|
TIBIAL DISTAL AUGMENT
|
Facility
|
OP
|
$3,609.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$902.25 |
| Max. Negotiated Rate |
$3,428.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,165.40
|
| Rate for Payer: Cash Price |
$2,165.40
|
| Rate for Payer: Cash Price |
$2,165.40
|
| Rate for Payer: Cigna Commercial |
$3,067.65
|
| Rate for Payer: First Health Commercial |
$3,248.10
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,248.10
|
| Rate for Payer: GEHA Commercial |
$2,887.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,248.10
|
| Rate for Payer: Humana ChoiceCare |
$938.34
|
| Rate for Payer: Multiplan All |
$3,284.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,165.40
|
| Rate for Payer: OMNI Networks Commercial |
$2,526.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,248.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,428.55
|
| Rate for Payer: Three Rivers Provider Network All |
$2,706.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,175.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$902.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,356.37
|
| Rate for Payer: Zelis Auto |
$1,443.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,804.50
|
|
|
TIBIAL INSERT
|
Facility
|
OP
|
$11,358.56
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003534
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,839.64 |
| Max. Negotiated Rate |
$10,790.63 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$6,815.14
|
| Rate for Payer: Cash Price |
$6,815.14
|
| Rate for Payer: Cash Price |
$6,815.14
|
| Rate for Payer: Cigna Commercial |
$9,654.78
|
| Rate for Payer: First Health Commercial |
$10,222.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,222.70
|
| Rate for Payer: GEHA Commercial |
$9,086.85
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,222.70
|
| Rate for Payer: Humana ChoiceCare |
$2,953.23
|
| Rate for Payer: Multiplan All |
$10,336.29
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,815.14
|
| Rate for Payer: OMNI Networks Commercial |
$7,950.99
|
| Rate for Payer: One Health Plan PPO/POS |
$10,222.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,790.63
|
| Rate for Payer: Three Rivers Provider Network All |
$8,518.92
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$9,995.53
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,839.64
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,563.46
|
| Rate for Payer: Zelis Auto |
$4,543.42
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,679.28
|
|
|
TIBIAL INSERT
|
Facility
|
IP
|
$11,358.56
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003534
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,543.42 |
| Max. Negotiated Rate |
$10,790.63 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9,086.85
|
| Rate for Payer: Cash Price |
$6,815.14
|
| Rate for Payer: Cash Price |
$6,815.14
|
| Rate for Payer: Cigna Commercial |
$9,654.78
|
| Rate for Payer: First Health Commercial |
$10,222.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$10,222.70
|
| Rate for Payer: GEHA Commercial |
$7,950.99
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$10,222.70
|
| Rate for Payer: Multiplan All |
$10,336.29
|
| Rate for Payer: OMNI Networks Commercial |
$7,950.99
|
| Rate for Payer: One Health Plan PPO/POS |
$10,222.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$10,790.63
|
| Rate for Payer: Three Rivers Provider Network All |
$8,518.92
|
| Rate for Payer: United Payors & United Providers UP&UP |
$10,563.46
|
| Rate for Payer: Zelis Auto |
$4,543.42
|
|
|
TIB/PER REVASC ADD-ON
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
6137232
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$178.81 |
| Max. Negotiated Rate |
$622.25 |
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cigna Commercial |
$556.75
|
| Rate for Payer: First Health Commercial |
$589.50
|
| Rate for Payer: First Health Workers Compensation |
$252.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$589.50
|
| Rate for Payer: GEHA Commercial |
$458.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$589.50
|
| Rate for Payer: Multiplan All |
$596.05
|
| Rate for Payer: OMNI Networks Commercial |
$458.50
|
| Rate for Payer: One Health Plan PPO/POS |
$589.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$622.25
|
| Rate for Payer: Three Rivers Provider Network All |
$491.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$609.15
|
| Rate for Payer: Zelis Auto |
$262.00
|
| Rate for Payer: Zelis Worker's Compensation |
$178.81
|
|
|
TIB/PER REVASC ADD-ON
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
6137232
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$5,549.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,549.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$393.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,549.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,396.12
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cigna Commercial |
