|
CRITICAL CARE, INITIAL 30-74 MIN
|
Facility
|
IP
|
$843.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
9899291
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$230.14 |
| Max. Negotiated Rate |
$800.85 |
| Rate for Payer: Cash Price |
$505.80
|
| Rate for Payer: Cigna Commercial |
$716.55
|
| Rate for Payer: First Health Commercial |
$758.70
|
| Rate for Payer: First Health Workers Compensation |
$325.48
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$758.70
|
| Rate for Payer: GEHA Commercial |
$590.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$758.70
|
| Rate for Payer: Multiplan All |
$767.13
|
| Rate for Payer: OMNI Networks Commercial |
$590.10
|
| Rate for Payer: One Health Plan PPO/POS |
$758.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$800.85
|
| Rate for Payer: Three Rivers Provider Network All |
$632.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$783.99
|
| Rate for Payer: Zelis Auto |
$337.20
|
| Rate for Payer: Zelis Worker's Compensation |
$230.14
|
|
|
CR N BLOCK OTHER PERIPHERAL
|
Facility
|
OP
|
$1,624.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
3704450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$298.13 |
| Max. Negotiated Rate |
$1,542.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$974.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$298.13
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$671.04
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cigna Commercial |
$1,380.40
|
| Rate for Payer: First Health Commercial |
$1,461.60
|
| Rate for Payer: First Health Workers Compensation |
$863.63
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,461.60
|
| Rate for Payer: GEHA Commercial |
$1,299.20
|
| Rate for Payer: GEHA Medicare |
$671.04
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,461.60
|
| Rate for Payer: Humana ChoiceCare |
$738.14
|
| Rate for Payer: Humana Medicare Advantage |
$671.04
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,127.35
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$304.20
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$671.04
|
| Rate for Payer: Multiplan All |
$1,477.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,140.77
|
| Rate for Payer: OMNI Networks Commercial |
$1,136.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,461.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$351.25
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$304.20
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$671.04
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,542.80
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,342.08
|
| Rate for Payer: Three Rivers Provider Network All |
$1,218.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$657.62
|
| Rate for Payer: United Healthcare Managed Medicaid |
$304.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$671.04
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,510.32
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$671.04
|
| Rate for Payer: Zelis Auto |
$649.60
|
| Rate for Payer: Zelis Medicare |
$570.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$805.25
|
| Rate for Payer: Zelis Worker's Compensation |
$610.65
|
|
|
CR N BLOCK OTHER PERIPHERAL
|
Facility
|
IP
|
$1,624.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
3704450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$443.35 |
| Max. Negotiated Rate |
$1,542.80 |
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cigna Commercial |
$1,380.40
|
| Rate for Payer: First Health Commercial |
$1,461.60
|
| Rate for Payer: First Health Workers Compensation |
$627.03
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,461.60
|
| Rate for Payer: GEHA Commercial |
$1,136.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,461.60
|
| Rate for Payer: Multiplan All |
$1,477.84
|
| Rate for Payer: OMNI Networks Commercial |
$1,136.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,461.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,542.80
|
| Rate for Payer: Three Rivers Provider Network All |
$1,218.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,510.32
|
| Rate for Payer: Zelis Auto |
$649.60
|
| Rate for Payer: Zelis Worker's Compensation |
$443.35
|
|
|
CR NJX DX/THER SBST INTRLMNR CRV/THRC W/
|
Facility
|
IP
|
$1,218.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
3702324
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$332.51 |
| Max. Negotiated Rate |
$1,157.10 |
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cigna Commercial |
$1,035.30
|
| Rate for Payer: First Health Commercial |
$1,096.20
|
| Rate for Payer: First Health Workers Compensation |
$470.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,096.20
|
| Rate for Payer: GEHA Commercial |
$852.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,096.20
|
| Rate for Payer: Multiplan All |
$1,108.38
|
| Rate for Payer: OMNI Networks Commercial |
$852.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,096.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,157.10
|
| Rate for Payer: Three Rivers Provider Network All |
$913.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,132.74
|
| Rate for Payer: Zelis Auto |
