|
CERV/VAG CANCR SCR;PELV&CLN BRST EXAM
|
Facility
|
IP
|
$108.66
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
8500101
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$29.66 |
| Max. Negotiated Rate |
$103.23 |
| Rate for Payer: Cash Price |
$65.20
|
| Rate for Payer: Cigna Commercial |
$92.36
|
| Rate for Payer: First Health Commercial |
$97.79
|
| Rate for Payer: First Health Workers Compensation |
$41.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$97.79
|
| Rate for Payer: GEHA Commercial |
$76.06
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$97.79
|
| Rate for Payer: Multiplan All |
$98.88
|
| Rate for Payer: OMNI Networks Commercial |
$76.06
|
| Rate for Payer: One Health Plan PPO/POS |
$97.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$103.23
|
| Rate for Payer: Three Rivers Provider Network All |
$81.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$101.05
|
| Rate for Payer: Zelis Auto |
$43.46
|
| Rate for Payer: Zelis Worker's Compensation |
$29.66
|
|
|
CERV/VAG CANCR SCR;PELV&CLN BRST EXAM
|
Facility
|
OP
|
$108.66
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
8500101
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$27.16 |
| Max. Negotiated Rate |
$175.66 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$65.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$87.83
|
| Rate for Payer: Cash Price |
$65.20
|
| Rate for Payer: Cash Price |
$65.20
|
| Rate for Payer: Cigna Commercial |
$92.36
|
| Rate for Payer: First Health Commercial |
$97.79
|
| Rate for Payer: First Health Workers Compensation |
$41.95
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$97.79
|
| Rate for Payer: GEHA Commercial |
$86.93
|
| Rate for Payer: GEHA Medicare |
$87.83
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$97.79
|
| Rate for Payer: Humana ChoiceCare |
$96.61
|
| Rate for Payer: Humana Medicare Advantage |
$87.83
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$147.55
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$87.83
|
| Rate for Payer: Multiplan All |
$98.88
|
| Rate for Payer: New Mexico Health Connections Medicare |
$149.31
|
| Rate for Payer: OMNI Networks Commercial |
$76.06
|
| Rate for Payer: One Health Plan PPO/POS |
$97.79
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$87.83
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$103.23
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$175.66
|
| Rate for Payer: Three Rivers Provider Network All |
$81.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.07
|
| Rate for Payer: United Healthcare Managed Medicaid |
$27.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.83
|
| Rate for Payer: United Payors & United Providers UP&UP |
$101.05
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$87.83
|
| Rate for Payer: Zelis Auto |
$43.46
|
| Rate for Payer: Zelis Medicare |
$74.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$105.40
|
| Rate for Payer: Zelis Worker's Compensation |
$29.66
|
|
|
CESSJ THROMBOLYTIC THER W/CATHETER RMVL
|
Facility
|
IP
|
$6,719.00
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
1000048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,834.29 |
| Max. Negotiated Rate |
$6,383.05 |
| Rate for Payer: Cash Price |
$4,031.40
|
| Rate for Payer: Cigna Commercial |
$5,711.15
|
| Rate for Payer: First Health Commercial |
$6,047.10
|
| Rate for Payer: First Health Workers Compensation |
$2,594.21
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,047.10
|
| Rate for Payer: GEHA Commercial |
$4,703.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,047.10
|
| Rate for Payer: Multiplan All |
$6,114.29
|
| Rate for Payer: OMNI Networks Commercial |
$4,703.30
|
| Rate for Payer: One Health Plan PPO/POS |
$6,047.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,383.05
|
| Rate for Payer: Three Rivers Provider Network All |
$5,039.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,248.67
|
| Rate for Payer: Zelis Auto |
$2,687.60
|
| Rate for Payer: Zelis Worker's Compensation |
$1,834.29
|
|
|
CESSJ THROMBOLYTIC THER W/CATHETER RMVL
|
Facility
|
IP
|
$432.00
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
6137214
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$117.94 |
| Max. Negotiated Rate |
$410.40 |
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna Commercial |
$367.20
|
| Rate for Payer: First Health Commercial |
$388.80
|
| Rate for Payer: First Health Workers Compensation |
$166.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$388.80
|
| Rate for Payer: GEHA Commercial |
$302.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$388.80
|
| Rate for Payer: Multiplan All |
$393.12
|
| Rate for Payer: OMNI Networks Commercial |
$302.40
|
| Rate for Payer: One Health Plan PPO/POS |
$388.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$410.40
|
| Rate for Payer: Three Rivers Provider Network All |
$324.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$401.76
|