$556.75
|
| Rate for Payer: First Health Commercial |
$589.50
|
| Rate for Payer: First Health Workers Compensation |
$252.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$589.50
|
| Rate for Payer: GEHA Commercial |
$524.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$589.50
|
| Rate for Payer: Humana ChoiceCare |
$170.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,485.64
|
| Rate for Payer: Multiplan All |
$596.05
|
| Rate for Payer: New Mexico Health Connections Medicare |
$393.00
|
| Rate for Payer: OMNI Networks Commercial |
$458.50
|
| Rate for Payer: One Health Plan PPO/POS |
$589.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5,179.30
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,485.64
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$622.25
|
| Rate for Payer: Three Rivers Provider Network All |
$491.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$576.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,485.64
|
| Rate for Payer: United Payors & United Providers UP&UP |
$609.15
|
| Rate for Payer: Zelis Auto |
$262.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$327.50
|
| Rate for Payer: Zelis Worker's Compensation |
$178.81
|
|
|
TIB/PER REVASC STENT & ATHER
|
Facility
|
IP
|
$2,479.00
|
|
|
Service Code
|
CPT 37231
|
| Hospital Charge Code |
6137231
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$676.77 |
| Max. Negotiated Rate |
$2,355.05 |
| Rate for Payer: Cash Price |
$1,487.40
|
| Rate for Payer: Cigna Commercial |
$2,107.15
|
| Rate for Payer: First Health Commercial |
$2,231.10
|
| Rate for Payer: First Health Workers Compensation |
$957.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,231.10
|
| Rate for Payer: GEHA Commercial |
$1,735.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,231.10
|
| Rate for Payer: Multiplan All |
$2,255.89
|
| Rate for Payer: OMNI Networks Commercial |
$1,735.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,231.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,355.05
|
| Rate for Payer: Three Rivers Provider Network All |
$1,859.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,305.47
|
| Rate for Payer: Zelis Auto |
$991.60
|
| Rate for Payer: Zelis Worker's Compensation |
$676.77
|
|
|
TIB/PER REVASC STENT & ATHER
|
Facility
|
OP
|
$2,479.00
|
|
|
Service Code
|
CPT 37231
|
| Hospital Charge Code |
6137231
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$676.77 |
| Max. Negotiated Rate |
$34,101.24 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20,403.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,487.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20,403.10
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16,163.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17,050.62
|
| Rate for Payer: Cash Price |
$1,487.40
|
| Rate for Payer: Cash Price |
$1,487.40
|
| Rate for Payer: Cigna Commercial |
$2,107.15
|
| Rate for Payer: First Health Commercial |
$2,231.10
|
| Rate for Payer: First Health Workers Compensation |
$957.14
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,231.10
|
| Rate for Payer: GEHA Commercial |
$1,983.20
|
| Rate for Payer: GEHA Medicare |
$17,050.62
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,231.10
|
| 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 |
$16,492.51
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,050.62
|
| Rate for Payer: Multiplan All |
$2,255.89
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28,986.05
|
| Rate for Payer: OMNI Networks Commercial |
$1,735.30
|
| Rate for Payer: One Health Plan PPO/POS |
$2,231.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19,042.90
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16,492.51
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17,050.62
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,355.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34,101.24
|
| Rate for Payer: Three Rivers Provider Network All |
$1,859.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16,709.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16,492.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,050.62
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,305.47
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17,050.62
|
| Rate for Payer: Zelis Auto |
$991.60
|
| 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 |
$676.77
|
|
|
TIB/PER REVASC STNT & ATHER
|
Facility
|
IP
|
$1,306.00
|
|
|
Service Code
|
CPT 37235
|
| Hospital Charge Code |
6137235
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$356.54 |
| Max. Negotiated Rate |
$1,240.70 |
| Rate for Payer: Cash Price |
$783.60
|
| Rate for Payer: Cigna Commercial |
$1,110.10
|
| Rate for Payer: First Health Commercial |
$1,175.40
|
| Rate for Payer: First Health Workers Compensation |
$504.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,175.40
|
| Rate for Payer: GEHA Commercial |
$914.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,175.40
|
