|
CATHETER BARRX 90FRA FOCAL
|
Facility
|
OP
|
$5,298.00
|
|
|
Service Code
|
CPT C1733
|
| Hospital Charge Code |
7006566
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,324.50 |
| Max. Negotiated Rate |
$5,033.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,178.80
|
| Rate for Payer: Cash Price |
$3,178.80
|
| Rate for Payer: Cash Price |
$3,178.80
|
| Rate for Payer: Cigna Commercial |
$4,503.30
|
| Rate for Payer: First Health Commercial |
$4,768.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,768.20
|
| Rate for Payer: GEHA Commercial |
$4,238.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,768.20
|
| Rate for Payer: Humana ChoiceCare |
$1,377.48
|
| Rate for Payer: Multiplan All |
$4,821.18
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,178.80
|
| Rate for Payer: OMNI Networks Commercial |
$3,708.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,768.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,033.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,973.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$4,662.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,324.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,927.14
|
| Rate for Payer: Zelis Auto |
$2,119.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,649.00
|
|
|
CATHETER BARRX 90FRA FOCAL
|
Facility
|
IP
|
$5,298.00
|
|
|
Service Code
|
CPT C1733
|
| Hospital Charge Code |
7006566
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,119.20 |
| Max. Negotiated Rate |
$5,033.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,238.40
|
| Rate for Payer: Cash Price |
$3,178.80
|
| Rate for Payer: Cash Price |
$3,178.80
|
| Rate for Payer: Cigna Commercial |
$4,503.30
|
| Rate for Payer: First Health Commercial |
$4,768.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$4,768.20
|
| Rate for Payer: GEHA Commercial |
$3,708.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$4,768.20
|
| Rate for Payer: Multiplan All |
$4,821.18
|
| Rate for Payer: OMNI Networks Commercial |
$3,708.60
|
| Rate for Payer: One Health Plan PPO/POS |
$4,768.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,033.10
|
| Rate for Payer: Three Rivers Provider Network All |
$3,973.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$4,927.14
|
| Rate for Payer: Zelis Auto |
$2,119.20
|
|
|
CATHETER BARRX ULTRA-LONG RFA
|
Facility
|
OP
|
$6,181.00
|
|
|
Service Code
|
CPT C1733
|
| Hospital Charge Code |
7006567
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.25 |
| Max. Negotiated Rate |
$5,871.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,708.60
|
| Rate for Payer: Cash Price |
$3,708.60
|
| Rate for Payer: Cash Price |
$3,708.60
|
| Rate for Payer: Cigna Commercial |
$5,253.85
|
| Rate for Payer: First Health Commercial |
$5,562.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,562.90
|
| Rate for Payer: GEHA Commercial |
$4,944.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,562.90
|
| Rate for Payer: Humana ChoiceCare |
$1,607.06
|
| Rate for Payer: Multiplan All |
$5,624.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,708.60
|
| Rate for Payer: OMNI Networks Commercial |
$4,326.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,562.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,871.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,635.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,439.28
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,545.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,748.33
|
| Rate for Payer: Zelis Auto |
$2,472.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,090.50
|
|
|
CATHETER BARRX ULTRA-LONG RFA
|
Facility
|
IP
|
$6,181.00
|
|
|
Service Code
|
CPT C1733
|
| Hospital Charge Code |
7006567
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,472.40 |
| Max. Negotiated Rate |
$5,871.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,944.80
|
| Rate for Payer: Cash Price |
$3,708.60
|
| Rate for Payer: Cash Price |
$3,708.60
|
| Rate for Payer: Cigna Commercial |
$5,253.85
|
| Rate for Payer: First Health Commercial |
$5,562.90
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,562.90
|
| Rate for Payer: GEHA Commercial |
$4,326.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,562.90
|
| Rate for Payer: Multiplan All |
$5,624.71
|
| Rate for Payer: OMNI Networks Commercial |
$4,326.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,562.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,871.95
|
| Rate for Payer: Three Rivers Provider Network All |
$4,635.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,748.33
|
| Rate for Payer: Zelis Auto |
$2,472.40
|
|
|
CATHETER CHANGE XRAY
|
Facility
|
IP
|
$1,563.00
|
|
|
Service Code
|
CPT 75984
|
| Hospital Charge Code |
2407200
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.46 |
| Max. Negotiated Rate |
$1,484.85 |
| Rate for Payer: Cash Price |
$937.80
|
| Rate for Payer: Cash Price |
$937.80
|
| Rate for Payer: Cigna Commercial |
$1,328.55
|
| Rate for Payer: First Health Commercial |
$1,406.70
|
| Rate for Payer: First Health Workers Compensation |
$123.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,406.70
|
| Rate for Payer: GEHA Commercial |
$1,094.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,406.70
|
| Rate for Payer: Multiplan All |
$1,422.33
|
| Rate for Payer: OMNI Networks Commercial |
$1,094.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,406.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,484.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,172.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,453.59