| Rate for Payer: Zelis Auto |
$172.80
|
| Rate for Payer: Zelis Worker's Compensation |
$117.94
|
|
|
CESSJ THROMBOLYTIC THER W/CATHETER RMVL
|
Facility
|
OP
|
$432.00
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
6137214
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$117.94 |
| Max. Negotiated Rate |
$5,977.36 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,487.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$259.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,487.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,970.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$2,988.68
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna Commercial |
$367.20
|
| Rate for Payer: First Health Commercial |
$388.80
|
| Rate for Payer: First Health Workers Compensation |
$166.80
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$388.80
|
| Rate for Payer: GEHA Commercial |
$345.60
|
| Rate for Payer: GEHA Medicare |
$2,988.68
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$388.80
|
| Rate for Payer: Humana ChoiceCare |
$3,287.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,988.68
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,020.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,010.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$2,988.68
|
| Rate for Payer: Multiplan All |
$393.12
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,080.76
|
| Rate for Payer: OMNI Networks Commercial |
$302.40
|
| Rate for Payer: One Health Plan PPO/POS |
$388.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,321.20
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,010.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$2,988.68
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$410.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$5,977.36
|
| Rate for Payer: Three Rivers Provider Network All |
$324.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,928.91
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,010.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,988.68
|
| Rate for Payer: United Payors & United Providers UP&UP |
$401.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$2,988.68
|
| Rate for Payer: Zelis Auto |
$172.80
|
| Rate for Payer: Zelis Medicare |
$2,540.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,586.42
|
| Rate for Payer: Zelis Worker's Compensation |
$117.94
|
|
|
CETIRIZINE HCL 10MG TAB
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 51079059720
|
| Hospital Charge Code |
3300167
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
CETIRIZINE HCL 10MG TAB
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 51079059720
|
| Hospital Charge Code |
3300167
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$2.55
|
| Rate for Payer: First Health Commercial |
$2.70
|
| Rate for Payer: First Health Workers Compensation |
$1.16
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2.70
|
| Rate for Payer: GEHA Commercial |
$2.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2.70
|
| Rate for Payer: Humana ChoiceCare |
$0.78
|
| Rate for Payer: Multiplan All |
$2.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1.80
|
| Rate for Payer: OMNI Networks Commercial |
$2.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2.79
|
| Rate for Payer: Zelis Auto |
$1.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1.50
|
| Rate for Payer: Zelis Worker's Compensation |
$0.82
|
|
|
ch50 (complement,total) REF001941
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
2286162
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.13 |
| Max. Negotiated Rate |
$201.40 |
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cigna Commercial |
$180.20
|
| Rate for Payer: First Health Commercial |
$190.80
|
| Rate for Payer: First Health Workers Compensation |
$41.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$190.80
|
| Rate for Payer: GEHA Commercial |
$148.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$190.80
|
| Rate for Payer: Multiplan All |
$192.92
|
| Rate for Payer: OMNI Networks Commercial |
$148.40
|
| Rate for Payer: One Health Plan PPO/POS |
$190.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$201.40
|
| Rate for Payer: Three Rivers Provider Network All |
$159.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$197.16
|
| Rate for Payer: Zelis Auto |
$84.80
|
| Rate for Payer: Zelis Worker's Compensation |
$29.13
|
|
|
ch50 (complement,total) REF001941
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
2286162
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$201.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$36.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$127.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$36.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$28.97
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$20.32
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cigna Commercial |
$180.20
|
| Rate for Payer: First Health Commercial |
