|
INSERT BLADDER CATH COMPLEX
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
1000031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$248.70 |
| Max. Negotiated Rate |
$865.45 |
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cigna Commercial |
$774.35
|
| Rate for Payer: First Health Commercial |
$819.90
|
| Rate for Payer: First Health Workers Compensation |
$351.74
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$819.90
|
| Rate for Payer: GEHA Commercial |
$637.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$819.90
|
| Rate for Payer: Multiplan All |
$829.01
|
| Rate for Payer: OMNI Networks Commercial |
$637.70
|
| Rate for Payer: One Health Plan PPO/POS |
$819.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$865.45
|
| Rate for Payer: Three Rivers Provider Network All |
$683.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$847.23
|
| Rate for Payer: Zelis Auto |
$364.40
|
| Rate for Payer: Zelis Worker's Compensation |
$248.70
|
|
|
INSERT CATH PLEURA W/ IMAGE
|
Facility
|
OP
|
$481.00
|
|
|
Service Code
|
CPT 32557
|
| Hospital Charge Code |
6132557
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$131.31 |
| Max. Negotiated Rate |
$2,950.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$584.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$288.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$584.70
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$463.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,475.05
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$408.85
|
| Rate for Payer: First Health Commercial |
$432.90
|
| Rate for Payer: First Health Workers Compensation |
$185.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$432.90
|
| Rate for Payer: GEHA Commercial |
$384.80
|
| Rate for Payer: GEHA Medicare |
$1,475.05
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$432.90
|
| Rate for Payer: Humana ChoiceCare |
$1,622.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,475.05
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,478.08
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$472.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,475.05
|
| Rate for Payer: Multiplan All |
$437.71
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,507.59
|
| Rate for Payer: OMNI Networks Commercial |
$336.70
|
| Rate for Payer: One Health Plan PPO/POS |
$432.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$545.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$472.63
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,475.05
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$456.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$2,950.10
|
| Rate for Payer: Three Rivers Provider Network All |
$360.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,445.55
|
| Rate for Payer: United Healthcare Managed Medicaid |
$472.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,475.05
|
| Rate for Payer: United Payors & United Providers UP&UP |
$447.33
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,475.05
|
| Rate for Payer: Zelis Auto |
$192.40
|
| Rate for Payer: Zelis Medicare |
$1,253.79
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,770.06
|
| Rate for Payer: Zelis Worker's Compensation |
$131.31
|
|
|
INSERT CATH PLEURA W/ IMAGE
|
Facility
|
IP
|
$481.00
|
|
|
Service Code
|
CPT 32557
|
| Hospital Charge Code |
6132557
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$131.31 |
| Max. Negotiated Rate |
$456.95 |
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$408.85
|
| Rate for Payer: First Health Commercial |
$432.90
|
| Rate for Payer: First Health Workers Compensation |
$185.71
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$432.90
|
| Rate for Payer: GEHA Commercial |
$336.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$432.90
|
| Rate for Payer: Multiplan All |
$437.71
|
| Rate for Payer: OMNI Networks Commercial |
$336.70
|
| Rate for Payer: One Health Plan PPO/POS |
$432.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$456.95
|
| Rate for Payer: Three Rivers Provider Network All |
$360.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$447.33
|
| Rate for Payer: Zelis Auto |
$192.40
|
| Rate for Payer: Zelis Worker's Compensation |
$131.31
|
|
|
INSERT CHST TB W/ASP
|
Facility
|
IP
|
$1,124.00
|
|
| Hospital Charge Code |
2407228
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$306.85 |
| Max. Negotiated Rate |
$1,067.80 |
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cigna Commercial |
$955.40
|
| Rate for Payer: First Health Commercial |
$1,011.60
|
| Rate for Payer: First Health Workers Compensation |
$433.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,011.60
|
| Rate for Payer: GEHA Commercial |
$786.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,011.60
|
| Rate for Payer: Multiplan All |
$1,022.84
|
| Rate for Payer: OMNI Networks Commercial |
$786.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,011.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,067.80
|
| Rate for Payer: Three Rivers Provider Network All |
$843.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,045.32
|
| Rate for Payer: Zelis Auto |
$449.60
|
| Rate for Payer: Zelis Worker's Compensation |
$306.85
|
|
|
INSERT CHST TB W/ASP
|
Facility
|
OP
|
$1,124.00
|
|
| Hospital Charge Code |
2407228
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$281.00 |
| Max. Negotiated Rate |
$1,067.80 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$674.40
|
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cigna Commercial |
