|
THORACOSCOPY W/THYMUS RESECT
|
Facility
|
OP
|
$2,576.00
|
|
|
Service Code
|
CPT 32673
|
| Hospital Charge Code |
6132673
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$644.00 |
| Max. Negotiated Rate |
$2,447.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,545.60
|
| Rate for Payer: Cash Price |
$1,545.60
|
| Rate for Payer: Cigna Commercial |
$2,189.60
|
| Rate for Payer: First Health Commercial |
$2,318.40
|
| Rate for Payer: First Health Workers Compensation |
$994.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,318.40
|
| Rate for Payer: GEHA Commercial |
$2,060.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,318.40
|
| Rate for Payer: Humana ChoiceCare |
$669.76
|
| Rate for Payer: Multiplan All |
$2,344.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,545.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,803.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,318.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,447.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,932.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,266.88
|
| Rate for Payer: United Healthcare Managed Medicaid |
$644.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,395.68
|
| Rate for Payer: Zelis Auto |
$1,030.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,288.00
|
| Rate for Payer: Zelis Worker's Compensation |
$703.25
|
|
|
THORACOSCOPY W/THYMUS RESECT
|
Facility
|
IP
|
$2,576.00
|
|
|
Service Code
|
CPT 32673
|
| Hospital Charge Code |
6132673
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$703.25 |
| Max. Negotiated Rate |
$2,447.20 |
| Rate for Payer: Cash Price |
$1,545.60
|
| Rate for Payer: Cigna Commercial |
$2,189.60
|
| Rate for Payer: First Health Commercial |
$2,318.40
|
| Rate for Payer: First Health Workers Compensation |
$994.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,318.40
|
| Rate for Payer: GEHA Commercial |
$1,803.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,318.40
|
| Rate for Payer: Multiplan All |
$2,344.16
|
| Rate for Payer: OMNI Networks Commercial |
$1,803.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,318.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,447.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,932.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,395.68
|
| Rate for Payer: Zelis Auto |
$1,030.40
|
| Rate for Payer: Zelis Worker's Compensation |
$703.25
|
|
|
THORACOSCOPY W/WEDGE RESECT
|
Facility
|
IP
|
$1,835.00
|
|
|
Service Code
|
CPT 32666
|
| Hospital Charge Code |
6132666
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$500.95 |
| Max. Negotiated Rate |
$1,743.25 |
| Rate for Payer: Cash Price |
$1,101.00
|
| Rate for Payer: Cigna Commercial |
$1,559.75
|
| Rate for Payer: First Health Commercial |
$1,651.50
|
| Rate for Payer: First Health Workers Compensation |
$708.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,651.50
|
| Rate for Payer: GEHA Commercial |
$1,284.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,651.50
|
| Rate for Payer: Multiplan All |
$1,669.85
|
| Rate for Payer: OMNI Networks Commercial |
$1,284.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,651.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,743.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,376.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,706.55
|
| Rate for Payer: Zelis Auto |
$734.00
|
| Rate for Payer: Zelis Worker's Compensation |
$500.95
|
|
|
THORACOSCOPY W/WEDGE RESECT
|
Facility
|
OP
|
$1,835.00
|
|
|
Service Code
|
CPT 32666
|
| Hospital Charge Code |
6132666
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$458.75 |
| Max. Negotiated Rate |
$1,743.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,101.00
|
| Rate for Payer: Cash Price |
$1,101.00
|
| Rate for Payer: Cigna Commercial |
$1,559.75
|
| Rate for Payer: First Health Commercial |
$1,651.50
|
| Rate for Payer: First Health Workers Compensation |
$708.49
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,651.50
|
| Rate for Payer: GEHA Commercial |
$1,468.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,651.50
|
| Rate for Payer: Humana ChoiceCare |
$477.10
|
| Rate for Payer: Multiplan All |
$1,669.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,101.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,284.50
|
| Rate for Payer: One Health Plan PPO/POS |
$1,651.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,743.25
|
| Rate for Payer: Three Rivers Provider Network All |
$1,376.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,614.80
|
| Rate for Payer: United Healthcare Managed Medicaid |
$458.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,706.55
|
| Rate for Payer: Zelis Auto |
$734.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$917.50
|
| Rate for Payer: Zelis Worker's Compensation |
$500.95
|
|
|
THORACOSCOPY W/W RESECT ADDL
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
CPT 32667
|
| Hospital Charge Code |