|
| Rate for Payer: Zelis Auto |
$625.20
|
| Rate for Payer: Zelis Worker's Compensation |
$87.46
|
|
|
CATHETER CHANGE XRAY
|
Facility
|
OP
|
$1,563.00
|
|
|
Service Code
|
CPT 75984
|
| Hospital Charge Code |
2407200
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.46 |
| Max. Negotiated Rate |
$1,484.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$937.80
|
| Rate for Payer: Cash Price |
$937.80
|
| Rate for Payer: Cash Price |
$937.80
|
| Rate for Payer: Cigna Commercial |
$1,328.55
|
| Rate for Payer: First Health Commercial |
$1,406.70
|
| Rate for Payer: First Health Workers Compensation |
$123.69
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,406.70
|
| Rate for Payer: GEHA Commercial |
$1,250.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,406.70
|
| Rate for Payer: Humana ChoiceCare |
$406.38
|
| Rate for Payer: Multiplan All |
$1,422.33
|
| Rate for Payer: New Mexico Health Connections Medicare |
$937.80
|
| Rate for Payer: OMNI Networks Commercial |
$1,094.10
|
| Rate for Payer: One Health Plan PPO/POS |
$1,406.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,484.85
|
| Rate for Payer: Three Rivers Provider Network All |
$1,172.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,375.44
|
| Rate for Payer: United Healthcare Commercial |
$1,328.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$390.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,453.59
|
| Rate for Payer: Zelis Auto |
$625.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$781.50
|
| Rate for Payer: Zelis Worker's Compensation |
$87.46
|
|
|
CATHETER CHEST TUBE 12 FR
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
90031076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.30
|
| Rate for Payer: GEHA Commercial |
$39.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.30
|
| Rate for Payer: Multiplan All |
$51.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.90
|
| Rate for Payer: One Health Plan PPO/POS |
$51.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.15
|
| Rate for Payer: Three Rivers Provider Network All |
$42.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.01
|
| Rate for Payer: Zelis Auto |
$22.80
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
CATHETER CHEST TUBE 12 FR
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
90031076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.30
|
| Rate for Payer: GEHA Commercial |
$45.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.30
|
| Rate for Payer: Humana ChoiceCare |
$14.82
|
| Rate for Payer: Multiplan All |
$51.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.20
|
| Rate for Payer: OMNI Networks Commercial |
$39.90
|
| Rate for Payer: One Health Plan PPO/POS |
$51.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.15
|
| Rate for Payer: Three Rivers Provider Network All |
$42.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$50.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.01
|
| Rate for Payer: Zelis Auto |
$22.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.50
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
CATHETER CHEST TUBE 12 FR
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7000041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.30
|
| Rate for Payer: GEHA Commercial |
$45.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.30
|
| Rate for Payer: Humana ChoiceCare |
$14.82
|
| Rate for Payer: Multiplan All |
$51.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.20
|
| Rate for Payer: OMNI Networks Commercial |
$39.90
|
| Rate for Payer: One Health Plan PPO/POS |
$51.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.15
|
| Rate for Payer: Three Rivers Provider Network All |
$42.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$50.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.01
|
| Rate for Payer: Zelis Auto |
$22.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.50
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
CATHETER CHEST TUBE 12 FR
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7000041
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.30
|
| Rate for Payer: GEHA Commercial |
$39.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.30
|
| Rate for Payer: Multiplan All |
$51.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.90
|
| Rate for Payer: One Health Plan PPO/POS |
$51.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.15
|
| Rate for Payer: Three Rivers Provider Network All |
$42.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.01
|
| Rate for Payer: Zelis Auto |
$22.80
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
CATHETER CHEST TUBE 16 FR
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7000044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.30
|
| Rate for Payer: GEHA Commercial |
$45.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.30
|
| Rate for Payer: Humana ChoiceCare |
$14.82
|
| Rate for Payer: Multiplan All |
$51.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.20
|
| Rate for Payer: OMNI Networks Commercial |
$39.90
|
| Rate for Payer: One Health Plan PPO/POS |
$51.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.15
|
| Rate for Payer: Three Rivers Provider Network All |
$42.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$50.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.01
|
| Rate for Payer: Zelis Auto |
