|
TRT INITIAL HYDRATION 31 MIN-1 HR
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
7896360
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$172.54 |
| Max. Negotiated Rate |
$600.40 |
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cigna Commercial |
$537.20
|
| Rate for Payer: First Health Commercial |
$568.80
|
| Rate for Payer: First Health Workers Compensation |
$244.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$568.80
|
| Rate for Payer: GEHA Commercial |
$442.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$568.80
|
| Rate for Payer: Multiplan All |
$575.12
|
| Rate for Payer: OMNI Networks Commercial |
$442.40
|
| Rate for Payer: One Health Plan PPO/POS |
$568.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$600.40
|
| Rate for Payer: Three Rivers Provider Network All |
$474.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$587.76
|
| Rate for Payer: Zelis Auto |
$252.80
|
| Rate for Payer: Zelis Worker's Compensation |
$172.54
|
|
|
TRT INITIAL HYDRATION 31 MIN-1 HR
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
7896360
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$89.94 |
| Max. Negotiated Rate |
$600.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$113.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$379.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$113.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$89.94
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$200.06
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cigna Commercial |
$537.20
|
| Rate for Payer: First Health Commercial |
$568.80
|
| Rate for Payer: First Health Workers Compensation |
$244.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$568.80
|
| Rate for Payer: GEHA Commercial |
$505.60
|
| Rate for Payer: GEHA Medicare |
$200.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$568.80
|
| Rate for Payer: Humana ChoiceCare |
$220.07
|
| Rate for Payer: Humana Medicare Advantage |
$200.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$336.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$91.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$200.06
|
| Rate for Payer: Multiplan All |
$575.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$340.10
|
| Rate for Payer: OMNI Networks Commercial |
$442.40
|
| Rate for Payer: One Health Plan PPO/POS |
$568.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$105.97
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$91.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$200.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$600.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$400.12
|
| Rate for Payer: Three Rivers Provider Network All |
$474.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$196.06
|
| Rate for Payer: United Healthcare Commercial |
$537.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$91.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$200.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$587.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$200.06
|
| Rate for Payer: Zelis Auto |
$252.80
|
| Rate for Payer: Zelis Medicare |
$170.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$240.07
|
| Rate for Payer: Zelis Worker's Compensation |
$172.54
|
|
|
TRT INTRAMUSCULAR/SQ INJECTION
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
1900065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$247.00 |
| 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 |
$156.00
|
| 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 |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$221.00
|
| Rate for Payer: First Health Commercial |
$234.00
|
| Rate for Payer: First Health Workers Compensation |
$100.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.00
|
| Rate for Payer: GEHA Commercial |
$208.00
|
| Rate for Payer: GEHA Medicare |
$67.58
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.00
|
| 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 |
$236.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$114.89
|
| Rate for Payer: OMNI Networks Commercial |
$182.00
|
| Rate for Payer: One Health Plan PPO/POS |
$234.00
|
| 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 |
$247.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$135.16
|
| Rate for Payer: Three Rivers Provider Network All |
$195.00
|
| 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 |
$241.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$67.58
|
| Rate for Payer: Zelis Auto |
$104.00
|
| Rate for Payer: Zelis Medicare |
$57.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$81.10
|
| Rate for Payer: Zelis Worker's Compensation |
$70.98
|
|
|
TRT INTRAMUSCULAR/SQ INJECTION
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
1900065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$221.00
|
| Rate for Payer: First Health Commercial |
$234.00
|
| Rate for Payer: First Health Workers Compensation |
$100.39
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$234.00
|
| Rate for Payer: GEHA Commercial |
$182.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$234.00
|
| Rate for Payer: Multiplan All |
$236.60
|
| Rate for Payer: OMNI Networks Commercial |
$182.00
|
| Rate for Payer: One Health Plan PPO/POS |
$234.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$247.00
|
| Rate for Payer: Three Rivers Provider Network All |
$195.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$241.80
|