$487.20
|
| Rate for Payer: Zelis Worker's Compensation |
$332.51
|
|
|
CR NJX DX/THER SBST INTRLMNR CRV/THRC W/
|
Facility
|
OP
|
$1,218.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
3702324
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$487.20 |
| Max. Negotiated Rate |
$1,725.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$957.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$730.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$957.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$758.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$862.67
|
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cigna Commercial |
$1,035.30
|
| Rate for Payer: First Health Commercial |
$1,096.20
|
| Rate for Payer: First Health Workers Compensation |
$1,110.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,096.20
|
| Rate for Payer: GEHA Commercial |
$974.40
|
| Rate for Payer: GEHA Medicare |
$862.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,096.20
|
| Rate for Payer: Humana ChoiceCare |
$948.94
|
| Rate for Payer: Humana Medicare Advantage |
$862.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,449.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$774.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$862.67
|
| Rate for Payer: Multiplan All |
$1,108.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,466.54
|
| Rate for Payer: OMNI Networks Commercial |
$852.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,096.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$894.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$774.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$862.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,157.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,725.34
|
| Rate for Payer: Three Rivers Provider Network All |
$913.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$845.42
|
| Rate for Payer: United Healthcare Managed Medicaid |
$774.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$862.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,132.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$862.67
|
| Rate for Payer: Zelis Auto |
$487.20
|
| Rate for Payer: Zelis Medicare |
$733.27
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,035.20
|
| Rate for Payer: Zelis Worker's Compensation |
$785.03
|
|
|
CR NJX DX/THER SBST INTRLMNR CRV/THRC W/
|
Facility
|
OP
|
$1,218.00
|
|
|
Service Code
|
CPT 62326
|
| Hospital Charge Code |
3702326
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$487.20 |
| Max. Negotiated Rate |
$1,725.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$957.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$730.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$957.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$758.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$862.67
|
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cigna Commercial |
$1,035.30
|
| Rate for Payer: First Health Commercial |
$1,096.20
|
| Rate for Payer: First Health Workers Compensation |
$1,110.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,096.20
|
| Rate for Payer: GEHA Commercial |
$974.40
|
| Rate for Payer: GEHA Medicare |
$862.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,096.20
|
| Rate for Payer: Humana ChoiceCare |
$948.94
|
| Rate for Payer: Humana Medicare Advantage |
$862.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,449.29
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$774.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$862.67
|
| Rate for Payer: Multiplan All |
$1,108.38
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,466.54
|
| Rate for Payer: OMNI Networks Commercial |
$852.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,096.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$894.12
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$774.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$862.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,157.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,725.34
|
| Rate for Payer: Three Rivers Provider Network All |
$913.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$845.42
|
| Rate for Payer: United Healthcare Managed Medicaid |
$774.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$862.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,132.74
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$862.67
|
| Rate for Payer: Zelis Auto |
$487.20
|
| Rate for Payer: Zelis Medicare |
$733.27
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,035.20
|
| Rate for Payer: Zelis Worker's Compensation |
$785.03
|
|
|
CR NJX DX/THER SBST INTRLMNR CRV/THRC W/
|
Facility
|
IP
|
$1,218.00
|
|
|
Service Code
|
CPT 62326
|
| Hospital Charge Code |
3702326
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$332.51 |
| Max. Negotiated Rate |
$1,157.10 |
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cigna Commercial |
$1,035.30
|
| Rate for Payer: First Health Commercial |
$1,096.20
|
| Rate for Payer: First Health Workers Compensation |
$470.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,096.20
|
| Rate for Payer: GEHA Commercial |