6132667
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$428.40
|
| Rate for Payer: First Health Commercial |
$453.60
|
| Rate for Payer: First Health Workers Compensation |
$194.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$453.60
|
| Rate for Payer: GEHA Commercial |
$352.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$453.60
|
| Rate for Payer: Multiplan All |
$458.64
|
| Rate for Payer: OMNI Networks Commercial |
$352.80
|
| Rate for Payer: One Health Plan PPO/POS |
$453.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$478.80
|
| Rate for Payer: Three Rivers Provider Network All |
$378.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$468.72
|
| Rate for Payer: Zelis Auto |
$201.60
|
| Rate for Payer: Zelis Worker's Compensation |
$137.59
|
|
|
THORACOSCOPY W/W RESECT ADDL
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
CPT 32667
|
| Hospital Charge Code |
6132667
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$428.40
|
| Rate for Payer: First Health Commercial |
$453.60
|
| Rate for Payer: First Health Workers Compensation |
$194.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$453.60
|
| Rate for Payer: GEHA Commercial |
$403.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$453.60
|
| Rate for Payer: Humana ChoiceCare |
$131.04
|
| Rate for Payer: Multiplan All |
$458.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$302.40
|
| Rate for Payer: OMNI Networks Commercial |
$352.80
|
| Rate for Payer: One Health Plan PPO/POS |
$453.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$478.80
|
| Rate for Payer: Three Rivers Provider Network All |
$378.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$443.52
|
| Rate for Payer: United Healthcare Managed Medicaid |
$126.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$468.72
|
| Rate for Payer: Zelis Auto |
$201.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$252.00
|
| Rate for Payer: Zelis Worker's Compensation |
$137.59
|
|
|
THORACOSCOPY W/W RESECT DIAG
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 32668
|
| Hospital Charge Code |
6132668
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$137.32 |
| Max. Negotiated Rate |
$477.85 |
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$427.55
|
| Rate for Payer: First Health Commercial |
$452.70
|
| Rate for Payer: First Health Workers Compensation |
$194.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$452.70
|
| Rate for Payer: GEHA Commercial |
$352.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$452.70
|
| Rate for Payer: Multiplan All |
$457.73
|
| Rate for Payer: OMNI Networks Commercial |
$352.10
|
| Rate for Payer: One Health Plan PPO/POS |
$452.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$477.85
|
| Rate for Payer: Three Rivers Provider Network All |
$377.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$467.79
|
| Rate for Payer: Zelis Auto |
$201.20
|
| Rate for Payer: Zelis Worker's Compensation |
$137.32
|
|
|
THORACOSCOPY W/W RESECT DIAG
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 32668
|
| Hospital Charge Code |
6132668
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$125.75 |
| Max. Negotiated Rate |
$477.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$301.80
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$427.55
|
| Rate for Payer: First Health Commercial |
$452.70
|
| Rate for Payer: First Health Workers Compensation |
$194.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$452.70
|
| Rate for Payer: GEHA Commercial |
$402.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$452.70
|
| Rate for Payer: Humana ChoiceCare |
$130.78
|
| Rate for Payer: Multiplan All |
$457.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$301.80
|
| Rate for Payer: OMNI Networks Commercial |
$352.10
|
| Rate for Payer: One Health Plan PPO/POS |
$452.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$477.85
|
| Rate for Payer: Three Rivers Provider Network All |
$377.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$442.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$467.79
|
| Rate for Payer: Zelis Auto |
$201.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$251.50
|
| Rate for Payer: Zelis Worker's Compensation |
$137.32
|
|
|
THORAX STEREO RAD TARGETW/TX
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 32701
|
| Hospital Charge Code |
6132701
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$145.00 |
| Max. Negotiated Rate |
$551.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$348.00
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$493.00
|
| Rate for Payer: First Health Commercial |
$522.00
|
| Rate for Payer: First Health Workers Compensation |
$223.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$522.00
|
| Rate for Payer: GEHA Commercial |
$464.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$522.00
|
| Rate for Payer: Humana ChoiceCare |
$150.80
|
| Rate for Payer: Multiplan All |