| Rate for Payer: Zelis Auto |
$104.00
|
| Rate for Payer: Zelis Worker's Compensation |
$70.98
|
|
|
TRT INTRAMUSCULAR/SQ INJECTION
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
7800000
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
TRT INTRAMUSCULAR/SQ INJECTION
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
7800000
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
TRT IV PUSH EACH NEW DRUG
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
1996375
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$313.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$198.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$44.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$43.81
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cigna Commercial |
$280.50
|
| Rate for Payer: First Health Commercial |
$297.00
|
| Rate for Payer: First Health Workers Compensation |
$127.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$297.00
|
| Rate for Payer: GEHA Commercial |
$264.00
|
| Rate for Payer: GEHA Medicare |
$43.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$297.00
|
| Rate for Payer: Humana ChoiceCare |
$48.19
|
| Rate for Payer: Humana Medicare Advantage |
$43.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$73.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$45.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$43.81
|
| Rate for Payer: Multiplan All |
$300.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$74.48
|
| Rate for Payer: OMNI Networks Commercial |
$231.00
|
| Rate for Payer: One Health Plan PPO/POS |
$297.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$52.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$45.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$43.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$313.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$87.62
|
| Rate for Payer: Three Rivers Provider Network All |
$247.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$42.93
|
| Rate for Payer: United Healthcare Commercial |
$280.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$306.90
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$43.81
|
| Rate for Payer: Zelis Auto |
$132.00
|
| Rate for Payer: Zelis Medicare |
$37.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$52.57
|
| Rate for Payer: Zelis Worker's Compensation |
$90.09
|
|
|
TRT IV PUSH EACH NEW DRUG
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
7896375
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$252.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$159.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$44.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$43.81
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$226.10
|
| Rate for Payer: First Health Commercial |
$239.40
|
| Rate for Payer: First Health Workers Compensation |
$102.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$239.40
|
| Rate for Payer: GEHA Commercial |
$212.80
|
| Rate for Payer: GEHA Medicare |
$43.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$239.40
|
| Rate for Payer: Humana ChoiceCare |
$48.19
|
| Rate for Payer: Humana Medicare Advantage |
$43.81
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$73.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$45.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$43.81
|
| Rate for Payer: Multiplan All |
$242.06
|
| Rate for Payer: New Mexico Health Connections Medicare |
$74.48
|
| Rate for Payer: OMNI Networks Commercial |
$186.20
|
| Rate for Payer: One Health Plan PPO/POS |
$239.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$52.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$45.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$43.81
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$252.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$87.62
|
| Rate for Payer: Three Rivers Provider Network All |
$199.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$42.93
|
| Rate for Payer: United Healthcare Commercial |
$226.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.81
|
| Rate for Payer: United Payors & United Providers UP&UP |
$247.38
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$43.81
|
| Rate for Payer: Zelis Auto |
$106.40
|
| Rate for Payer: Zelis Medicare |
$37.24
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$52.57
|
| Rate for Payer: Zelis Worker's Compensation |
$72.62
|
|
|
TRT IV PUSH EACH NEW DRUG
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
1996375
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$90.09 |
| Max. Negotiated Rate |
$313.50 |
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cigna Commercial |
$280.50
|
| Rate for Payer: First Health Commercial |
$297.00
|
| Rate for Payer: First Health Workers Compensation |
$127.41
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$297.00
|
| Rate for Payer: GEHA Commercial |
$231.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$297.00
|
| Rate for Payer: Multiplan All |
$300.30
|
| Rate for Payer: OMNI Networks Commercial |
$231.00
|
| Rate for Payer: One Health Plan PPO/POS |
$297.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$313.50
|
| Rate for Payer: Three Rivers Provider Network All |
$247.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$306.90
|
| Rate for Payer: Zelis Auto |
$132.00
|
| Rate for Payer: Zelis Worker's Compensation |
$90.09
|
|
|
TRT IV PUSH EACH NEW DRUG
