|
TRANSPLANT PALM TENDON
|
Facility
|
OP
|
$1,591.00
|
|
|
Service Code
|
CPT 26485
|
| Hospital Charge Code |
6126485
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$434.34 |
| Max. Negotiated Rate |
$6,161.78 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$954.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,855.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,261.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,080.89
|
| Rate for Payer: Cash Price |
$954.60
|
| Rate for Payer: Cash Price |
$954.60
|
| Rate for Payer: Cigna Commercial |
$1,352.35
|
| Rate for Payer: First Health Commercial |
$1,431.90
|
| Rate for Payer: First Health Workers Compensation |
$614.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,431.90
|
| Rate for Payer: GEHA Commercial |
$1,272.80
|
| Rate for Payer: GEHA Medicare |
$3,080.89
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,431.90
|
| Rate for Payer: Humana ChoiceCare |
$3,388.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,080.89
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,175.90
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,307.85
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,080.89
|
| Rate for Payer: Multiplan All |
$1,447.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,237.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,113.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,431.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,664.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,307.85
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,080.89
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,511.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,161.78
|
| Rate for Payer: Three Rivers Provider Network All |
$1,193.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,019.27
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,307.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,080.89
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,479.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,080.89
|
| Rate for Payer: Zelis Auto |
$636.40
|
| Rate for Payer: Zelis Medicare |
$2,618.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,697.07
|
| Rate for Payer: Zelis Worker's Compensation |
$434.34
|
|
|
TRANSPLANT PALM TENDON
|
Facility
|
IP
|
$1,591.00
|
|
|
Service Code
|
CPT 26485
|
| Hospital Charge Code |
6126485
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$434.34 |
| Max. Negotiated Rate |
$1,511.45 |
| Rate for Payer: Cash Price |
$954.60
|
| Rate for Payer: Cigna Commercial |
$1,352.35
|
| Rate for Payer: First Health Commercial |
$1,431.90
|
| Rate for Payer: First Health Workers Compensation |
$614.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,431.90
|
| Rate for Payer: GEHA Commercial |
$1,113.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,431.90
|
| Rate for Payer: Multiplan All |
$1,447.81
|
| Rate for Payer: OMNI Networks Commercial |
$1,113.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,431.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,511.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,193.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,479.63
|
| Rate for Payer: Zelis Auto |
$636.40
|
| Rate for Payer: Zelis Worker's Compensation |
$434.34
|
|
|
TRANSPLANTS OF THIGH TENDONS
|
Facility
|
OP
|
$1,856.00
|
|
|
Service Code
|
CPT 27397
|
| Hospital Charge Code |
6127397
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$506.69 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,113.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,709.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,730.88
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$1,113.60
|
| Rate for Payer: Cash Price |
$1,113.60
|
| Rate for Payer: Cigna Commercial |
$1,577.60
|
| Rate for Payer: First Health Commercial |
$1,670.40
|
| Rate for Payer: First Health Workers Compensation |
$716.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,670.40
|
| Rate for Payer: GEHA Commercial |
$1,484.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,670.40
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,806.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$1,688.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$1,299.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,670.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,395.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,806.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,763.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$1,392.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,806.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,726.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$742.40
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$506.69
|
|
|
TRANSPLANTS OF THIGH TENDONS
|
Facility
|
IP
|
$1,856.00
|
|
|
Service Code
|
CPT 27397
|
| Hospital Charge Code |
6127397
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$506.69 |
| Max. Negotiated Rate |
$1,763.20 |
| Rate for Payer: Cash Price |
$1,113.60
|
| Rate for Payer: Cigna Commercial |
$1,577.60
|
| Rate for Payer: First Health Commercial |
$1,670.40
|
| Rate for Payer: First Health Workers Compensation |
$716.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,670.40
|
| Rate for Payer: GEHA Commercial |
$1,299.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,670.40
|
| Rate for Payer: Multiplan All |
$1,688.96
|
| Rate for Payer: OMNI Networks Commercial |
$1,299.20
|
| Rate for Payer: One Health Plan PPO/POS |
$1,670.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,763.20
|