$190.80
|
| Rate for Payer: First Health Workers Compensation |
$41.19
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$190.80
|
| Rate for Payer: GEHA Commercial |
$169.60
|
| Rate for Payer: GEHA Medicare |
$20.32
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$190.80
|
| Rate for Payer: Humana ChoiceCare |
$22.35
|
| Rate for Payer: Humana Medicare Advantage |
$20.32
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$34.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$29.56
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$20.32
|
| Rate for Payer: Multiplan All |
$192.92
|
| Rate for Payer: New Mexico Health Connections Medicare |
$34.54
|
| Rate for Payer: OMNI Networks Commercial |
$148.40
|
| Rate for Payer: One Health Plan PPO/POS |
$190.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$34.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$29.56
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$20.32
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$201.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$40.64
|
| Rate for Payer: Three Rivers Provider Network All |
$159.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$19.91
|
| Rate for Payer: United Healthcare Commercial |
$180.20
|
| Rate for Payer: United Healthcare Managed Medicaid |
$29.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.32
|
| Rate for Payer: United Payors & United Providers UP&UP |
$197.16
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$20.32
|
| Rate for Payer: Zelis Auto |
$84.80
|
| Rate for Payer: Zelis Medicare |
$17.27
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$24.38
|
| Rate for Payer: Zelis Worker's Compensation |
$29.13
|
|
|
CHANGE CYSTOSTOMY TUBE COMPLICATED
|
Facility
|
IP
|
$7,339.41
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
8151710
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,003.66 |
| Max. Negotiated Rate |
$6,972.44 |
| Rate for Payer: Cash Price |
$4,403.65
|
| Rate for Payer: Cigna Commercial |
$6,238.50
|
| Rate for Payer: First Health Commercial |
$6,605.47
|
| Rate for Payer: First Health Workers Compensation |
$2,833.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,605.47
|
| Rate for Payer: GEHA Commercial |
$5,137.59
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,605.47
|
| Rate for Payer: Multiplan All |
$6,678.86
|
| Rate for Payer: OMNI Networks Commercial |
$5,137.59
|
| Rate for Payer: One Health Plan PPO/POS |
$6,605.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,972.44
|
| Rate for Payer: Three Rivers Provider Network All |
$5,504.56
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,825.65
|
| Rate for Payer: Zelis Auto |
$2,935.76
|
| Rate for Payer: Zelis Worker's Compensation |
$2,003.66
|
|
|
CHANGE CYSTOSTOMY TUBE COMPLICATED
|
Facility
|
OP
|
$7,339.41
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
8151710
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$510.56 |
| Max. Negotiated Rate |
$6,972.44 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$644.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,403.65
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$644.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$510.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$633.79
|
| Rate for Payer: Cash Price |
$4,403.65
|
| Rate for Payer: Cash Price |
$4,403.65
|
| Rate for Payer: Cigna Commercial |
$6,238.50
|
| Rate for Payer: First Health Commercial |
$6,605.47
|
| Rate for Payer: First Health Workers Compensation |
$2,833.75
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$6,605.47
|
| Rate for Payer: GEHA Commercial |
$5,871.53
|
| Rate for Payer: GEHA Medicare |
$633.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$6,605.47
|
| Rate for Payer: Humana ChoiceCare |
$697.17
|
| Rate for Payer: Humana Medicare Advantage |
$633.79
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,064.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$520.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$633.79
|
| Rate for Payer: Multiplan All |
$6,678.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,077.44
|
| Rate for Payer: OMNI Networks Commercial |
$5,137.59
|
| Rate for Payer: One Health Plan PPO/POS |
$6,605.47
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$601.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$520.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$633.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,972.44
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,267.58
|
| Rate for Payer: Three Rivers Provider Network All |
$5,504.56
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$621.11
|
| Rate for Payer: United Healthcare Managed Medicaid |
$520.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$633.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$6,825.65
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$633.79
|
| Rate for Payer: Zelis Auto |
$2,935.76