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
7896375
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$72.62 |
| Max. Negotiated Rate |
$252.70 |
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$226.10
|
| Rate for Payer: First Health Commercial |
$239.40
|
| Rate for Payer: First Health Workers Compensation |
$102.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$239.40
|
| Rate for Payer: GEHA Commercial |
$186.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$239.40
|
| Rate for Payer: Multiplan All |
$242.06
|
| Rate for Payer: OMNI Networks Commercial |
$186.20
|
| Rate for Payer: One Health Plan PPO/POS |
$239.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$252.70
|
| Rate for Payer: Three Rivers Provider Network All |
$199.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$247.38
|
| Rate for Payer: Zelis Auto |
$106.40
|
| Rate for Payer: Zelis Worker's Compensation |
$72.62
|
|
|
TRT IV PUSH INITIAL
|
Facility
|
OP
|
$407.55
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
7896374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$44.49 |
| Max. Negotiated Rate |
$400.12 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$244.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$44.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$200.06
|
| Rate for Payer: Cash Price |
$244.53
|
| Rate for Payer: Cash Price |
$244.53
|
| Rate for Payer: Cigna Commercial |
$346.42
|
| Rate for Payer: First Health Commercial |
$366.80
|
| Rate for Payer: First Health Workers Compensation |
$157.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$366.80
|
| Rate for Payer: GEHA Commercial |
$326.04
|
| Rate for Payer: GEHA Medicare |
$200.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$366.80
|
| Rate for Payer: Humana ChoiceCare |
$220.07
|
| Rate for Payer: Humana Medicare Advantage |
$200.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$336.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$45.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$200.06
|
| Rate for Payer: Multiplan All |
$370.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$340.10
|
| Rate for Payer: OMNI Networks Commercial |
$285.29
|
| Rate for Payer: One Health Plan PPO/POS |
$366.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$52.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$45.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$200.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.17
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$400.12
|
| Rate for Payer: Three Rivers Provider Network All |
$305.66
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$196.06
|
| Rate for Payer: United Healthcare Commercial |
$346.42
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$200.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$200.06
|
| Rate for Payer: Zelis Auto |
$163.02
|
| Rate for Payer: Zelis Medicare |
$170.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$240.07
|
| Rate for Payer: Zelis Worker's Compensation |
$111.26
|
|
|
TRT IV PUSH INITIAL
|
Facility
|
IP
|
$492.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
1996374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$134.32 |
| Max. Negotiated Rate |
$467.40 |
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cigna Commercial |
$418.20
|
| Rate for Payer: First Health Commercial |
$442.80
|
| Rate for Payer: First Health Workers Compensation |
$189.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$442.80
|
| Rate for Payer: GEHA Commercial |
$344.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$442.80
|
| Rate for Payer: Multiplan All |
$447.72
|
| Rate for Payer: OMNI Networks Commercial |
$344.40
|
| Rate for Payer: One Health Plan PPO/POS |
$442.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$467.40
|
| Rate for Payer: Three Rivers Provider Network All |
$369.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$457.56
|
| Rate for Payer: Zelis Auto |
$196.80
|
| Rate for Payer: Zelis Worker's Compensation |
$134.32
|
|
|
TRT IV PUSH INITIAL
|
Facility
|
IP
|
$407.55
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
7896374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$111.26 |
| Max. Negotiated Rate |
$387.17 |
| Rate for Payer: Cash Price |
$244.53
|
| Rate for Payer: Cigna Commercial |
$346.42
|
| Rate for Payer: First Health Commercial |
$366.80
|
| Rate for Payer: First Health Workers Compensation |
$157.36
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$366.80
|
| Rate for Payer: GEHA Commercial |
$285.29
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$366.80
|
| Rate for Payer: Multiplan All |
$370.87
|
| Rate for Payer: OMNI Networks Commercial |
$285.29
|
| Rate for Payer: One Health Plan PPO/POS |
$366.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$387.17
|
| Rate for Payer: Three Rivers Provider Network All |
$305.66
|
| Rate for Payer: United Payors & United Providers UP&UP |
$379.02
|
| Rate for Payer: Zelis Auto |
$163.02
|
| Rate for Payer: Zelis Worker's Compensation |
$111.26
|
|
|
TRT IV PUSH INITIAL
|
Facility
|
OP
|
$492.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
1996374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$44.49 |
| Max. Negotiated Rate |
$467.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$295.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$56.16
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$44.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$200.06