$852.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,096.20
|
| Rate for Payer: Multiplan All |
$1,108.38
|
| Rate for Payer: OMNI Networks Commercial |
$852.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,096.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,157.10
|
| Rate for Payer: Three Rivers Provider Network All |
$913.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,132.74
|
| Rate for Payer: Zelis Auto |
$487.20
|
| Rate for Payer: Zelis Worker's Compensation |
$332.51
|
|
|
CROTALIDAE IMMUNE FAB
|
Facility
|
IP
|
$9,338.00
|
|
|
Service Code
|
CPT J0840
|
| Hospital Charge Code |
3300211
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,549.27 |
| Max. Negotiated Rate |
$8,871.10 |
| Rate for Payer: Cash Price |
$5,602.80
|
| Rate for Payer: Cigna Commercial |
$7,937.30
|
| Rate for Payer: First Health Commercial |
$8,404.20
|
| Rate for Payer: First Health Workers Compensation |
$3,605.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,404.20
|
| Rate for Payer: GEHA Commercial |
$6,536.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,404.20
|
| Rate for Payer: Multiplan All |
$8,497.58
|
| Rate for Payer: OMNI Networks Commercial |
$6,536.60
|
| Rate for Payer: One Health Plan PPO/POS |
$8,404.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,871.10
|
| Rate for Payer: Three Rivers Provider Network All |
$7,003.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,684.34
|
| Rate for Payer: Zelis Auto |
$3,735.20
|
| Rate for Payer: Zelis Worker's Compensation |
$2,549.27
|
|
|
CROTALIDAE IMMUNE FAB
|
Facility
|
OP
|
$9,338.00
|
|
|
Service Code
|
CPT J0840
|
| Hospital Charge Code |
3300211
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,554.41 |
| Max. Negotiated Rate |
$8,871.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,739.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$5,602.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,739.68
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,962.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,828.72
|
| Rate for Payer: Cash Price |
$5,602.80
|
| Rate for Payer: Cash Price |
$5,602.80
|
| Rate for Payer: Cigna Commercial |
$7,937.30
|
| Rate for Payer: First Health Commercial |
$8,404.20
|
| Rate for Payer: First Health Workers Compensation |
$3,605.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$8,404.20
|
| Rate for Payer: GEHA Commercial |
$2,011.59
|
| Rate for Payer: GEHA Medicare |
$1,828.72
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$8,404.20
|
| Rate for Payer: Humana ChoiceCare |
$2,011.59
|
| Rate for Payer: Humana Medicare Advantage |
$1,828.72
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$3,072.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$3,022.91
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,828.72
|
| Rate for Payer: Multiplan All |
$8,497.58
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,108.82
|
| Rate for Payer: OMNI Networks Commercial |
$6,536.60
|
| Rate for Payer: One Health Plan PPO/POS |
$8,404.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,490.37
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$3,022.91
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,828.72
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$8,871.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,657.44
|
| Rate for Payer: Three Rivers Provider Network All |
$7,003.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,792.15
|
| Rate for Payer: United Healthcare Managed Medicaid |
$3,022.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,828.72
|
| Rate for Payer: United Payors & United Providers UP&UP |
$8,684.34
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,828.72
|
| Rate for Payer: Zelis Auto |
$3,735.20
|
| Rate for Payer: Zelis Medicare |
$1,554.41
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$2,194.46
|
| Rate for Payer: Zelis Worker's Compensation |
$2,549.27
|
|
|
CRP REF
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
2300065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: First Health Workers Compensation |
$10.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$102.60
|
| Rate for Payer: GEHA Commercial |
$79.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$102.60
|
| Rate for Payer: Multiplan All |
$103.74
|
| Rate for Payer: OMNI Networks Commercial |
$79.80
|
| Rate for Payer: One Health Plan PPO/POS |
$102.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$108.30
|
| Rate for Payer: Three Rivers Provider Network All |
$85.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$106.02
|
| Rate for Payer: Zelis Auto |
$45.60
|
| Rate for Payer: Zelis Worker's Compensation |
$7.32
|
|
|
CRP REF
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
2300065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$68.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: First Health Workers Compensation |
$10.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$102.60
|
| Rate for Payer: GEHA Commercial |
$91.20
|
| Rate for Payer: GEHA Medicare |
$5.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$102.60
|
| Rate for Payer: Humana ChoiceCare |
$5.70
|