$527.80
|
| Rate for Payer: New Mexico Health Connections Medicare |
$348.00
|
| Rate for Payer: OMNI Networks Commercial |
$406.00
|
| Rate for Payer: One Health Plan PPO/POS |
$522.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$551.00
|
| Rate for Payer: Three Rivers Provider Network All |
$435.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$510.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$145.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$539.40
|
| Rate for Payer: Zelis Auto |
$232.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$290.00
|
| Rate for Payer: Zelis Worker's Compensation |
$158.34
|
|
|
THORAX STEREO RAD TARGETW/TX
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 32701
|
| Hospital Charge Code |
6132701
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$158.34 |
| Max. Negotiated Rate |
$551.00 |
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$493.00
|
| Rate for Payer: First Health Commercial |
$522.00
|
| Rate for Payer: First Health Workers Compensation |
$223.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$522.00
|
| Rate for Payer: GEHA Commercial |
$406.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$522.00
|
| Rate for Payer: Multiplan All |
$527.80
|
| Rate for Payer: OMNI Networks Commercial |
$406.00
|
| Rate for Payer: One Health Plan PPO/POS |
$522.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$551.00
|
| Rate for Payer: Three Rivers Provider Network All |
$435.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$539.40
|
| Rate for Payer: Zelis Auto |
$232.00
|
| Rate for Payer: Zelis Worker's Compensation |
$158.34
|
|
|
THRAPUTIC PRPHYLCTIC/DX INJECTION SQ/IM
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
7296372
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$52.96 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$164.90
|
| Rate for Payer: First Health Commercial |
$174.60
|
| Rate for Payer: First Health Workers Compensation |
$74.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$174.60
|
| Rate for Payer: GEHA Commercial |
$135.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$174.60
|
| Rate for Payer: Multiplan All |
$176.54
|
| Rate for Payer: OMNI Networks Commercial |
$135.80
|
| Rate for Payer: One Health Plan PPO/POS |
$174.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$184.30
|
| Rate for Payer: Three Rivers Provider Network All |
$145.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$180.42
|
| Rate for Payer: Zelis Auto |
$77.60
|
| Rate for Payer: Zelis Worker's Compensation |
$52.96
|
|
|
THRAPUTIC PRPHYLCTIC/DX INJECTION SQ/IM
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
7296372
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$116.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$38.51
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$30.50
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$164.90
|
| Rate for Payer: First Health Commercial |
$174.60
|
| Rate for Payer: First Health Workers Compensation |
$74.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$174.60
|
| Rate for Payer: GEHA Commercial |
$155.20
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$174.60
|
| Rate for Payer: Humana ChoiceCare |
$74.34
|
| Rate for Payer: Humana Medicare Advantage |
$67.58
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$113.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$31.12
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$67.58
|
| Rate for Payer: Multiplan All |
$176.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$135.80
|
| Rate for Payer: One Health Plan PPO/POS |
$174.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$35.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$31.12
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$67.58
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$184.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$145.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$66.23
|
| Rate for Payer: United Healthcare Managed Medicaid |
$31.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.58
|
| Rate for Payer: United Payors & United Providers UP&UP |
$180.42
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$77.60
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$52.96
|
|
|
THRLUML BALO ANGIOP 1ST ART
|
Facility
|
OP
|
$7,343.00
|
|
|
Service Code
|
CPT 37246
|
| Hospital Charge Code |
6191053
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,004.64 |
| Max. Negotiated Rate |
$10,827.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7,234.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,405.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7,234.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,731.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,413.82
|
| Rate for Payer: Cash Price |
$4,405.80
|
| Rate for Payer: Cash Price |
$4,405.80
|
| Rate for Payer: Cigna Commercial |
$6,241.55
|