$22.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.50
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
CATHETER CHEST TUBE 16 FR
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7000044
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.30
|
| Rate for Payer: GEHA Commercial |
$39.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.30
|
| Rate for Payer: Multiplan All |
$51.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.90
|
| Rate for Payer: One Health Plan PPO/POS |
$51.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.15
|
| Rate for Payer: Three Rivers Provider Network All |
$42.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.01
|
| Rate for Payer: Zelis Auto |
$22.80
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
CATHETER CHEST TUBE 16 FR
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
90031077
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.30
|
| Rate for Payer: GEHA Commercial |
$39.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.30
|
| Rate for Payer: Multiplan All |
$51.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.90
|
| Rate for Payer: One Health Plan PPO/POS |
$51.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.15
|
| Rate for Payer: Three Rivers Provider Network All |
$42.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.01
|
| Rate for Payer: Zelis Auto |
$22.80
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
CATHETER CHEST TUBE 16 FR
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
90031077
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.30
|
| Rate for Payer: GEHA Commercial |
$45.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.30
|
| Rate for Payer: Humana ChoiceCare |
$14.82
|
| Rate for Payer: Multiplan All |
$51.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.20
|
| Rate for Payer: OMNI Networks Commercial |
$39.90
|
| Rate for Payer: One Health Plan PPO/POS |
$51.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.15
|
| Rate for Payer: Three Rivers Provider Network All |
$42.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$50.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.01
|
| Rate for Payer: Zelis Auto |
$22.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.50
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
CATHETER CHEST TUBE 20FR
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
90031078
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.30
|
| Rate for Payer: GEHA Commercial |
$45.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.30
|
| Rate for Payer: Humana ChoiceCare |
$14.82
|
| Rate for Payer: Multiplan All |
$51.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.20
|
| Rate for Payer: OMNI Networks Commercial |
$39.90
|
| Rate for Payer: One Health Plan PPO/POS |
$51.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.15
|
| Rate for Payer: Three Rivers Provider Network All |
$42.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$50.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.01
|
| Rate for Payer: Zelis Auto |
$22.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.50
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
CATHETER CHEST TUBE 20FR
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
90031078
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.30
|
| Rate for Payer: GEHA Commercial |
$39.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.30
|
| Rate for Payer: Multiplan All |
$51.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.90
|
| Rate for Payer: One Health Plan PPO/POS |
$51.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.15
|
| Rate for Payer: Three Rivers Provider Network All |
$42.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.01
|
| Rate for Payer: Zelis Auto |
$22.80
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
CATHETER CHEST TUBE 20FR
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7000051
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.30
|
| Rate for Payer: GEHA Commercial |
$39.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.30
|
| Rate for Payer: Multiplan All |
$51.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.90
|
| Rate for Payer: One Health Plan PPO/POS |
$51.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.15
|
| Rate for Payer: Three Rivers Provider Network All |
$42.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.01
|
| Rate for Payer: Zelis Auto |
$22.80
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
CATHETER CHEST TUBE 20FR
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7000051
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.30
|
| Rate for Payer: GEHA Commercial |
$45.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.30
|
| Rate for Payer: Humana ChoiceCare |
$14.82
|
| Rate for Payer: Multiplan All |
$51.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.20
|
| Rate for Payer: OMNI Networks Commercial |
$39.90
|
| Rate for Payer: One Health Plan PPO/POS |
$51.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.15
|
| Rate for Payer: Three Rivers Provider Network All |
$42.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$50.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.01
|
| Rate for Payer: Zelis Auto |
$22.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.50
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
CATHETER CHEST TUBE 24 FR
|
Facility
|
OP
|
$57.00
|
|
| Hospital Charge Code |
90031151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.30
