|
BLADDER INSTILLATION ANTICARCINOGENIC AG
|
Facility
|
IP
|
$2,331.00
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
6100008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$636.36 |
| Max. Negotiated Rate |
$2,214.45 |
| Rate for Payer: Cash Price |
$1,398.60
|
| Rate for Payer: Cigna Commercial |
$1,981.35
|
| Rate for Payer: First Health Commercial |
$2,097.90
|
| Rate for Payer: First Health Workers Compensation |
$900.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,097.90
|
| Rate for Payer: GEHA Commercial |
$1,631.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,097.90
|
| Rate for Payer: Multiplan All |
$2,121.21
|
| Rate for Payer: OMNI Networks Commercial |
$1,631.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,097.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,214.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,748.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,167.83
|
| Rate for Payer: Zelis Auto |
$932.40
|
| Rate for Payer: Zelis Worker's Compensation |
$636.36
|
|
|
BLADDER INSTILLATION ANTICARCINOGENIC AG
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
6151720
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$69.61 |
| Max. Negotiated Rate |
$1,267.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$305.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$153.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$305.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$242.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$633.79
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$216.75
|
| Rate for Payer: First Health Commercial |
$229.50
|
| Rate for Payer: First Health Workers Compensation |
$98.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$229.50
|
| Rate for Payer: GEHA Commercial |
$204.00
|
| Rate for Payer: GEHA Medicare |
$633.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$229.50
|
| Rate for Payer: Humana ChoiceCare |
$697.17
|
| Rate for Payer: Humana Medicare Advantage |
$633.79
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,064.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$246.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$633.79
|
| Rate for Payer: Multiplan All |
$232.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,077.44
|
| Rate for Payer: OMNI Networks Commercial |
$178.50
|
| Rate for Payer: One Health Plan PPO/POS |
$229.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$285.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$246.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$633.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$242.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,267.58
|
| Rate for Payer: Three Rivers Provider Network All |
$191.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$621.11
|
| Rate for Payer: United Healthcare Managed Medicaid |
$246.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$633.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$237.15
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$633.79
|
| Rate for Payer: Zelis Auto |
$102.00
|
| Rate for Payer: Zelis Medicare |
$538.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$760.55
|
| Rate for Payer: Zelis Worker's Compensation |
$69.61
|
|
|
BLADDER PRESSURE MEASUREMENT DURING FILL
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
CPT 51726
|
| Hospital Charge Code |
23500046
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$173.90 |
| Max. Negotiated Rate |
$605.15 |
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$541.45
|
| Rate for Payer: First Health Commercial |
$573.30
|
| Rate for Payer: First Health Workers Compensation |
$245.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$573.30
|
| Rate for Payer: GEHA Commercial |
$445.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$573.30
|
| Rate for Payer: Multiplan All |
$579.67
|
| Rate for Payer: OMNI Networks Commercial |
$445.90
|
| Rate for Payer: One Health Plan PPO/POS |
$573.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$605.15
|
| Rate for Payer: Three Rivers Provider Network All |
$477.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$592.41
|
| Rate for Payer: Zelis Auto |
$254.80
|
| Rate for Payer: Zelis Worker's Compensation |
$173.90
|
|
|
BLADDER PRESSURE MEASUREMENT DURING FILL
|
Facility
|
OP
|
$637.00
|
|
|
Service Code
|
CPT 51726
|
| Hospital Charge Code |
23500046
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$173.90 |
| Max. Negotiated Rate |
$605.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$305.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$382.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$305.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$242.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$230.94
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$541.45
|
| Rate for Payer: First Health Commercial |
$573.30
|
| Rate for Payer: First Health Workers Compensation |
$245.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$573.30
|
| Rate for Payer: GEHA Commercial |
$509.60
|
| Rate for Payer: GEHA Medicare |
$230.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$573.30
|
| Rate for Payer: Humana ChoiceCare |
$254.03
|
| Rate for Payer: Humana Medicare Advantage |
$230.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$387.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$246.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$230.94
|
| Rate for Payer: Multiplan All |
$579.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$392.60
|
| Rate for Payer: OMNI Networks Commercial |
$445.90
|
| Rate for Payer: One Health Plan PPO/POS |
$573.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$285.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$246.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$230.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$605.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$461.88
|
| Rate for Payer: Three Rivers Provider Network All |
$477.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$226.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$246.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$592.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$230.94
|
| Rate for Payer: Zelis Auto |
$254.80
|
| Rate for Payer: Zelis Medicare |
$196.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.13
|
| Rate for Payer: Zelis Worker's Compensation |
$173.90
|
|
|
blastomyces abs, quant REF164293
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
2200483
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.96 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$23.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$79.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$23.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$18.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12.90