| Rate for Payer: Multiplan All |
$1,188.46
|
| Rate for Payer: OMNI Networks Commercial |
$914.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,175.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,240.70
|
| Rate for Payer: Three Rivers Provider Network All |
$979.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,214.58
|
| Rate for Payer: Zelis Auto |
$522.40
|
| Rate for Payer: Zelis Worker's Compensation |
$356.54
|
|
|
TIB/PER REVASC STNT & ATHER
|
Facility
|
OP
|
$1,306.00
|
|
|
Service Code
|
CPT 37235
|
| Hospital Charge Code |
6137235
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$339.56 |
| Max. Negotiated Rate |
$5,549.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,549.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$783.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,549.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,396.12
|
| Rate for Payer: Cash Price |
$783.60
|
| Rate for Payer: Cash Price |
$783.60
|
| Rate for Payer: Cigna Commercial |
$1,110.10
|
| Rate for Payer: First Health Commercial |
$1,175.40
|
| Rate for Payer: First Health Workers Compensation |
$504.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,175.40
|
| Rate for Payer: GEHA Commercial |
$1,044.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,175.40
|
| Rate for Payer: Humana ChoiceCare |
$339.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$4,485.64
|
| Rate for Payer: Multiplan All |
$1,188.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$783.60
|
| Rate for Payer: OMNI Networks Commercial |
$914.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,175.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5,179.30
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,485.64
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,240.70
|
| Rate for Payer: Three Rivers Provider Network All |
$979.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,149.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,485.64
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,214.58
|
| Rate for Payer: Zelis Auto |
$522.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$653.00
|
| Rate for Payer: Zelis Worker's Compensation |
$356.54
|
|
|
TIB/PER REVASC W/ATHER
|
Facility
|
OP
|
$2,301.00
|
|
|
Service Code
|
CPT 37229
|
| Hospital Charge Code |
6137229
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$628.17 |
| Max. Negotiated Rate |
$34,101.24 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11,780.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,380.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11,780.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9,332.87
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17,050.62
|
| Rate for Payer: Cash Price |
$1,380.60
|
| Rate for Payer: Cash Price |
$1,380.60
|
| Rate for Payer: Cigna Commercial |
$1,955.85
|
| Rate for Payer: First Health Commercial |
$2,070.90
|
| Rate for Payer: First Health Workers Compensation |
$888.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,070.90
|
| Rate for Payer: GEHA Commercial |
$1,840.80
|
| Rate for Payer: GEHA Medicare |
$17,050.62
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,070.90
|
| 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 |
$9,522.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,050.62
|
| Rate for Payer: Multiplan All |
$2,093.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28,986.05
|
| Rate for Payer: OMNI Networks Commercial |
$1,610.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,070.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10,995.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9,522.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17,050.62
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,185.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34,101.24
|
| Rate for Payer: Three Rivers Provider Network All |
$1,725.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16,709.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9,522.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,050.62
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,139.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17,050.62
|
| Rate for Payer: Zelis Auto |
$920.40
|
| 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 |
$628.17
|
|
|
TIB/PER REVASC W/ATHER
|
Facility
|
IP
|
$2,301.00
|
|
|
Service Code
|
CPT 37229
|
| Hospital Charge Code |
6137229
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$628.17 |
| Max. Negotiated Rate |
$2,185.95 |
| Rate for Payer: Cash Price |
$1,380.60
|
| Rate for Payer: Cigna Commercial |
$1,955.85
|
| Rate for Payer: First Health Commercial |
$2,070.90
|
| Rate for Payer: First Health Workers Compensation |
$888.42
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,070.90
|
| Rate for Payer: GEHA Commercial |
$1,610.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,070.90
|
| Rate for Payer: Multiplan All |
$2,093.91
|
| Rate for Payer: OMNI Networks Commercial |