$955.40
|
| Rate for Payer: First Health Commercial |
$1,011.60
|
| Rate for Payer: First Health Workers Compensation |
$433.98
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,011.60
|
| Rate for Payer: GEHA Commercial |
$899.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,011.60
|
| Rate for Payer: Humana ChoiceCare |
$292.24
|
| Rate for Payer: Multiplan All |
$1,022.84
|
| Rate for Payer: New Mexico Health Connections Medicare |
$674.40
|
| Rate for Payer: OMNI Networks Commercial |
$786.80
|
| Rate for Payer: One Health Plan PPO/POS |
$1,011.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,067.80
|
| Rate for Payer: Three Rivers Provider Network All |
$843.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$989.12
|
| Rate for Payer: United Healthcare Managed Medicaid |
$281.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,045.32
|
| Rate for Payer: Zelis Auto |
$449.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$562.00
|
| Rate for Payer: Zelis Worker's Compensation |
$306.85
|
|
|
INSERT DRUG DELIVERY IMPLANT
|
Facility
|
OP
|
$282.54
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
7211981
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$77.13 |
| Max. Negotiated Rate |
$397.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$397.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$169.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$397.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$314.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$169.52
|
| Rate for Payer: Cash Price |
$169.52
|
| Rate for Payer: Cigna Commercial |
$240.16
|
| Rate for Payer: First Health Commercial |
$254.29
|
| Rate for Payer: First Health Workers Compensation |
$109.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$254.29
|
| Rate for Payer: GEHA Commercial |
$226.03
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$254.29
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$320.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$257.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$197.78
|
| Rate for Payer: One Health Plan PPO/POS |
$254.29
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$370.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$320.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$268.41
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$211.91
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$320.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$262.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$113.02
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$77.13
|
|
|
INSERT DRUG DELIVERY IMPLANT
|
Facility
|
IP
|
$282.54
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
7211981
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$77.13 |
| Max. Negotiated Rate |
$268.41 |
| Rate for Payer: Cash Price |
$169.52
|
| Rate for Payer: Cigna Commercial |
$240.16
|
| Rate for Payer: First Health Commercial |
$254.29
|
| Rate for Payer: First Health Workers Compensation |
$109.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$254.29
|
| Rate for Payer: GEHA Commercial |
$197.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$254.29
|
| Rate for Payer: Multiplan All |
$257.11
|
| Rate for Payer: OMNI Networks Commercial |
$197.78
|
| Rate for Payer: One Health Plan PPO/POS |
$254.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$268.41
|
| Rate for Payer: Three Rivers Provider Network All |
$211.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$262.76
|
| Rate for Payer: Zelis Auto |
$113.02
|
| Rate for Payer: Zelis Worker's Compensation |
$77.13
|
|
|
INSERT IA PERCUT DEVICE
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
6133967
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$188.92 |
| Max. Negotiated Rate |
$657.40 |
| Rate for Payer: Cash Price |
$415.20
|
| Rate for Payer: Cigna Commercial |
$588.20
|
| Rate for Payer: First Health Commercial |
$622.80
|
| Rate for Payer: First Health Workers Compensation |
$267.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$622.80
|
| Rate for Payer: GEHA Commercial |
$484.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$622.80
|
| Rate for Payer: Multiplan All |
$629.72
|
| Rate for Payer: OMNI Networks Commercial |
$484.40
|
| Rate for Payer: One Health Plan PPO/POS |
$622.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$657.40
|
| Rate for Payer: Three Rivers Provider Network All |
$519.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$643.56
|
| Rate for Payer: Zelis Auto |
$276.80
|
| Rate for Payer: Zelis Worker's Compensation |
$188.92
|
|
|
INSERT IA PERCUT DEVICE
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
6133967
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$173.00 |
| Max. Negotiated Rate |
$657.40 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$415.20
|
| Rate for Payer: Cash Price |
$415.20
|
| Rate for Payer: Cigna Commercial |
$588.20
|
| Rate for Payer: First Health Commercial |
$622.80
|
| Rate for Payer: First Health Workers Compensation |
$267.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$622.80
|
| Rate for Payer: GEHA Commercial |
$553.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$622.80
|
| Rate for Payer: Humana ChoiceCare |
$179.92
|
| Rate for Payer: Multiplan All |
$629.72
|
| Rate for Payer: New Mexico Health Connections Medicare |
$415.20
|
| Rate for Payer: OMNI Networks Commercial |
$484.40
|
| Rate for Payer: One Health Plan PPO/POS |