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cigna Commercial |
$418.20
|
| Rate for Payer: First Health Commercial |
$442.80
|
| Rate for Payer: First Health Workers Compensation |
$189.96
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$442.80
|
| Rate for Payer: GEHA Commercial |
$393.60
|
| Rate for Payer: GEHA Medicare |
$200.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$442.80
|
| Rate for Payer: Humana ChoiceCare |
$220.07
|
| Rate for Payer: Humana Medicare Advantage |
$200.06
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$336.10
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$45.40
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$200.06
|
| Rate for Payer: Multiplan All |
$447.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$340.10
|
| Rate for Payer: OMNI Networks Commercial |
$344.40
|
| Rate for Payer: One Health Plan PPO/POS |
$442.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$52.42
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$45.40
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$200.06
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$467.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$400.12
|
| Rate for Payer: Three Rivers Provider Network All |
$369.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$196.06
|
| Rate for Payer: United Healthcare Commercial |
$418.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$45.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$200.06
|
| Rate for Payer: United Payors & United Providers UP&UP |
$457.56
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$200.06
|
| Rate for Payer: Zelis Auto |
$196.80
|
| Rate for Payer: Zelis Medicare |
$170.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$240.07
|
| Rate for Payer: Zelis Worker's Compensation |
$134.32
|
|
|
TRT IV PUSH SAME DRUG AT INTERVALS >30 M
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
7896376
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$265.20
|
| Rate for Payer: First Health Commercial |
$280.80
|
| Rate for Payer: First Health Workers Compensation |
$120.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$280.80
|
| Rate for Payer: GEHA Commercial |
$249.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$280.80
|
| Rate for Payer: Humana ChoiceCare |
$81.12
|
| Rate for Payer: Multiplan All |
$283.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$187.20
|
| Rate for Payer: OMNI Networks Commercial |
$218.40
|
| Rate for Payer: One Health Plan PPO/POS |
$280.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$296.40
|
| Rate for Payer: Three Rivers Provider Network All |
$234.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$274.56
|
| Rate for Payer: United Healthcare Commercial |
$265.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$78.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$290.16
|
| Rate for Payer: Zelis Auto |
$124.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$156.00
|
| Rate for Payer: Zelis Worker's Compensation |
$85.18
|
|
|
TRT IV PUSH SAME DRUG AT INTERVALS >30 M
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
7896376
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$85.18 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$265.20
|
| Rate for Payer: First Health Commercial |
$280.80
|
| Rate for Payer: First Health Workers Compensation |
$120.46
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$280.80
|
| Rate for Payer: GEHA Commercial |
$218.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$280.80
|
| Rate for Payer: Multiplan All |
$283.92
|
| Rate for Payer: OMNI Networks Commercial |
$218.40
|
| Rate for Payer: One Health Plan PPO/POS |
$280.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$296.40
|
| Rate for Payer: Three Rivers Provider Network All |
$234.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$290.16
|
| Rate for Payer: Zelis Auto |
$124.80
|
| Rate for Payer: Zelis Worker's Compensation |
$85.18
|
|
|
TRT IV PUSH SAME DRUG AT INTERVALS >30 M
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
1996376
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$83.54 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna Commercial |
$260.10
|
| Rate for Payer: First Health Commercial |
$275.40
|
| Rate for Payer: First Health Workers Compensation |
$118.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$275.40
|
| Rate for Payer: GEHA Commercial |
$214.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$275.40
|
| Rate for Payer: Multiplan All |
$278.46
|
| Rate for Payer: OMNI Networks Commercial |
$214.20
|
| Rate for Payer: One Health Plan PPO/POS |
$275.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$290.70
|
| Rate for Payer: Three Rivers Provider Network All |
$229.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$284.58
|
| Rate for Payer: Zelis Auto |
$122.40
|
| Rate for Payer: Zelis Worker's Compensation |
$83.54
|
|
|
TRT IV PUSH SAME DRUG AT INTERVALS >30 M
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
1996376
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna Commercial |
$260.10
|
| Rate for Payer: First Health Commercial |
$275.40
|
| Rate for Payer: First Health Workers Compensation |
$118.15
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$275.40
|
| Rate for Payer: GEHA Commercial |
$244.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$275.40
|
| Rate for Payer: Humana ChoiceCare |