| Rate for Payer: Humana Medicare Advantage |
$5.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.18
|
| Rate for Payer: Multiplan All |
$103.74
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.81
|
| Rate for Payer: OMNI Networks Commercial |
$79.80
|
| Rate for Payer: One Health Plan PPO/POS |
$102.60
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.71
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$108.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.36
|
| Rate for Payer: Three Rivers Provider Network All |
$85.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$96.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$106.02
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.18
|
| Rate for Payer: Zelis Auto |
$45.60
|
| Rate for Payer: Zelis Medicare |
$4.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.22
|
| Rate for Payer: Zelis Worker's Compensation |
$7.32
|
|
|
CRP (Vitros) AGH
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
2232219
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$158.95
|
| Rate for Payer: First Health Commercial |
$168.30
|
| Rate for Payer: First Health Workers Compensation |
$10.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$168.30
|
| Rate for Payer: GEHA Commercial |
$130.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$168.30
|
| Rate for Payer: Multiplan All |
$170.17
|
| Rate for Payer: OMNI Networks Commercial |
$130.90
|
| Rate for Payer: One Health Plan PPO/POS |
$168.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$177.65
|
| Rate for Payer: Three Rivers Provider Network All |
$140.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$173.91
|
| Rate for Payer: Zelis Auto |
$74.80
|
| Rate for Payer: Zelis Worker's Compensation |
$7.32
|
|
|
CRP (Vitros) AGH
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
2232219
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$9.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$112.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$9.33
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$7.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$158.95
|
| Rate for Payer: First Health Commercial |
$168.30
|
| Rate for Payer: First Health Workers Compensation |
$10.35
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$168.30
|
| Rate for Payer: GEHA Commercial |
$149.60
|
| Rate for Payer: GEHA Medicare |
$5.18
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$168.30
|
| Rate for Payer: Humana ChoiceCare |
$5.70
|
| Rate for Payer: Humana Medicare Advantage |
$5.18
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$8.70
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$7.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$5.18
|
| Rate for Payer: Multiplan All |
$170.17
|
| Rate for Payer: New Mexico Health Connections Medicare |
$8.81
|
| Rate for Payer: OMNI Networks Commercial |
$130.90
|
| Rate for Payer: One Health Plan PPO/POS |
$168.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$8.71
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$7.54
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$5.18
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$177.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$10.36
|
| Rate for Payer: Three Rivers Provider Network All |
$140.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5.08
|
| Rate for Payer: United Healthcare Commercial |
$158.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$7.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Payors & United Providers UP&UP |
$173.91
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$5.18
|
| Rate for Payer: Zelis Auto |
$74.80
|
| Rate for Payer: Zelis Medicare |
$4.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$6.22
|
| Rate for Payer: Zelis Worker's Compensation |
$7.32
|
|
|
CRYOABLATE PROSTATE
|
Facility
|
IP
|
$2,407.00
|
|
|
Service Code
|
CPT 55873
|
| Hospital Charge Code |
6155873
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$657.11 |
| Max. Negotiated Rate |
$2,286.65 |
| Rate for Payer: Cash Price |
$1,444.20
|
| Rate for Payer: Cigna Commercial |
$2,045.95
|
| Rate for Payer: First Health Commercial |
$2,166.30
|
| Rate for Payer: First Health Workers Compensation |
$929.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,166.30
|
| Rate for Payer: GEHA Commercial |
$1,684.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,166.30
|
| Rate for Payer: Multiplan All |
$2,190.37
|
| Rate for Payer: OMNI Networks Commercial |
$1,684.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,166.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,286.65
|
| Rate for Payer: Three Rivers Provider Network All |
$1,805.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,238.51
|
| Rate for Payer: Zelis Auto |
$962.80
|
| Rate for Payer: Zelis Worker's Compensation |
$657.11
|
|
|
CRYOABLATE PROSTATE
|
Facility
|
OP
|
$2,407.00
|
|
|
Service Code
|
CPT 55873
|
| Hospital Charge Code |
6155873
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$657.11 |
| Max. Negotiated Rate |
$17,920.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11,512.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,444.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11,512.53
