|
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,32,FR
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7000043
|
|
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,32,FR
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7000043
|
|
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,36FR
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7000052
|
|
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,36FR
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
7000052
|
|
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 HEMODIALYSIS GLIDEPATH 13FR
|
Facility
|
IP
|
$1,721.68
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
7003195
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$688.67 |
| Max. Negotiated Rate |
$1,635.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,377.34
|
| Rate for Payer: Cash Price |
$1,033.01
|
| Rate for Payer: Cash Price |
$1,033.01
|
| Rate for Payer: Cigna Commercial |
$1,463.43
|
| Rate for Payer: First Health Commercial |
$1,549.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,549.51
|
| Rate for Payer: GEHA Commercial |
$1,205.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,549.51
|
| Rate for Payer: Multiplan All |
$1,566.73
|
| Rate for Payer: OMNI Networks Commercial |
$1,205.18
|
| Rate for Payer: One Health Plan PPO/POS |
$1,549.51
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,635.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,291.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,601.16
|
| Rate for Payer: Zelis Auto |
$688.67
|
|
|
CATHETER HEMODIALYSIS GLIDEPATH 13FR
|
Facility
|
OP
|
$1,721.68
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
7003195
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.42 |
| Max. Negotiated Rate |
$1,635.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,033.01
|
| Rate for Payer: Cash Price |
$1,033.01
|
| Rate for Payer: Cash Price |
$1,033.01
|
| Rate for Payer: Cigna Commercial |
$1,463.43
|
| Rate for Payer: First Health Commercial |
$1,549.51
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,549.51
|
| Rate for Payer: GEHA Commercial |
$1,377.34
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,549.51
|
| Rate for Payer: Humana ChoiceCare |
$447.64
|
| Rate for Payer: Multiplan All |
$1,566.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,033.01
|
| Rate for Payer: OMNI Networks Commercial |
$1,205.18
|
| Rate for Payer: One Health Plan PPO/POS |
$1,549.51
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,635.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,291.26
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,515.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$430.42
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,601.16
|
| Rate for Payer: Zelis Auto |
$688.67
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$860.84
|
|
|
CATHETER IV SAFETY 20GX1"
|
Facility
|
IP
|
$16.00
|
|
| Hospital Charge Code |
7000098
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$13.60
|
| Rate for Payer: First Health Commercial |
$14.40
|
| Rate for Payer: First Health Workers Compensation |
$6.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14.40
|
| Rate for Payer: GEHA Commercial |
$11.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14.40
|
| Rate for Payer: Multiplan All |
$14.56
|
| Rate for Payer: OMNI Networks Commercial |
$11.20
|
| Rate for Payer: One Health Plan PPO/POS |
$14.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15.20
|
| Rate for Payer: Three Rivers Provider Network All |
$12.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14.88
|
| Rate for Payer: Zelis Auto |
$6.40
|
| Rate for Payer: Zelis Worker's Compensation |
$4.37
|
|
|
CATHETER IV SAFETY 20GX1"
|
Facility
|
OP
|
$16.00
|
|
| Hospital Charge Code |
7000098
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$13.60
|
| Rate for Payer: First Health Commercial |
$14.40
|
| Rate for Payer: First Health Workers Compensation |
$6.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$14.40
|
| Rate for Payer: GEHA Commercial |
$12.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$14.40
|
| Rate for Payer: Humana ChoiceCare |
$4.16
|
| Rate for Payer: Multiplan All |
$14.56
|
| Rate for Payer: New Mexico Health Connections Medicare |
$9.60
|
| Rate for Payer: OMNI Networks Commercial |
$11.20
|
| Rate for Payer: One Health Plan PPO/POS |
$14.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$15.20
|
| Rate for Payer: Three Rivers Provider Network All |
$12.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$14.08
|
| Rate for Payer: United Healthcare Managed Medicaid |
$4.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$14.88
|
| Rate for Payer: Zelis Auto |
$6.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8.00
|
| Rate for Payer: Zelis Worker's Compensation |
$4.37
|
|
|
CATHETERIZE FOR URINE SPEC
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT P9612
|
| Hospital Charge Code |
10009612
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$136.00
|
| Rate for Payer: First Health Commercial |
