|
TUBERCULIN PPD INJ 5 UNIT/0.1ML
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
3300930
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$16.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$16.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$13.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$23.25
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$42.50
|
| Rate for Payer: First Health Commercial |
$45.00
|
| Rate for Payer: First Health Workers Compensation |
$11.86
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$45.00
|
| Rate for Payer: GEHA Commercial |
$40.00
|
| Rate for Payer: GEHA Medicare |
$23.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$45.00
|
| Rate for Payer: Humana ChoiceCare |
$25.57
|
| Rate for Payer: Humana Medicare Advantage |
$23.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$39.06
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$13.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$23.25
|
| Rate for Payer: Multiplan All |
$45.50
|
| Rate for Payer: New Mexico Health Connections Medicare |
$39.52
|
| Rate for Payer: OMNI Networks Commercial |
$35.00
|
| Rate for Payer: One Health Plan PPO/POS |
$45.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$15.55
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$13.47
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$23.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$47.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$46.50
|
| Rate for Payer: Three Rivers Provider Network All |
$37.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$22.79
|
| Rate for Payer: United Healthcare Commercial |
$42.50
|
| Rate for Payer: United Healthcare Managed Medicaid |
$13.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$46.50
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$23.25
|
| Rate for Payer: Zelis Auto |
$20.00
|
| Rate for Payer: Zelis Medicare |
$19.76
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$27.90
|
| Rate for Payer: Zelis Worker's Compensation |
$8.39
|
|
|
TUBE THORACOSTOMY INCLUDES WATER SEAL
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
6132551
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$146.60 |
| Max. Negotiated Rate |
$2,950.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$561.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$322.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$561.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$444.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,475.05
|
| Rate for Payer: Cash Price |
$322.20
|
| Rate for Payer: Cash Price |
$322.20
|
| Rate for Payer: Cigna Commercial |
$456.45
|
| Rate for Payer: First Health Commercial |
$483.30
|
| Rate for Payer: First Health Workers Compensation |
$207.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$483.30
|
| Rate for Payer: GEHA Commercial |
$429.60
|
| Rate for Payer: GEHA Medicare |
$1,475.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$483.30
|
| Rate for Payer: Humana ChoiceCare |
$1,622.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,475.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,478.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$453.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,475.05
|
| Rate for Payer: Multiplan All |
$488.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,507.59
|
| Rate for Payer: OMNI Networks Commercial |
$375.90
|
| Rate for Payer: One Health Plan PPO/POS |
$483.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$523.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$453.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,475.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$510.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,950.10
|
| Rate for Payer: Three Rivers Provider Network All |
$402.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,445.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$453.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,475.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$499.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,475.05
|
| Rate for Payer: Zelis Auto |
$214.80
|
| Rate for Payer: Zelis Medicare |
$1,253.79
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,770.06
|
| Rate for Payer: Zelis Worker's Compensation |
$146.60
|
|
|
TUBE THORACOSTOMY INCLUDES WATER SEAL
|
Facility
|
IP
|
$537.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
6132551
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$146.60 |
| Max. Negotiated Rate |
$510.15 |
| Rate for Payer: Cash Price |
$322.20
|
| Rate for Payer: Cigna Commercial |
$456.45
|
| Rate for Payer: First Health Commercial |
$483.30
|
| Rate for Payer: First Health Workers Compensation |
$207.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$483.30
|
| Rate for Payer: GEHA Commercial |
$375.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$483.30
|
| Rate for Payer: Multiplan All |
$488.67
|