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$112.20
|
| Rate for Payer: First Health Commercial |
$118.80
|
| Rate for Payer: First Health Workers Compensation |
$20.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$118.80
|
| Rate for Payer: GEHA Commercial |
$105.60
|
| Rate for Payer: GEHA Medicare |
$12.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$118.80
|
| Rate for Payer: Humana ChoiceCare |
$14.19
|
| Rate for Payer: Humana Medicare Advantage |
$12.90
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$21.67
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$18.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12.90
|
| Rate for Payer: Multiplan All |
$120.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$21.93
|
| Rate for Payer: OMNI Networks Commercial |
$92.40
|
| Rate for Payer: One Health Plan PPO/POS |
$118.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$21.67
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$18.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$125.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$25.80
|
| Rate for Payer: Three Rivers Provider Network All |
$99.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$12.64
|
| Rate for Payer: United Healthcare Commercial |
$112.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$18.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.90
|
| Rate for Payer: United Payors & United Providers UP&UP |
$122.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12.90
|
| Rate for Payer: Zelis Auto |
$52.80
|
| Rate for Payer: Zelis Medicare |
$10.96
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$15.48
|
| Rate for Payer: Zelis Worker's Compensation |
$14.68
|
|
|
blastomyces abs, quant REF164293
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
2200483
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$112.20
|
| Rate for Payer: First Health Commercial |
$118.80
|
| Rate for Payer: First Health Workers Compensation |
$20.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$118.80
|
| Rate for Payer: GEHA Commercial |
$92.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$118.80
|
| Rate for Payer: Multiplan All |
$120.12
|
| Rate for Payer: OMNI Networks Commercial |
$92.40
|
| Rate for Payer: One Health Plan PPO/POS |
$118.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$125.40
|
| Rate for Payer: Three Rivers Provider Network All |
$99.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$122.76
|
| Rate for Payer: Zelis Auto |
$52.80
|
| Rate for Payer: Zelis Worker's Compensation |
$14.68
|
|
|
BL DRAW < 3 YRS FEM/JUGULAR
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 36400
|
| Hospital Charge Code |
6136400
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$59.85 |
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$53.55
|
| Rate for Payer: First Health Commercial |
$56.70
|
| Rate for Payer: First Health Workers Compensation |
$24.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$56.70
|
| Rate for Payer: GEHA Commercial |
$44.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$56.70
|
| Rate for Payer: Multiplan All |
$57.33
|
| Rate for Payer: OMNI Networks Commercial |
$44.10
|
| Rate for Payer: One Health Plan PPO/POS |
$56.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$59.85
|
| Rate for Payer: Three Rivers Provider Network All |
$47.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$58.59
|
| Rate for Payer: Zelis Auto |
$25.20
|
| Rate for Payer: Zelis Worker's Compensation |
$17.20
|
|
|
BL DRAW < 3 YRS FEM/JUGULAR
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 36400
|
| Hospital Charge Code |
6136400
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$59.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$53.55
|
| Rate for Payer: First Health Commercial |
$56.70
|
| Rate for Payer: First Health Workers Compensation |
$24.32
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$56.70
|
| Rate for Payer: GEHA Commercial |
$50.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$56.70
|
| Rate for Payer: Humana ChoiceCare |
$16.38
|
| Rate for Payer: Multiplan All |
$57.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$37.80
|
| Rate for Payer: OMNI Networks Commercial |
$44.10
|
| Rate for Payer: One Health Plan PPO/POS |
$56.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$59.85
|
| Rate for Payer: Three Rivers Provider Network All |
$47.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$15.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$58.59
|
| Rate for Payer: Zelis Auto |
$25.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$31.50
|
| Rate for Payer: Zelis Worker's Compensation |
$17.20
|
|
|
BL DRAW <3 YRS OTHER VEIN
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
CPT 36406
|
| Hospital Charge Code |
6136406
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$24.70 |
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$22.10
|
| Rate for Payer: First Health Commercial |
$23.40
|
| Rate for Payer: First Health Workers Compensation |
$10.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$23.40
|
| Rate for Payer: GEHA Commercial |
$18.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$23.40
|
| Rate for Payer: Multiplan All |
$23.66
|
| Rate for Payer: OMNI Networks Commercial |
$18.20
|
| Rate for Payer: One Health Plan PPO/POS |
$23.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$24.70
|
| Rate for Payer: Three Rivers Provider Network All |
$19.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$24.18
|
| Rate for Payer: Zelis Auto |
$10.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.10
|
|
|
BL DRAW <3 YRS OTHER VEIN
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 36406
|
| Hospital Charge Code |
6136406
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$24.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$22.10
|
| Rate for Payer: First Health Commercial |
$23.40
|
| Rate for Payer: First Health Workers Compensation |
$10.04
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$23.40
|
| Rate for Payer: GEHA Commercial |
$20.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$23.40
|
| Rate for Payer: Humana ChoiceCare |
$6.76
|
| Rate for Payer: Multiplan All |
$23.66
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15.60
|
| Rate for Payer: OMNI Networks Commercial |
$18.20
|
| Rate for Payer: One Health Plan PPO/POS |
$23.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$24.70
|
| Rate for Payer: Three Rivers Provider Network All |
$19.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$22.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$6.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$24.18
|
| Rate for Payer: Zelis Auto |
$10.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$13.00