| Rate for Payer: Three Rivers Provider Network All |
$1,392.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,726.08
|
| Rate for Payer: Zelis Auto |
$742.40
|
| Rate for Payer: Zelis Worker's Compensation |
$506.69
|
|
|
TRANSPLANT URETER TO SKIN
|
Facility
|
OP
|
$1,949.00
|
|
|
Service Code
|
CPT 50860
|
| Hospital Charge Code |
6150860
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$487.25 |
| Max. Negotiated Rate |
$1,851.55 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,169.40
|
| Rate for Payer: Cash Price |
$1,169.40
|
| Rate for Payer: Cigna Commercial |
$1,656.65
|
| Rate for Payer: First Health Commercial |
$1,754.10
|
| Rate for Payer: First Health Workers Compensation |
$752.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,754.10
|
| Rate for Payer: GEHA Commercial |
$1,559.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,754.10
|
| Rate for Payer: Humana ChoiceCare |
$506.74
|
| Rate for Payer: Multiplan All |
$1,773.59
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,169.40
|
| Rate for Payer: OMNI Networks Commercial |
$1,364.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,754.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,851.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,461.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,715.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$487.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,812.57
|
| Rate for Payer: Zelis Auto |
$779.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$974.50
|
| Rate for Payer: Zelis Worker's Compensation |
$532.08
|
|
|
TRANSPLANT URETER TO SKIN
|
Facility
|
IP
|
$1,949.00
|
|
|
Service Code
|
CPT 50860
|
| Hospital Charge Code |
6150860
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$532.08 |
| Max. Negotiated Rate |
$1,851.55 |
| Rate for Payer: Cash Price |
$1,169.40
|
| Rate for Payer: Cigna Commercial |
$1,656.65
|
| Rate for Payer: First Health Commercial |
$1,754.10
|
| Rate for Payer: First Health Workers Compensation |
$752.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,754.10
|
| Rate for Payer: GEHA Commercial |
$1,364.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,754.10
|
| Rate for Payer: Multiplan All |
$1,773.59
|
| Rate for Payer: OMNI Networks Commercial |
$1,364.30
|
| Rate for Payer: One Health Plan PPO/POS |
$1,754.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,851.55
|
| Rate for Payer: Three Rivers Provider Network All |
$1,461.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,812.57
|
| Rate for Payer: Zelis Auto |
$779.60
|
| Rate for Payer: Zelis Worker's Compensation |
$532.08
|
|
|
TRANSPLJ HEMATOPOIETIC BOOST
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
CPT 38243
|
| Hospital Charge Code |
6138243
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$3,113.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,347.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$216.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,347.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,067.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,556.56
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna Commercial |
$306.00
|
| Rate for Payer: First Health Commercial |
$324.00
|
| Rate for Payer: First Health Workers Compensation |
$139.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$324.00
|
| Rate for Payer: GEHA Commercial |
$288.00
|
| Rate for Payer: GEHA Medicare |
$1,556.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$324.00
|
| Rate for Payer: Humana ChoiceCare |
$1,712.22
|
| Rate for Payer: Humana Medicare Advantage |
$1,556.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,615.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,089.50
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,556.56
|
| Rate for Payer: Multiplan All |
$327.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,646.15
|
| Rate for Payer: OMNI Networks Commercial |
$252.00
|
| Rate for Payer: One Health Plan PPO/POS |
$324.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,257.98
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,089.50
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,556.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$342.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,113.12
|
| Rate for Payer: Three Rivers Provider Network All |
$270.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,525.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,089.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,556.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$334.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,556.56
|
| Rate for Payer: Zelis Auto |
$144.00
|
| Rate for Payer: Zelis Medicare |
$1,323.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,867.87
|
| Rate for Payer: Zelis Worker's Compensation |
$98.28
|
|
|
TRANSPLJ HEMATOPOIETIC BOOST
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
CPT 38243
|
| Hospital Charge Code |
6138243
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna Commercial |
$306.00
|
| Rate for Payer: First Health Commercial |
$324.00
|
| Rate for Payer: First Health Workers Compensation |
$139.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$324.00
|
| Rate for Payer: GEHA Commercial |
$252.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$324.00
|
| Rate for Payer: Multiplan All |
$327.60
|
| Rate for Payer: OMNI Networks Commercial |
$252.00
|
| Rate for Payer: One Health Plan PPO/POS |
$324.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$342.00
|
| Rate for Payer: Three Rivers Provider Network All |
$270.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$334.80