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9,120.23
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$8,960.30
|
| Rate for Payer: Cash Price |
$1,444.20
|
| Rate for Payer: Cash Price |
$1,444.20
|
| Rate for Payer: Cigna Commercial |
$2,045.95
|
| Rate for Payer: First Health Commercial |
$2,166.30
|
| Rate for Payer: First Health Workers Compensation |
$929.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,166.30
|
| Rate for Payer: GEHA Commercial |
$1,925.60
|
| Rate for Payer: GEHA Medicare |
$8,960.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,166.30
|
| Rate for Payer: Humana ChoiceCare |
$9,856.33
|
| Rate for Payer: Humana Medicare Advantage |
$8,960.30
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$15,053.30
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9,305.96
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$8,960.30
|
| Rate for Payer: Multiplan All |
$2,190.37
|
| Rate for Payer: New Mexico Health Connections Medicare |
$15,232.51
|
| Rate for Payer: OMNI Networks Commercial |
$1,684.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,166.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10,745.03
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9,305.96
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$8,960.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,286.65
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$17,920.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,805.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$8,781.09
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9,305.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,960.30
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,238.51
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$8,960.30
|
| Rate for Payer: Zelis Auto |
$962.80
|
| Rate for Payer: Zelis Medicare |
$7,616.26
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$10,752.36
|
| Rate for Payer: Zelis Worker's Compensation |
$657.11
|
|
|
CRYOABLATE RENAL MASS OPEN
|
Facility
|
IP
|
$2,511.00
|
|
|
Service Code
|
CPT 50250
|
| Hospital Charge Code |
6150250
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$685.50 |
| Max. Negotiated Rate |
$2,385.45 |
| Rate for Payer: Cash Price |
$1,506.60
|
| Rate for Payer: Cigna Commercial |
$2,134.35
|
| Rate for Payer: First Health Commercial |
$2,259.90
|
| Rate for Payer: First Health Workers Compensation |
$969.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,259.90
|
| Rate for Payer: GEHA Commercial |
$1,757.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,259.90
|
| Rate for Payer: Multiplan All |
$2,285.01
|
| Rate for Payer: OMNI Networks Commercial |
$1,757.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,259.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,385.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,883.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,335.23
|
| Rate for Payer: Zelis Auto |
$1,004.40
|
| Rate for Payer: Zelis Worker's Compensation |
$685.50
|
|
|
CRYOABLATE RENAL MASS OPEN
|
Facility
|
OP
|
$2,511.00
|
|
|
Service Code
|
CPT 50250
|
| Hospital Charge Code |
6150250
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$627.75 |
| Max. Negotiated Rate |
$2,385.45 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,506.60
|
| Rate for Payer: Cash Price |
$1,506.60
|
| Rate for Payer: Cigna Commercial |
$2,134.35
|
| Rate for Payer: First Health Commercial |
$2,259.90
|
| Rate for Payer: First Health Workers Compensation |
$969.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,259.90
|
| Rate for Payer: GEHA Commercial |
$2,008.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,259.90
|
| Rate for Payer: Humana ChoiceCare |
$652.86
|
| Rate for Payer: Multiplan All |
$2,285.01
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,506.60
|
| Rate for Payer: OMNI Networks Commercial |
$1,757.70
|
| Rate for Payer: One Health Plan PPO/POS |
$2,259.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,385.45
|
| Rate for Payer: Three Rivers Provider Network All |
$1,883.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,209.68
|
| Rate for Payer: United Healthcare Managed Medicaid |
$627.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,335.23
|
| Rate for Payer: Zelis Auto |
$1,004.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,255.50
|
| Rate for Payer: Zelis Worker's Compensation |
$685.50
|
|
|
cryoglobulin REF001594
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
2200315
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$12.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$84.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Worker's Compensation |
$8.50
|
|
|
cryoglobulin REF001594
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
2200315
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$11.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$11.64
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$9.22
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$102.00
|
| Rate for Payer: First Health Commercial |
$108.00
|
| Rate for Payer: First Health Workers Compensation |