| Rate for Payer: OMNI Networks Commercial |
$375.90
|
| Rate for Payer: One Health Plan PPO/POS |
$483.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$510.15
|
| Rate for Payer: Three Rivers Provider Network All |
$402.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$499.41
|
| Rate for Payer: Zelis Auto |
$214.80
|
| Rate for Payer: Zelis Worker's Compensation |
$146.60
|
|
|
TUBE THORACOSTOMY INCLUDES WATER SEAL
|
Facility
|
IP
|
$2,067.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
21632551
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$564.29 |
| Max. Negotiated Rate |
$1,963.65 |
| Rate for Payer: Cash Price |
$1,240.20
|
| Rate for Payer: Cigna Commercial |
$1,756.95
|
| Rate for Payer: First Health Commercial |
$1,860.30
|
| Rate for Payer: First Health Workers Compensation |
$798.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,860.30
|
| Rate for Payer: GEHA Commercial |
$1,446.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,860.30
|
| Rate for Payer: Multiplan All |
$1,880.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,446.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,860.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,963.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,550.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,922.31
|
| Rate for Payer: Zelis Auto |
$826.80
|
| Rate for Payer: Zelis Worker's Compensation |
$564.29
|
|
|
TUBE THORACOSTOMY INCLUDES WATER SEAL
|
Facility
|
OP
|
$2,067.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
21632551
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$444.71 |
| Max. Negotiated Rate |
$2,950.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$561.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,240.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$561.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$444.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,475.05
|
| Rate for Payer: Cash Price |
$1,240.20
|
| Rate for Payer: Cash Price |
$1,240.20
|
| Rate for Payer: Cigna Commercial |
$1,756.95
|
| Rate for Payer: First Health Commercial |
$1,860.30
|
| Rate for Payer: First Health Workers Compensation |
$798.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,860.30
|
| Rate for Payer: GEHA Commercial |
$1,653.60
|
| Rate for Payer: GEHA Medicare |
$1,475.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,860.30
|
| Rate for Payer: Humana ChoiceCare |
$1,622.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,475.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,478.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$453.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,475.05
|
| Rate for Payer: Multiplan All |
$1,880.97
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,507.59
|
| Rate for Payer: OMNI Networks Commercial |
$1,446.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,860.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$523.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$453.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,475.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,963.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,950.10
|
| Rate for Payer: Three Rivers Provider Network All |
$1,550.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,445.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$453.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,475.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,922.31
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,475.05
|
| Rate for Payer: Zelis Auto |
$826.80
|
| Rate for Payer: Zelis Medicare |
$1,253.79
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,770.06
|
| Rate for Payer: Zelis Worker's Compensation |
$564.29
|
|
|
TUBE THORACOSTOMY INCLUDES WATER SEAL
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
8532020
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$146.60 |
| Max. Negotiated Rate |
$2,950.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$561.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$322.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$561.36
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$444.71
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,475.05
|
| Rate for Payer: Cash Price |
$322.20
|
| Rate for Payer: Cash Price |
$322.20
|
| Rate for Payer: Cigna Commercial |
$456.45
|
| Rate for Payer: First Health Commercial |
$483.30
|
| Rate for Payer: First Health Workers Compensation |
$207.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$483.30
|
| Rate for Payer: GEHA Commercial |
$429.60
|
| Rate for Payer: GEHA Medicare |
$1,475.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$483.30
|
| Rate for Payer: Humana ChoiceCare |
$1,622.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,475.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,478.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$453.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,475.05