| Rate for Payer: First Health Commercial |
$6,608.70
|
| Rate for Payer: First Health Workers Compensation |
$2,835.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,608.70
|
| Rate for Payer: GEHA Commercial |
$5,874.40
|
| Rate for Payer: GEHA Medicare |
$5,413.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,608.70
|
| Rate for Payer: Humana ChoiceCare |
$5,955.20
|
| Rate for Payer: Humana Medicare Advantage |
$5,413.82
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,095.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,848.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,413.82
|
| Rate for Payer: Multiplan All |
$6,682.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,203.49
|
| Rate for Payer: OMNI Networks Commercial |
$5,140.10
|
| Rate for Payer: One Health Plan PPO/POS |
$6,608.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,752.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,848.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,413.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,975.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10,827.64
|
| Rate for Payer: Three Rivers Provider Network All |
$5,507.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,305.54
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,848.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,413.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,828.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,413.82
|
| Rate for Payer: Zelis Auto |
$2,937.20
|
| Rate for Payer: Zelis Medicare |
$4,601.75
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,496.58
|
| Rate for Payer: Zelis Worker's Compensation |
$2,004.64
|
|
|
THRLUML BALO ANGIOP 1ST ART
|
Facility
|
IP
|
$7,343.00
|
|
|
Service Code
|
CPT 37246
|
| Hospital Charge Code |
6191053
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,004.64 |
| Max. Negotiated Rate |
$6,975.85 |
| Rate for Payer: Cash Price |
$4,405.80
|
| Rate for Payer: Cigna Commercial |
$6,241.55
|
| Rate for Payer: First Health Commercial |
$6,608.70
|
| Rate for Payer: First Health Workers Compensation |
$2,835.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,608.70
|
| Rate for Payer: GEHA Commercial |
$5,140.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,608.70
|
| Rate for Payer: Multiplan All |
$6,682.13
|
| Rate for Payer: OMNI Networks Commercial |
$5,140.10
|
| Rate for Payer: One Health Plan PPO/POS |
$6,608.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,975.85
|
| Rate for Payer: Three Rivers Provider Network All |
$5,507.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,828.99
|
| Rate for Payer: Zelis Auto |
$2,937.20
|
| Rate for Payer: Zelis Worker's Compensation |
$2,004.64
|
|
|
THRLUML BALO ANGIOP 1ST VEIN
|
Facility
|
IP
|
$7,343.00
|
|
|
Service Code
|
CPT 37248
|
| Hospital Charge Code |
6191054
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,004.64 |
| Max. Negotiated Rate |
$6,975.85 |
| Rate for Payer: Cash Price |
$4,405.80
|
| Rate for Payer: Cigna Commercial |
$6,241.55
|
| Rate for Payer: First Health Commercial |
$6,608.70
|
| Rate for Payer: First Health Workers Compensation |
$2,835.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,608.70
|
| Rate for Payer: GEHA Commercial |
$5,140.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,608.70
|
| Rate for Payer: Multiplan All |
$6,682.13
|
| Rate for Payer: OMNI Networks Commercial |
$5,140.10
|
| Rate for Payer: One Health Plan PPO/POS |
$6,608.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,975.85
|
| Rate for Payer: Three Rivers Provider Network All |
$5,507.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,828.99
|
| Rate for Payer: Zelis Auto |
$2,937.20
|
| Rate for Payer: Zelis Worker's Compensation |
$2,004.64
|
|
|
THRLUML BALO ANGIOP 1ST VEIN
|
Facility
|
OP
|
$7,343.00
|
|
|
Service Code
|
CPT 37248
|
| Hospital Charge Code |
6191054
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$2,004.64 |
| Max. Negotiated Rate |
$10,827.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$7,234.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,405.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$7,234.74
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$5,731.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,413.82
|
| Rate for Payer: Cash Price |
$4,405.80
|
| Rate for Payer: Cash Price |
$4,405.80
|
| Rate for Payer: Cigna Commercial |
$6,241.55
|
| Rate for Payer: First Health Commercial |
$6,608.70
|
| Rate for Payer: First Health Workers Compensation |
$2,835.13
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,608.70
|
| Rate for Payer: GEHA Commercial |
$5,874.40
|
| Rate for Payer: GEHA Medicare |
$5,413.82
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,608.70
|
| Rate for Payer: Humana ChoiceCare |
$5,955.20
|
| Rate for Payer: Humana Medicare Advantage |
$5,413.82
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,095.22