|
| Rate for Payer: Zelis Worker's Compensation |
$7.10
|
|
|
BL DRAW <3 YRS SCALP VEIN
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 36405
|
| Hospital Charge Code |
6136405
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$43.35
|
| Rate for Payer: First Health Commercial |
$45.90
|
| Rate for Payer: First Health Workers Compensation |
$19.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.90
|
| Rate for Payer: GEHA Commercial |
$35.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.90
|
| Rate for Payer: Multiplan All |
$46.41
|
| Rate for Payer: OMNI Networks Commercial |
$35.70
|
| Rate for Payer: One Health Plan PPO/POS |
$45.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$48.45
|
| Rate for Payer: Three Rivers Provider Network All |
$38.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$47.43
|
| Rate for Payer: Zelis Auto |
$20.40
|
| Rate for Payer: Zelis Worker's Compensation |
$13.92
|
|
|
BL DRAW <3 YRS SCALP VEIN
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 36405
|
| Hospital Charge Code |
6136405
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$43.35
|
| Rate for Payer: First Health Commercial |
$45.90
|
| Rate for Payer: First Health Workers Compensation |
$19.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.90
|
| Rate for Payer: GEHA Commercial |
$40.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.90
|
| Rate for Payer: Humana ChoiceCare |
$13.26
|
| Rate for Payer: Multiplan All |
$46.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$30.60
|
| Rate for Payer: OMNI Networks Commercial |
$35.70
|
| Rate for Payer: One Health Plan PPO/POS |
$45.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$48.45
|
| Rate for Payer: Three Rivers Provider Network All |
$38.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$44.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$12.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$47.43
|
| Rate for Payer: Zelis Auto |
$20.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$25.50
|
| Rate for Payer: Zelis Worker's Compensation |
$13.92
|
|
|
BLDR IRRIGATION SMPL LAVAGE &/INSTLJ
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
6151700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$161.75 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$550.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$161.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$230.94
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: First Health Workers Compensation |
$354.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$733.60
|
| Rate for Payer: GEHA Medicare |
$230.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Humana ChoiceCare |
$254.03
|
| Rate for Payer: Humana Medicare Advantage |
$230.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$387.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$165.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$230.94
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$392.60
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$190.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$165.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$230.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$461.88
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$226.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$230.94
|
| Rate for Payer: Zelis Auto |
$366.80
|
| Rate for Payer: Zelis Medicare |
$196.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.13
|
| Rate for Payer: Zelis Worker's Compensation |
$250.34
|
|
|
BLDR IRRIGATION SMPL LAVAGE &/INSTLJ
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
8951700
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$250.34 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: First Health Workers Compensation |
$354.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$641.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
| Rate for Payer: Zelis Worker's Compensation |
$250.34
|
|
|
BLDR IRRIGATION SMPL LAVAGE &/INSTLJ
|
Facility
|
IP
|
$917.00
|
|
| Hospital Charge Code |
8150090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.34 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: First Health Workers Compensation |
$354.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$641.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
| Rate for Payer: Zelis Worker's Compensation |
$250.34
|
|
|
BLDR IRRIGATION SMPL LAVAGE &/INSTLJ
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
23500042
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$250.34 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: First Health Workers Compensation |
$354.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$641.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
| Rate for Payer: Zelis Worker's Compensation |
$250.34
|
|
|
BLDR IRRIGATION SMPL LAVAGE &/INSTLJ
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
10051700
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.34 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: First Health Workers Compensation |
$354.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$641.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
| Rate for Payer: Zelis Worker's Compensation |
$250.34
|
|
|
BLDR IRRIGATION SMPL LAVAGE &/INSTLJ
|
Facility
|
OP
|
$917.00
|
|
| Hospital Charge Code |
8150090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.25 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: First Health Workers Compensation |
$354.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$733.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Humana ChoiceCare |
$238.42
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$550.20
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$806.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$229.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$458.50
|
| Rate for Payer: Zelis Worker's Compensation |
$250.34
|
|
|
BLDR IRRIGATION SMPL LAVAGE &/INSTLJ
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
23500042
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$161.75 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$550.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$161.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$230.94
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: First Health Workers Compensation |
$354.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$733.60
|
| Rate for Payer: GEHA Medicare |
$230.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Humana ChoiceCare |
$254.03
|
| Rate for Payer: Humana Medicare Advantage |
$230.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$387.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$165.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$230.94
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$392.60