|
| Rate for Payer: Zelis Auto |
$144.00
|
| Rate for Payer: Zelis Worker's Compensation |
$98.28
|
|
|
TRANSPLT ALLO HCT/DONOR
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
CPT 38240
|
| Hospital Charge Code |
6138240
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$156.16 |
| Max. Negotiated Rate |
$112,316.02 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,369.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$343.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,369.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,668.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$56,158.01
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$486.20
|
| Rate for Payer: First Health Commercial |
$514.80
|
| Rate for Payer: First Health Workers Compensation |
$220.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$514.80
|
| Rate for Payer: GEHA Commercial |
$457.60
|
| Rate for Payer: GEHA Medicare |
$56,158.01
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$514.80
|
| Rate for Payer: Humana ChoiceCare |
$61,773.81
|
| Rate for Payer: Humana Medicare Advantage |
$56,158.01
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$94,345.46
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,723.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$56,158.01
|
| Rate for Payer: Multiplan All |
$520.52
|
| Rate for Payer: New Mexico Health Connections Medicare |
$95,468.62
|
| Rate for Payer: OMNI Networks Commercial |
$400.40
|
| Rate for Payer: One Health Plan PPO/POS |
$514.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,144.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,723.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$56,158.01
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$543.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$112,316.02
|
| Rate for Payer: Three Rivers Provider Network All |
$429.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$55,034.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,723.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56,158.01
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.96
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$56,158.01
|
| Rate for Payer: Zelis Auto |
$228.80
|
| Rate for Payer: Zelis Medicare |
$47,734.31
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67,389.61
|
| Rate for Payer: Zelis Worker's Compensation |
$156.16
|
|
|
TRANSPLT ALLO HCT/DONOR
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
CPT 38240
|
| Hospital Charge Code |
6138240
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$156.16 |
| Max. Negotiated Rate |
$543.40 |
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$486.20
|
| Rate for Payer: First Health Commercial |
$514.80
|
| Rate for Payer: First Health Workers Compensation |
$220.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$514.80
|
| Rate for Payer: GEHA Commercial |
$400.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$514.80
|
| Rate for Payer: Multiplan All |
$520.52
|
| Rate for Payer: OMNI Networks Commercial |
$400.40
|
| Rate for Payer: One Health Plan PPO/POS |
$514.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$543.40
|
| Rate for Payer: Three Rivers Provider Network All |
$429.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$531.96
|
| Rate for Payer: Zelis Auto |
$228.80
|
| Rate for Payer: Zelis Worker's Compensation |
$156.16
|
|
|
TRANSPLT ALLO LYMPHOCYTES
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
CPT 38242
|
| Hospital Charge Code |
6138242
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$98.55 |
| Max. Negotiated Rate |
$3,113.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,207.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$216.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,207.48
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$956.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,556.56
|
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cigna Commercial |
$306.85
|
| Rate for Payer: First Health Commercial |
$324.90
|
| Rate for Payer: First Health Workers Compensation |
$139.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$324.90
|
| Rate for Payer: GEHA Commercial |
$288.80
|
| Rate for Payer: GEHA Medicare |
$1,556.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$324.90
|
| Rate for Payer: Humana ChoiceCare |
$1,712.22
|
| Rate for Payer: Humana Medicare Advantage |
$1,556.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,615.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$976.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,556.56
|
| Rate for Payer: Multiplan All |
$328.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,646.15
|
| Rate for Payer: OMNI Networks Commercial |
$252.70
|
| Rate for Payer: One Health Plan PPO/POS |
$324.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,126.99
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$976.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,556.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$342.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,113.12
|
| Rate for Payer: Three Rivers Provider Network All |
$270.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,525.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$976.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,556.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$335.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,556.56
|
| Rate for Payer: Zelis Auto |
$144.40
|
| Rate for Payer: Zelis Medicare |
$1,323.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,867.87
|
| Rate for Payer: Zelis Worker's Compensation |