$12.02
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$108.00
|
| Rate for Payer: GEHA Commercial |
$96.00
|
| Rate for Payer: GEHA Medicare |
$6.47
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$108.00
|
| Rate for Payer: Humana ChoiceCare |
$7.12
|
| Rate for Payer: Humana Medicare Advantage |
$6.47
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$10.87
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$9.41
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6.47
|
| Rate for Payer: Multiplan All |
$109.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11.00
|
| Rate for Payer: OMNI Networks Commercial |
$84.00
|
| Rate for Payer: One Health Plan PPO/POS |
$108.00
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$10.86
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$9.41
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6.47
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$114.00
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$12.94
|
| Rate for Payer: Three Rivers Provider Network All |
$90.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6.34
|
| Rate for Payer: United Healthcare Commercial |
$102.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$9.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.47
|
| Rate for Payer: United Payors & United Providers UP&UP |
$111.60
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6.47
|
| Rate for Payer: Zelis Auto |
$48.00
|
| Rate for Payer: Zelis Medicare |
$5.50
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$7.76
|
| Rate for Payer: Zelis Worker's Compensation |
$8.50
|
|
|
CRYOSURG ABLATE FA EACH
|
Facility
|
IP
|
$683.00
|
|
|
Service Code
|
CPT 19105
|
| Hospital Charge Code |
6119105
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$186.46 |
| Max. Negotiated Rate |
$648.85 |
| Rate for Payer: Cash Price |
$409.80
|
| Rate for Payer: Cigna Commercial |
$580.55
|
| Rate for Payer: First Health Commercial |
$614.70
|
| Rate for Payer: First Health Workers Compensation |
$263.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$614.70
|
| Rate for Payer: GEHA Commercial |
$478.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$614.70
|
| Rate for Payer: Multiplan All |
$621.53
|
| Rate for Payer: OMNI Networks Commercial |
$478.10
|
| Rate for Payer: One Health Plan PPO/POS |
$614.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$648.85
|
| Rate for Payer: Three Rivers Provider Network All |
$512.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$635.19
|
| Rate for Payer: Zelis Auto |
$273.20
|
| Rate for Payer: Zelis Worker's Compensation |
$186.46
|
|
|
CRYOSURG ABLATE FA EACH
|
Facility
|
OP
|
$683.00
|
|
|
Service Code
|
CPT 19105
|
| Hospital Charge Code |
6119105
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$186.46 |
| Max. Negotiated Rate |
$7,421.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,454.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$409.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,454.43
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,736.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,710.50
|
| Rate for Payer: Cash Price |
$409.80
|
| Rate for Payer: Cash Price |
$409.80
|
| Rate for Payer: Cigna Commercial |
$580.55
|
| Rate for Payer: First Health Commercial |
$614.70
|
| Rate for Payer: First Health Workers Compensation |
$263.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$614.70
|
| Rate for Payer: GEHA Commercial |
$546.40
|
| Rate for Payer: GEHA Medicare |
$3,710.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$614.70
|
| Rate for Payer: Humana ChoiceCare |
$4,081.55
|
| Rate for Payer: Humana Medicare Advantage |
$3,710.50
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$6,233.64
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,792.33
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,710.50
|
| Rate for Payer: Multiplan All |
$621.53
|
| Rate for Payer: New Mexico Health Connections Medicare |
$6,307.85
|
| Rate for Payer: OMNI Networks Commercial |
$478.10
|
| Rate for Payer: One Health Plan PPO/POS |
$614.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$3,224.13
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,792.33
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,710.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$648.85
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$7,421.00
|
| Rate for Payer: Three Rivers Provider Network All |
$512.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$3,636.29
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,792.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,710.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$635.19
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,710.50
|
| Rate for Payer: Zelis Auto |
$273.20
|
| Rate for Payer: Zelis Medicare |
$3,153.93
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$4,452.60
|
| Rate for Payer: Zelis Worker's Compensation |
$186.46
|
|
|
CRYOSURGERY ANAL LESION(S)
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
CPT 46916
|
| Hospital Charge Code |
6146916
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$119.30 |