$1,610.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,070.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,185.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,725.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,139.93
|
| Rate for Payer: Zelis Auto |
$920.40
|
| Rate for Payer: Zelis Worker's Compensation |
$628.17
|
|
|
TIBPER REVASC W/ATHER ADD-ON
|
Facility
|
IP
|
$1,067.00
|
|
|
Service Code
|
CPT 37233
|
| Hospital Charge Code |
6137233
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$291.29 |
| Max. Negotiated Rate |
$1,013.65 |
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Cigna Commercial |
$906.95
|
| Rate for Payer: First Health Commercial |
$960.30
|
| Rate for Payer: First Health Workers Compensation |
$411.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$960.30
|
| Rate for Payer: GEHA Commercial |
$746.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$960.30
|
| Rate for Payer: Multiplan All |
$970.97
|
| Rate for Payer: OMNI Networks Commercial |
$746.90
|
| Rate for Payer: One Health Plan PPO/POS |
$960.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,013.65
|
| Rate for Payer: Three Rivers Provider Network All |
$800.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$992.31
|
| Rate for Payer: Zelis Auto |
$426.80
|
| Rate for Payer: Zelis Worker's Compensation |
$291.29
|
|
|
TIBPER REVASC W/ATHER ADD-ON
|
Facility
|
OP
|
$1,067.00
|
|
|
Service Code
|
CPT 37233
|
| Hospital Charge Code |
6137233
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$277.42 |
| Max. Negotiated Rate |
$11,780.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11,780.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$640.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11,780.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9,332.87
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Cigna Commercial |
$906.95
|
| Rate for Payer: First Health Commercial |
$960.30
|
| Rate for Payer: First Health Workers Compensation |
$411.97
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$960.30
|
| Rate for Payer: GEHA Commercial |
$853.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$960.30
|
| Rate for Payer: Humana ChoiceCare |
$277.42
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9,522.94
|
| Rate for Payer: Multiplan All |
$970.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$640.20
|
| Rate for Payer: OMNI Networks Commercial |
$746.90
|
| Rate for Payer: One Health Plan PPO/POS |
$960.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10,995.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9,522.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,013.65
|
| Rate for Payer: Three Rivers Provider Network All |
$800.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$938.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9,522.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$992.31
|
| Rate for Payer: Zelis Auto |
$426.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$533.50
|
| Rate for Payer: Zelis Worker's Compensation |
$291.29
|
|
|
TIB/PER REVASC W/STENT
|
Facility
|
IP
|
$2,283.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
6137230
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$623.26 |
| Max. Negotiated Rate |
$2,168.85 |
| Rate for Payer: Cash Price |
$1,369.80
|
| Rate for Payer: Cigna Commercial |
$1,940.55
|
| Rate for Payer: First Health Commercial |
$2,054.70
|
| Rate for Payer: First Health Workers Compensation |
$881.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,054.70
|
| Rate for Payer: GEHA Commercial |
$1,598.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,054.70
|
| Rate for Payer: Multiplan All |
$2,077.53
|
| Rate for Payer: OMNI Networks Commercial |
$1,598.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,054.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,168.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,712.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,123.19
|
| Rate for Payer: Zelis Auto |
$913.20
|
| Rate for Payer: Zelis Worker's Compensation |
$623.26
|
|
|
TIB/PER REVASC W/STENT
|
Facility
|
OP
|
$2,283.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
6137230
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$623.26 |
| Max. Negotiated Rate |
$34,101.24 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11,780.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,369.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11,780.95
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9,332.87
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$17,050.62
|
| Rate for Payer: Cash Price |
$1,369.80
|
| Rate for Payer: Cash Price |
$1,369.80
|
| Rate for Payer: Cigna Commercial |
$1,940.55
|
| Rate for Payer: First Health Commercial |
$2,054.70
|
| Rate for Payer: First Health Workers Compensation |
$881.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,054.70
|
| Rate for Payer: GEHA Commercial |
$1,826.40
|
| Rate for Payer: GEHA Medicare |
