payer: Three Rivers Provider Network All |
$437.56
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$513.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$145.85
|
| Rate for Payer: United Payors & United Providers UP&UP |
$542.57
|
| Rate for Payer: Zelis Auto |
$233.36
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$291.70
|
| Rate for Payer: Zelis Worker's Compensation |
$159.27
|
|
|
RMVL OF SUTRES UNDR ANESTH BY SAME SURG
|
Facility
|
OP
|
$834.00
|
|
|
Service Code
|
CPT 15850
|
| Hospital Charge Code |
6115850
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$208.50 |
| Max. Negotiated Rate |
$792.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$500.40
|
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cigna Commercial |
$708.90
|
| Rate for Payer: First Health Commercial |
$750.60
|
| Rate for Payer: First Health Workers Compensation |
$322.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$750.60
|
| Rate for Payer: GEHA Commercial |
$667.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$750.60
|
| Rate for Payer: Humana ChoiceCare |
$216.84
|
| Rate for Payer: Multiplan All |
$758.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$500.40
|
| Rate for Payer: OMNI Networks Commercial |
$583.80
|
| Rate for Payer: One Health Plan PPO/POS |
$750.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$792.30
|
| Rate for Payer: Three Rivers Provider Network All |
$625.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$733.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$208.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$775.62
|
| Rate for Payer: Zelis Auto |
$333.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$417.00
|
| Rate for Payer: Zelis Worker's Compensation |
$227.68
|
|
|
RMVL OF SUTRES UNDR ANESTH BY SAME SURG
|
Facility
|
IP
|
$834.00
|
|
|
Service Code
|
CPT 15850
|
| Hospital Charge Code |
6115850
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$227.68 |
| Max. Negotiated Rate |
$792.30 |
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cigna Commercial |
$708.90
|
| Rate for Payer: First Health Commercial |
$750.60
|
| Rate for Payer: First Health Workers Compensation |
$322.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$750.60
|
| Rate for Payer: GEHA Commercial |
$583.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$750.60
|
| Rate for Payer: Multiplan All |
$758.94
|
| Rate for Payer: OMNI Networks Commercial |
$583.80
|
| Rate for Payer: One Health Plan PPO/POS |
$750.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$792.30
|
| Rate for Payer: Three Rivers Provider Network All |
$625.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$775.62
|
| Rate for Payer: Zelis Auto |
$333.60
|
| Rate for Payer: Zelis Worker's Compensation |
$227.68
|
|
|
RMVL SKIN TAGS MLT FIBRQ TAGS ANY EA ADD
|
Facility
|
OP
|
$51.81
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
7211201
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$88.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$31.09
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$70.39
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cigna Commercial |
$44.04
|
| Rate for Payer: First Health Commercial |
$46.63
|
| Rate for Payer: First Health Workers Compensation |
$20.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$46.63
|
| Rate for Payer: GEHA Commercial |
$41.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$46.63
|
| Rate for Payer: Humana ChoiceCare |
$13.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$71.83
|
| Rate for Payer: Multiplan All |
$47.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$31.09
|
| Rate for Payer: OMNI Networks Commercial |
$36.27
|
| Rate for Payer: One Health Plan PPO/POS |
$46.63
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$82.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$71.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$49.22
|
| Rate for Payer: Three Rivers Provider Network All |
$38.86
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$45.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$71.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$48.18
|
| Rate for Payer: Zelis Auto |
$20.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$25.91
|
| Rate for Payer: Zelis Worker's Compensation |
$14.14
|
|
|
RMVL SKIN TAGS MLT FIBRQ TAGS ANY EA ADD
|
Facility
|
IP
|
$51.81
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
7211201
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$14.14 |
| Max. Negotiated Rate |
$49.22 |
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cigna Commercial |
$44.04
|
| Rate for Payer: First Health Commercial |
$46.63
|
| Rate for Payer: First Health Workers Compensation |
$20.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$46.63
|
| Rate for Payer: GEHA Commercial |
$36.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$46.63
|
| Rate for Payer: Multiplan All |
$47.15
|
| Rate for Payer: OMNI Networks Commercial |
$36.27
|
| Rate for Payer: One Health Plan PPO/POS |
$46.63
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$49.22
|
| Rate for Payer: Three Rivers Provider Network All |
$38.86
|
| Rate for Payer: United Payors & United Providers UP&UP |
$48.18
|
| Rate for Payer: Zelis Auto |
$20.72
|
| Rate for Payer: Zelis Worker's Compensation |
$14.14
|
|
|
RMVL SKIN TAGS, MULT FIBROCU ANY AREA
|
Facility
|
OP
|
$1,842.93
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
8111200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$1,750.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,105.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| Rate for Payer: Cash Price |
$1,105.76
|
| Rate for Payer: Cash Price |