|
| Rate for Payer: Multiplan All |
$488.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,507.59
|
| Rate for Payer: OMNI Networks Commercial |
$375.90
|
| Rate for Payer: One Health Plan PPO/POS |
$483.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$523.94
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$453.77
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,475.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$510.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,950.10
|
| Rate for Payer: Three Rivers Provider Network All |
$402.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,445.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$453.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,475.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$499.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,475.05
|
| Rate for Payer: Zelis Auto |
$214.80
|
| Rate for Payer: Zelis Medicare |
$1,253.79
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,770.06
|
| Rate for Payer: Zelis Worker's Compensation |
$146.60
|
|
|
TUBE THORACOSTOMY INCLUDES WATER SEAL
|
Facility
|
IP
|
$537.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
8532020
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$146.60 |
| Max. Negotiated Rate |
$510.15 |
| Rate for Payer: Cash Price |
$322.20
|
| Rate for Payer: Cigna Commercial |
$456.45
|
| Rate for Payer: First Health Commercial |
$483.30
|
| Rate for Payer: First Health Workers Compensation |
$207.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$483.30
|
| Rate for Payer: GEHA Commercial |
$375.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$483.30
|
| Rate for Payer: Multiplan All |
$488.67
|
| Rate for Payer: OMNI Networks Commercial |
$375.90
|
| Rate for Payer: One Health Plan PPO/POS |
$483.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$510.15
|
| Rate for Payer: Three Rivers Provider Network All |
$402.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$499.41
|
| Rate for Payer: Zelis Auto |
$214.80
|
| Rate for Payer: Zelis Worker's Compensation |
$146.60
|
|
|
TUBE THORACOSTOMY INCLUDES WATER SEAL
|
Facility
|
IP
|
$1,121.00
|
|
| Hospital Charge Code |
8150092
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$306.03 |
| Max. Negotiated Rate |
$1,064.95 |
| Rate for Payer: Cash Price |
$672.60
|
| Rate for Payer: Cigna Commercial |
$952.85
|
| Rate for Payer: First Health Commercial |
$1,008.90
|
| Rate for Payer: First Health Workers Compensation |
$432.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,008.90
|
| Rate for Payer: GEHA Commercial |
$784.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,008.90
|
| Rate for Payer: Multiplan All |
$1,020.11
|
| Rate for Payer: OMNI Networks Commercial |
$784.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,008.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,064.95
|
| Rate for Payer: Three Rivers Provider Network All |
$840.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,042.53
|
| Rate for Payer: Zelis Auto |
$448.40
|
| Rate for Payer: Zelis Worker's Compensation |
$306.03
|
|
|
TUBE THORACOSTOMY INCLUDES WATER SEAL
|
Facility
|
OP
|
$1,121.00
|
|
| Hospital Charge Code |
8150092
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$280.25 |
| Max. Negotiated Rate |
$1,064.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$672.60
|
| Rate for Payer: Cash Price |
$672.60
|
| Rate for Payer: Cigna Commercial |
$952.85
|
| Rate for Payer: First Health Commercial |
$1,008.90
|
| Rate for Payer: First Health Workers Compensation |
$432.82
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,008.90
|
| Rate for Payer: GEHA Commercial |
$896.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,008.90
|
| Rate for Payer: Humana ChoiceCare |
$291.46
|
| Rate for Payer: Multiplan All |
$1,020.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$672.60
|
| Rate for Payer: OMNI Networks Commercial |
$784.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,008.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,064.95
|
| Rate for Payer: Three Rivers Provider Network All |
$840.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$986.48
|
| Rate for Payer: United Healthcare Managed Medicaid |
$280.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,042.53
|
| Rate for Payer: Zelis Auto |
$448.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$560.50
|
| Rate for Payer: Zelis Worker's Compensation |
$306.03
|
|
|
TUBE THORACOSTOMY INCLUDES WATER SEAL
|
Facility
|
IP
|
$2,067.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
1000059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$564.29 |
| Max. Negotiated Rate |
$1,963.65 |
| Rate for Payer: Cash Price |
$1,240.20
|
| Rate for Payer: Cigna Commercial |
$1,756.95
|
| Rate for Payer: First Health Commercial |
$1,860.30
|
| Rate for Payer: First Health Workers Compensation |
$798.07
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,860.30
|