$17,050.62
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,054.70
|
| 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 |
$9,522.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$17,050.62
|
| Rate for Payer: Multiplan All |
$2,077.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$28,986.05
|
| Rate for Payer: OMNI Networks Commercial |
$1,598.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,054.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10,995.56
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9,522.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$17,050.62
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,168.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$34,101.24
|
| Rate for Payer: Three Rivers Provider Network All |
$1,712.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$16,709.61
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9,522.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,050.62
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,123.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$17,050.62
|
| Rate for Payer: Zelis Auto |
$913.20
|
| 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 |
$623.26
|
|
|
TIB/PER REVASC W/TLA
|
Facility
|
OP
|
$1,772.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
6137228
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$483.76 |
| Max. Negotiated Rate |
$21,536.64 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$5,549.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,063.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$5,549.25
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$4,396.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$10,768.32
|
| Rate for Payer: Cash Price |
$1,063.20
|
| Rate for Payer: Cash Price |
$1,063.20
|
| Rate for Payer: Cigna Commercial |
$1,506.20
|
| Rate for Payer: First Health Commercial |
$1,594.80
|
| Rate for Payer: First Health Workers Compensation |
$684.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,594.80
|
| Rate for Payer: GEHA Commercial |
$1,417.60
|
| Rate for Payer: GEHA Medicare |
$10,768.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,594.80
|
| 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 |
$4,485.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$10,768.32
|
| Rate for Payer: Multiplan All |
$1,612.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$18,306.14
|
| Rate for Payer: OMNI Networks Commercial |
$1,240.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,594.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$5,179.30
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$4,485.64
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$10,768.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,683.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$21,536.64
|
| Rate for Payer: Three Rivers Provider Network All |
$1,329.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$10,552.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4,485.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,768.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,647.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$10,768.32
|
| Rate for Payer: Zelis Auto |
$708.80
|
| 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 |
$483.76
|
|
|
TIB/PER REVASC W/TLA
|
Facility
|
IP
|
$1,772.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
6137228
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$483.76 |
| Max. Negotiated Rate |
$1,683.40 |
| Rate for Payer: Cash Price |
$1,063.20
|
| Rate for Payer: Cigna Commercial |
$1,506.20
|
| Rate for Payer: First Health Commercial |
$1,594.80
|
| Rate for Payer: First Health Workers Compensation |
$684.17
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,594.80
|
| Rate for Payer: GEHA Commercial |
$1,240.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,594.80
|
| Rate for Payer: Multiplan All |
$1,612.52
|
| Rate for Payer: OMNI Networks Commercial |
$1,240.40
|
| Rate for Payer: One Health Plan PPO/POS |
$1,594.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,683.40
|
| Rate for Payer: Three Rivers Provider Network All |
$1,329.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,647.96
|
| Rate for Payer: Zelis Auto |
$708.80
|
| Rate for Payer: Zelis Worker's Compensation |
$483.76
|
|
|
TICE BCG 50MG
|
Facility
|
OP
|
$889.00
|
|
|
Service Code
|
CPT J9030
|
| Hospital Charge Code |
3301050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$844.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$533.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3.35
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cigna Commercial |
$755.65
|
| Rate for Payer: First Health Commercial |
$800.10
|
| Rate for Payer: First Health Workers Compensation |
$343.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$800.10
|
| Rate for Payer: GEHA Commercial |
$3.59
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$800.10
|