| Max. Negotiated Rate |
$415.15 |
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cigna Commercial |
$371.45
|
| Rate for Payer: First Health Commercial |
$393.30
|
| Rate for Payer: First Health Workers Compensation |
$168.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$393.30
|
| Rate for Payer: GEHA Commercial |
$305.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$393.30
|
| Rate for Payer: Multiplan All |
$397.67
|
| Rate for Payer: OMNI Networks Commercial |
$305.90
|
| Rate for Payer: One Health Plan PPO/POS |
$393.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$415.15
|
| Rate for Payer: Three Rivers Provider Network All |
$327.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$406.41
|
| Rate for Payer: Zelis Auto |
$174.80
|
| Rate for Payer: Zelis Worker's Compensation |
$119.30
|
|
|
CRYOSURGERY ANAL LESION(S)
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
CPT 46916
|
| Hospital Charge Code |
6146916
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$119.30 |
| Max. Negotiated Rate |
$415.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$262.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$155.84
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$123.45
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cigna Commercial |
$371.45
|
| Rate for Payer: First Health Commercial |
$393.30
|
| Rate for Payer: First Health Workers Compensation |
$168.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$393.30
|
| Rate for Payer: GEHA Commercial |
$349.60
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$393.30
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$125.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$397.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| Rate for Payer: OMNI Networks Commercial |
$305.90
|
| Rate for Payer: One Health Plan PPO/POS |
$393.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$145.45
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$125.97
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$415.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$327.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$125.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$406.41
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$174.80
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$119.30
|
|
|
CRYOSURGERY PENIS LESION(S)
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 54056
|
| Hospital Charge Code |
6154056
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$91.45 |
| Max. Negotiated Rate |
$385.08 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$201.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$192.54
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$284.75
|
| Rate for Payer: First Health Commercial |
$301.50
|
| Rate for Payer: First Health Workers Compensation |
$129.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$301.50
|
| Rate for Payer: GEHA Commercial |
$268.00
|
| Rate for Payer: GEHA Medicare |
$192.54
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$301.50
|
| Rate for Payer: Humana ChoiceCare |
$211.79
|
| Rate for Payer: Humana Medicare Advantage |
$192.54
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$323.47
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$192.54
|
| Rate for Payer: Multiplan All |
$304.85
|
| Rate for Payer: New Mexico Health Connections Medicare |
$327.32
|
| Rate for Payer: OMNI Networks Commercial |
$234.50
|
| Rate for Payer: One Health Plan PPO/POS |
$301.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$192.54
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$318.25
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$385.08
|
| Rate for Payer: Three Rivers Provider Network All |
$251.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$188.69
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.54
|
| Rate for Payer: United Payors & United Providers UP&UP |
$311.55
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$192.54
|
| Rate for Payer: Zelis Auto |
$134.00
|
| Rate for Payer: Zelis Medicare |
$163.66
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$231.05
|
| Rate for Payer: Zelis Worker's Compensation |
$91.45
|
|
|
CRYOSURGERY PENIS LESION(S)
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 54056
|
| Hospital Charge Code |
6154056
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$91.45 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$284.75
|
| Rate for Payer: First Health Commercial |
$301.50
|
| Rate for Payer: First Health Workers Compensation |
$129.34
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$301.50
|
| Rate for Payer: GEHA Commercial |
$234.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$301.50
|
| Rate for Payer: Multiplan All |
$304.85
|
| Rate for Payer: OMNI Networks Commercial |
$234.50
|
| Rate for Payer: One Health Plan PPO/POS |
$301.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$318.25
|
| Rate for Payer: Three Rivers Provider Network All |
$251.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$311.55
|
| Rate for Payer: Zelis Auto |
$134.00
|
| Rate for Payer: Zelis Worker's Compensation |
$91.45
|
|