$1,105.76
|
| Rate for Payer: Cigna Commercial |
$1,566.49
|
| Rate for Payer: First Health Commercial |
$1,658.64
|
| Rate for Payer: First Health Workers Compensation |
$711.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,658.64
|
| Rate for Payer: GEHA Commercial |
$1,474.34
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,658.64
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$1,677.07
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| Rate for Payer: OMNI Networks Commercial |
$1,290.05
|
| Rate for Payer: One Health Plan PPO/POS |
$1,658.64
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,750.78
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$1,382.20
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,713.92
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$737.17
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$503.12
|
|
|
RMVL SKIN TAGS, MULT FIBROCU ANY AREA
|
Facility
|
IP
|
$1,842.93
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
8111200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$503.12 |
| Max. Negotiated Rate |
$1,750.78 |
| Rate for Payer: Cash Price |
$1,105.76
|
| Rate for Payer: Cigna Commercial |
$1,566.49
|
| Rate for Payer: First Health Commercial |
$1,658.64
|
| Rate for Payer: First Health Workers Compensation |
$711.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,658.64
|
| Rate for Payer: GEHA Commercial |
$1,290.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,658.64
|
| Rate for Payer: Multiplan All |
$1,677.07
|
| Rate for Payer: OMNI Networks Commercial |
$1,290.05
|
| Rate for Payer: One Health Plan PPO/POS |
$1,658.64
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,750.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,382.20
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,713.92
|
| Rate for Payer: Zelis Auto |
$737.17
|
| Rate for Payer: Zelis Worker's Compensation |
$503.12
|
|
|
RMVL SPINAL NSTIM ELTRD PRQ ARRAY W/FLUO
|
Facility
|
IP
|
$995.00
|
|
| Hospital Charge Code |
6163661
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$271.63 |
| Max. Negotiated Rate |
$945.25 |
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cigna Commercial |
$845.75
|
| Rate for Payer: First Health Commercial |
$895.50
|
| Rate for Payer: First Health Workers Compensation |
$384.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$895.50
|
| Rate for Payer: GEHA Commercial |
$696.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$895.50
|
| Rate for Payer: Multiplan All |
$905.45
|
| Rate for Payer: OMNI Networks Commercial |
$696.50
|
| Rate for Payer: One Health Plan PPO/POS |
$895.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$945.25
|
| Rate for Payer: Three Rivers Provider Network All |
$746.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$925.35
|
| Rate for Payer: Zelis Auto |
$398.00
|
| Rate for Payer: Zelis Worker's Compensation |
$271.63
|
|
|
RMVL SPINAL NSTIM ELTRD PRQ ARRAY W/FLUO
|
Facility
|
OP
|
$995.00
|
|
| Hospital Charge Code |
6163661
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$248.75 |
| Max. Negotiated Rate |
$945.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$597.00
|
| Rate for Payer: Cash Price |
$597.00
|
| Rate for Payer: Cigna Commercial |
$845.75
|
| Rate for Payer: First Health Commercial |
$895.50
|
| Rate for Payer: First Health Workers Compensation |
$384.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$895.50
|
| Rate for Payer: GEHA Commercial |
$796.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$895.50
|
| Rate for Payer: Humana ChoiceCare |
$258.70
|
| Rate for Payer: Multiplan All |
$905.45
|
| Rate for Payer: New Mexico Health Connections Medicare |
$597.00
|
| Rate for Payer: OMNI Networks Commercial |
$696.50
|
| Rate for Payer: One Health Plan PPO/POS |
$895.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$945.25
|
| Rate for Payer: Three Rivers Provider Network All |
$746.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$875.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$248.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$925.35
|
| Rate for Payer: Zelis Auto |
$398.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$497.50
|
| Rate for Payer: Zelis Worker's Compensation |
$271.63
|
|
|
RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRP
|
Facility
|
IP
|
$536.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
6136590
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$146.33 |
| Max. Negotiated Rate |
$509.20 |
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cigna Commercial |
$455.60
|
| Rate for Payer: First Health Commercial |
$482.40
|
| Rate for Payer: First Health Workers Compensation |
$206.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$482.40
|
| Rate for Payer: GEHA Commercial |
$375.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$482.40
|
| Rate for Payer: Multiplan All |
$487.76
|
| Rate for Payer: OMNI Networks Commercial |
$375.20
|
| Rate for Payer: One Health Plan PPO/POS |
$482.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$509.20
|
| Rate for Payer: Three Rivers Provider Network All |
$402.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$498.48
|
| Rate for Payer: Zelis Auto |
$214.40
|
| Rate for Payer: Zelis Worker's Compensation |
$146.33
|
|
|
RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRP
|
Facility
|
OP
|
$536.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
6136590
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$146.33 |
| Max. Negotiated Rate |
$3,010.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,264.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$321.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,264.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,001.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,505.25