| Rate for Payer: Humana ChoiceCare |
$231.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3.42
|
| Rate for Payer: Multiplan All |
$808.99
|
| Rate for Payer: New Mexico Health Connections Medicare |
$533.40
|
| Rate for Payer: OMNI Networks Commercial |
$622.30
|
| Rate for Payer: One Health Plan PPO/POS |
$800.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3.95
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3.42
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$844.55
|
| Rate for Payer: Three Rivers Provider Network All |
$666.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$782.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$826.77
|
| Rate for Payer: Zelis Auto |
$355.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$444.50
|
| Rate for Payer: Zelis Worker's Compensation |
$242.70
|
|
|
TICE BCG 50MG
|
Facility
|
IP
|
$889.00
|
|
|
Service Code
|
CPT J9030
|
| Hospital Charge Code |
3301050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$242.70 |
| Max. Negotiated Rate |
$844.55 |
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cigna Commercial |
$755.65
|
| Rate for Payer: First Health Commercial |
$800.10
|
| Rate for Payer: First Health Workers Compensation |
$343.24
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$800.10
|
| Rate for Payer: GEHA Commercial |
$622.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$800.10
|
| Rate for Payer: Multiplan All |
$808.99
|
| Rate for Payer: OMNI Networks Commercial |
$622.30
|
| Rate for Payer: One Health Plan PPO/POS |
$800.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$844.55
|
| Rate for Payer: Three Rivers Provider Network All |
$666.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$826.77
|
| Rate for Payer: Zelis Auto |
$355.60
|
| Rate for Payer: Zelis Worker's Compensation |
$242.70
|
|
|
TIGECYCLINE (TYGACIL) 50MG VIAL
|
Facility
|
IP
|
$625.00
|
|
|
Service Code
|
CPT J3243
|
| Hospital Charge Code |
3302332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$170.62 |
| Max. Negotiated Rate |
$593.75 |
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$531.25
|
| Rate for Payer: First Health Commercial |
$562.50
|
| Rate for Payer: First Health Workers Compensation |
$241.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$562.50
|
| Rate for Payer: GEHA Commercial |
$437.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$562.50
|
| Rate for Payer: Multiplan All |
$568.75
|
| Rate for Payer: OMNI Networks Commercial |
$437.50
|
| Rate for Payer: One Health Plan PPO/POS |
$562.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$593.75
|
| Rate for Payer: Three Rivers Provider Network All |
$468.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$581.25
|
| Rate for Payer: Zelis Auto |
$250.00
|
| Rate for Payer: Zelis Worker's Compensation |
$170.62
|
|
|
TIGECYCLINE (TYGACIL) 50MG VIAL
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
CPT J3243
|
| Hospital Charge Code |
3302332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$593.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3.12
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2.47
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$531.25
|
| Rate for Payer: First Health Commercial |
$562.50
|
| Rate for Payer: First Health Workers Compensation |
$241.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$562.50
|
| Rate for Payer: GEHA Commercial |
$0.43
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$562.50
|
| Rate for Payer: Humana ChoiceCare |
$162.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2.52
|
| Rate for Payer: Multiplan All |
$568.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$375.00
|
| Rate for Payer: OMNI Networks Commercial |
$437.50
|
| Rate for Payer: One Health Plan PPO/POS |
$562.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2.91
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2.52
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$593.75
|
| Rate for Payer: Three Rivers Provider Network All |
$468.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$550.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$581.25
|
| Rate for Payer: Zelis Auto |
$250.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$312.50
|
| Rate for Payer: Zelis Worker's Compensation |
$170.62
|
|
|
TILT TABLE STUDY
|
Facility
|
IP
|
$2,971.60
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
4093660
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$811.25 |
| Max. Negotiated Rate |
$2,823.02 |
| Rate for Payer: Cash Price |
$1,782.96
|
| Rate for Payer: Cigna Commercial |
$2,525.86
|
| Rate for Payer: First Health Commercial |
$2,674.44
|
| Rate for Payer: First Health Workers Compensation |
$1,147.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,674.44
|
| Rate for Payer: GEHA Commercial |
$2,080.12
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,674.44
|
| Rate for Payer: Multiplan All |
$2,704.16
|
| Rate for Payer: OMNI Networks Commercial |
$2,080.12
|