$98.55
|
|
|
TRANSPLT ALLO LYMPHOCYTES
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
CPT 38242
|
| Hospital Charge Code |
6138242
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$98.55 |
| Max. Negotiated Rate |
$342.95 |
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cigna Commercial |
$306.85
|
| Rate for Payer: First Health Commercial |
$324.90
|
| Rate for Payer: First Health Workers Compensation |
$139.38
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$324.90
|
| Rate for Payer: GEHA Commercial |
$252.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$324.90
|
| Rate for Payer: Multiplan All |
$328.51
|
| Rate for Payer: OMNI Networks Commercial |
$252.70
|
| Rate for Payer: One Health Plan PPO/POS |
$324.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$342.95
|
| Rate for Payer: Three Rivers Provider Network All |
$270.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$335.73
|
| Rate for Payer: Zelis Auto |
$144.40
|
| Rate for Payer: Zelis Worker's Compensation |
$98.55
|
|
|
TRANSPLT AUTOL HCT/DONOR
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 38241
|
| Hospital Charge Code |
6138241
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$140.59 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$360.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
|
TRANSPLT AUTOL HCT/DONOR
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
CPT 38241
|
| Hospital Charge Code |
6138241
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$140.59 |
| Max. Negotiated Rate |
$3,369.01 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,369.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$309.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,369.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,668.93
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,556.56
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$437.75
|
| Rate for Payer: First Health Commercial |
$463.50
|
| Rate for Payer: First Health Workers Compensation |
$198.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$463.50
|
| Rate for Payer: GEHA Commercial |
$412.00
|
| Rate for Payer: GEHA Medicare |
$1,556.56
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$463.50
|
| Rate for Payer: Humana ChoiceCare |
$1,712.22
|
| Rate for Payer: Humana Medicare Advantage |
$1,556.56
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,615.02
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,723.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,556.56
|
| Rate for Payer: Multiplan All |
$468.65
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,646.15
|
| Rate for Payer: OMNI Networks Commercial |
$360.50
|
| Rate for Payer: One Health Plan PPO/POS |
$463.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,144.41
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,723.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,556.56
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$489.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,113.12
|
| Rate for Payer: Three Rivers Provider Network All |
$386.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,525.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,723.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,556.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$478.95
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,556.56
|
| Rate for Payer: Zelis Auto |
$206.00
|
| Rate for Payer: Zelis Medicare |
$1,323.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,867.87
|
| Rate for Payer: Zelis Worker's Compensation |
$140.59
|
|
|
TRANSTHOR DIAPHRAG HERN RPR
|
Facility
|
IP
|
$2,658.00
|
|
|
Service Code
|
CPT 43334
|
| Hospital Charge Code |
6143334
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$725.63 |
| Max. Negotiated Rate |
$2,525.10 |
| Rate for Payer: Cash Price |
$1,594.80
|
| Rate for Payer: Cigna Commercial |
$2,259.30
|
| Rate for Payer: First Health Commercial |
$2,392.20
|
| Rate for Payer: First Health Workers Compensation |
$1,026.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,392.20
|
| Rate for Payer: GEHA Commercial |
$1,860.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,392.20
|
| Rate for Payer: Multiplan All |
$2,418.78
|
| Rate for Payer: OMNI Networks Commercial |
$1,860.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,392.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,525.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,993.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,471.94
|
| Rate for Payer: Zelis Auto |
$1,063.20
|
| Rate for Payer: Zelis Worker's Compensation |
$725.63
|
|
|
TRANSTHOR DIAPHRAG HERN RPR
|
Facility
|
OP
|
$2,852.00
|
|
|
Service Code
|
CPT 43335
|
| Hospital Charge Code |
6143335
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$713.00 |
| Max. Negotiated Rate |
$2,709.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,711.20
|
| Rate for Payer: Cash Price |
$1,711.20
|
| Rate for Payer: Cigna Commercial |
$2,424.20
|
| Rate for Payer: First Health Commercial |
$2,566.80
|
| Rate for Payer: First Health Workers Compensation |
$1,101.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,566.80
|
| Rate for Payer: GEHA Commercial |
$2,281.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,566.80
|
| Rate for Payer: Humana ChoiceCare |
$741.52
|
| Rate for Payer: Multiplan All |
$2,595.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,711.20
|
| Rate for Payer: OMNI Networks Commercial |
$1,996.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,566.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,709.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,139.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,509.76