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$5,848.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,413.82
|
| Rate for Payer: Multiplan All |
$6,682.13
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,203.49
|
| Rate for Payer: OMNI Networks Commercial |
$5,140.10
|
| Rate for Payer: One Health Plan PPO/POS |
$6,608.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$6,752.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$5,848.08
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,413.82
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,975.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10,827.64
|
| Rate for Payer: Three Rivers Provider Network All |
$5,507.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,305.54
|
| Rate for Payer: United Healthcare Managed Medicaid |
$5,848.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,413.82
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,828.99
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,413.82
|
| Rate for Payer: Zelis Auto |
$2,937.20
|
| Rate for Payer: Zelis Medicare |
$4,601.75
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,496.58
|
| Rate for Payer: Zelis Worker's Compensation |
$2,004.64
|
|
|
THRMBC/NFS DIALY CIRC W TRANS BALLOON AN
|
Facility
|
IP
|
$14,842.00
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
6191051
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$4,051.87 |
| Max. Negotiated Rate |
$14,099.90 |
| Rate for Payer: Cash Price |
$8,905.20
|
| Rate for Payer: Cigna Commercial |
$12,615.70
|
| Rate for Payer: First Health Commercial |
$13,357.80
|
| Rate for Payer: First Health Workers Compensation |
$5,730.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13,357.80
|
| Rate for Payer: GEHA Commercial |
$10,389.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13,357.80
|
| Rate for Payer: Multiplan All |
$13,506.22
|
| Rate for Payer: OMNI Networks Commercial |
$10,389.40
|
| Rate for Payer: One Health Plan PPO/POS |
$13,357.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14,099.90
|
| Rate for Payer: Three Rivers Provider Network All |
$11,131.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,803.06
|
| Rate for Payer: Zelis Auto |
$5,936.80
|
| Rate for Payer: Zelis Worker's Compensation |
$4,051.87
|
|
|
THRMBC/NFS DIALY CIRC W TRANS BALLOON AN
|
Facility
|
OP
|
$14,842.00
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
6191051
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$4,051.87 |
| Max. Negotiated Rate |
$21,536.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$14,622.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$8,905.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$14,622.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$11,583.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10,768.32
|
| Rate for Payer: Cash Price |
$8,905.20
|
| Rate for Payer: Cash Price |
$8,905.20
|
| Rate for Payer: Cigna Commercial |
$12,615.70
|
| Rate for Payer: First Health Commercial |
$13,357.80
|
| Rate for Payer: First Health Workers Compensation |
$5,730.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$13,357.80
|
| Rate for Payer: GEHA Commercial |
$11,873.60
|
| Rate for Payer: GEHA Medicare |
$10,768.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$13,357.80
|
| Rate for Payer: Humana ChoiceCare |
$11,845.15
|
| Rate for Payer: Humana Medicare Advantage |
$10,768.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$18,090.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$11,819.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10,768.32
|
| Rate for Payer: Multiplan All |
$13,506.22
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18,306.14
|
| Rate for Payer: OMNI Networks Commercial |
$10,389.40
|
| Rate for Payer: One Health Plan PPO/POS |
$13,357.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$13,647.63
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$11,819.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10,768.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$14,099.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$21,536.64
|
| Rate for Payer: Three Rivers Provider Network All |
$11,131.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10,552.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$11,819.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,768.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$13,803.06
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10,768.32
|
| Rate for Payer: Zelis Auto |
$5,936.80
|
| Rate for Payer: Zelis Medicare |
$9,153.07
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$12,921.98
|
| Rate for Payer: Zelis Worker's Compensation |
$4,051.87
|
|
|
THRMBC/NFS DIALY CIRC W TRANSCATH PLCMNT
|
Facility
|
IP
|
$22,496.00
|
|
|
Service Code
|
CPT 36906
|
| Hospital Charge Code |
6191052
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$6,141.41 |
| Max. Negotiated Rate |
$21,371.20 |