| Rate for Payer: One Health Plan PPO/POS |
$2,674.44
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,823.02
|
| Rate for Payer: Three Rivers Provider Network All |
$2,228.70
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,763.59
|
| Rate for Payer: Zelis Auto |
$1,188.64
|
| Rate for Payer: Zelis Worker's Compensation |
$811.25
|
|
|
TILT TABLE STUDY
|
Facility
|
OP
|
$2,971.60
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
4093660
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$350.07 |
| Max. Negotiated Rate |
$2,823.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$441.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,782.96
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$441.90
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$350.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$503.83
|
| Rate for Payer: Cash Price |
$1,782.96
|
| Rate for Payer: Cash Price |
$1,782.96
|
| Rate for Payer: Cigna Commercial |
$2,525.86
|
| Rate for Payer: First Health Commercial |
$2,674.44
|
| Rate for Payer: First Health Workers Compensation |
$1,147.33
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,674.44
|
| Rate for Payer: GEHA Commercial |
$2,377.28
|
| Rate for Payer: GEHA Medicare |
$503.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,674.44
|
| Rate for Payer: Humana ChoiceCare |
$554.21
|
| Rate for Payer: Humana Medicare Advantage |
$503.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$846.43
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$357.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$503.83
|
| Rate for Payer: Multiplan All |
$2,704.16
|
| Rate for Payer: New Mexico Health Connections Medicare |
$856.51
|
| Rate for Payer: OMNI Networks Commercial |
$2,080.12
|
| Rate for Payer: One Health Plan PPO/POS |
$2,674.44
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$412.44
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$357.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$503.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,823.02
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,007.66
|
| Rate for Payer: Three Rivers Provider Network All |
$2,228.70
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$493.75
|
| Rate for Payer: United Healthcare Commercial |
$2,525.86
|
| Rate for Payer: United Healthcare Managed Medicaid |
$357.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$503.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,763.59
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$503.83
|
| Rate for Payer: Zelis Auto |
$1,188.64
|
| Rate for Payer: Zelis Medicare |
$428.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$604.60
|
| Rate for Payer: Zelis Worker's Compensation |
$811.25
|
|
|
TIMOLOL 0.25% OPTH SOLN
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
NDC 60758080205
|
| Hospital Charge Code |
3300893
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.75 |
| Max. Negotiated Rate |
$101.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$90.95
|
| Rate for Payer: First Health Commercial |
$96.30
|
| Rate for Payer: First Health Workers Compensation |
$41.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$96.30
|
| Rate for Payer: GEHA Commercial |
$85.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$96.30
|
| Rate for Payer: Humana ChoiceCare |
$27.82
|
| Rate for Payer: Multiplan All |
$97.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$64.20
|
| Rate for Payer: OMNI Networks Commercial |
$74.90
|
| Rate for Payer: One Health Plan PPO/POS |
$96.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$101.65
|
| Rate for Payer: Three Rivers Provider Network All |
$80.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$94.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$26.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$99.51
|
| Rate for Payer: Zelis Auto |
$42.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$53.50
|
| Rate for Payer: Zelis Worker's Compensation |
$29.21
|
|
|
TIMOLOL 0.25% OPTH SOLN
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
NDC 60758080205
|
| Hospital Charge Code |
3300893
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.21 |
| Max. Negotiated Rate |
$101.65 |
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$90.95
|
| Rate for Payer: First Health Commercial |
$96.30
|
| Rate for Payer: First Health Workers Compensation |
$41.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$96.30
|
| Rate for Payer: GEHA Commercial |
$74.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$96.30
|
| Rate for Payer: Multiplan All |
$97.37
|
| Rate for Payer: OMNI Networks Commercial |
$74.90
|
| Rate for Payer: One Health Plan PPO/POS |
$96.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$101.65
|
| Rate for Payer: Three Rivers Provider Network All |
$80.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$99.51
|
| Rate for Payer: Zelis Auto |
$42.80
|
| Rate for Payer: Zelis Worker's Compensation |
$29.21
|
|