$144.00
|
| Rate for Payer: First Health Workers Compensation |
$61.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$144.00
|
| Rate for Payer: GEHA Commercial |
$112.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.00
|
| Rate for Payer: Multiplan All |
$145.60
|
| Rate for Payer: OMNI Networks Commercial |
$112.00
|
| Rate for Payer: One Health Plan PPO/POS |
$144.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.00
|
| Rate for Payer: Three Rivers Provider Network All |
$120.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$148.80
|
| Rate for Payer: Zelis Auto |
$64.00
|
| Rate for Payer: Zelis Worker's Compensation |
$43.68
|
|
|
CATHFLO ACTIVASE 2MG
|
Facility
|
OP
|
$890.00
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
3301309
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.28 |
| Max. Negotiated Rate |
$845.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$102.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$534.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$102.66
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$81.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$94.45
|
| Rate for Payer: Cash Price |
$534.00
|
| Rate for Payer: Cash Price |
$534.00
|
| Rate for Payer: Cigna Commercial |
$756.50
|
| Rate for Payer: First Health Commercial |
$801.00
|
| Rate for Payer: First Health Workers Compensation |
$343.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$801.00
|
| Rate for Payer: GEHA Commercial |
$103.89
|
| Rate for Payer: GEHA Medicare |
$94.45
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$801.00
|
| Rate for Payer: Humana ChoiceCare |
$103.89
|
| Rate for Payer: Humana Medicare Advantage |
$94.45
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$158.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$82.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$94.45
|
| Rate for Payer: Multiplan All |
$809.90
|
| Rate for Payer: New Mexico Health Connections Medicare |
$160.56
|
| Rate for Payer: OMNI Networks Commercial |
$623.00
|
| Rate for Payer: One Health Plan PPO/POS |
$801.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$95.82
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$82.98
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$94.45
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$845.50
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$188.90
|
| Rate for Payer: Three Rivers Provider Network All |
$667.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$92.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$82.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.45
|
| Rate for Payer: United Payors & United Providers UP&UP |
$827.70
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$94.45
|
| Rate for Payer: Zelis Auto |
$356.00
|
| Rate for Payer: Zelis Medicare |
$80.28
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$113.34
|
| Rate for Payer: Zelis Worker's Compensation |
$242.97
|
|
|
CATHFLO ACTIVASE 2MG
|
Facility
|
IP
|
$890.00
|
|
|
Service Code
|
CPT J2997
|
| Hospital Charge Code |
3301309
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$242.97 |
| Max. Negotiated Rate |
$845.50 |
| Rate for Payer: Cash Price |
$534.00
|
| Rate for Payer: Cigna Commercial |
$756.50
|
| Rate for Payer: First Health Commercial |
$801.00
|
| Rate for Payer: First Health Workers Compensation |
$343.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$801.00
|
| Rate for Payer: GEHA Commercial |
$623.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$801.00
|
| Rate for Payer: Multiplan All |
$809.90
|
| Rate for Payer: OMNI Networks Commercial |
$623.00
|
| Rate for Payer: One Health Plan PPO/POS |
$801.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$845.50
|
| Rate for Payer: Three Rivers Provider Network All |
$667.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$827.70
|
| Rate for Payer: Zelis Auto |
$356.00
|
| Rate for Payer: Zelis Worker's Compensation |
$242.97
|
|
|
CATH GROSHONG 7FR SURECUFF
|
Facility
|
OP
|
$914.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
7003198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.50 |
| Max. Negotiated Rate |
$868.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$548.40
|
| Rate for Payer: Cash Price |
$548.40
|
| Rate for Payer: Cash Price |
$548.40
|
| Rate for Payer: Cigna Commercial |
$776.90
|
| Rate for Payer: First Health Commercial |
$822.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$822.60
|
| Rate for Payer: GEHA Commercial |
$731.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$822.60
|
| Rate for Payer: Humana ChoiceCare |
$237.64
|
| Rate for Payer: Multiplan All |
$831.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$548.40
|
| Rate for Payer: OMNI Networks Commercial |
$639.80
|
| Rate for Payer: One Health Plan PPO/POS |
$822.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$868.30
|
| Rate for Payer: Three Rivers Provider Network All |
$685.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$804.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$228.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$850.02