$622.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$657.40
|
| Rate for Payer: Three Rivers Provider Network All |
$519.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$608.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$173.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$643.56
|
| Rate for Payer: Zelis Auto |
$276.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$346.00
|
| Rate for Payer: Zelis Worker's Compensation |
$188.92
|
|
|
INSERTION DRUG DELIVERY IMPLANT
|
Facility
|
IP
|
$282.54
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
8511981
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$77.13 |
| Max. Negotiated Rate |
$268.41 |
| Rate for Payer: Cash Price |
$169.52
|
| Rate for Payer: Cigna Commercial |
$240.16
|
| Rate for Payer: First Health Commercial |
$254.29
|
| Rate for Payer: First Health Workers Compensation |
$109.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$254.29
|
| Rate for Payer: GEHA Commercial |
$197.78
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$254.29
|
| Rate for Payer: Multiplan All |
$257.11
|
| Rate for Payer: OMNI Networks Commercial |
$197.78
|
| Rate for Payer: One Health Plan PPO/POS |
$254.29
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$268.41
|
| Rate for Payer: Three Rivers Provider Network All |
$211.91
|
| Rate for Payer: United Payors & United Providers UP&UP |
$262.76
|
| Rate for Payer: Zelis Auto |
$113.02
|
| Rate for Payer: Zelis Worker's Compensation |
$77.13
|
|
|
INSERTION DRUG DELIVERY IMPLANT
|
Facility
|
OP
|
$282.54
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
8511981
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$77.13 |
| Max. Negotiated Rate |
$397.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$397.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$169.52
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$397.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$314.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: Cash Price |
$169.52
|
| Rate for Payer: Cash Price |
$169.52
|
| Rate for Payer: Cigna Commercial |
$240.16
|
| Rate for Payer: First Health Commercial |
$254.29
|
| Rate for Payer: First Health Workers Compensation |
$109.09
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$254.29
|
| Rate for Payer: GEHA Commercial |
$226.03
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$254.29
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$320.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: Multiplan All |
$257.11
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: OMNI Networks Commercial |
$197.78
|
| Rate for Payer: One Health Plan PPO/POS |
$254.29
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$370.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$320.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$268.41
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: Three Rivers Provider Network All |
$211.91
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$320.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: United Payors & United Providers UP&UP |
$262.76
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Auto |
$113.02
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$77.13
|
|
|
INSERTION, DRUG-DELIVERY IMPLANT (IE, BIORESORBABLE, BIODEGRADABLE, NON-BIODEGRADABLE)
|
Facility
|
OP
|
$397.05
|
|
|
Service Code
|
CPT 11981
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$104.04 |
| Max. Negotiated Rate |
$397.05 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$397.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$397.05
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$314.54
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$122.40
|
| Rate for Payer: First Health Workers Compensation |
$157.53
|
| Rate for Payer: GEHA Medicare |
$122.40
|
| Rate for Payer: Humana ChoiceCare |
$134.64
|
| Rate for Payer: Humana Medicare Advantage |
$122.40
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$205.63
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$320.95
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$122.40
|
| Rate for Payer: New Mexico Health Connections Medicare |
$208.08
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$370.58
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$320.95
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$122.40
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$244.80
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$119.95
|
| Rate for Payer: United Healthcare Managed Medicaid |
$320.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.40
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$122.40
|
| Rate for Payer: Zelis Medicare |
$104.04
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$146.88
|
| Rate for Payer: Zelis Worker's Compensation |
$111.38
|
|
|
INSERTION GI TUBE
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
CPT 74340
|
| Hospital Charge Code |
2400211
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.42 |
| Max. Negotiated Rate |
$893.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$564.60
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$799.85
|
| Rate for Payer: First Health Commercial |
$846.90
|
| Rate for Payer: First Health Workers Compensation |
$132.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$846.90
|
| Rate for Payer: GEHA Commercial |
$752.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$846.90
|
| Rate for Payer: Humana ChoiceCare |
$244.66
|
| Rate for Payer: Multiplan All |
$856.31
|
| Rate for Payer: New Mexico Health Connections Medicare |