|
| Rate for Payer: United Healthcare Managed Medicaid |
$713.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,652.36
|
| Rate for Payer: Zelis Auto |
$1,140.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,426.00
|
| Rate for Payer: Zelis Worker's Compensation |
$778.60
|
|
|
TRANSTHOR DIAPHRAG HERN RPR
|
Facility
|
OP
|
$2,658.00
|
|
|
Service Code
|
CPT 43334
|
| Hospital Charge Code |
6143334
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$664.50 |
| Max. Negotiated Rate |
$2,525.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,594.80
|
| Rate for Payer: Cash Price |
$1,594.80
|
| Rate for Payer: Cigna Commercial |
$2,259.30
|
| Rate for Payer: First Health Commercial |
$2,392.20
|
| Rate for Payer: First Health Workers Compensation |
$1,026.25
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,392.20
|
| Rate for Payer: GEHA Commercial |
$2,126.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,392.20
|
| Rate for Payer: Humana ChoiceCare |
$691.08
|
| Rate for Payer: Multiplan All |
$2,418.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,594.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,860.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,392.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,525.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,993.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,339.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$664.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,471.94
|
| Rate for Payer: Zelis Auto |
$1,063.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,329.00
|
| Rate for Payer: Zelis Worker's Compensation |
$725.63
|
|
|
TRANSTHOR DIAPHRAG HERN RPR
|
Facility
|
IP
|
$2,852.00
|
|
|
Service Code
|
CPT 43335
|
| Hospital Charge Code |
6143335
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$778.60 |
| Max. Negotiated Rate |
$2,709.40 |
| Rate for Payer: Cash Price |
$1,711.20
|
| Rate for Payer: Cigna Commercial |
$2,424.20
|
| Rate for Payer: First Health Commercial |
$2,566.80
|
| Rate for Payer: First Health Workers Compensation |
$1,101.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,566.80
|
| Rate for Payer: GEHA Commercial |
$1,996.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,566.80
|
| Rate for Payer: Multiplan All |
$2,595.32
|
| Rate for Payer: OMNI Networks Commercial |
$1,996.40
|
| Rate for Payer: One Health Plan PPO/POS |
$2,566.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,709.40
|
| Rate for Payer: Three Rivers Provider Network All |
$2,139.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,652.36
|
| Rate for Payer: Zelis Auto |
$1,140.80
|
| Rate for Payer: Zelis Worker's Compensation |
$778.60
|
|
|
TRANSURETHRAL ELECTROSURGICAL RESECTION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED)
|
Facility
|
OP
|
$9,654.20
|
|
|
Service Code
|
CPT 52601
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,899.64 |
| Max. Negotiated Rate |
$9,654.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,660.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,660.24
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,899.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$4,827.10
|
| Rate for Payer: First Health Workers Compensation |
$6,212.48
|
| Rate for Payer: GEHA Medicare |
$4,827.10
|
| Rate for Payer: Humana ChoiceCare |
$5,309.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,827.10
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8,109.53
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,958.69
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$4,827.10
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8,206.07
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,416.22
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,958.69
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$4,827.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$9,654.20
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,730.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,958.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,827.10
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$4,827.10
|
| Rate for Payer: Zelis Medicare |
$4,103.03
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$5,792.52
|
| Rate for Payer: Zelis Worker's Compensation |
$4,392.66
|
|
|
TRANSURETHRAL RESECTION OF BLADDER NECK (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$6,549.86
|
|
|
Service Code
|
CPT 52500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,044.30 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,580.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,044.30
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: First Health Workers Compensation |
$4,214.83
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Humana ChoiceCare |
$3,602.42
|
| Rate for Payer: Humana Medicare Advantage |
$3,274.93
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,501.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,085.94
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,408.50
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,085.94
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,085.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Medicare |
$2,783.69
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,929.92
|
| Rate for Payer: Zelis Worker's Compensation |
$2,980.19
|
|
|
TRANSURETHRAL RF TREATMENT
|
Facility
|
OP
|
$704.00
|
|
|
Service Code
|
CPT 53860
|
| Hospital Charge Code |
6153860