|
| Rate for Payer: Zelis Auto |
$365.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$457.00
|
|
|
CATH GROSHONG 7FR SURECUFF
|
Facility
|
IP
|
$914.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
7003198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$365.60 |
| Max. Negotiated Rate |
$868.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$731.20
|
| Rate for Payer: Cash Price |
$548.40
|
| Rate for Payer: Cash Price |
$548.40
|
| Rate for Payer: Cigna Commercial |
$776.90
|
| Rate for Payer: First Health Commercial |
$822.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$822.60
|
| Rate for Payer: GEHA Commercial |
$639.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$822.60
|
| Rate for Payer: Multiplan All |
$831.74
|
| Rate for Payer: OMNI Networks Commercial |
$639.80
|
| Rate for Payer: One Health Plan PPO/POS |
$822.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$868.30
|
| Rate for Payer: Three Rivers Provider Network All |
$685.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$850.02
|
| Rate for Payer: Zelis Auto |
$365.60
|
|
|
CATH HYSTEROSALPINGO
|
Facility
|
OP
|
$525.00
|
|
| Hospital Charge Code |
2407247
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$446.25
|
| Rate for Payer: First Health Commercial |
$472.50
|
| Rate for Payer: First Health Workers Compensation |
$202.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$472.50
|
| Rate for Payer: GEHA Commercial |
$420.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$472.50
|
| Rate for Payer: Humana ChoiceCare |
$136.50
|
| Rate for Payer: Multiplan All |
$477.75
|
| Rate for Payer: New Mexico Health Connections Medicare |
$315.00
|
| Rate for Payer: OMNI Networks Commercial |
$367.50
|
| Rate for Payer: One Health Plan PPO/POS |
$472.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$498.75
|
| Rate for Payer: Three Rivers Provider Network All |
$393.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$462.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$131.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$488.25
|
| Rate for Payer: Zelis Auto |
$210.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$262.50
|
| Rate for Payer: Zelis Worker's Compensation |
$143.32
|
|
|
CATH HYSTEROSALPINGO
|
Facility
|
IP
|
$525.00
|
|
| Hospital Charge Code |
2407247
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$143.32 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$446.25
|
| Rate for Payer: First Health Commercial |
$472.50
|
| Rate for Payer: First Health Workers Compensation |
$202.70
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$472.50
|
| Rate for Payer: GEHA Commercial |
$367.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$472.50
|
| Rate for Payer: Multiplan All |
$477.75
|
| Rate for Payer: OMNI Networks Commercial |
$367.50
|
| Rate for Payer: One Health Plan PPO/POS |
$472.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$498.75
|
| Rate for Payer: Three Rivers Provider Network All |
$393.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$488.25
|
| Rate for Payer: Zelis Auto |
$210.00
|
| Rate for Payer: Zelis Worker's Compensation |
$143.32
|
|
|
CATH, INF, PER/CENT/MIDLINE
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
336585
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.61 |
| Max. Negotiated Rate |
$861.65 |
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cigna Commercial |
$770.95
|
| Rate for Payer: First Health Commercial |
$816.30
|
| Rate for Payer: First Health Workers Compensation |
$350.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$816.30
|
| Rate for Payer: GEHA Commercial |
$634.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$816.30
|
| Rate for Payer: Multiplan All |
$825.37
|
| Rate for Payer: OMNI Networks Commercial |
$634.90
|
| Rate for Payer: One Health Plan PPO/POS |
$816.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$861.65
|
| Rate for Payer: Three Rivers Provider Network All |
$680.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$843.51
|
| Rate for Payer: Zelis Auto |
$362.80
|
| Rate for Payer: Zelis Worker's Compensation |
$247.61
|
|
|
CATH, INF, PER/CENT/MIDLINE
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
1004004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.61 |
| Max. Negotiated Rate |
$861.65 |
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cigna Commercial |
$770.95
|
| Rate for Payer: First Health Commercial |
$816.30
|
| Rate for Payer: First Health Workers Compensation |
$350.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$816.30
|
| Rate for Payer: GEHA Commercial |
$634.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$816.30
|
| Rate for Payer: Multiplan All |
$825.37
|
| Rate for Payer: OMNI Networks Commercial |
$634.90
|
| Rate for Payer: One Health Plan PPO/POS |
$816.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$861.65
|
| Rate for Payer: Three Rivers Provider Network All |