$564.60
|
| Rate for Payer: OMNI Networks Commercial |
$658.70
|
| Rate for Payer: One Health Plan PPO/POS |
$846.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$893.95
|
| Rate for Payer: Three Rivers Provider Network All |
$705.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$828.08
|
| Rate for Payer: United Healthcare Commercial |
$799.85
|
| Rate for Payer: United Healthcare Managed Medicaid |
$235.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$875.13
|
| Rate for Payer: Zelis Auto |
$376.40
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$470.50
|
| Rate for Payer: Zelis Worker's Compensation |
$93.42
|
|
|
INSERTION GI TUBE
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
CPT 74340
|
| Hospital Charge Code |
2400211
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.42 |
| Max. Negotiated Rate |
$893.95 |
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$799.85
|
| Rate for Payer: First Health Commercial |
$846.90
|
| Rate for Payer: First Health Workers Compensation |
$132.12
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$846.90
|
| Rate for Payer: GEHA Commercial |
$658.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$846.90
|
| Rate for Payer: Multiplan All |
$856.31
|
| Rate for Payer: OMNI Networks Commercial |
$658.70
|
| Rate for Payer: One Health Plan PPO/POS |
$846.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$893.95
|
| Rate for Payer: Three Rivers Provider Network All |
$705.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$875.13
|
| Rate for Payer: Zelis Auto |
$376.40
|
| Rate for Payer: Zelis Worker's Compensation |
$93.42
|
|
|
INSERTION INTRAUTERINE DEVICE IUD
|
Facility
|
OP
|
$98.01
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
8558300
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$389.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$389.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$58.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$389.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$308.38
|
| Rate for Payer: Cash Price |
$58.81
|
| Rate for Payer: Cash Price |
$58.81
|
| Rate for Payer: Cigna Commercial |
$83.31
|
| Rate for Payer: First Health Commercial |
$88.21
|
| Rate for Payer: First Health Workers Compensation |
$37.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.21
|
| Rate for Payer: GEHA Commercial |
$78.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.21
|
| Rate for Payer: Humana ChoiceCare |
$25.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$314.66
|
| Rate for Payer: Multiplan All |
$89.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$58.81
|
| Rate for Payer: OMNI Networks Commercial |
$68.61
|
| Rate for Payer: One Health Plan PPO/POS |
$88.21
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$363.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$314.66
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$93.11
|
| Rate for Payer: Three Rivers Provider Network All |
$73.51
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$314.66
|
| Rate for Payer: United Payors & United Providers UP&UP |
$91.15
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$49.01
|
| Rate for Payer: Zelis Worker's Compensation |
$26.76
|
|
|
INSERTION INTRAUTERINE DEVICE IUD
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
23500076
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$389.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$389.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$23.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$389.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$308.38
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$33.15
|
| Rate for Payer: First Health Commercial |
$35.10
|
| Rate for Payer: First Health Workers Compensation |
$15.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$35.10
|
| Rate for Payer: GEHA Commercial |
$31.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$35.10
|
| Rate for Payer: Humana ChoiceCare |
$10.14
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$314.66
|
| Rate for Payer: Multiplan All |
$35.49
|
| Rate for Payer: New Mexico Health Connections Medicare |
$23.40
|
| Rate for Payer: OMNI Networks Commercial |
$27.30
|
| Rate for Payer: One Health Plan PPO/POS |
$35.10
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$363.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$314.66
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$37.05
|
| Rate for Payer: Three Rivers Provider Network All |
$29.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$34.32
|
| Rate for Payer: United Healthcare Managed Medicaid |
$314.66
|
| Rate for Payer: United Payors & United Providers UP&UP |
$36.27
|
| Rate for Payer: Zelis Auto |
$15.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$19.50
|
| Rate for Payer: Zelis Worker's Compensation |
$10.65
|
|
|
INSERTION INTRAUTERINE DEVICE IUD
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
23500076
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$37.05 |
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$33.15
|
| Rate for Payer: First Health Commercial |
$35.10
|
| Rate for Payer: First Health Workers Compensation |
$15.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$35.10
|
| Rate for Payer: GEHA Commercial |
$27.30
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$35.10
|
| Rate for Payer: Multiplan All |
$35.49
|
| Rate for Payer: OMNI Networks Commercial |
$27.30
|
| Rate for Payer: One Health Plan PPO/POS |