| Rate for Payer: GEHA Commercial |
$1,446.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,860.30
|
| Rate for Payer: Multiplan All |
$1,880.97
|
| Rate for Payer: OMNI Networks Commercial |
$1,446.90
|
| Rate for Payer: One Health Plan PPO/POS |
$1,860.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,963.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,550.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,922.31
|
| Rate for Payer: Zelis Auto |
$826.80
|
| Rate for Payer: Zelis Worker's Compensation |
$564.29
|
|
|
TUBIGRIP STOCKINETTE SZ F 4'' DM
|
Facility
|
IP
|
$393.00
|
|
| Hospital Charge Code |
90030900
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$107.29 |
| Max. Negotiated Rate |
$373.35 |
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cigna Commercial |
$334.05
|
| Rate for Payer: First Health Commercial |
$353.70
|
| Rate for Payer: First Health Workers Compensation |
$151.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$353.70
|
| Rate for Payer: GEHA Commercial |
$275.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$353.70
|
| Rate for Payer: Multiplan All |
$357.63
|
| Rate for Payer: OMNI Networks Commercial |
$275.10
|
| Rate for Payer: One Health Plan PPO/POS |
$353.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$373.35
|
| Rate for Payer: Three Rivers Provider Network All |
$294.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$365.49
|
| Rate for Payer: Zelis Auto |
$157.20
|
| Rate for Payer: Zelis Worker's Compensation |
$107.29
|
|
|
TUBIGRIP STOCKINETTE SZ F 4'' DM
|
Facility
|
OP
|
$393.00
|
|
| Hospital Charge Code |
90030900
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$98.25 |
| Max. Negotiated Rate |
$373.35 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$235.80
|
| Rate for Payer: Cash Price |
$235.80
|
| Rate for Payer: Cigna Commercial |
$334.05
|
| Rate for Payer: First Health Commercial |
$353.70
|
| Rate for Payer: First Health Workers Compensation |
$151.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$353.70
|
| Rate for Payer: GEHA Commercial |
$314.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$353.70
|
| Rate for Payer: Humana ChoiceCare |
$102.18
|
| Rate for Payer: Multiplan All |
$357.63
|
| Rate for Payer: New Mexico Health Connections Medicare |
$235.80
|
| Rate for Payer: OMNI Networks Commercial |
$275.10
|
| Rate for Payer: One Health Plan PPO/POS |
$353.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$373.35
|
| Rate for Payer: Three Rivers Provider Network All |
$294.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$345.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$98.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$365.49
|
| Rate for Payer: Zelis Auto |
$157.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$196.50
|
| Rate for Payer: Zelis Worker's Compensation |
$107.29
|
|
|
TUBING WITH HEATING ELEMENT
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT A4604
|
| Hospital Charge Code |
3000024
|
|
Hospital Revenue Code
|
292
|
| Min. Negotiated Rate |
$32.21 |
| Max. Negotiated Rate |
$112.10 |
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$100.30
|
| Rate for Payer: First Health Commercial |
$106.20
|
| Rate for Payer: First Health Workers Compensation |
$45.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$106.20
|
| Rate for Payer: GEHA Commercial |
$82.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$106.20
|
| Rate for Payer: Multiplan All |
$107.38
|
| Rate for Payer: OMNI Networks Commercial |
$82.60
|
| Rate for Payer: One Health Plan PPO/POS |
$106.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$112.10
|
| Rate for Payer: Three Rivers Provider Network All |
$88.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$109.74
|
| Rate for Payer: Zelis Auto |
$47.20
|
| Rate for Payer: Zelis Worker's Compensation |
$32.21
|
|
|
TUBING WITH HEATING ELEMENT
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT A4604
|
| Hospital Charge Code |
3000024
|
|
Hospital Revenue Code
|
292
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$112.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$70.80
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$100.30
|
| Rate for Payer: First Health Commercial |
$106.20
|
| Rate for Payer: First Health Workers Compensation |
$45.56
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$106.20
|
| Rate for Payer: GEHA Commercial |
$94.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$106.20
|
| Rate for Payer: Humana ChoiceCare |
$30.68
|
| Rate for Payer: Multiplan All |
$107.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$70.80
|
| Rate for Payer: OMNI Networks Commercial |
$82.60
|
| Rate for Payer: One Health Plan PPO/POS |
$106.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$112.10
|
| Rate for Payer: Three Rivers Provider Network All |
$88.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$103.84
|
| Rate for Payer: United Healthcare Managed Medicaid |