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cigna Commercial |
$455.60
|
| Rate for Payer: First Health Commercial |
$482.40
|
| Rate for Payer: First Health Workers Compensation |
$206.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$482.40
|
| Rate for Payer: GEHA Commercial |
$428.80
|
| Rate for Payer: GEHA Medicare |
$1,505.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$482.40
|
| Rate for Payer: Humana ChoiceCare |
$1,655.78
|
| Rate for Payer: Humana Medicare Advantage |
$1,505.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,528.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,022.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,505.25
|
| Rate for Payer: Multiplan All |
$487.76
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,558.93
|
| Rate for Payer: OMNI Networks Commercial |
$375.20
|
| Rate for Payer: One Health Plan PPO/POS |
$482.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,180.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,022.34
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,505.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$509.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,010.50
|
| Rate for Payer: Three Rivers Provider Network All |
$402.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,475.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,022.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,505.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$498.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,505.25
|
| Rate for Payer: Zelis Auto |
$214.40
|
| Rate for Payer: Zelis Medicare |
$1,279.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,806.30
|
| Rate for Payer: Zelis Worker's Compensation |
$146.33
|
|
|
RMVL TUN CVC W/O SUBQ PORT/PMP
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
9436589
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$138.68 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: First Health Workers Compensation |
$196.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$355.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: Zelis Auto |
$203.20
|
| Rate for Payer: Zelis Worker's Compensation |
$138.68
|
|
|
RMVL TUN CVC W/O SUBQ PORT/PMP
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
20336589
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$138.68 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: First Health Workers Compensation |
$196.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$355.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: Zelis Auto |
$203.20
|
| Rate for Payer: Zelis Worker's Compensation |
$138.68
|
|
|
RMVL TUN CVC W/O SUBQ PORT/PMP
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
9436589
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$138.68 |
| Max. Negotiated Rate |
$1,198.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$731.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$304.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$731.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$579.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$599.08
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: First Health Workers Compensation |
$196.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$406.40
|
| Rate for Payer: GEHA Medicare |
$599.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Humana ChoiceCare |
$658.99
|
| Rate for Payer: Humana Medicare Advantage |
$599.08
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,006.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$591.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$599.08
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,018.44
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$683.02
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$591.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$599.08
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,198.16
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$587.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$591.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$599.08
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$599.08
|
| Rate for Payer: Zelis Auto |
$203.20
|
| Rate for Payer: Zelis Medicare |
$509.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$718.90
|
| Rate for Payer: Zelis Worker's Compensation |
$138.68
|
|
|
RMVL TUN CVC W/O SUBQ PORT/PMP
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
6136589
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$117.66 |
| Max. Negotiated Rate |
$1,198.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$731.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$258.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$731.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$579.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$599.08
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: First Health Workers Compensation |
$166.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$344.80
|
| Rate for Payer: GEHA Medicare |
$599.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Humana ChoiceCare |
$658.99
|
| Rate for Payer: Humana Medicare Advantage |
$599.08
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,006.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$591.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$599.08
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,018.44
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$683.02
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$591.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$599.08