| Rate for Payer: Cash Price |
$13,497.60
|
| Rate for Payer: Cigna Commercial |
$19,121.60
|
| Rate for Payer: First Health Commercial |
$20,246.40
|
| Rate for Payer: First Health Workers Compensation |
$8,685.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$20,246.40
|
| Rate for Payer: GEHA Commercial |
$15,747.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$20,246.40
|
| Rate for Payer: Multiplan All |
$20,471.36
|
| Rate for Payer: OMNI Networks Commercial |
$15,747.20
|
| Rate for Payer: One Health Plan PPO/POS |
$20,246.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$21,371.20
|
| Rate for Payer: Three Rivers Provider Network All |
$16,872.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$20,921.28
|
| Rate for Payer: Zelis Auto |
$8,998.40
|
| Rate for Payer: Zelis Worker's Compensation |
$6,141.41
|
|
|
THRMBC/NFS DIALY CIRC W TRANSCATH PLCMNT
|
Facility
|
OP
|
$22,496.00
|
|
|
Service Code
|
CPT 36906
|
| Hospital Charge Code |
6191052
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$6,141.41 |
| Max. Negotiated Rate |
$34,101.24 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$22,163.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$13,497.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$22,163.85
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$17,558.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17,050.62
|
| Rate for Payer: Cash Price |
$13,497.60
|
| Rate for Payer: Cash Price |
$13,497.60
|
| Rate for Payer: Cigna Commercial |
$19,121.60
|
| Rate for Payer: First Health Commercial |
$20,246.40
|
| Rate for Payer: First Health Workers Compensation |
$8,685.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$20,246.40
|
| Rate for Payer: GEHA Commercial |
$17,996.80
|
| Rate for Payer: GEHA Medicare |
$17,050.62
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$20,246.40
|
| Rate for Payer: Humana ChoiceCare |
$18,755.68
|
| Rate for Payer: Humana Medicare Advantage |
$17,050.62
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$28,645.04
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$17,915.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,050.62
|
| Rate for Payer: Multiplan All |
$20,471.36
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28,986.05
|
| Rate for Payer: OMNI Networks Commercial |
$15,747.20
|
| Rate for Payer: One Health Plan PPO/POS |
$20,246.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$20,686.26
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$17,915.78
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17,050.62
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$21,371.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34,101.24
|
| Rate for Payer: Three Rivers Provider Network All |
$16,872.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16,709.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$17,915.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,050.62
|
| Rate for Payer: United Payors & United Providers UP&UP |
$20,921.28
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17,050.62
|
| Rate for Payer: Zelis Auto |
$8,998.40
|
| Rate for Payer: Zelis Medicare |
$14,493.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$20,460.74
|
| Rate for Payer: Zelis Worker's Compensation |
$6,141.41
|
|
|
THROAT MUSCLE SURGERY
|
Facility
|
OP
|
$1,078.00
|
|
|
Service Code
|
CPT 43030
|
| Hospital Charge Code |
6143030
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$294.29 |
| Max. Negotiated Rate |
$11,234.32 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$646.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,737.86
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,376.73
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5,617.16
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cigna Commercial |
$916.30
|
| Rate for Payer: First Health Commercial |
$970.20
|
| Rate for Payer: First Health Workers Compensation |
$416.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$970.20
|
| Rate for Payer: GEHA Commercial |
$862.40
|
| Rate for Payer: GEHA Medicare |
$5,617.16
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$970.20
|
| Rate for Payer: Humana ChoiceCare |
$6,178.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,617.16
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$9,436.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,404.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5,617.16
|
| Rate for Payer: Multiplan All |
$980.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9,549.17
|
| Rate for Payer: OMNI Networks Commercial |
$754.60
|
| Rate for Payer: One Health Plan PPO/POS |
$970.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,622.00
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,404.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5,617.16
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,024.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$11,234.32
|