$29.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$109.74
|
| Rate for Payer: Zelis Auto |
$47.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$59.00
|
| Rate for Payer: Zelis Worker's Compensation |
$32.21
|
|
|
TUMOR IMMUNOHISTOCHEM/MANUAL
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
2200169
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$105.85 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna Commercial |
$357.00
|
| Rate for Payer: First Health Commercial |
$378.00
|
| Rate for Payer: First Health Workers Compensation |
$149.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$378.00
|
| Rate for Payer: GEHA Commercial |
$294.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$378.00
|
| Rate for Payer: Multiplan All |
$382.20
|
| Rate for Payer: OMNI Networks Commercial |
$294.00
|
| Rate for Payer: One Health Plan PPO/POS |
$378.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$399.00
|
| Rate for Payer: Three Rivers Provider Network All |
$315.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$390.60
|
| Rate for Payer: Zelis Auto |
$168.00
|
| Rate for Payer: Zelis Worker's Compensation |
$105.85
|
|
|
TUMOR IMMUNOHISTOCHEM/MANUAL
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
2200169
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$127.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$252.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$127.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$100.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$162.71
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna Commercial |
$357.00
|
| Rate for Payer: First Health Commercial |
$378.00
|
| Rate for Payer: First Health Workers Compensation |
$149.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$378.00
|
| Rate for Payer: GEHA Commercial |
$336.00
|
| Rate for Payer: GEHA Medicare |
$162.71
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$378.00
|
| Rate for Payer: Humana ChoiceCare |
$178.98
|
| Rate for Payer: Humana Medicare Advantage |
$162.71
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$273.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$102.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$162.71
|
| Rate for Payer: Multiplan All |
$382.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$276.61
|
| Rate for Payer: OMNI Networks Commercial |
$294.00
|
| Rate for Payer: One Health Plan PPO/POS |
$378.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$118.78
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$102.87
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$162.71
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$399.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$325.42
|
| Rate for Payer: Three Rivers Provider Network All |
$315.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$159.46
|
| Rate for Payer: United Healthcare Commercial |
$357.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$102.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.71
|
| Rate for Payer: United Payors & United Providers UP&UP |
$390.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$162.71
|
| Rate for Payer: Zelis Auto |
$168.00
|
| Rate for Payer: Zelis Medicare |
$138.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$195.25
|
| Rate for Payer: Zelis Worker's Compensation |
$105.85
|
|
|
TUMOR LOC SINGLE DAY
|
Facility
|
IP
|
$3,459.00
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
2410083
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$275.20 |
| Max. Negotiated Rate |
$3,286.05 |
| Rate for Payer: Cash Price |
$2,075.40
|
| Rate for Payer: Cash Price |
$2,075.40
|
| Rate for Payer: Cigna Commercial |
$2,940.15
|
| Rate for Payer: First Health Commercial |
$3,113.10
|
| Rate for Payer: First Health Workers Compensation |
$389.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,113.10
|
| Rate for Payer: GEHA Commercial |
$2,421.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,113.10
|
| Rate for Payer: Multiplan All |
$3,147.69
|
| Rate for Payer: OMNI Networks Commercial |
$2,421.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,113.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,286.05
|
| Rate for Payer: Three Rivers Provider Network All |
$2,594.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,216.87
|
| Rate for Payer: Zelis Auto |
$1,383.60
|
| Rate for Payer: Zelis Worker's Compensation |
$275.20
|
|
|
TUMOR LOC SINGLE DAY
|
Facility
|
OP
|
$3,459.00
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
2410083
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$275.20 |
| Max. Negotiated Rate |
$3,286.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$765.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,075.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$765.62
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$606.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,239.61
|
| Rate for Payer: Cash Price |