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,198.16
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$587.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$591.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$599.08
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$599.08
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Medicare |
$509.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$718.90
|
| Rate for Payer: Zelis Worker's Compensation |
$117.66
|
|
|
RMVL TUN CVC W/O SUBQ PORT/PMP
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
6136589
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$117.66 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Cigna Commercial |
$366.35
|
| Rate for Payer: First Health Commercial |
$387.90
|
| Rate for Payer: First Health Workers Compensation |
$166.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$387.90
|
| Rate for Payer: GEHA Commercial |
$301.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$387.90
|
| Rate for Payer: Multiplan All |
$392.21
|
| Rate for Payer: OMNI Networks Commercial |
$301.70
|
| Rate for Payer: One Health Plan PPO/POS |
$387.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$409.45
|
| Rate for Payer: Three Rivers Provider Network All |
$323.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$400.83
|
| Rate for Payer: Zelis Auto |
$172.40
|
| Rate for Payer: Zelis Worker's Compensation |
$117.66
|
|
|
RMVL TUN CVC W/O SUBQ PORT/PMP
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
20336589
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$138.68 |
| Max. Negotiated Rate |
$1,198.16 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$731.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$304.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$731.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$579.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$599.08
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$431.80
|
| Rate for Payer: First Health Commercial |
$457.20
|
| Rate for Payer: First Health Workers Compensation |
$196.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$457.20
|
| Rate for Payer: GEHA Commercial |
$406.40
|
| Rate for Payer: GEHA Medicare |
$599.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$457.20
|
| Rate for Payer: Humana ChoiceCare |
$658.99
|
| Rate for Payer: Humana Medicare Advantage |
$599.08
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,006.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$591.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$599.08
|
| Rate for Payer: Multiplan All |
$462.28
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,018.44
|
| Rate for Payer: OMNI Networks Commercial |
$355.60
|
| Rate for Payer: One Health Plan PPO/POS |
$457.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$683.02
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$591.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$599.08
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$482.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,198.16
|
| Rate for Payer: Three Rivers Provider Network All |
$381.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$587.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$591.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$599.08
|
| Rate for Payer: United Payors & United Providers UP&UP |
$472.44
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$599.08
|
| Rate for Payer: Zelis Auto |
$203.20
|
| Rate for Payer: Zelis Medicare |
$509.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$718.90
|
| Rate for Payer: Zelis Worker's Compensation |
$138.68
|
|
|
RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR
|
Facility
|
OP
|
$400.23
|
|
|
Service Code
|
CPT 11983
|
| Hospital Charge Code |
8511983
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$109.26 |
| Max. Negotiated Rate |
$773.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$395.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$240.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$395.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$312.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$386.66
|
| Rate for Payer: Cash Price |
$240.14
|
| Rate for Payer: Cash Price |
$240.14
|
| Rate for Payer: Cigna Commercial |
$340.20
|
| Rate for Payer: First Health Commercial |
$360.21
|
| Rate for Payer: First Health Workers Compensation |
$154.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.21
|
| Rate for Payer: GEHA Commercial |
$320.18
|
| Rate for Payer: GEHA Medicare |
$386.66
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.21
|
| Rate for Payer: Humana ChoiceCare |
$425.33
|
| Rate for Payer: Humana Medicare Advantage |
$386.66
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$649.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$319.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$386.66
|
| Rate for Payer: Multiplan All |
$364.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$657.32
|
| Rate for Payer: OMNI Networks Commercial |
$280.16
|
| Rate for Payer: One Health Plan PPO/POS |
$360.21
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$368.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$319.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$386.66
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.22
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$773.32
|
| Rate for Payer: Three Rivers Provider Network All |
$300.17
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$378.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$319.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$386.66