$35.10
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$37.05
|
| Rate for Payer: Three Rivers Provider Network All |
$29.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$36.27
|
| Rate for Payer: Zelis Auto |
$15.60
|
| Rate for Payer: Zelis Worker's Compensation |
$10.65
|
|
|
INSERTION INTRAUTERINE DEVICE IUD
|
Facility
|
IP
|
$98.01
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
8558300
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$26.76 |
| Max. Negotiated Rate |
$93.11 |
| Rate for Payer: Cash Price |
$58.81
|
| Rate for Payer: Cigna Commercial |
$83.31
|
| Rate for Payer: First Health Commercial |
$88.21
|
| Rate for Payer: First Health Workers Compensation |
$37.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.21
|
| Rate for Payer: GEHA Commercial |
$68.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.21
|
| Rate for Payer: Multiplan All |
$89.19
|
| Rate for Payer: OMNI Networks Commercial |
$68.61
|
| Rate for Payer: One Health Plan PPO/POS |
$88.21
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$93.11
|
| Rate for Payer: Three Rivers Provider Network All |
$73.51
|
| Rate for Payer: United Payors & United Providers UP&UP |
$91.15
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Worker's Compensation |
$26.76
|
|
|
INSERTION INTRAUTERINE DEVICE IUD
|
Facility
|
OP
|
$98.01
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
7258300
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$389.26 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$389.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$58.81
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$389.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$308.38
|
| Rate for Payer: Cash Price |
$58.81
|
| Rate for Payer: Cash Price |
$58.81
|
| Rate for Payer: Cigna Commercial |
$83.31
|
| Rate for Payer: First Health Commercial |
$88.21
|
| Rate for Payer: First Health Workers Compensation |
$37.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.21
|
| Rate for Payer: GEHA Commercial |
$78.41
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.21
|
| Rate for Payer: Humana ChoiceCare |
$25.48
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$314.66
|
| Rate for Payer: Multiplan All |
$89.19
|
| Rate for Payer: New Mexico Health Connections Medicare |
$58.81
|
| Rate for Payer: OMNI Networks Commercial |
$68.61
|
| Rate for Payer: One Health Plan PPO/POS |
$88.21
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$363.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$314.66
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$93.11
|
| Rate for Payer: Three Rivers Provider Network All |
$73.51
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$86.25
|
| Rate for Payer: United Healthcare Managed Medicaid |
$314.66
|
| Rate for Payer: United Payors & United Providers UP&UP |
$91.15
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$49.01
|
| Rate for Payer: Zelis Worker's Compensation |
$26.76
|
|
|
INSERTION INTRAUTERINE DEVICE IUD
|
Facility
|
OP
|
$3,203.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
21658300
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$308.38 |
| Max. Negotiated Rate |
$3,042.85 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$389.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,921.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$389.26
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$308.38
|
| Rate for Payer: Cash Price |
$1,921.80
|
| Rate for Payer: Cash Price |
$1,921.80
|
| Rate for Payer: Cigna Commercial |
$2,722.55
|
| Rate for Payer: First Health Commercial |
$2,882.70
|
| Rate for Payer: First Health Workers Compensation |
$1,236.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,882.70
|
| Rate for Payer: GEHA Commercial |
$2,562.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,882.70
|
| Rate for Payer: Humana ChoiceCare |
$832.78
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$314.66
|
| Rate for Payer: Multiplan All |
$2,914.73
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,921.80
|
| Rate for Payer: OMNI Networks Commercial |
$2,242.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,882.70
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$363.31
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$314.66
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,042.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,402.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,818.64
|
| Rate for Payer: United Healthcare Managed Medicaid |
$314.66
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,978.79
|
| Rate for Payer: Zelis Auto |
$1,281.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,601.50
|
| Rate for Payer: Zelis Worker's Compensation |
$874.42
|
|
|
INSERTION INTRAUTERINE DEVICE IUD
|
Facility
|
IP
|
$98.01
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
7258300
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$26.76 |
| Max. Negotiated Rate |
$93.11 |
| Rate for Payer: Cash Price |
$58.81
|
| Rate for Payer: Cigna Commercial |
$83.31
|
| Rate for Payer: First Health Commercial |
$88.21
|
| Rate for Payer: First Health Workers Compensation |
$37.84
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$88.21
|
| Rate for Payer: GEHA Commercial |
$68.61
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$88.21
|
| Rate for Payer: Multiplan All |
$89.19
|
| Rate for Payer: OMNI Networks Commercial |
$68.61
|
| Rate for Payer: One Health Plan PPO/POS |
$88.21
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$93.11