$2,075.40
|
| Rate for Payer: Cash Price |
$2,075.40
|
| Rate for Payer: Cigna Commercial |
$2,940.15
|
| Rate for Payer: First Health Commercial |
$3,113.10
|
| Rate for Payer: First Health Workers Compensation |
$389.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,113.10
|
| Rate for Payer: GEHA Commercial |
$2,767.20
|
| Rate for Payer: GEHA Medicare |
$1,239.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,113.10
|
| Rate for Payer: Humana ChoiceCare |
$1,363.57
|
| Rate for Payer: Humana Medicare Advantage |
$1,239.61
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,082.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$618.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,239.61
|
| Rate for Payer: Multiplan All |
$3,147.69
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,107.34
|
| Rate for Payer: OMNI Networks Commercial |
$2,421.30
|
| Rate for Payer: One Health Plan PPO/POS |
$3,113.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$714.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$618.87
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,239.61
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,286.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,479.22
|
| Rate for Payer: Three Rivers Provider Network All |
$2,594.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,214.82
|
| Rate for Payer: United Healthcare Commercial |
$2,940.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$618.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,239.61
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,216.87
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,239.61
|
| Rate for Payer: Zelis Auto |
$1,383.60
|
| Rate for Payer: Zelis Medicare |
$1,053.67
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,487.53
|
| Rate for Payer: Zelis Worker's Compensation |
$275.20
|
|
|
TUNA IGE
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299637
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$39.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
TUNA IGE
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
2299637
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$47.60
|
| Rate for Payer: First Health Commercial |
$50.40
|
| Rate for Payer: First Health Workers Compensation |
$11.22
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$50.40
|
| Rate for Payer: GEHA Commercial |
$44.80
|
| Rate for Payer: GEHA Medicare |
$5.22
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$50.40
|
| Rate for Payer: Humana ChoiceCare |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.59
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.22
|
| Rate for Payer: Multiplan All |
$50.96
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.20
|
| Rate for Payer: One Health Plan PPO/POS |
$50.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.76
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.59
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.22
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$53.20
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.44
|
| Rate for Payer: Three Rivers Provider Network All |
$42.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.12
|
| Rate for Payer: United Healthcare Commercial |
$47.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Payors & United Providers UP&UP |
$52.08
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.22
|
| Rate for Payer: Zelis Auto |
$22.40
|
| Rate for Payer: Zelis Medicare |
$4.44
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.26
|
| Rate for Payer: Zelis Worker's Compensation |
$7.93
|
|
|
TVT GYNECARE MESH
|
Facility
|
IP
|
$2,305.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
7006707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.00 |
| Max. Negotiated Rate |
$2,189.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,844.00
|
| Rate for Payer: Cash Price |
$1,383.00
|
| Rate for Payer: Cash Price |
$1,383.00
|
| Rate for Payer: Cigna Commercial |
$1,959.25
|
| Rate for Payer: First Health Commercial |
$2,074.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,074.50
|
| Rate for Payer: GEHA Commercial |
$1,613.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,074.50
|
| Rate for Payer: Multiplan All |
$2,097.55
|
| Rate for Payer: OMNI Networks Commercial |
$1,613.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,074.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,189.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,728.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,143.65
|
| Rate for Payer: Zelis Auto |
$922.00
|
|
|
TVT GYNECARE MESH
|
Facility
|
OP
|
$2,305.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
7006707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.25 |
| Max. Negotiated Rate |
$2,189.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,383.00
|
| Rate for Payer: Cash Price |
$1,383.00
|
| Rate for Payer: Cash Price |
$1,383.00
|
| Rate for Payer: Cigna Commercial |