|
| Rate for Payer: Zelis Medicare |
$538.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$760.55
|
| Rate for Payer: Zelis Worker's Compensation |
$2,003.66
|
|
|
CHANGE CYSTOSTOMY TUBE SIMPLE
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
6151705
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$461.88 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$96.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$161.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$230.94
|
| Rate for Payer: Cash Price |
$96.00
|
| 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 |
$128.00
|
| Rate for Payer: GEHA Medicare |
$230.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$144.00
|
| Rate for Payer: Humana ChoiceCare |
$254.03
|
| Rate for Payer: Humana Medicare Advantage |
$230.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$387.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$165.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$230.94
|
| Rate for Payer: Multiplan All |
$145.60
|
| Rate for Payer: New Mexico Health Connections Medicare |
$392.60
|
| Rate for Payer: OMNI Networks Commercial |
$112.00
|
| Rate for Payer: One Health Plan PPO/POS |
$144.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$190.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$165.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$230.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$152.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$461.88
|
| Rate for Payer: Three Rivers Provider Network All |
$120.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$226.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$148.80
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$230.94
|
| Rate for Payer: Zelis Auto |
$64.00
|
| Rate for Payer: Zelis Medicare |
$196.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.13
|
| Rate for Payer: Zelis Worker's Compensation |
$43.68
|
|
|
CHANGE CYSTOSTOMY TUBE SIMPLE
|
Facility
|
IP
|
$1,701.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
8151705
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$464.37 |
| Max. Negotiated Rate |
$1,615.95 |
| Rate for Payer: Cash Price |
$1,020.60
|
| Rate for Payer: Cigna Commercial |
$1,445.85
|
| Rate for Payer: First Health Commercial |
$1,530.90
|
| Rate for Payer: First Health Workers Compensation |
$656.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,530.90
|
| Rate for Payer: GEHA Commercial |
$1,190.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,530.90
|
| Rate for Payer: Multiplan All |
$1,547.91
|
| Rate for Payer: OMNI Networks Commercial |
$1,190.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,530.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,615.95
|
| Rate for Payer: Three Rivers Provider Network All |
$1,275.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,581.93
|
| Rate for Payer: Zelis Auto |
$680.40
|
| Rate for Payer: Zelis Worker's Compensation |
$464.37
|
|
|
CHANGE CYSTOSTOMY TUBE SIMPLE
|
Facility
|
OP
|
$1,701.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
8151705
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$161.75 |
| Max. Negotiated Rate |
$1,615.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,020.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$204.18
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$161.75
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$230.94
|
| Rate for Payer: Cash Price |
$1,020.60
|
| Rate for Payer: Cash Price |
$1,020.60
|
| Rate for Payer: Cigna Commercial |
$1,445.85
|
| Rate for Payer: First Health Commercial |
$1,530.90
|
| Rate for Payer: First Health Workers Compensation |
$656.76
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,530.90
|
| Rate for Payer: GEHA Commercial |
$1,360.80
|
| Rate for Payer: GEHA Medicare |
$230.94
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,530.90
|
| Rate for Payer: Humana ChoiceCare |
$254.03
|
| Rate for Payer: Humana Medicare Advantage |
$230.94
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$387.98
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$165.05
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$230.94
|
| Rate for Payer: Multiplan All |
$1,547.91
|
| Rate for Payer: New Mexico Health Connections Medicare |
$392.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,190.70
|
| Rate for Payer: One Health Plan PPO/POS |
$1,530.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$190.57
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$165.05
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$230.94
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,615.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$461.88
|
| Rate for Payer: Three Rivers Provider Network All |
$1,275.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$226.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$165.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.94