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$386.66
|
| Rate for Payer: Zelis Auto |
$160.09
|
| Rate for Payer: Zelis Medicare |
$328.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$463.99
|
| Rate for Payer: Zelis Worker's Compensation |
$109.26
|
|
|
RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR
|
Facility
|
IP
|
$400.23
|
|
|
Service Code
|
CPT 11983
|
| Hospital Charge Code |
8511983
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$109.26 |
| Max. Negotiated Rate |
$380.22 |
| Rate for Payer: Cash Price |
$240.14
|
| Rate for Payer: Cigna Commercial |
$340.20
|
| Rate for Payer: First Health Commercial |
$360.21
|
| Rate for Payer: First Health Workers Compensation |
$154.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.21
|
| Rate for Payer: GEHA Commercial |
$280.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.21
|
| Rate for Payer: Multiplan All |
$364.21
|
| Rate for Payer: OMNI Networks Commercial |
$280.16
|
| Rate for Payer: One Health Plan PPO/POS |
$360.21
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.22
|
| Rate for Payer: Three Rivers Provider Network All |
$300.17
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.21
|
| Rate for Payer: Zelis Auto |
$160.09
|
| Rate for Payer: Zelis Worker's Compensation |
$109.26
|
|
|
RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR
|
Facility
|
OP
|
$400.23
|
|
|
Service Code
|
CPT 11983
|
| Hospital Charge Code |
7211983
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$109.26 |
| Max. Negotiated Rate |
$773.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$395.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$240.14
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$395.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$312.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$386.66
|
| Rate for Payer: Cash Price |
$240.14
|
| Rate for Payer: Cash Price |
$240.14
|
| Rate for Payer: Cigna Commercial |
$340.20
|
| Rate for Payer: First Health Commercial |
$360.21
|
| Rate for Payer: First Health Workers Compensation |
$154.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.21
|
| Rate for Payer: GEHA Commercial |
$320.18
|
| Rate for Payer: GEHA Medicare |
$386.66
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.21
|
| Rate for Payer: Humana ChoiceCare |
$425.33
|
| Rate for Payer: Humana Medicare Advantage |
$386.66
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$649.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$319.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$386.66
|
| Rate for Payer: Multiplan All |
$364.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$657.32
|
| Rate for Payer: OMNI Networks Commercial |
$280.16
|
| Rate for Payer: One Health Plan PPO/POS |
$360.21
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$368.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$319.35
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$386.66
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.22
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$773.32
|
| Rate for Payer: Three Rivers Provider Network All |
$300.17
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$378.93
|
| Rate for Payer: United Healthcare Managed Medicaid |
$319.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$386.66
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$386.66
|
| Rate for Payer: Zelis Auto |
$160.09
|
| Rate for Payer: Zelis Medicare |
$328.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$463.99
|
| Rate for Payer: Zelis Worker's Compensation |
$109.26
|
|
|
RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR
|
Facility
|
IP
|
$400.23
|
|
|
Service Code
|
CPT 11983
|
| Hospital Charge Code |
7211983
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$109.26 |
| Max. Negotiated Rate |
$380.22 |
| Rate for Payer: Cash Price |
$240.14
|
| Rate for Payer: Cigna Commercial |
$340.20
|
| Rate for Payer: First Health Commercial |
$360.21
|
| Rate for Payer: First Health Workers Compensation |
$154.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$360.21
|
| Rate for Payer: GEHA Commercial |
$280.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$360.21
|
| Rate for Payer: Multiplan All |
$364.21
|
| Rate for Payer: OMNI Networks Commercial |
$280.16
|
| Rate for Payer: One Health Plan PPO/POS |
$360.21
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$380.22
|
| Rate for Payer: Three Rivers Provider Network All |
$300.17
|
| Rate for Payer: United Payors & United Providers UP&UP |
$372.21
|
| Rate for Payer: Zelis Auto |
$160.09
|
| Rate for Payer: Zelis Worker's Compensation |
$109.26
|
|
|
RMVL W/RINSJ NON-BIODEGRAD DRUG DLVR IMP
|
Facility
|
IP
|
$541.00
|
|
|
Service Code
|
CPT 11983
|
| Hospital Charge Code |
6111983
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$147.69 |
| Max. Negotiated Rate |
$513.95 |
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cigna Commercial |
$459.85
|
| Rate for Payer: First Health Commercial |
$486.90
|
| Rate for Payer: First Health Workers Compensation |
$208.88
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$486.90
|
| Rate for Payer: GEHA Commercial |
$378.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$486.90
|
| Rate for Payer: Multiplan All |
$492.31
|
| Rate for Payer: OMNI Networks Commercial |
$378.70
|
| Rate for Payer: One Health Plan PPO/POS |
$486.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$513.95
|
| Rate for Payer: Three Rivers Provider Network All |
$405.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$503.13
|
| Rate for Payer: Zelis Auto |
$216.40
|
| Rate for Payer: Zelis Worker's Compensation |
$147.69
|
|