|
| Rate for Payer: Three Rivers Provider Network All |
$73.51
|
| Rate for Payer: United Payors & United Providers UP&UP |
$91.15
|
| Rate for Payer: Zelis Auto |
$39.20
|
| Rate for Payer: Zelis Worker's Compensation |
$26.76
|
|
|
INSERTION INTRAUTERINE DEVICE IUD
|
Facility
|
IP
|
$3,203.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
21658300
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$874.42 |
| Max. Negotiated Rate |
$3,042.85 |
| Rate for Payer: Cash Price |
$1,921.80
|
| Rate for Payer: Cigna Commercial |
$2,722.55
|
| Rate for Payer: First Health Commercial |
$2,882.70
|
| Rate for Payer: First Health Workers Compensation |
$1,236.68
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,882.70
|
| Rate for Payer: GEHA Commercial |
$2,242.10
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,882.70
|
| Rate for Payer: Multiplan All |
$2,914.73
|
| Rate for Payer: OMNI Networks Commercial |
$2,242.10
|
| Rate for Payer: One Health Plan PPO/POS |
$2,882.70
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,042.85
|
| Rate for Payer: Three Rivers Provider Network All |
$2,402.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,978.79
|
| Rate for Payer: Zelis Auto |
$1,281.20
|
| Rate for Payer: Zelis Worker's Compensation |
$874.42
|
|
|
INSERTION OF SINUS TARSI IMPLANT
|
Facility
|
OP
|
$13,566.52
|
|
|
Service Code
|
CPT 0335T
|
| Hospital Charge Code |
6103350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,217.82 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,799.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,799.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,217.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: First Health Workers Compensation |
$8,730.06
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,262.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,612.93
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,262.99
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,262.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$6,172.77
|
|
|
INSERTION OF SINUS TARSI IMPLANT
|
Facility
|
OP
|
$6,331.00
|
|
|
Service Code
|
CPT 0335T
|
| Hospital Charge Code |
6103350
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,728.36 |
| Max. Negotiated Rate |
$13,566.52 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$2,799.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,798.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$2,799.57
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,217.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$6,783.26
|
| Rate for Payer: Cash Price |
$3,798.60
|
| Rate for Payer: Cash Price |
$3,798.60
|
| Rate for Payer: Cigna Commercial |
$5,381.35
|
| Rate for Payer: First Health Commercial |
$5,697.90
|
| Rate for Payer: First Health Workers Compensation |
$2,444.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,697.90
|
| Rate for Payer: GEHA Commercial |
$5,064.80
|
| Rate for Payer: GEHA Medicare |
$6,783.26
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,697.90
|
| Rate for Payer: Humana ChoiceCare |
$7,461.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,783.26
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$11,395.88
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,262.99
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$6,783.26
|
| Rate for Payer: Multiplan All |
$5,761.21
|
| Rate for Payer: New Mexico Health Connections Medicare |
$11,531.54
|
| Rate for Payer: OMNI Networks Commercial |
$4,431.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,697.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,612.93
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,262.99
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$6,783.26
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,014.45
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$13,566.52
|
| Rate for Payer: Three Rivers Provider Network All |
$4,748.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$6,647.59
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,262.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,783.26
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,887.83
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$6,783.26
|
| Rate for Payer: Zelis Auto |
$2,532.40
|
| Rate for Payer: Zelis Medicare |
$5,765.77
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$8,139.91
|
| Rate for Payer: Zelis Worker's Compensation |
$1,728.36
|
|
|
INSERTION OF SINUS TARSI IMPLANT
|
Facility
|
IP
|
$6,331.00
|
|
|
Service Code
|
CPT 0335T
|
| Hospital Charge Code |
6103350
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,728.36 |
| Max. Negotiated Rate |
$6,014.45 |
| Rate for Payer: Cash Price |
$3,798.60
|
| Rate for Payer: Cigna Commercial |
$5,381.35
|
| Rate for Payer: First Health Commercial |
$5,697.90
|
| Rate for Payer: First Health Workers Compensation |
$2,444.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,697.90
|
| Rate for Payer: GEHA Commercial |
$4,431.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,697.90
|
| Rate for Payer: Multiplan All |
$5,761.21
|
| Rate for Payer: OMNI Networks Commercial |
$4,431.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,697.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,014.45
|
| Rate for Payer: Three Rivers Provider Network All |
$4,748.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,887.83
|
| Rate for Payer: Zelis Auto |
$2,532.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,728.36
|
|