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,581.93
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$230.94
|
| Rate for Payer: Zelis Auto |
$680.40
|
| Rate for Payer: Zelis Medicare |
$196.30
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$277.13
|
| Rate for Payer: Zelis Worker's Compensation |
$464.37
|
|
|
CHANGE CYSTOSTOMY TUBE SIMPLE
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
6151705
|
|
Hospital Revenue Code
|
975
|
| 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
|
|
|
CHANGE GASTRIC PORT, OPEN
|
Facility
|
IP
|
$951.00
|
|
|
Service Code
|
CPT 43888
|
| Hospital Charge Code |
6143888
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$259.62 |
| Max. Negotiated Rate |
$903.45 |
| Rate for Payer: Cash Price |
$570.60
|
| Rate for Payer: Cigna Commercial |
$808.35
|
| Rate for Payer: First Health Commercial |
$855.90
|
| Rate for Payer: First Health Workers Compensation |
$367.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$855.90
|
| Rate for Payer: GEHA Commercial |
$665.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$855.90
|
| Rate for Payer: Multiplan All |
$865.41
|
| Rate for Payer: OMNI Networks Commercial |
$665.70
|
| Rate for Payer: One Health Plan PPO/POS |
$855.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$903.45
|
| Rate for Payer: Three Rivers Provider Network All |
$713.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$884.43
|
| Rate for Payer: Zelis Auto |
$380.40
|
| Rate for Payer: Zelis Worker's Compensation |
$259.62
|
|
|
CHANGE GASTRIC PORT, OPEN
|
Facility
|
OP
|
$951.00
|
|
|
Service Code
|
CPT 43888
|
| Hospital Charge Code |
6143888
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$237.75 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$570.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,476.24
|
| Rate for Payer: Cash Price |
$570.60
|
| Rate for Payer: Cash Price |
$570.60
|
| Rate for Payer: Cigna Commercial |
$808.35
|
| Rate for Payer: First Health Commercial |
$855.90
|
| Rate for Payer: First Health Workers Compensation |
$367.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$855.90
|
| Rate for Payer: GEHA Commercial |
$760.80
|
| Rate for Payer: GEHA Medicare |
$3,476.24
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$855.90
|
| Rate for Payer: Humana ChoiceCare |
$3,823.86
|
| Rate for Payer: Humana Medicare Advantage |
$3,476.24
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,840.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,476.24
|
| Rate for Payer: Multiplan All |
$865.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,909.61
|
| Rate for Payer: OMNI Networks Commercial |
$665.70
|
| Rate for Payer: One Health Plan PPO/POS |
$855.90
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,476.24
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$903.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,952.48
|
| Rate for Payer: Three Rivers Provider Network All |
$713.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,406.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$237.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,476.24
|
| Rate for Payer: United Payors & United Providers UP&UP |
$884.43
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,476.24
|
| Rate for Payer: Zelis Auto |
$380.40
|
| Rate for Payer: Zelis Medicare |
$2,954.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,171.49
|
| Rate for Payer: Zelis Worker's Compensation |
$259.62
|
|
|
CHANGE G-TUBE TO G-J PERC
|
Facility
|
OP
|
$471.00
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
6149446
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$128.58 |
| Max. Negotiated Rate |
$3,602.54 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$282.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$884.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$700.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,801.27
|
| Rate for Payer: Cash Price |
$282.60
|
| Rate for Payer: Cash Price |
$282.60
|
| Rate for Payer: Cigna Commercial |
$400.35
|
| Rate for Payer: First Health Commercial |
$423.90
|
| Rate for Payer: First Health Workers Compensation |
$181.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$423.90
|
| Rate for Payer: GEHA Commercial |
$376.80
|
| Rate for Payer: GEHA Medicare |
$1,801.27
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$423.90
|
| Rate for Payer: Humana ChoiceCare |
$1,981.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,801.27
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,026.13
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$714.83
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,801.27
|
| Rate for Payer: Multiplan All |
$428.61
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,062.16
|
| Rate for Payer: OMNI Networks Commercial |
$329.70
|
| Rate for Payer: One Health Plan PPO/POS |
$423.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$825.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$714.83