$680.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$843.51
|
| Rate for Payer: Zelis Auto |
$362.80
|
| Rate for Payer: Zelis Worker's Compensation |
$247.61
|
|
|
CATH, INF, PER/CENT/MIDLINE
|
Facility
|
IP
|
$907.00
|
|
| Hospital Charge Code |
8136601
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$247.61 |
| Max. Negotiated Rate |
$861.65 |
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cigna Commercial |
$770.95
|
| Rate for Payer: First Health Commercial |
$816.30
|
| Rate for Payer: First Health Workers Compensation |
$350.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$816.30
|
| Rate for Payer: GEHA Commercial |
$634.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$816.30
|
| Rate for Payer: Multiplan All |
$825.37
|
| Rate for Payer: OMNI Networks Commercial |
$634.90
|
| Rate for Payer: One Health Plan PPO/POS |
$816.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$861.65
|
| Rate for Payer: Three Rivers Provider Network All |
$680.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$843.51
|
| Rate for Payer: Zelis Auto |
$362.80
|
| Rate for Payer: Zelis Worker's Compensation |
$247.61
|
|
|
CATH, INF, PER/CENT/MIDLINE
|
Facility
|
OP
|
$907.00
|
|
| Hospital Charge Code |
8136601
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$226.75 |
| Max. Negotiated Rate |
$861.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$544.20
|
| Rate for Payer: Cash Price |
$544.20
|
| Rate for Payer: Cigna Commercial |
$770.95
|
| Rate for Payer: First Health Commercial |
$816.30
|
| Rate for Payer: First Health Workers Compensation |
$350.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$816.30
|
| Rate for Payer: GEHA Commercial |
$725.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$816.30
|
| Rate for Payer: Humana ChoiceCare |
$235.82
|
| Rate for Payer: Multiplan All |
$825.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$544.20
|
| Rate for Payer: OMNI Networks Commercial |
$634.90
|
| Rate for Payer: One Health Plan PPO/POS |
$816.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$861.65
|
| Rate for Payer: Three Rivers Provider Network All |
$680.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$798.16
|
| Rate for Payer: United Healthcare Managed Medicaid |
$226.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$843.51
|
| Rate for Payer: Zelis Auto |
$362.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$453.50
|
| Rate for Payer: Zelis Worker's Compensation |
$247.61
|
|
|
CAUTERIZATION OF CERVIX
|
Facility
|
OP
|
$352.00
|
|
|
Service Code
|
CPT 57510
|
| Hospital Charge Code |
6157510
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$96.10 |
| 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 |
$211.20
|
| 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 |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$299.20
|
| Rate for Payer: First Health Commercial |
$316.80
|
| Rate for Payer: First Health Workers Compensation |
$135.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$316.80
|
| Rate for Payer: GEHA Commercial |
$281.60
|
| Rate for Payer: GEHA Medicare |
$3,019.09
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$316.80
|
| 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 |
$320.32
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,132.45
|
| Rate for Payer: OMNI Networks Commercial |
$246.40
|
| Rate for Payer: One Health Plan PPO/POS |
$316.80
|
| 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 |
$334.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,038.18
|
| Rate for Payer: Three Rivers Provider Network All |
$264.00
|
| 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 |
$327.36
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,019.09
|
| Rate for Payer: Zelis Auto |
$140.80
|
| 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 |
$96.10
|
|
|
CAUTERIZATION OF CERVIX
|
Facility
|
IP
|
$352.00
|
|
|
Service Code
|
CPT 57510
|
| Hospital Charge Code |
6157510
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$96.10 |
| Max. Negotiated Rate |
$334.40 |
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$299.20
|
| Rate for Payer: First Health Commercial |
$316.80
|
| Rate for Payer: First Health Workers Compensation |
$135.91
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$316.80
|
| Rate for Payer: GEHA Commercial |
$246.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$316.80
|
| Rate for Payer: Multiplan All |
$320.32
|
| Rate for Payer: OMNI Networks Commercial |
$246.40
|
| Rate for Payer: One Health Plan PPO/POS |
$316.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$334.40
|
| Rate for Payer: Three Rivers Provider Network All |
$264.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$327.36
|
| Rate for Payer: Zelis Auto |
$140.80
|
| Rate for Payer: Zelis Worker's Compensation |
$96.10
|
|
|
CAUTERY CERVIX CRYOCAUTERY INITAIL/REPEA
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
23500052
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$108.93 |
| Max. Negotiated Rate |
$379.05 |
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cigna Commercial |