$79.56
|
| Rate for Payer: Multiplan All |
$278.46
|
| Rate for Payer: New Mexico Health Connections Medicare |
$183.60
|
| Rate for Payer: OMNI Networks Commercial |
$214.20
|
| Rate for Payer: One Health Plan PPO/POS |
$275.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$290.70
|
| Rate for Payer: Three Rivers Provider Network All |
$229.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$269.28
|
| Rate for Payer: United Healthcare Commercial |
$260.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$76.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$284.58
|
| Rate for Payer: Zelis Auto |
$122.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$153.00
|
| Rate for Payer: Zelis Worker's Compensation |
$83.54
|
|
|
TRTMNT OF SPRFCL WND DEHISCENCE SIMP CLO
|
Facility
|
IP
|
$5,704.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
1012020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,557.19 |
| Max. Negotiated Rate |
$5,418.80 |
| Rate for Payer: Cash Price |
$3,422.40
|
| Rate for Payer: Cigna Commercial |
$4,848.40
|
| Rate for Payer: First Health Commercial |
$5,133.60
|
| Rate for Payer: First Health Workers Compensation |
$2,202.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,133.60
|
| Rate for Payer: GEHA Commercial |
$3,992.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,133.60
|
| Rate for Payer: Multiplan All |
$5,190.64
|
| Rate for Payer: OMNI Networks Commercial |
$3,992.80
|
| Rate for Payer: One Health Plan PPO/POS |
$5,133.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,418.80
|
| Rate for Payer: Three Rivers Provider Network All |
$4,278.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,304.72
|
| Rate for Payer: Zelis Auto |
$2,281.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,557.19
|
|
|
TRTMNT OF SPRFCL WND DEHISCENCE SIMP CLO
|
Facility
|
IP
|
$5,704.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
1912020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,557.19 |
| Max. Negotiated Rate |
$5,418.80 |
| Rate for Payer: Cash Price |
$3,422.40
|
| Rate for Payer: Cigna Commercial |
$4,848.40
|
| Rate for Payer: First Health Commercial |
$5,133.60
|
| Rate for Payer: First Health Workers Compensation |
$2,202.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,133.60
|
| Rate for Payer: GEHA Commercial |
$3,992.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,133.60
|
| Rate for Payer: Multiplan All |
$5,190.64
|
| Rate for Payer: OMNI Networks Commercial |
$3,992.80
|
| Rate for Payer: One Health Plan PPO/POS |
$5,133.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,418.80
|
| Rate for Payer: Three Rivers Provider Network All |
$4,278.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,304.72
|
| Rate for Payer: Zelis Auto |
$2,281.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,557.19
|
|
|
TRTMNT OF SPRFCL WND DEHISCENCE SIMP CLO
|
Facility
|
OP
|
$5,704.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
1912020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$355.53 |
| Max. Negotiated Rate |
$5,418.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,422.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$448.79
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$355.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$581.24
|
| Rate for Payer: Cash Price |
$3,422.40
|
| Rate for Payer: Cash Price |
$3,422.40
|
| Rate for Payer: Cigna Commercial |
$4,848.40
|
| Rate for Payer: First Health Commercial |
$5,133.60
|
| Rate for Payer: First Health Workers Compensation |
$2,202.31
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,133.60
|
| Rate for Payer: GEHA Commercial |
$4,563.20
|
| Rate for Payer: GEHA Medicare |
$581.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,133.60
|
| Rate for Payer: Humana ChoiceCare |
$639.36
|
| Rate for Payer: Humana Medicare Advantage |
$581.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$976.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$362.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$581.24
|
| Rate for Payer: Multiplan All |
$5,190.64
|
| Rate for Payer: New Mexico Health Connections Medicare |
$988.11
|
| Rate for Payer: OMNI Networks Commercial |
$3,992.80
|
| Rate for Payer: One Health Plan PPO/POS |
$5,133.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$418.87
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$362.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$581.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,418.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,162.48
|
| Rate for Payer: Three Rivers Provider Network All |
$4,278.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$569.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$362.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,304.72
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$581.24
|
| Rate for Payer: Zelis Auto |
$2,281.60
|
| Rate for Payer: Zelis Medicare |
$494.05
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$697.49
|
| Rate for Payer: Zelis Worker's Compensation |
$1,557.19
|
|
|
TRURL DSTRJ PRSTATE TISS MICROWAVE THERM
|
Facility
|
OP
|
$3,991.00
|
|
|
Service Code
|
CPT 53850
|
| Hospital Charge Code |
9200011
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$1,089.54 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,719.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,394.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,719.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,739.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$2,394.60