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,801.27
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$447.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,602.54
|
| Rate for Payer: Three Rivers Provider Network All |
$353.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,765.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$714.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,801.27
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.03
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,801.27
|
| Rate for Payer: Zelis Auto |
$188.40
|
| Rate for Payer: Zelis Medicare |
$1,531.08
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,161.52
|
| Rate for Payer: Zelis Worker's Compensation |
$128.58
|
|
|
CHANGE G-TUBE TO G-J PERC
|
Facility
|
IP
|
$471.00
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
6149446
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$128.58 |
| Max. Negotiated Rate |
$447.45 |
| Rate for Payer: Cash Price |
$282.60
|
| Rate for Payer: Cigna Commercial |
$400.35
|
| Rate for Payer: First Health Commercial |
$423.90
|
| Rate for Payer: First Health Workers Compensation |
$181.85
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$423.90
|
| Rate for Payer: GEHA Commercial |
$329.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$423.90
|
| Rate for Payer: Multiplan All |
$428.61
|
| Rate for Payer: OMNI Networks Commercial |
$329.70
|
| Rate for Payer: One Health Plan PPO/POS |
$423.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$447.45
|
| Rate for Payer: Three Rivers Provider Network All |
$353.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$438.03
|
| Rate for Payer: Zelis Auto |
$188.40
|
| Rate for Payer: Zelis Worker's Compensation |
$128.58
|
|
|
CHANGE OF BLADDER TUBE
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
6151710
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$67.43 |
| Max. Negotiated Rate |
$1,267.58 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$644.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$148.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$644.49
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$510.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$633.79
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$209.95
|
| Rate for Payer: First Health Commercial |
$222.30
|
| Rate for Payer: First Health Workers Compensation |
$95.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$222.30
|
| Rate for Payer: GEHA Commercial |
$197.60
|
| Rate for Payer: GEHA Medicare |
$633.79
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$222.30
|
| Rate for Payer: Humana ChoiceCare |
$697.17
|
| Rate for Payer: Humana Medicare Advantage |
$633.79
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,064.77
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$520.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$633.79
|
| Rate for Payer: Multiplan All |
$224.77
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,077.44
|
| Rate for Payer: OMNI Networks Commercial |
$172.90
|
| Rate for Payer: One Health Plan PPO/POS |
$222.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$601.52
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$520.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$633.79
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$234.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,267.58
|
| Rate for Payer: Three Rivers Provider Network All |
$185.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$621.11
|
| Rate for Payer: United Healthcare Managed Medicaid |
$520.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$633.79
|
| Rate for Payer: United Payors & United Providers UP&UP |
$229.71
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$633.79
|
| Rate for Payer: Zelis Auto |
$98.80
|
| Rate for Payer: Zelis Medicare |
$538.72
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$760.55
|
| Rate for Payer: Zelis Worker's Compensation |
$67.43
|
|
|
CHANGE OF BLADDER TUBE
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
6151710
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$67.43 |
| Max. Negotiated Rate |
$234.65 |
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$209.95
|
| Rate for Payer: First Health Commercial |
$222.30
|
| Rate for Payer: First Health Workers Compensation |
$95.37
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$222.30
|
| Rate for Payer: GEHA Commercial |
$172.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$222.30
|
| Rate for Payer: Multiplan All |
$224.77
|
| Rate for Payer: OMNI Networks Commercial |
$172.90
|
| Rate for Payer: One Health Plan PPO/POS |
$222.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$234.65
|
| Rate for Payer: Three Rivers Provider Network All |
$185.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$229.71
|
| Rate for Payer: Zelis Auto |
$98.80
|
| Rate for Payer: Zelis Worker's Compensation |
$67.43
|
|
|