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$192.19 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,031.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$422.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,031.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,609.07
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$598.40
|
| Rate for Payer: First Health Commercial |
$633.60
|
| Rate for Payer: First Health Workers Compensation |
$271.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$633.60
|
| Rate for Payer: GEHA Commercial |
$563.20
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$633.60
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,641.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$640.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$492.80
|
| Rate for Payer: One Health Plan PPO/POS |
$633.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,895.73
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,641.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$668.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$528.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,641.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$654.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$281.60
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$192.19
|
|
|
TRANSURETHRAL RF TREATMENT
|
Facility
|
IP
|
$704.00
|
|
|
Service Code
|
CPT 53860
|
| Hospital Charge Code |
6153860
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$192.19 |
| Max. Negotiated Rate |
$668.80 |
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$598.40
|
| Rate for Payer: First Health Commercial |
$633.60
|
| Rate for Payer: First Health Workers Compensation |
$271.81
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$633.60
|
| Rate for Payer: GEHA Commercial |
$492.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$633.60
|
| Rate for Payer: Multiplan All |
$640.64
|
| Rate for Payer: OMNI Networks Commercial |
$492.80
|
| Rate for Payer: One Health Plan PPO/POS |
$633.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$668.80
|
| Rate for Payer: Three Rivers Provider Network All |
$528.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$654.72
|
| Rate for Payer: Zelis Auto |
$281.60
|
| Rate for Payer: Zelis Worker's Compensation |
$192.19
|
|
|
TRAVOPROST OPHTH SOLN 0.004%
|
Facility
|
OP
|
$871.00
|
|
|
Service Code
|
NDC 00781618556
|
| Hospital Charge Code |
3300914
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$217.75 |
| Max. Negotiated Rate |
$827.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$522.60
|
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cigna Commercial |
$740.35
|
| Rate for Payer: First Health Commercial |
$783.90
|
| Rate for Payer: First Health Workers Compensation |
$336.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.90
|
| Rate for Payer: GEHA Commercial |
$696.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.90
|
| Rate for Payer: Humana ChoiceCare |
$226.46
|
| Rate for Payer: Multiplan All |
$792.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$522.60
|
| Rate for Payer: OMNI Networks Commercial |
$609.70
|
| Rate for Payer: One Health Plan PPO/POS |
$783.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$827.45
|
| Rate for Payer: Three Rivers Provider Network All |
$653.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$766.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$217.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$810.03
|
| Rate for Payer: Zelis Auto |
$348.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$435.50
|
| Rate for Payer: Zelis Worker's Compensation |
$237.78
|
|
|
TRAVOPROST OPHTH SOLN 0.004%
|
Facility
|
IP
|
$871.00
|
|
|
Service Code
|
NDC 00781618556
|
| Hospital Charge Code |
3300914
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$237.78 |
| Max. Negotiated Rate |
$827.45 |
| Rate for Payer: Cash Price |
$522.60
|
| Rate for Payer: Cigna Commercial |
$740.35
|
| Rate for Payer: First Health Commercial |
$783.90
|
| Rate for Payer: First Health Workers Compensation |
$336.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$783.90
|
| Rate for Payer: GEHA Commercial |
$609.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$783.90
|
| Rate for Payer: Multiplan All |
$792.61
|
| Rate for Payer: OMNI Networks Commercial |
$609.70
|
| Rate for Payer: One Health Plan PPO/POS |
$783.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$827.45
|
| Rate for Payer: Three Rivers Provider Network All |
$653.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$810.03
|
| Rate for Payer: Zelis Auto |
$348.40
|
| Rate for Payer: Zelis Worker's Compensation |
$237.78
|
|
|
TRAY CVC TRIPLE-LUMEN COOK MEDICAL
|
Facility
|
IP
|
$738.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
7002759
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$201.47 |
| Max. Negotiated Rate |
$701.10 |
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cigna Commercial |
$627.30
|
| Rate for Payer: First Health Commercial |
$664.20
|
| Rate for Payer: First Health Workers Compensation |
$284.94
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$664.20
|
| Rate for Payer: GEHA Commercial |
$516.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$664.20
|
| Rate for Payer: Multiplan All |
$671.58
|
| Rate for Payer: OMNI Networks Commercial |
$516.60
|
| Rate for Payer: One Health Plan PPO/POS |
$664.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$701.10
|
| Rate for Payer: Three Rivers Provider Network All |
$553.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$686.34
|
| Rate for Payer: Zelis Auto |
$295.20
|
| Rate for Payer: Zelis Worker's Compensation |
$201.47
|
|