$339.15
|
| Rate for Payer: First Health Commercial |
$359.10
|
| Rate for Payer: First Health Workers Compensation |
$154.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$359.10
|
| Rate for Payer: GEHA Commercial |
$279.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$359.10
|
| Rate for Payer: Multiplan All |
$363.09
|
| Rate for Payer: OMNI Networks Commercial |
$279.30
|
| Rate for Payer: One Health Plan PPO/POS |
$359.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$379.05
|
| Rate for Payer: Three Rivers Provider Network All |
$299.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$371.07
|
| Rate for Payer: Zelis Auto |
$159.60
|
| Rate for Payer: Zelis Worker's Compensation |
$108.93
|
|
|
CAUTERY CERVIX CRYOCAUTERY INITAIL/REPEA
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
23500052
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$108.93 |
| Max. Negotiated Rate |
$577.68 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$239.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$122.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$288.84
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cigna Commercial |
$339.15
|
| Rate for Payer: First Health Commercial |
$359.10
|
| Rate for Payer: First Health Workers Compensation |
$154.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$359.10
|
| Rate for Payer: GEHA Commercial |
$319.20
|
| Rate for Payer: GEHA Medicare |
$288.84
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$359.10
|
| Rate for Payer: Humana ChoiceCare |
$317.72
|
| Rate for Payer: Humana Medicare Advantage |
$288.84
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$485.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$124.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$288.84
|
| Rate for Payer: Multiplan All |
$363.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$491.03
|
| Rate for Payer: OMNI Networks Commercial |
$279.30
|
| Rate for Payer: One Health Plan PPO/POS |
$359.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$144.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$124.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$288.84
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$379.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$577.68
|
| Rate for Payer: Three Rivers Provider Network All |
$299.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$283.06
|
| Rate for Payer: United Healthcare Managed Medicaid |
$124.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$288.84
|
| Rate for Payer: United Payors & United Providers UP&UP |
$371.07
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$288.84
|
| Rate for Payer: Zelis Auto |
$159.60
|
| Rate for Payer: Zelis Medicare |
$245.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$346.61
|
| Rate for Payer: Zelis Worker's Compensation |
$108.93
|
|
|
CAUTERY CERVIX CRYOCAUTERY INITIAL/REPEA
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
6157511
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$108.93 |
| Max. Negotiated Rate |
$577.68 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$239.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$122.37
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$288.84
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cigna Commercial |
$339.15
|
| Rate for Payer: First Health Commercial |
$359.10
|
| Rate for Payer: First Health Workers Compensation |
$154.05
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$359.10
|
| Rate for Payer: GEHA Commercial |
$319.20
|
| Rate for Payer: GEHA Medicare |
$288.84
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$359.10
|
| Rate for Payer: Humana ChoiceCare |
$317.72
|
| Rate for Payer: Humana Medicare Advantage |
$288.84
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$485.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$124.86
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$288.84
|
| Rate for Payer: Multiplan All |
$363.09
|
| Rate for Payer: New Mexico Health Connections Medicare |
$491.03
|
| Rate for Payer: OMNI Networks Commercial |
$279.30
|
| Rate for Payer: One Health Plan PPO/POS |
$359.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$144.17
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$124.86
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$288.84
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$379.05
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$577.68
|
| Rate for Payer: Three Rivers Provider Network All |
$299.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$283.06
|
| Rate for Payer: United Healthcare Managed Medicaid |
$124.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$288.84
|
| Rate for Payer: United Payors & United Providers UP&UP |
$371.07
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$288.84
|
| Rate for Payer: Zelis Auto |
$159.60
|
| Rate for Payer: Zelis Medicare |
$245.51
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$346.61
|
| Rate for Payer: Zelis Worker's Compensation |
$108.93
|
|