CHANGE OF CYSTOSTOMY TUBE; SIMPLE
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
251705
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.97 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cigna Commercial |
$183.60
|
| Rate for Payer: First Health Commercial |
$194.40
|
| Rate for Payer: First Health Workers Compensation |
$83.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$194.40
|
| Rate for Payer: GEHA Commercial |
$151.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$194.40
|
| Rate for Payer: Multiplan All |
$196.56
|
| Rate for Payer: OMNI Networks Commercial |
$151.20
|
| Rate for Payer: One Health Plan PPO/POS |
$194.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$205.20
|
| Rate for Payer: Three Rivers Provider Network All |
$162.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$200.88
|
| Rate for Payer: Zelis Auto |
$86.40
|
| Rate for Payer: Zelis Worker's Compensation |
$58.97
|
|
|
CHANGE OF URETER TUBE/STENT
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
6150688
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$66.89 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$208.25
|
| Rate for Payer: First Health Commercial |
$220.50
|
| Rate for Payer: First Health Workers Compensation |
$94.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$220.50
|
| Rate for Payer: GEHA Commercial |
$171.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$220.50
|
| Rate for Payer: Multiplan All |
$222.95
|
| Rate for Payer: OMNI Networks Commercial |
$171.50
|
| Rate for Payer: One Health Plan PPO/POS |
$220.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$232.75
|
| Rate for Payer: Three Rivers Provider Network All |
$183.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$227.85
|
| Rate for Payer: Zelis Auto |
$98.00
|
| Rate for Payer: Zelis Worker's Compensation |
$66.89
|
|
|
CHANGE OF URETER TUBE/STENT
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
6150688
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$66.89 |
| Max. Negotiated Rate |
$3,890.28 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,548.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$147.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,548.02
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,226.34
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,945.14
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$208.25
|
| Rate for Payer: First Health Commercial |
$220.50
|
| Rate for Payer: First Health Workers Compensation |
$94.59
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$220.50
|
| Rate for Payer: GEHA Commercial |
$196.00
|
| Rate for Payer: GEHA Medicare |
$1,945.14
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$220.50
|
| Rate for Payer: Humana ChoiceCare |
$2,139.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,945.14
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,267.84
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,251.31
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,945.14
|
| Rate for Payer: Multiplan All |
$222.95
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,306.74
|
| Rate for Payer: OMNI Networks Commercial |
$171.50
|
| Rate for Payer: One Health Plan PPO/POS |
$220.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,444.81
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,251.31
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,945.14
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$232.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,890.28
|
| Rate for Payer: Three Rivers Provider Network All |
$183.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,906.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,251.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,945.14
|
| Rate for Payer: United Payors & United Providers UP&UP |
$227.85
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,945.14
|
| Rate for Payer: Zelis Auto |
$98.00
|
| Rate for Payer: Zelis Medicare |
$1,653.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,334.17
|
| Rate for Payer: Zelis Worker's Compensation |
$66.89
|
|
|
CHANGE OF WINDPIPE AIRWAY
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
6131502
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$93.50
|
| Rate for Payer: First Health Commercial |
$99.00
|
| Rate for Payer: First Health Workers Compensation |
$42.47
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$99.00
|
| Rate for Payer: GEHA Commercial |
$77.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$99.00
|
| Rate for Payer: Multiplan All |
$100.10
|
| Rate for Payer: OMNI Networks Commercial |
$77.00
|
| Rate for Payer: One Health Plan PPO/POS |
$99.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$104.50
|
| Rate for Payer: Three Rivers Provider Network All |
$82.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$102.30
|
| Rate for Payer: Zelis Auto |
$44.00
|
| Rate for Payer: Zelis Worker's Compensation |
$30.03
|
|