| Rate for Payer: Three Rivers Provider Network All |
$808.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,504.82
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,404.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,617.16
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,002.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5,617.16
|
| Rate for Payer: Zelis Auto |
$431.20
|
| Rate for Payer: Zelis Medicare |
$4,774.59
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6,740.59
|
| Rate for Payer: Zelis Worker's Compensation |
$294.29
|
|
|
THROAT MUSCLE SURGERY
|
Facility
|
IP
|
$1,078.00
|
|
|
Service Code
|
CPT 43030
|
| Hospital Charge Code |
6143030
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$294.29 |
| Max. Negotiated Rate |
$1,024.10 |
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cigna Commercial |
$916.30
|
| Rate for Payer: First Health Commercial |
$970.20
|
| Rate for Payer: First Health Workers Compensation |
$416.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$970.20
|
| Rate for Payer: GEHA Commercial |
$754.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$970.20
|
| Rate for Payer: Multiplan All |
$980.98
|
| Rate for Payer: OMNI Networks Commercial |
$754.60
|
| Rate for Payer: One Health Plan PPO/POS |
$970.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,024.10
|
| Rate for Payer: Three Rivers Provider Network All |
$808.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,002.54
|
| Rate for Payer: Zelis Auto |
$431.20
|
| Rate for Payer: Zelis Worker's Compensation |
$294.29
|
|
|
THROMBIN FOR SOLN 5000 UNIT
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
NDC 60793021505
|
| Hospital Charge Code |
3300889
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$92.27 |
| Max. Negotiated Rate |
$321.10 |
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Cigna Commercial |
$287.30
|
| Rate for Payer: First Health Commercial |
$304.20
|
| Rate for Payer: First Health Workers Compensation |
$130.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$304.20
|
| Rate for Payer: GEHA Commercial |
$236.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$304.20
|
| Rate for Payer: Multiplan All |
$307.58
|
| Rate for Payer: OMNI Networks Commercial |
$236.60
|
| Rate for Payer: One Health Plan PPO/POS |
$304.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$321.10
|
| Rate for Payer: Three Rivers Provider Network All |
$253.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$314.34
|
| Rate for Payer: Zelis Auto |
$135.20
|
| Rate for Payer: Zelis Worker's Compensation |
$92.27
|
|
|
THROMBIN FOR SOLN 5000 UNIT
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
NDC 60793021505
|
| Hospital Charge Code |
3300889
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$321.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$202.80
|
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Cigna Commercial |
$287.30
|
| Rate for Payer: First Health Commercial |
$304.20
|
| Rate for Payer: First Health Workers Compensation |
$130.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$304.20
|
| Rate for Payer: GEHA Commercial |
$270.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$304.20
|
| Rate for Payer: Humana ChoiceCare |
$87.88
|
| Rate for Payer: Multiplan All |
$307.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$202.80
|
| Rate for Payer: OMNI Networks Commercial |
$236.60
|
| Rate for Payer: One Health Plan PPO/POS |
$304.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$321.10
|
| Rate for Payer: Three Rivers Provider Network All |
$253.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$297.44
|
| Rate for Payer: United Healthcare Managed Medicaid |
$84.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$314.34
|
| Rate for Payer: Zelis Auto |
$135.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$169.00
|
| Rate for Payer: Zelis Worker's Compensation |
$92.27
|
|
|
THROMBIN FOR SOLN KIT 20,000 UNIT
|
Facility
|
IP
|
$786.00
|
|
|
Service Code
|
NDC 60793021720
|
| Hospital Charge Code |
3300890
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$214.58 |
| Max. Negotiated Rate |
$746.70 |
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cigna Commercial |
$668.10
|
| Rate for Payer: First Health Commercial |
$707.40
|
| Rate for Payer: First Health Workers Compensation |
$303.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$707.40
|
| Rate for Payer: GEHA Commercial |
$550.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$707.40
|
| Rate for Payer: Multiplan All |
$715.26
|
| Rate for Payer: OMNI Networks Commercial |
$550.20
|
| Rate for Payer: One Health Plan PPO/POS |
$707.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$746.70
|
| Rate for Payer: Three Rivers Provider Network All |
$589.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$730.98
|
| Rate for Payer: Zelis Auto |
$314.40
|
| Rate for Payer: Zelis Worker's Compensation |
$214.58
|
|