|
| Rate for Payer: GEHA Commercial |
$45.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.30
|
| Rate for Payer: Humana ChoiceCare |
$14.82
|
| Rate for Payer: Multiplan All |
$51.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.20
|
| Rate for Payer: OMNI Networks Commercial |
$39.90
|
| Rate for Payer: One Health Plan PPO/POS |
$51.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.15
|
| Rate for Payer: Three Rivers Provider Network All |
$42.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$50.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.01
|
| Rate for Payer: Zelis Auto |
$22.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.50
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
CATHETER CHEST TUBE 24 FR
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7000045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.30
|
| Rate for Payer: GEHA Commercial |
$39.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.30
|
| Rate for Payer: Multiplan All |
$51.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.90
|
| Rate for Payer: One Health Plan PPO/POS |
$51.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.15
|
| Rate for Payer: Three Rivers Provider Network All |
$42.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.01
|
| Rate for Payer: Zelis Auto |
$22.80
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
CATHETER CHEST TUBE 24 FR
|
Facility
|
IP
|
$57.00
|
|
| Hospital Charge Code |
90031151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.30
|
| Rate for Payer: GEHA Commercial |
$39.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.30
|
| Rate for Payer: Multiplan All |
$51.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.90
|
| Rate for Payer: One Health Plan PPO/POS |
$51.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.15
|
| Rate for Payer: Three Rivers Provider Network All |
$42.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.01
|
| Rate for Payer: Zelis Auto |
$22.80
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
CATHETER CHEST TUBE 24 FR
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7000045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.30
|
| Rate for Payer: GEHA Commercial |
$45.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.30
|
| Rate for Payer: Humana ChoiceCare |
$14.82
|
| Rate for Payer: Multiplan All |
$51.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.20
|
| Rate for Payer: OMNI Networks Commercial |
$39.90
|
| Rate for Payer: One Health Plan PPO/POS |
$51.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.15
|
| Rate for Payer: Three Rivers Provider Network All |
$42.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$50.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.01
|
| Rate for Payer: Zelis Auto |
$22.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.50
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
CATHETER CHEST TUBE 28 FR
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7000042
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.30
|
| Rate for Payer: GEHA Commercial |
$45.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.30
|
| Rate for Payer: Humana ChoiceCare |
$14.82
|
| Rate for Payer: Multiplan All |
$51.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.20
|
| Rate for Payer: OMNI Networks Commercial |
$39.90
|
| Rate for Payer: One Health Plan PPO/POS |
$51.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.15
|
| Rate for Payer: Three Rivers Provider Network All |
$42.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$50.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.01
|
| Rate for Payer: Zelis Auto |
$22.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.50
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
CATHETER CHEST TUBE 28 FR
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
90031152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.30
|
| Rate for Payer: GEHA Commercial |
$45.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.30
|
| Rate for Payer: Humana ChoiceCare |
$14.82
|
| Rate for Payer: Multiplan All |
$51.87
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.20
|
| Rate for Payer: OMNI Networks Commercial |
$39.90
|
| Rate for Payer: One Health Plan PPO/POS |
$51.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.15
|
| Rate for Payer: Three Rivers Provider Network All |
$42.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$50.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$14.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.01
|
| Rate for Payer: Zelis Auto |
$22.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$28.50
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
|
CATHETER CHEST TUBE 28 FR
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
90031152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: First Health Workers Compensation |
$22.01
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$51.30
|
| Rate for Payer: GEHA Commercial |
$39.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$51.30
|
| Rate for Payer: Multiplan All |
$51.87
|
| Rate for Payer: OMNI Networks Commercial |
$39.90
|
| Rate for Payer: One Health Plan PPO/POS |
$51.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$54.15
|
| Rate for Payer: Three Rivers Provider Network All |
$42.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$53.01
|
| Rate for Payer: Zelis Auto |
$22.80
|
| Rate for Payer: Zelis Worker's Compensation |
$15.56
|
|