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$190.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$165.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$230.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$461.88
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$226.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$230.94
|
| Rate for Payer: Zelis Auto |
$366.80
|
| Rate for Payer: Zelis Medicare |
$196.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.13
|
| Rate for Payer: Zelis Worker's Compensation |
$250.34
|
|
|
BLDR IRRIGATION SMPL LAVAGE &/INSTLJ
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
8951700
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$161.75 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$550.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$161.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$230.94
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: First Health Workers Compensation |
$354.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$733.60
|
| Rate for Payer: GEHA Medicare |
$230.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Humana ChoiceCare |
$254.03
|
| Rate for Payer: Humana Medicare Advantage |
$230.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$387.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$165.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$230.94
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$392.60
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$190.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$165.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$230.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$461.88
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$226.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$230.94
|
| Rate for Payer: Zelis Auto |
$366.80
|
| Rate for Payer: Zelis Medicare |
$196.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.13
|
| Rate for Payer: Zelis Worker's Compensation |
$250.34
|
|
|
BLDR IRRIGATION SMPL LAVAGE &/INSTLJ
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
6151700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$250.34 |
| Max. Negotiated Rate |
$871.15 |
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$779.45
|
| Rate for Payer: First Health Commercial |
$825.30
|
| Rate for Payer: First Health Workers Compensation |
$354.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$825.30
|
| Rate for Payer: GEHA Commercial |
$641.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$825.30
|
| Rate for Payer: Multiplan All |
$834.47
|
| Rate for Payer: OMNI Networks Commercial |
$641.90
|
| Rate for Payer: One Health Plan PPO/POS |
$825.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$871.15
|
| Rate for Payer: Three Rivers Provider Network All |
$687.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$852.81
|
| Rate for Payer: Zelis Auto |
$366.80
|
| Rate for Payer: Zelis Worker's Compensation |
$250.34
|
|
|
BLEPHAROTOMY DRAINAGE ABSCESS EYELID
|
Facility
|
IP
|
$1,122.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
8167700
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
BLEPHAROTOMY DRAINAGE ABSCESS EYELID
|
Facility
|
OP
|
$1,122.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
8167700
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$241.27 |
| Max. Negotiated Rate |
$1,065.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$326.25
|
| 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 |
$326.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$258.46
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$283.85
|
| 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 |
$283.85
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,009.80
|
| Rate for Payer: Humana ChoiceCare |
$312.24
|
| Rate for Payer: Humana Medicare Advantage |
$283.85
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$476.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$263.72
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$283.85
|
| Rate for Payer: Multiplan All |
$1,021.02
|
| Rate for Payer: New Mexico Health Connections Medicare |
$482.55
|
| 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 |
$304.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$263.72
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$283.85
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,065.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$567.70
|
| Rate for Payer: Three Rivers Provider Network All |
$841.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$278.17
|
| Rate for Payer: United Healthcare Managed Medicaid |
$263.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.85
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,043.46
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$283.85
|
| Rate for Payer: Zelis Auto |
$448.80
|
| Rate for Payer: Zelis Medicare |
$241.27
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$340.62
|
| Rate for Payer: Zelis Worker's Compensation |
$306.31
|
|
|
BLOOD DRAW OFF VAD
|
Facility
|
OP
|
$242.00
|
|
| Hospital Charge Code |
8150101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.50 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: First Health Workers Compensation |
$93.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$193.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| Rate for Payer: Humana ChoiceCare |
$62.92
|
| Rate for Payer: Multiplan All |
$220.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$145.20
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$229.90
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$212.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$60.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.06
|
| Rate for Payer: Zelis Auto |
$96.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$121.00
|
| Rate for Payer: Zelis Worker's Compensation |
$66.07
|
|
|
BLOOD DRAW OFF VAD
|
Facility
|
IP
|
$242.00
|
|
| Hospital Charge Code |
8150101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$66.07 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$205.70
|
| Rate for Payer: First Health Commercial |
$217.80
|
| Rate for Payer: First Health Workers Compensation |
$93.44
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$217.80
|
| Rate for Payer: GEHA Commercial |
$169.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$217.80
|
| Rate for Payer: Multiplan All |
$220.22
|
| Rate for Payer: OMNI Networks Commercial |
$169.40
|
| Rate for Payer: One Health Plan PPO/POS |
$217.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$229.90
|
| Rate for Payer: Three Rivers Provider Network All |
$181.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$225.06
|
| Rate for Payer: Zelis Auto |
$96.80
|
| Rate for Payer: Zelis Worker's Compensation |
$66.07
|
|