|
| Rate for Payer: Cash Price |
$2,394.60
|
| Rate for Payer: Cigna Commercial |
$3,392.35
|
| Rate for Payer: First Health Commercial |
$3,591.90
|
| Rate for Payer: First Health Workers Compensation |
$1,540.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,591.90
|
| Rate for Payer: GEHA Commercial |
$3,192.80
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,591.90
|
| 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 |
$3,815.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$3,631.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$2,793.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,591.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,405.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,815.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,791.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$2,993.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,815.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,711.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$1,596.40
|
| 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 |
$1,089.54
|
|
|
TRURL DSTRJ PRSTATE TISS MICROWAVE THERM
|
Facility
|
IP
|
$3,991.00
|
|
|
Service Code
|
CPT 53850
|
| Hospital Charge Code |
9200011
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$1,089.54 |
| Max. Negotiated Rate |
$3,791.45 |
| Rate for Payer: Cash Price |
$2,394.60
|
| Rate for Payer: Cigna Commercial |
$3,392.35
|
| Rate for Payer: First Health Commercial |
$3,591.90
|
| Rate for Payer: First Health Workers Compensation |
$1,540.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,591.90
|
| Rate for Payer: GEHA Commercial |
$2,793.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,591.90
|
| Rate for Payer: Multiplan All |
$3,631.81
|
| Rate for Payer: OMNI Networks Commercial |
$2,793.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,591.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,791.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,993.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,711.63
|
| Rate for Payer: Zelis Auto |
$1,596.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,089.54
|
|
|
TRURL DSTRJ PRSTATE TISS MICROWAVE THERM
|
Facility
|
IP
|
$3,991.00
|
|
|
Service Code
|
CPT 53850
|
| Hospital Charge Code |
6153850
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,089.54 |
| Max. Negotiated Rate |
$3,791.45 |
| Rate for Payer: Cash Price |
$2,394.60
|
| Rate for Payer: Cigna Commercial |
$3,392.35
|
| Rate for Payer: First Health Commercial |
$3,591.90
|
| Rate for Payer: First Health Workers Compensation |
$1,540.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,591.90
|
| Rate for Payer: GEHA Commercial |
$2,793.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,591.90
|
| Rate for Payer: Multiplan All |
$3,631.81
|
| Rate for Payer: OMNI Networks Commercial |
$2,793.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,591.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,791.45
|
| Rate for Payer: Three Rivers Provider Network All |
$2,993.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,711.63
|
| Rate for Payer: Zelis Auto |
$1,596.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,089.54
|
|
|
TRURL DSTRJ PRSTATE TISS MICROWAVE THERM
|
Facility
|
OP
|
$3,991.00
|
|
|
Service Code
|
CPT 53850
|
| Hospital Charge Code |
6153850
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,089.54 |
| Max. Negotiated Rate |
$6,549.86 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$4,719.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,394.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$4,719.77
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$3,739.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,274.93
|
| Rate for Payer: Cash Price |
$2,394.60
|
| Rate for Payer: Cash Price |
$2,394.60
|
| Rate for Payer: Cigna Commercial |
$3,392.35
|
| Rate for Payer: First Health Commercial |
$3,591.90
|
| Rate for Payer: First Health Workers Compensation |
$1,540.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,591.90
|
| Rate for Payer: GEHA Commercial |
$3,192.80
|
| Rate for Payer: GEHA Medicare |
$3,274.93
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,591.90
|
| 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 |
$3,815.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,274.93
|
| Rate for Payer: Multiplan All |
$3,631.81
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,567.38
|
| Rate for Payer: OMNI Networks Commercial |
$2,793.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,591.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$4,405.11
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,815.14
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,274.93
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,791.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,549.86
|
| Rate for Payer: Three Rivers Provider Network All |
$2,993.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,209.43
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,815.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,274.93
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,711.63
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,274.93
|
| Rate for Payer: Zelis Auto |
$1,596.40
|
| 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 |
$1,089.54
|
|