$1,959.25
|
| Rate for Payer: First Health Commercial |
$2,074.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,074.50
|
| Rate for Payer: GEHA Commercial |
$1,844.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,074.50
|
| Rate for Payer: Humana ChoiceCare |
$599.30
|
| Rate for Payer: Multiplan All |
$2,097.55
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,383.00
|
| Rate for Payer: OMNI Networks Commercial |
$1,613.50
|
| Rate for Payer: One Health Plan PPO/POS |
$2,074.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,189.75
|
| Rate for Payer: Three Rivers Provider Network All |
$1,728.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,028.40
|
| Rate for Payer: United Healthcare Managed Medicaid |
$576.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,143.65
|
| Rate for Payer: Zelis Auto |
$922.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,152.50
|
|
|
TX INCOMPLETE ABORTION ANY TRIMESTER SUR
|
Facility
|
OP
|
$947.00
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
6159812
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$258.53 |
| Max. Negotiated Rate |
$6,038.18 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$568.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,605.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,019.09
|
| Rate for Payer: Cash Price |
$568.20
|
| Rate for Payer: Cash Price |
$568.20
|
| Rate for Payer: Cigna Commercial |
$804.95
|
| Rate for Payer: First Health Commercial |
$852.30
|
| Rate for Payer: First Health Workers Compensation |
$365.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$852.30
|
| Rate for Payer: GEHA Commercial |
$757.60
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$852.30
|
| Rate for Payer: Humana ChoiceCare |
$3,321.00
|
| Rate for Payer: Humana Medicare Advantage |
$3,019.09
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,072.07
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,638.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,019.09
|
| Rate for Payer: Multiplan All |
$861.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$662.90
|
| Rate for Payer: One Health Plan PPO/POS |
$852.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,891.64
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,638.29
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,019.09
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$899.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$710.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,958.71
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,638.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,019.09
|
| Rate for Payer: United Payors & United Providers UP&UP |
$880.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$378.80
|
| Rate for Payer: Zelis Medicare |
$2,566.23
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,622.91
|
| Rate for Payer: Zelis Worker's Compensation |
$258.53
|
|
|
TX INCOMPLETE ABORTION ANY TRIMESTER SUR
|
Facility
|
IP
|
$947.00
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
6159812
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$258.53 |
| Max. Negotiated Rate |
$899.65 |
| Rate for Payer: Cash Price |
$568.20
|
| Rate for Payer: Cigna Commercial |
$804.95
|
| Rate for Payer: First Health Commercial |
$852.30
|
| Rate for Payer: First Health Workers Compensation |
$365.64
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$852.30
|
| Rate for Payer: GEHA Commercial |
$662.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$852.30
|
| Rate for Payer: Multiplan All |
$861.77
|
| Rate for Payer: OMNI Networks Commercial |
$662.90
|
| Rate for Payer: One Health Plan PPO/POS |
$852.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$899.65
|
| Rate for Payer: Three Rivers Provider Network All |
$710.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$880.71
|
| Rate for Payer: Zelis Auto |
$378.80
|
| Rate for Payer: Zelis Worker's Compensation |
$258.53
|
|
|
TX NOSE FX W/O STABILI
|
Facility
|
IP
|
$5,386.00
|
|
| Hospital Charge Code |
8121315
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,470.38 |
| Max. Negotiated Rate |
$5,116.70 |
| Rate for Payer: Cash Price |
$3,231.60
|
| Rate for Payer: Cigna Commercial |
$4,578.10
|
| Rate for Payer: First Health Commercial |
$4,847.40
|
| Rate for Payer: First Health Workers Compensation |
$2,079.53
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,847.40
|
| Rate for Payer: GEHA Commercial |
$3,770.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,847.40
|
| Rate for Payer: Multiplan All |
$4,901.26
|
| Rate for Payer: OMNI Networks Commercial |
$3,770.20
|
| Rate for Payer: One Health Plan PPO/POS |
$4,847.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,116.70
|
| Rate for Payer: Three Rivers Provider Network All |
$4,039.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,008.98
|
| Rate for Payer: Zelis Auto |
$2,154.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,470.38
|
|
